APAP Discussion

[CollegeGirl]

Recently there has been a lot of disagreement among posters here in regards to APAPs. Things have been hashed out over and over again on threads belonging to people looking for help - and in my opinion, that's not a good place for us to do that. I think we need to at least try to come to some sort of general consensus on things (If that's even possible).

Please, let's be civil about this. No personal attacks, no flaming, no "camoflauged" personal attacks (ie - "SOME people seem to think they're above doing blah blah blah.") Just good, old fashioned, "Here's what I believe, and here's why I believe it."

Onto my opinions:

First of all, a warning. Don't even attempt to play around with your numbers until you have your leaks under control. Leaks can seriously skew data (especially leaks that make it to "large leak" status) so that it appears you're having few events at a pressure when you are actually having many. Get your leaks taken care of first, and then you can accurately see the changes in the number of your apnea events that occur with different pressures. In order to find out what leak rate you're aiming for, look in the manual that came with your mask. There should be a chart that says "vent flow rate."

If you don't have your manual, search this board for "vent flow rate" and the name of your mask. If you can't find it, post asking for help. When you find the vent flow rate chart, look for your titrated pressure. That's where you want your leak rate to be on machines that don't take vent flow rate into account (for example, Respironics). For machines that DO take vent flow rate into account (you'll know this because you'll have to change mask settings if you use a different mask) a leak rate of 0 is ideal.

One more warning: Make any changes to your treatment one at a time, and slowly. The only way to tell what is causing a change in how you feel or what your AHI is, is to isolate one variable and change it for a period of time (a week is usually good).

Now, what I think about auto:

1). The vast majority of CPAP users do not need an auto. Most people are treated just fine with straight CPAP pressure. In fact, some people feel better on straight CPAP than they do in auto mode, period. If you already have a CPAP and you're feeling great, IMHO, there's no need to mess with what works. If you do want an auto anyway, though, see below.

2). If someone decides they want to start out with an auto "just in case," that's great, but in my opinion the smartest way to go about things is to start with that auto set to straight CPAP mode at your titrated pressure. As long as your titration was correct, that should be the pressure that treats you best. Give it some time. At least a week on that straight pressure (If it's your first week on CPAP, I'd maybe give it two weeks, as, at the very least, week 1 will be spent adjusting to CPAP in general). If you have any issues at all that indicate auto mode may be helpful (if you have gas/bloating issues, if you still are waking up gasping/choking), you can always change to auto mode then.

3). For those who decide to switch to auto mode (and to those who are having problems on straight cpap and switching to auto), making sure you don't have your range wide open at 4-20 is important. If you're having issues such as still gasping/choking or still feeling tired, or if you're feeling suffocated* (in other words, if you have reason to think you might need a higher pressure) I would suggest setting the lowest number of the range to your titrated pressure and the highest number to 20. If you notice after a while that your machine stays at your lowest pressure most of the night, try lowering the bottom number of the range a little bit. It could be that you don't need as high a pressure.

4). If your numbers are good at your current pressure but you're having aerophagia issues, first try raising your Cflex/EPR setting. Sometimes that little bit of pressure relief can be enough to help. You can also try turning Cflex OFF if it's already on, as the change in pressure can worsen aerophagia in some people. If not, try starting your auto range at one or two cms under your titrated pressure and seeing what happens. If you're still experiencing those issues after several days, you can bump the lower end of the auto range down a little further. But be careful you don't trade less bloating for a whole lot more apneas. If this seems to be the case (you can't eliminate bloating without seriously raising AHI) you may want to talk to your doctor about BiPap. Additionally, people who experience this symptom (and people with apnea in general, actually) often have GERD (reflux disease). With this, acid from the stomach weakens the sphincter between the stomach and the esophagus, which allows air to pass through more readily. Sometimes treating the GERD helps with the aerophagia, but it generally takes time to repair damage already done.

5). There has been quite a bit of talk on the boards lately about Central Apnea and runaway pressure. I personally believe these concerns to be largely without merit as it concerns the majority of CPAP users. Yes, there will be some people who could have just the right kind of snore that somehow triggers the auto to keep going up and up...And yes, there will be some people who have easily-triggered centrals that the auto causes at high pressures - but these people are in the minority of users, and a week of experiencing either of these things is not going to be any more detrimental than a week on too low a pressure (which also results in apneas). Letting the auto do its thing in the higher ranges for a week is, for most, more efficient than the current "two above, two below" philosophy that seems to have permeated this board, as the patient will be able to see more quickly what the optimal pressure seems to be, instead of having to adjust his/her pressure in tiny increments for 3 or 4 weeks.

*Remember that "suffocation" feelings can also be caused by other things. For example, by not being able to breathe out against the pressure (try upping Cflex or EPR. If your CPAP machine doesn't have that capability, try a machine that does, if possible. If you have that all the way up, and you still can't breathe out, you may want to talk to your doctor about an auto). Also, suffocation feelings can be caused by using ramp. Try it without the ramp and see if that helps. Additionally, some people have experienced problems breathing when using Cflex (feeling like they can't catch their breath), so trying things without Cflex is also a good idea.

Also remember that these are only my opinions based on two years of reading these boards fairly religiously. I am not a doctor or any kind of medical professional, and it's always advisable to speak with your doctor regarding any issues you have with treatment.

[sleepyjane]

thank you for this information. I was told that auto pap may solve my problems on here recently and doctor changed his new recommendation for bipap (18/14) from my old cpap 16. I have since found out about auto bipap which I am going to fax his in a day or two to see if he will switch to that as I am retaining carbon dioxide in my lungs.

Reading your post will be helpful to keep in mind and also reminded me If was thinking I would like to have him set it to not go lower than 14 as I was having suffocation problems with 14 and under in the sleep lab and they had to start me at 15 instead of 10 like doctor initially told them. This will hopefully avoid this problem if he agree to it.

[NightHawkeye]

Very nice summary, CollegeGirl, and a good read for anyone new to therapy.

Additional item worth mentioning is the cost differential between CPAP and APAP:
The difference in cost between the lowest priced CPAP machine and the lowest priced APAP machine (as of today on CPAP.com) is the difference between $247.50 and $479.00, a difference of $231.50. In this case, the APAP costs nearly twice what a basic CPAP does. In many cases, DME's willingly seem to provide more expensive CPAP machines which have bells and whistles like EPR, C-flex, and data recording capabilities, making the true cost of APAP somewhat less, somewhere in the $100 to $150 range (if one wanted to slog through a detailed statistical analysis).

Whether the cost difference is important is an individual matter, of course. In my own case, fooling around with a standard CPAP machine just didn't seem justified for the small difference in price. (I went even further, and rationalized getting a BiPAP-auto as my first machine.)

CPAP.com's sales figures indicate that only 33% of buyers choose APAP machines, while 62% choose CPAP machines. Clearly, most folks opt for CPAP rather than APAP. That says a lot.

Regards,
Bill

[bookwrm63]

Hey CG,

An excellent post from you! When I first joined this forum, I was kindof in a tizzy because so many people (very kind and well intentioned) basically told me that APAP was the ONLY way to go. I felt so cheated that I only had a straight CPAP machine and when my doc wouldn't write the RX for one, I felt let down. Well, after getting some more info and a few PM's, I just asked my DME to upgrade my Cpap to one with data recording and they finally did. I realized that I really was doing fine on straight CPAP and really just wanted to know "my numbers". I know there are those out there who feel an APAP is the only way to go and that is fine, but you're right in saying that the answer to every issue is NOT always "get an APAP". That's what I heard over and over and it sets alot of people up for a fall if they can't get one.

You really made me feel alot better about my machine and therapy CG!

Thank you!

Mary

[MartiniLover]

Thanks for really putting things in perspective.

I am a 2 1/2 year user of CPAP, and BiPap, and my BiBap has "died".

I think I am an astute person but had not given this enough thought as to what I would do in this situation.

My first thought, being my insurance company won't pay for another is to defiantly buy off the internet. <HeeHee> Local DME wants to charge $225 a month for same machine I have now. <my eyes roll>

It has been quite a decision as to buying what I have been using, or stepping up to a automatic. Do I really need it? Will I be sorry if I don't do it now, when I have the chance.

It is the indecision that is killing me. About the time I make up my mind I change it. Brain fog has now set in, and that doesn't help. Sinus are acting up, plugging nose and ears. That doesn't help. I am so tired..........

[Hurricane]

Why not an APAP? You still have the option to switch it to Cpap, who knows how your physical condition might change in a few months, at least you have the option then to try APAP and find out at what numbers you are doing better at. Just my view.
Ed

[DreamStalker]

Great advice CG!

I would add that there are a couple of other reasons for wanting an APAP.

1) Some folks may have different pressure requirements for side sleeping vs. back sleeping and if they do not sleep in one position throughout the night, the APAP would adjust for the pressure requirements. True, one can just set to higher pressure for back sleeping and side sleeping should be taken care of ... but I suppose a reduction in pressure should add some comfort with regard to looser straps on some masks, breathing against lower pressures, and you have already mentioned possible relief from aerophagia.

2) More importantly however, there are those folks who may undergo weight changes that may also affect their pressure requirements. If one is loosing (or gaining) fatty tissue in the neck related to weight changes, having an APAP would benefit the user (at least financially) by not having to go in for re-titrations.

As Bill noted, the cost/benefit of an APAP outweighs that of CPAP in the long run ... especially when one incorporates their own health into the equation. Also, I think with an APAP, one is assured to have a machine capable of providing useful monitoring data whereas with a CPAP, one needs to be more familiar with the model they get.

So sure, most will do just fine with a CPAP ... just as most would do just fine driving a toyota corolla to get where they are most likely to go ... but if you have special needs or just want more options on where or how quickly you want to get there, an SUV or sports car may be more appropriate and they can get you to the same places that a toyota corolla can (BTW - I think corollas are great vehicles).

[Goofproof]

A fine much needed post CollegeGirl, and I agree on some of your points.

I do feel that most people would do better with a AUTO, not that they need to run it as an Auto. They need the data, and they need the options, that a Auto adds. The main thing that Auto can add to the mix, is a higher number of minutes, per night, spent at the lowest pressure you need.

I do however think that after you are used to CPAP, your new Auto should be set to 2 CM under your CPAP pressure, and 2 CM over it. This will allow you to find out how bad the Sleep Lab's guess was.

As CollegeGirl says, Fix the leaks first, The data is misleading, if you don't correct the basics. The treatment can't splint your airway if you can't keep the pressure in your airway.

I am concerned about, Central Apnea and runaway pressure. I have found my pressure limit to be 15.5 CM, it it goes higher than that it raises Centrals for me. I have also found APAP's, like to treat Snores, causing the machine to raise the pressure too high, part of that problem is caused by leaks. (Leaks cause pressure loss, that allows more snores, and the machine treats that by upping the pressure, whitch causes even more leaks.) The Dog's chasing it's tail. So I limit my pressure to a safe level so as not to induce Centrals.

I had my CPAP treatment under control, had found my ideal pressure, all was right with the CPAP WORLD, Then I got my New APAP, as with all new toys, it had to be played with. (So Few Christmases, in my Life) I thought I knew all about CPAP. I soon found out how easy it is to get lost, making adjustments too fast, changing too many things at a time, pretty soon you find your treatment suffers and your head spins, and BiPAP's, that everyone seems to be getting and don't have a clue as to how to set them up, or what they are really for. They just know they cost more so they have to be the best. Sometimes, Less is More.

One last thing I don't get, C-Flex and EPR, 90 to 95% of the people who have it available find it to be the best thing since Fried Chicken, and I love Fried Chicken. It's a comfort feature, and it can be turned off, more and more we hear preaching that it needs to be turned off. The problem is that new people here may take that as fact, it's not. Better time would be applied to why some have problems with it. If you lay there, and listen to your breathing, you don't go into your normal night breathing pattern and end up fighting the machine. If you focus on other things than your breathing, you don't even notice your breathing, breathing is a automatic function, you aren't suppose to control your breath rate or depth. Let nature take over like it's supposed to. But if you can't it can be shut off, and you can get along with finding fualt with something else.

Yes it would be nice to be able to test how all the machines treat us, but in the real world we are lucky to get a XPAP that records data so we can take care of ourselves, most end up with crappy low end junk not much better than a vacume cleaner running in reverse. The facts are that all of the top four XPAP makers produce machines that treat 95% of the owners well if set correctly.

I have to give up for now, the Soap Box is Shaking, I didn't mean to ramble on so long. I seem to have fallen into some of my pet peeves.

The good thing is, this forum has a lot of good info to pick from and a lot of good folks, that are willing to help, we may not always agree, but you can always find people who care. Jim

[NightHawkeye]

The good thing is, this forum has a lot of good info to pick from and a lot of good folks, that are willing to help, we may not always agree, but you can always find people who care.

A good point, Jim. It bears repeating.

Regards,
Bill

[BrianRT]

I think an interesting point was made by bookwrm63 in that, people with standard machines feel somewhat cheated since theirs is not an auto. But, come to find out, the standard CPAP #'s were doing just fine for bookwrm. I think people should be assured that just because your machine is a standard doesn't mean it's not doing it's job. For some people, knowing your #'s is essential and I don't blame them one bit (It's YOUR therapy, right?) but not having those capabilities doesn't mean you're any less of a hosehead. To continue the car analogy, it's akin to driving a car without a speedometer, tachometer, odometer etc. etc. You might not know the fine details, but it still gets you there.

[DreamStalker]

To continue the car analogy ... suppose you went to buy a car and except for a few really high end models, they all cost you the same co-pay. However, the car salesman insists that all you need is the toyota corolla and it is indeed a well made car as reported by consumer reports and lots of corolla owners. Of course, the car dealer gets their corollas for a lower cost than for say their toyota highlanders or their celicas (do they still make those?) ... I suppose I would feel a little cheated driving off the lot with a corolla instead of the highlander or the celica. If you do drive off the lot with a corolla ... and even though it won't make you less of a driver without one, do make sure you get a speedometer with it or you may find yourself in a little trouble with the dreamland patrol.

Did I mention that corollas with seedometers are great vehicles

I would like add that my intention is not to make folks feel bad about their machine but rather to inform newbies that choices may be available ... for some to a higher degree than others ... as is the norm for most everything in this world.

[Snoredog]

Recently there has been a lot of disagreement among posters here in regards to APAPs. Things have been hashed out over and over again on threads belonging to people looking for help - and in my opinion, that's not a good place for us to do that. I think we need to at least try to come to some sort of general consensus on things (If that's even possible).

Please, let's be civil about this. No personal attacks, no flaming, no "camoflauged" personal attacks (ie - "SOME people seem to think they're above doing blah blah blah.") Just good, old fashioned, "Here's what I believe, and here's why I believe it."

Onto my opinions:

First of all, a warning. Don't even attempt to play around with your numbers until you have your leaks under control. Leaks can seriously skew data (especially leaks that make it to "large leak" status) so that it appears you're having few events at a pressure when you are actually having many. Get your leaks taken care of first, and then you can accurately see the changes in the number of your apnea events that occur with different pressures. In order to find out what leak rate you're aiming for, look in the manual that came with your mask. There should be a chart that says "vent flow rate."

If you don't have your manual, search this board for "vent flow rate" and the name of your mask. If you can't find it, post asking for help. When you find the vent flow rate chart, look for your titrated pressure. That's where you want your leak rate to be on machines that don't take vent flow rate into account (for example, Respironics). For machines that DO take vent flow rate into account (you'll know this because you'll have to change mask settings if you use a different mask) a leak rate of 0 is ideal.

One more warning: Make any changes to your treatment one at a time, and slowly. The only way to tell what is causing a change in how you feel or what your AHI is, is to isolate one variable and change it for a period of time (a week is usually good).

Now, what I think about auto:

1). The vast majority of CPAP users do not need an auto. Most people are treated just fine with straight CPAP pressure. In fact, some people feel better on straight CPAP than they do in auto mode, period. If you already have a CPAP and you're feeling great, IMHO, there's no need to mess with what works. If you do want an auto anyway, though, see below.

2). If someone decides they want to start out with an auto "just in case," that's great, but in my opinion the smartest way to go about things is to start with that auto set to straight CPAP mode at your titrated pressure. As long as your titration was correct, that should be the pressure that treats you best. Give it some time. At least a week on that straight pressure (If it's your first week on CPAP, I'd maybe give it two weeks, as, at the very least, week 1 will be spent adjusting to CPAP in general). If you have any issues at all that indicate auto mode may be helpful (if you have gas/bloating issues, if you still are waking up gasping/choking), you can always change to auto mode then.

3). For those who decide to switch to auto mode (and to those who are having problems on straight cpap and switching to auto), making sure you don't have your range wide open at 4-20 is important. If you're having issues such as still gasping/choking or still feeling tired, or if you're feeling suffocated* (in other words, if you have reason to think you might need a higher pressure) I would suggest setting the lowest number of the range to your titrated pressure and the highest number to 20. If you notice after a while that your machine stays at your lowest pressure most of the night, try lowering the bottom number of the range a little bit. It could be that you don't need as high a pressure.

4). If your numbers are good at your current pressure but you're having aerophagia issues, first try raising your Cflex/EPR setting. Sometimes that little bit of pressure relief can be enough to help. You can also try turning Cflex OFF if it's already on, as the change in pressure can worsen aerophagia in some people. If not, try starting your auto range at one or two cms under your titrated pressure and seeing what happens. If you're still experiencing those issues after several days, you can bump the lower end of the auto range down a little further. But be careful you don't trade less bloating for a whole lot more apneas. If this seems to be the case (you can't eliminate bloating without seriously raising AHI) you may want to talk to your doctor about BiPap. Additionally, people who experience this symptom (and people with apnea in general, actually) often have GERD (reflux disease). With this, acid from the stomach weakens the sphincter between the stomach and the esophagus, which allows air to pass through more readily. Sometimes treating the GERD helps with the aerophagia, but it generally takes time to repair damage already done.

5). There has been quite a bit of talk on the boards lately about Central Apnea and runaway pressure. I personally believe these concerns to be largely without merit as it concerns the majority of CPAP users. Yes, there will be some people who could have just the right kind of snore that somehow triggers the auto to keep going up and up...And yes, there will be some people who have easily-triggered centrals that the auto causes at high pressures - but these people are in the minority of users, and a week of experiencing either of these things is not going to be any more detrimental than a week on too low a pressure (which also results in apneas). Letting the auto do its thing in the higher ranges for a week is, for most, more efficient than the current "two above, two below" philosophy that seems to have permeated this board, as the patient will be able to see more quickly what the optimal pressure seems to be, instead of having to adjust his/her pressure in tiny increments for 3 or 4 weeks.

*Remember that "suffocation" feelings can also be caused by other things. For example, by not being able to breathe out against the pressure (try upping Cflex or EPR. If your CPAP machine doesn't have that capability, try a machine that does, if possible. If you have that all the way up, and you still can't breathe out, you may want to talk to your doctor about an auto). Also, suffocation feelings can be caused by using ramp. Try it without the ramp and see if that helps. Additionally, some people have experienced problems breathing when using Cflex (feeling like they can't catch their breath), so trying things without Cflex is also a good idea.

Also remember that these are only my opinions based on two years of reading these boards fairly religiously. I am not a doctor or any kind of medical professional, and it's always advisable to speak with your doctor regarding any issues you have with treatment.

I haven't seen any disagreement on the topic, but then again I usually ignore your posts because you rarely know what you are talking about.

Take this paragraph below for example, you don't have the disorder so for you it is without merit so you continue to give bad advice about it. You are a train wreck waiting to happen. Fact is there are NO guidelines for autopaps setting them 2 above or 2 below. 2 above or 2 below what? the problem is compounded because people keep repeating that misguided information and some here choose to believe it.

5). There has been quite a bit of talk on the boards lately about Central Apnea and runaway pressure. I personally believe these concerns to be largely without merit as it concerns the majority of CPAP users. Yes, there will be some people who could have just the right kind of snore that somehow triggers the auto to keep going up and up...And yes, there will be some people who have easily-triggered centrals that the auto causes at high pressures - but these people are in the minority of users, and a week of experiencing either of these things is not going to be any more detrimental than a week on too low a pressure (which also results in apneas). Letting the auto do its thing in the higher ranges for a week is, for most, more efficient than the current "two above, two below" philosophy that seems to have permeated this board, as the patient will be able to see more quickly what the optimal pressure seems to be, instead of having to adjust his/her pressure in tiny increments for 3 or 4 weeks.

Fact is the PSG lab will find your ideal pressure and for many that pressure will avoid further complications such as pressure induced central apena. They don't usually titrate you with an autopap we can get off the shelf, so they have no idea if your SDB patterns will cause a runaway or not. They will recommend a pressure finding that avoids complications if at all possible.

Problem is many patients ignore that data and then go be bopping around with an autopap off the shelf with no idea what they are doing then follow more bad advice like the above. It is not that hard to figure out, if you don't improve with higher pressure you have gone the wrong direction. It is all quite simple when you think about it and apply a bit of common sense.

Here are the biggest blunders I've seen suggested:

Bad idea #1: Setting the Minimum pressure on an autopap to the lab found titrated pressure.

Bad thought process behind it: Oh they claim that if you set the Minimum pressure to what your lab found cpap pressure was you will be getting all the benefits of cpap PLUS the machine will be free to move on up and you will then find your ideal pressure. This is total BS. They tell people this regularly, they have no idea what their diagnostic PSG even looked like or if the patient is at risk of pressure induced Central apnea, or if the lab tech stopped at that pressure for a REASON.

Why is this bad? Allowing the autopap machine to run up from there is dangerous, just like an obstructive apnena, a pressure induced central apnea can put undue stress on the heart. If the patients heart is already compromised with a defect you may even put their life at risk. Putting a disclaimer at the bottom of your post that you are not a doctor doesn't cover your ass for stupidity.

Autopap runaways do occur and they happen more often than you think they do. Some machines are better than others, some people should not be on them at all.

When I give suggestions about a machine, I ignore the other posts in the thread, because they are usually from some cpap newbie who has been reading way too much of the wrong information, has never owned that particular machine and doesn't have the condition. When I give suggestions, I look at their current machine, settings, problem they are experiencing and if available their diagnostic data. There are key indicators to pick up on which helps identify the problem, such as their 90% pressure is always moving, they snore, they feel terrible.

And I agree with whomever said that leaks need to be taken care of first, they are absolutely correct, leaks can skew your data to the point where the machine will stop responding to events seen.

Like I said, the only disagreement I seen is what you made it.

[BrianRT]

I love car analogies. I use them a lot to explain medical concepts. But anyway, yeah, all things being equal, I would want the Supra turbo (what??....they're discontinued?!?.....blast it!!!), since I, myself, would know how to extract the max performance (the Supra being akin to an M series Auto Bipap, with the card reader and software, I would think)

It would depend on what YOU particularly want. If you just want something to get from point A to point B and back again and don't care about the small details, then get the Corolla. But if you want to take the extra effort to learn how to program the GPS and learn to drive a stick, and figure out the trip computer, then get the Supra. At least it's available for those that do care about the finer details. To use the Supra to do the point A/B thing would be overkill though.

To boil my point down though (since I feel I've got off track)......informed choice is the best choice!!

[rested gal]

Excellent post, CG! Very good suggestions for most autopap users.

I think something you mentioned in the lead-in to your autopap info is especially important for newcomers to the message board. New readers who see so much talk about autopaps and could, as Brian said, feel cheated.

1). The vast majority of CPAP users do not need an auto. Most people are treated just fine with straight CPAP pressure. In fact, some people feel better on straight CPAP than they do in auto mode, period. If you already have a CPAP and you're feeling great, IMHO, there's no need to mess with what works. If you do want an auto anyway,

In addition to mask and/or mouthbreathing leaks being a major problem for many people, I believe that a lot of "not feeling better" after starting CPAP treatment (straight CPAP) is due to other underlying health issues rather than "CPAP" not doing what it's supposed to do...keep the airway open during sleep.

Getting a different type of machine should be at the bottom of the list of things to work on if a new user doesn't feel better pretty soon while using straight CPAP. Regarding equipment, I think for most people, time and money are better spent on finding a comfortable mask than on pursuing a different type of machine.

A poster I enjoyed reading (wish he were still posting regularly) nicknamed Grabraham had the same concern that new people might feel they weren't getting "good treatment" if they didn't have an autopap:

I liked what Grabraham said in "A note to the new user":
viewtopic.php?t=4837

[sleepinginseattle]

The discussion of auto-adjusting CPAP (APAP) therapy vs. continuous pressure CPAP therapy is complicated by the notion of self-titration.

I think there ought to be general agreement to either discuss APAP therapy in the absence of a sleep doctor's guidance (self-titration) or with it. My reason is simple. If we pursue a discussion which assumes that the patient will not be seeking and/or following a sleep doctor's advice when engaged in self-titration but will be pursuing a course of treatment that is of their own making, then we need to keep in mind the health and well being of all patients, regardless of their baseline health status. That means we must consider the worst case scenarios and it also means that we acknowledge that we lack the training and skills to make informed suggestions that will result in effective therapy.

If we do pursue this discussion with self-titration as an explicit goal, there ought to be some guidelines that we all agree upon.

I would start with the following:

a) The medical community makes a genuine effort to provide effective patient care. The pursuit of self-titration is for economic and/or reasons NOT related to a distrust of doctors or sleep labs.

b) We are not experts. Our opinions are gleaned from experience, reading, and other sources. They may be clouded by our ability to recollect things accurately and they may not be representative of the views held by others or the experiences of others. We explicitly acknowledge that they are not recommendations for therapy.

c) Data collection and/or the use of software to evaluate the effectiveness of sleep therapy is NOT a requirement for an individual to have an informed opinion of the benefits of either APAP or CPAP therapy.

d) The use of medical research to support or refute an argument must stand on its own merits. It is wrong to assume that research that is inconclusive supports a positive or negative finding or that proof of an opinion is supported by the absence of research to disprove it.

e) We assume that the posts are open to the public and read by all. We like the public and will make a genuine effort to be courteous in our discussions. (This has already been suggested and I think it’s a good suggestion.)

Cale

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, auto, APAP