What are reasons to NOT get an Auto machine?

Wulfman · Post by **Wulfman** » Thu Jul 27, 2006 2:54 pm

That's what I figgered......
And why I added on a little of my own

Den

dsm · Post by **dsm** » Thu Jul 27, 2006 3:16 pm

MandoJohnny wrote: <snip>
According to my sleep doc, who is very good and who I trust, while APAPs are necessary for Central Apnea and some other conditions, they are no more effective for Obstructive Apnea and in some patients, they are worse. Sometimes APAPs can't keep up with the changes in required pressure fast enough, so people get too little pressure during critical times. It is better to keep a constant pressure at a level that is proven to keep the airway open.
<snip>

MJ,

The point about autos being neccesary for centrals is possibly a missquote ?
Ask your doc again.

Bilevels with timed control are the machines suitable for people with dominant Central Apnmea (plus of course the Resmed CS machines).

The patent write-ups on almost all autos I have seen, specificaly state that they back off if they think the users is experiencing a central. It is easy to understand if you consider that the user has stopped breathing & increasing pressure does nothing to clear a central - if anything it increases the probability of runaway centrals subsequent to the current event.

Re some autos being slow to respond to sudden apneas - I agree with that - esp if the user sets their auto to full range (4-20 cms) and again some vendors have in the past stated that if they detect a full flow-limitation that is determined to be an OSA. they will wait until the current event passes before increasing pressure as to do so while the event is in situ compounds some blockages.

Cheers

DSM

Goofproof · Post by **Goofproof** » Thu Jul 27, 2006 3:23 pm

[quote="dsm Re some autos being slow to respond to sudden apneas - I agree with that - esp if the user sets their auto to full range (4-20 cms) and again some vendors have in the past stated that if they detect a full flow-limitation that is determined to be an OSA. they will wait until the current event passes before increasing pressure as to do so while the event is in situ compounds some blockages.

Cheers

DSM

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, auto[/quote]

True, but if you set a range of 2 CM + and - your 90% range, and don't snore badly the machine will behave fine. Jim

MandoJohnny · Post by **MandoJohnny** » Thu Jul 27, 2006 3:31 pm

The point about autos being neccesary for centrals is possibly a missquote ?

Quite possible. He and I were talking in general terms about advanced XPAP features, especially all kinds of variable pressure features. I could have gotten my wires a little crossed on the conversation. The main point he made was that since my compliance is 100% with straight CPAP and my OSA is responding well to it, there was no advantage to going to any kind of a variable machine.

Goofproof · Post by **Goofproof** » Thu Jul 27, 2006 3:50 pm

[quote="Anonymous"]Hi Johnny,

You are misreading what the study is saying. People on CPAP spend less time with it because they don't tolerate the higher pressures as well and therefore stop treatment with the CPAP, thereby endangering their life while they sleep without it. With the APAP and lower pressure, they tolerate the therapy longer, basically until they wake up well rested.

DSM-Guest · Post by **DSM-Guest** » Thu Jul 27, 2006 4:39 pm

Goofproof wrote:
True, but if you set a range of 2 CM + and - your 90% range, and don't snore badly the machine will behave fine. Jim

Jim,

Absolutely !

A message that needs to be spread very widely. That kind of sensible thinking is what brings the best out in self therapy management.

Sadly too many newbies are sent out the door by their DME etc: with the machine configured for full free-ranging.

DSM

Paul B · Post by **Paul B** » Thu Jul 27, 2006 5:18 pm

Hey Wulfman, just because the studies are beyond 12 months ago doesn't make the data and results any less relevant. Sure the mask interfaces are better today. But the results of today's studies haven't been published yet.

Besides I love older things. I drive a 1998 car and I wouldn't trade it for anything. The dealer keeps calling me, but I tell him to bug off. My wife is getting up there, but I wouldn't trade her for anyone else either.

But when you're retired, like me, you shoot the bull just like someone else pointed out.

Still, the APAP is the way to go if only that it can be made into a CPAP if you want to. Having options and choices in your xPAP prolongs the life of what you purchase.

Wulfman · Post by **Wulfman** » Thu Jul 27, 2006 7:39 pm

Paul B wrote:Besides I love older things.

Sooooo Paul.......what kind (vintage) of computer are you using to surf the Internet.....a PC-XT?....386?....486?
Do you have a remote control on your TV?
I like "old" stuff, too....but some newer technology is a GOOD thing.

Our newest car is older than your '98 and my main drive-to-work vehicle is a '79.....and I have a couple older than that one, too.
If you read my posts, and the first one in this thread, you'll see that I AM all in favor of using an APAP.....I have one, too. Unfortunately, I found out that it spends the night chasing my snoring and actually raises my AHI, using a range of pressures.
I'm just one of those who does better on a fixed pressure.

Best wishes,

Den

Guest · Post by **Guest** » Thu Jul 27, 2006 10:37 pm

Hi Den,

The nice thing about an APAP is that it's 2 machines in one. For you, the CPAP setting works best, and I know that from experience and trial and error, it fits your breathing patterns and provides better therapy to you. But for others, the APAP may treat them more ideally and they can use that setting. In either case, the one machine provides more options than just buying a straight CPAP, and then at some time in the future having to go out and purchase a second machine.

Secondarily, and totally unrelated to this, I notice that you use a Respironics machine. I wonder if the different algorithms from either Resmed or Puritan-Bennett autos might not cause runaway results like you were experiencing. This conjecture on my part is totally off the cuff and may not bear fruitful results, nor may you have any interest in trying. Maybe you've already explored this.

At any rate, I wish you well, and as long as you're getting good results, you may not wish to take it any further.

All the best,

Paul

Paul B · Post by **Paul B** » Thu Jul 27, 2006 10:41 pm

Sorry, that last post was from me.

dsm · Post by **dsm** » Fri Jul 28, 2006 12:47 am

Paul B,

There are known runaway issues with the Remastar AUTO & The PB420e.

Haven't heard of it happening with the Resmed Spirit. On my own Remstar AUTO I had runaways on at least 3 occasions (machine goes to max setting & stays there).

(Am assuming this was the type of runaway you were talking about )

Cheers

DSM

Snoredog · Post by **Snoredog** » Fri Jul 28, 2006 1:15 am

[quote="dsm"]Paul B,

There are known runaway issues with the Remastar AUTO & The PB420e.

Haven't heard of it happening with the Resmed Spirit. On my own Remstar AUTO I had runaways on at least 3 occasions (machine goes to max setting & stays there).

(Am assuming this was the type of runaway you were talking about )

Cheers

DSM

-SWS · Post by **-SWS** » Fri Jul 28, 2006 7:35 am

The Remstar Auto ran away with Den's snores. Rested Gal bought a used Remstar Auto with C-Flex from a woman who experienced severe runaway with that model. The Remstar Auto, 420e, and Spirit have all run away for at least a few patients.

Which proves a valuable point IMHO: you cannot take any one person's response to an APAP algorithm and conclusively generalize that single person's response across an entire apneic patient population. The laws of probability across an extremely physiologically diverse human population simply don't work that way. That statement is true of BiLevel algorithms as well, IMO.

I agree about there being no reason other than cost not to choose APAP over CPAP, since APAP can be run as CPAP while still collecting valuable overnight sleep data. If a person does not fare well with an APAP's algorithm, they can still attempt a slow fixed-pressure re-titration drawn out over the course of several or many nights while at fixed pressure. Some doctors prefer to be in the loop for home-based re-titrations, while others like mine simply and cheerfully say "have at it".

mister_hose · Post by **mister_hose** » Fri Jul 28, 2006 8:36 am

I agree about there being no reason other than cost not to choose APAP over CPAP, since APAP can be run as CPAP while still collecting valuable overnight sleep data. If a person does not fare well with an APAP's algorithm, they can still attempt a slow fixed-pressure re-titration drawn out over the course of several or many nights while at fixed pressure.

I can do that too, but I don't have an APAP. Some of the current, high-end CPAPs collect all the same nightly detailed data as APAPs do. , such as the REMstar M-Series Pro CPAP, which I have. I can do a multi-night fixed-pressure titration, one pressure per night, and use my PC to evaluate the results.

However, I'm intrigued by APAP for a somewhat unorthodox possible application. My CPAP machine was set to my titration value, 13 cm, but I wonder if it'd be a good idea to buy an APAP and set it up with a range of, say, 13 to 20, or perhaps something more moderate like 13 to 16. This would be like "CPAP Plus". It never drops below my prescribed CPAP pressure of 13, yet can punch the pressure up if necessary for any rare, extreme events that may occur. It'd spend probably 95% of the night at 13, acting like a CPAP. It'd be kinda like "CPAP with insurance". This, compared to CPAP at 13 cm, ELIMINATES the otherwise-problematical question of "can the traditionally-configured APAP (say, 9-16 cm) respond to fast-onset apneas as fast as CPAP 13 cm?"

However, the question then would be, would the pressures above 13 cm, and the process of changing upward to them and downward away from them (back to 13), cause problems for me? My doc may have prescribed CPAP 13 cm because pressures higher than that, and/or pressure changes getting to/from there, may cause problems with me. I suppose I'd have to ask him about this approach (APAP set 13 to something higher).

What do you guys think about this "CPAP+" idea, of setting an APAP range from your CPAP titrated pressure to a bit higher?

Some doctors prefer to be in the loop for home-based re-titrations, while others like mine simply and cheerfully say "have at it".

Other doctors are ego-driven and take offense when you even know what "titration" means. I hope mine's not like that... otherwise, in 2.5 months when I go back to see him, he's gonna be royally pissed that I have Encore Pro and probably (by then) a 1-second-resolution recording pulse-ox wrist unit, and that I'm integrating all that data for various fixed pressures in order to second-guess his 13 cm guess. Heck, maybe I'll even have an APAP by then as a second unit!. Let's just say that would probably annoy that type of doctor a wee bit. =)

Ego-driven docs feel threatened or challenged by highly-informed, scientifically-minded patients, and get annoyed and assume a "parent-to-child" tone in the conversation. The best docs, when you tell them what you're doing, will get a grin a mile wide, a grin that says "oh thank God, I've finally got a SMART one!", right before they excitedly start talking to you in the "we're equals" tone.

I've had both kinds of docs. The second kind is quite preferable. =) Now I just have to determine what kind I've got for my sleep doc.

-SWS · Post by **-SWS** » Fri Jul 28, 2006 8:56 am

I agree, mister_hose. High-end CPAP with data collection capabilities should suit most people just fine. When I bought my first APAP there were no CPAP machines with data collection capabilities. I thus bought an APAP with the sole intent of collecting data while running it at 10 cm. To my great surprise, I slept a little better with that machine in APAP mode. I have been sleeping with my machine in APAP mode ever since, every now and then putting the machine back in CPAP mode just to verify my subjective clinical response. I'm very pleasantly surprised with my improved response to APAP each time I perform that experiment.

Anyone who is inclined to buy a high-end CPAP with data collection capabilities, might spend a little extra to get APAP capability. Who knows? You just might end up being pleasantly surprised with APAP as I was. If not there's always CPAP mode! As others in this thread have said, treatment options are not all too often a detriment. .

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