Sleep Tests 101: PAP Titration and the Home Study

Welcome to Part 2 of every kind of sleep test. In Part 1, I covered 1 type of sleep test: the polysomnography (PSG).

In this part, I will cover the PAP (positive airway pressure) titration and the home study.

What is PAP titration?

First up, we’ll review PAP titration. The PAP titration is very similar to the PSG study in the sense you’ll be hooked up to almost every wire you were in the PSG study. That’s important to understand since I’ve had several patients who come back for a titration study not expecting the hookup.

The PAP titration is almost the same as the PSG. But here’s the difference: the polysomnography has 2 respiratory signals that measure when you stop breathing, partially stop breathing, or measure when you’re breathing. Those respiratory signals aren’t included in the PAP titration. Instead, they’re replaced by CPAP (continuous positive airway pressure).

A couple of new items that will be used in the PAP titration will be a hose and humidifier:

• Hose – The hose connects the PAP machine to the mask. Naturally, the airflow moves from the machine through the hose into the mask and props open the airway!
• Humidifier – This is the location where the distilled water is stored. The humidifier heats up the water and the water filters into the hose and eventually into the airway. The heated humidity helps prevent dry mouth!

What is the home study?

This is exactly what it sounds like: a sleep study a person does at home. The patient comes to the sleep lab for a short time to learn how to do it at home. They only have to wear the equipment at home for 1 night.

I’ll put this disclaimer in, not every home study is the exact same, but I’ll speak primarily about the 1 my sleep lab does. As I previously mentioned, this is a fairly short procedure in regards to sleep lab duty. Basically, the person will come in and I’ll hook them up. The hookup includes just 3 different items: a nasal cannula, a respiratory belt, and a pulse oximeter or "pulse ox." I’ll do a quick summary of these items.

• Nasal cannula – The nasal cannula measures the breathing. Essentially, it’s our indicator to know whether the person has sleep apnea.
• Respiratory belt – The respiratory belt helps diagnose which type of sleep apnea the person has. There are 4 different types: obstructive apnea, mixed apnea, hypopnea, and central apnea.
• Pulse ox – The pulse ox helps us see the the drop in blood oxygen level when a person stops breathing.

Then I’ll have the person repeat the steps so I know they know how to do it.

What happens at home?

Once the person returns home, they will wait until their normal bedtime to place the equipment on. They can follow their bedtime routine and sleep in their normal sleep position. A fun fact regarding the home study equipment: Some places will mail the equipment to the person and the person will have to wear it 3 nights in a row.

Has anyone ever been through a PAP titration or a home study? If so, what was your experience? Was it like my description or different?

Tell us your sleep apnea story or please comment below!