Since this is not currently the case, what is the clinician to do, and more importantly, how should we respond to this situation as a community of sleep medicine physicians? The clinician can certainly react by carefully following the symptomatic response of patients started on autotitrating CPAP, assuming that a complaint is present in the first place. Drawbacks to this approach include a noticeable placebo effect that has been demonstrated in randomized controlled trials of CPAP,11as well as the frequent lack of a strong correlation between the severity of sleep apnea and any given symptom.12 At the other end of the spectrum would be the empiricist’s approach of testing the patient in the sleep laboratory during the application of the proposed autotitrating device. This is a technique that I have indeed applied on occasion in patients with complex combinations of sleep-disordered breathing events, and it at least provides the comfort of knowing whether the patient is responding adequately even if one does not exactly know why. An intermediate approach might be to depend on the quantification of respiratory events by the device itself, which is a form of circular reasoning that does not seem very appealing. Rigau and colleagues9 suggested that a consensus be reached among manufacturers to standardize the signals measured and the algorithms used, a strategy that I am afraid would stifle further research and development and is probably unworkable, given the competitive nature of the industry.9 I would rather propose a fifth strategy, consisting of the independent, standardized, verifiable testing of each apparatus using techniques such as those reported by Rigau et al9and Lofaso et al.10 Such an approach would be equivalent to the testing of appliances or automobiles by some not-for-profit consumer organizations, and could be performed by one or another of our professional societies or even by collaboration among them. With this information, the clinician could make an informed choice about using a specific autotitrating CPAP generator in each individual clinical situation. Can there be any doubt that our patients would benefit from opening up the black box to the light of day?