CPAP vs APAP vs BiPAP (poll)

[tschultz]

In preparation for getting my first machine I would like to know what people are actually using.
I am troubled by the low number of newer studies surrounding APAP vs CPAP and this forum seems like a good test group, so this is kind of an informal study if you want.

[Slinky]

You cannot buy a BPAP/VPAP Auto w/a CPAP/APAP script. I use the Resmed (S8) VPAP Auto and a PR SystemOne BPAP Auto w/Bi-Flex.

The poll only lets me vote once. I use the VPAP Auto in Auto mode but I use the PR SystemOne BPAP Auto in straight BPAP mode.

[JohnBFisher]

... I am troubled by the low number of newer studies surrounding APAP vs CPAP ...

Why? That problem set is WELL understood. Therapies have been well tested and proven over a long time frame. Further studies would not change the dataset.

Instead researchers are looking into newer therapies. For example there is the device to stimulate the tongue. A pacemaker of sorts to eliminate obstructive events. And there are issues that CPAP/APAP/BiPAP/Auto-BiPAP do not address, such as central sleep apnea (from various causes) and how effective AVS therapy is for them. And there is complex sleep apnea (understanding it, therapy effectiveness, etc). And there are folks who struble with COPD, using AVAPS mode of therapy.

When one problem is well understood most researchers - and their studies - focus on other areas that are not as well understood.

[tschultz]

Why? That problem set is WELL understood. Therapies have been well tested and proven over a long time frame. Further studies would not change the dataset.

At least here in Ontario, Canada, the consensus based on older studies is that APAP has no advantages over basic CPAP and this I don't think is true based on what I am reading across a number of users in multiple forums. Part of the problem I think stems from the studies looking at compliance and not the whole picture. Here in Ontario it seems VERY difficult to even get an APAP as they are not grouped with CPAP and require additional justification from the sleep doctor. This difficulty is found both at the government and insurance company levels, with widely varying requirements in other provinces and various insurance companies. At least in the USA CPAP and APAP are billed under the same category making things easier.

I have found a couple of newer studies that do show a reduction in AHI's and improved patient comfort due to the average lower pressures from APAP. Even these studies however are based on only a small group and have mixed results.

[ww]

Many of us had to buy an APAP (S9 ResMed) out of pocket anyway. It is worth the cost if you can afford one as many of our bodies change over the years and the APAP not only lets us know how we are doing, but it a good research tool to see how our therapy is going including those previous mysteries on which apneas were obstructive and which were not. It is unlikely that insurance companies really care that you are supplied the best machine for your therapy (read the forum posts carefully).

[avi123]

At least here in Ontario, Canada, the consensus based on older studies is that APAP has no advantages over basic CPAP and this I don't think is true based on what I am reading across a number of users in multiple forums. Part of the problem I think stems from the studies looking at compliance and not the whole picture. Here in Ontario it seems VERY difficult to even get an APAP as they are not grouped with CPAP and require additional justification from the sleep doctor. This difficulty is found both at the government and insurance company levels, with widely varying requirements in other provinces and various insurance companies. At least in the USA CPAP and APAP are billed under the same category making things easier.

[/quote]


IMO, the reasons to avoiding APAPS is both financially and medically. It costs more money and that's why insurers, like Medicare here in the US, apply qualifying restrictions for those who want to get it. On the medical side there are still safety issues when letting the APAP take over the setting of the pressures control.

[avi123]

Many of us had to buy an APAP (S9 ResMed) out of pocket anyway. It is worth the cost if you can afford one not only lets us know how we are doing, but it a good research tool to see how our therapy isas many of our bodies change over the years and the APAP going including those previous mysteries on which apneas were obstructive and which were not. It is unlikely that insurance companies really care that you are supplied the best machine for your therapy (read the forum posts carefully).

By the time our bodies will change, Resmed, most likely, will come out with newer models whereby the machines will automatically take action to change parameters to improve treatment instead of just telling us those statistical verbiage.

[jnk]

. . . the low number of newer studies surrounding APAP vs CPAP . . .

What's to study?

APAP can solve some problems and can make therapy more comfortable for some. Anecdotal is good enough to prove that without studies. Insurance in the U.S. doesn't care which you get here, since CPAP and APAP are the same insurance code anyway, meaning insurance never even finds out which you have, as I understand it.

Some studies were designed to see if an APAP set wide open, 4 cm to 2O cm, could treat as well as CPAP. The answer is: 'Yeah, usually close enough for most people.' That answer to that question, though, doesn't much matter to many here, since many of us raise the minimum on our APAPs to within a cm or two of what is needed to prevent apneas anyway. That one or two cm lower can make all the difference for comfort, yet allow treatment virtually as effective as using straight CPAP one or two cm higher. No scientific study is gonna care about patient comfort and preference, though. Which is a shame, given the dismal compliance rates with PAP therapy.

Other studies were designed to see if APAP is an advancement as a form of treatment over CPAP, as far as, for example, dramatically increasing compliance and preventing more events from occurring. The answer to that was: 'Nah, not really.' So some research docs then said: 'Eh, why bother?--CPAP does the job, so who needs APAP?' They considered APAP a failure since it wasn't the Holy Grail of treatment it was advertised to be at first. Of course, the negative feelings about APAP were mostly held by scientists who were not personally using PAP therapy of any kind. So who cares what they think? Docs who actually practice are, or should be, interested in what helps individual patients.

As best I can tell, the consensus around here, with a few notable exceptions, is that you get APAP so you can figure out over time whether you, as in YOU PERSONALLY, do better in APAP or CPAP mode. That way, even if you end up usually using CPAP mode, you still have APAP mode available for money-saving mini-home-titrations any time you or your doc or RRT want. In that sense, it is a no-brainer. Again, no study is gonna prove that.

Many have found they end up using straight CPAP mode most of the time once they are used to treatment. But they are still glad to have APAP capability at their fingertips to use at any time they need to. Running an APAP in CPAP mode is not in any way a failure of APAP. But it IS a testimony to the fact that no one has yet discovered anything that comes close to beating, in any substantial way, plain ole CPAP for effective treatment of OSA. That's why one's opinion of APAP often hinges on whether one considers APAP (1) 'an added feature that is included on some CPAP machines' or one considers APAP (2) 'an at-one-time-intended replacement for CPAP as a whole that failed to become that.' Two people with differing perspectives on that can go around and around without ever understanding the other's point of view, since they are actually discussing completely different concepts when using the same word: APAP.

In my opinion.

[brendatv]

I am just getting started. I was on auto until I had my titration study, then put on CPAP at 10 after that. My follow up indicates I would do better to go back to auto until my body adjusts to the Tx. She said eventually I would probably be able to go back to CPAP. My machine has both on it.

[tschultz]

jnk; I think you summarized the situation eloquently. It is unfortunate that patient comfort, which undoubetly impact useage, is not taken into consideration.

I don't expect APAP to replace a full night's sleep study with CPAP titration combined with polysomnogram, but I am quite sure that periodic tweaks to the CPAP settings based on the APAP 95% level is useful especially where people may lose weight or make other changes that impact their OSA and treatment requirements. My issue is that, other than costs which I am prepared to bear if necessary, I don't see any major negative of APAP over CPAP. Also it seems it is the APAP machines that have the most data logging which, with proper analysis and monitoring, can improve the treatment.

[jnk]

. . . Also it seems it is the APAP machines that have the most data logging which, with proper analysis and monitoring, can improve the treatment. . . .

Usually. But it seems there's one APAP to avoid, the S9 Escape, which has no data, for some odd reason: viewtopic.php?f=1&t=58561&p=552427#p552427

Many (including me) consider having data much more important than having APAP. Of course, the best thing is to have both.

I use an auto-titrating bilevel, but I think the Autoset and Elite are really cool in how they have EPR that gets suspended during events. To my way of thinking, that suspension of EPR makes those machines one step cooler (as in 'more advanced') than bilevel, in a sense.

EPR in the ResMeds is not quite true bilevel, but it is close. True bilevel is for people who need 4 cm or more of pressure support (or, delta). If 3 cm is enough for a patient, I would vote for a ResMed Elite or Autoset, myself.

But I'm not a doc or anything medical. Just one opinionated guy on the Internet.

[LinkC]

In my opinion.

Yet another opinion we share!

[jnk]

In my opinion.

Yet another opinion we share!

Well that's no fun. Can we at least pretend to argue about something, then, LinkC?

[ozij]

Studies only inform you of probabilities. There are always outliers, and you never know if you are one of them - as a matter of fact, as far as statistic are concerned, a single case does not even exist - the statistics used to understand studies are always there to describe a population, and are only valid for describing the response of a population as a whole. The probability of a single case is statistically nil.

That's why I would suggest you do your very best to try machines by various companies -- pay rent if necessary:

To give you an example:
My breathing pattern is such that it confuses the Respironics exhale inhale tracking - a Respironis BIPAP was the only machine I tried (after 4 years of therapy experience) which I could not even use through one night -- simply because that's the way I breathe. I belong to a small minority in this - but in bed at night I am 100% of the study, and the way the machine works for other people becomes irrelevant
I do better (subjectively) with a ResMed S9 auto than I do with a ReMed S8 auto - because I have some central apneas that make the S8 raise its pressure above the pressure that I need, I love the EPR - there are others like me, and yet there are some (a minority) who can't tolerate it.
You are not a company making decisions based on the 95% probability of getting things right - you want to get things 100% right for yourself. Which brings me back to where I started this post:
Try before you buy. Rent if you have to. I am very glad I did.

There has been a study showing that APAP mode does not give better health results. However, as jnk noted, the majority of studies using APAP's test them at wide open setting (min 4 max 20 or 15) because the producers publish those settings as thought they were the bulet. Nobody (AFAIK) has run a study comparing wide ranges with narrow ranges -- most of us discover that on APAP we do better when the range is narrow. And some of us discover we do better on fixed pressure and not on varying pressure - no matter what its range.

[Captain_Midnight]

T S, I had a straight CPAP for a couple of years. It was "okay", but no data feedback, so there was no knowing for sure whether my therapy was optimized.

Then, I bought an APAP, (M series) and used nightly data to refine my pressure range. Via gradual testing, I ended up setting the lower pressure a teesny bit HIGHER than my titrated pressure, with the upper pressure at 2.5 cm above that, because the M-series seems to work a bit better that way (for me, at least). (9 to 11.5)

My AHI plummeted, and I felt even better than before (on CPAP).

As I learned from reading the posts on this forum, setting an APAP wide open (5-20) is a prescription for failure. The real benefit to an APAP is having it set at a therapeutic pressure, the when one has a cold, allergies, or sleeps weird and needs an extra cm or two, voila!

I now use the PR-One, my AHIs average about 0.4, and I can't think of a thing that I would change.

Good luck with your selection.

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