PAP and bilevel titration logic
Know the common starting pressures, what drives pressure increases, and when bilevel becomes important.
Advanced Titration Certificate Exam Study Hub
Domain 3: Evaluation and Treatment
Domain 3 is the decision-making core of the exam. Many questions are really asking whether you can identify the right therapy for the right patient at the right time.
Highest-yield domainTreatment logic
Why this domain matters
This is the largest and most treatment-heavy part of the exam. It focuses on therapy selection, titration logic, troubleshooting, and matching the treatment to the patient’s disorder and clinical context.
Core topics
- continuous positive airway pressure
- automatic positive airway pressure
- bilevel positive airway pressure
- adaptive servo-ventilation
- volume-targeted ventilation
- oxygen therapy
- oral appliance therapy
- neurostimulator therapy
- high-flow nasal cannula
- surgical considerations
- behavioral therapy
High-yield topic clusters
OHS treatment matching
CPAP is first-line when severe obstructive sleep apnea predominates; noninvasive ventilation is first-line when hypoventilation predominates.
Oral appliance therapy
Custom titratable appliances are preferred, best fit is adult snoring and selected adult obstructive sleep apnea.
Neurostimulator therapy
Hypoglossal nerve stimulation fits selected adult obstructive sleep apnea; phrenic nerve stimulation fits central sleep apnea.
High-yield practical pearls
- Supplemental oxygen on a PAP circuit is added to the tubing with a T connector, not directly to the mask.
- End-tidal carbon dioxide sampling on PAP is taken from the patient, usually at the nares under the mask.
- Do not confuse oral appliance therapy with intraoral tongue stimulation.
- Do not confuse hypoglossal nerve stimulation with phrenic nerve stimulation.