Will you listen to sleep techs.., that do not know........?

[mckooi]

Hi,

I came acrossed some sleep techs or evet sleep study reserchers that only believe in straight cpap, not event know what is a leak compensation, dont like apap....etc. Even the osa sufferer has a high pressure of 18.5cm to 19cm yet the recommandtion from these sleep techs and researchers were straight cpap instead of apap or bipap. I am very concerning of their qualifications and knowledge in the sleep industry.............................

Any comment welcome.

I learnt alot more last few short months from this great forum (just to name a few like Rested Gal, Dr.Krakow, Wulfman, JSkinner case, SAG and many more......), the textbook by Clete Kushida of OSA Diagnosis and Treatment is excellent as well.

Arming with the knowledge and intellectual background in analysis I just wonder is the sleep-techs, researchers and sleep doc still have roles to play having seeing that the playing field from this group of people is rather static......as we are marching on together.

Mckooi



Mckooi

[KAZ]

You have to consider that some of the no Auto recommendations from sleep techs might be self serving in that the auto(along with excellent data gathering) is a possible threat to their business. Regards

[Nodzy]

Many doctors and RT's are deficient in knowledge about OSA's various types, levels and myriad of possibe complications, yet they treat and prescribe for OSA. Many, too, are woefully uninformed and lacking knowledge on the various brands and types of flow generators. And the software for the machines.... most med-types have NO or limited experience with one brand, let alone all of the brands.

As KAZ noted, most of the med-types perfer that the patient not have access to their sleep therpay data strictly because having it offers too much opportunity for the patient to present bothersome questions, find problems in their prescribed therapy... and buck the doctor or RT in some manner.

A closed-minded, or channel-minded, doctor or RT is about as good as using the rhythm method for birth control -- Ooops..... ooops..... ooops.

Personally, I prefer not be be a comatose or buried... "ooops."

Nodzy

[mindy]

There is a study in a cardiology journal that compares CPAP and APAP for cardio-patients. In this particular study, the finding was that CPAP helped but APAP did not show a beneficial effect. This study is far from definitive but I've heard that there is some level of debate in the sleep medical community about the effectiveness of APAP for some situations.

Fixed and autoadjusting continuous positive airway pressure treatments are not similar in reducing cardiovascular risk factors in patients with obstructive sleep apnea.

Patruno V, Aiolfi S, Costantino G, Murgia R, Selmi C, Malliani A, Montano N.

Chest. 2007 May;131(5):1393-9.

Mindy

[Country4ever]

Mindy,
That's interesting. Did the article say why they thought there was such a difference? I'm wondering if its that delay in treating the apnea/hypopnea, even for a minute or 2, that the apap seems to have. Don't most machines take 30 seconds per half centimeter, or something like that?
That could leave you in hypoxia for quite awhile all night.......even though your numbers might look good. I suppose that might be a good reason to keep those apap pressures closer together.

[mindy]

Hi Country,

They said that with CPAP there were significant reductions in systolic and diastolic blood pressure and something else called "homeostasis model assessment index (HOMA-IR)" but those treated with APAP did not have those reductions in cardiovascular disease risk factors. C-reative protein was reduced about the same in both groups.

Mindy

[Country4ever]

Thanks Mindy,
I have alot of trouble with reading and comprehension, and always appreciate others picking the good stuff out for me!
If that data was obtained with good science, then it concerns me ALOT to use APAP. I have started another post, asking some questions that your article got me to thinking about. Its the "AHI" post, but I go into the CPAP vs APAP question. Hmmm......I'm starting to appreciate the difference in these 2 methods of PAP. You can read my other post and give me your opinion. But its not hard for me at all to think that they may have a real valid point about CPAP vs APAP. APAP can allow for too much hypoxia. Thanks so much for leading me to this article!

[Guest]

Hi Mindy,

Can you please show me the web-link address to the article as this is related to the research that I am involving in Homeostatic over cpap treatment in OSA. Thank you.

Mckooi

[TossinNTurnin]

I certainly want to keep an eye on this as I know very little about it.

The RT at my doctors office does seem to be of the type that discourages patient participation.

The doctor, while he certainly wasn't doing cartwheels, having me ask questions... did sit down and was willing to discuss some of it with me.

He said in some cases, he'll prescribe APAP, but he felt that CPAP had more consistent results and would be better for me. I found it interesting in that he wasn't "Anti-APAP" but seems to believe that CPAP for most people is better.

He says he participated in a study related to it. Next time I see him I may ask him for some info on it.

In terms of how APAP "feels" to patients. There are people who say that they are awakened by the pressure changes during APAP. If that truly does happen with some people... I can see where frequent awakenings would cause a problem.

[kteague]

Below is a link to one thread on this subject. The article left too many unanswered questions for me.


viewtopic.php?p=177874

[Nodzy]

Very interesting, and I haven't looked deep into the medical aspects of the differences.

However, I do know that auto-titrating machines, for me, with the pressures set properly, manage to almost totally prevent central apnea events (NR), substantially lower the number of hypopneas (H), substantially lower the number of flow limitations (FL), substantially lower the number of obstructive apneas (OA) and appear to greatly reduce the number of snores (VS) if sleeping on my back.

Of course, the mask used plays a large roll in the effects. As do the pillows and other factors.

Overall, since starting on APAP in June of 2007, and using a Hybrid mask, I have less frequent and less severe episodes of chest pain and more stable blood pressure. My Type-2 Diabetes appears to now be controllable by food intake alone. That's in addition to numerous other notably positive effects. Though none of my other pre-APAP symptoms are healed or reduced consistently by thirty-percent (30%) or more. The initial body-shock of great therapy made me feel for several weeks like the healing percentage would be much greater. But that was just initial elation and ultimately an illusion.

Exactly how the APAP varying higher pressure affects my REM sleep is unknown to me at this time. But I am very curious to know if the higher APAP pressures necessary to lower the event numbers interfere in other ways with high-quality sleep and the natural repair, restore and resistance abilities of the body.

Nodzy

[mindy]

The paper I noted is the one in the previous thread. I have a couple of comments about points made in that thread:

1. We can't draw conclusions from reading only the abstract of a paper! It's crucial to read the whole thing so that one can determine the methods used and can evaluate if the methods are statistically sound.

2. A sample of 31 patients may sound "small" but in reality there are methods to calculate the number required to show a specific amount of difference. I haven't re-read that paper in awhile but have been involved in research in which the number of patients has been similarly small and yet still valid.

3. A single study is rarely definitive. It can provide some interesting results and then we must determine the causal pathway(s) and do additional studies to validate and find out more.

I'm not so sure that this needs to be a CPAP Vs. APAP contest. I used my APAP in APAP mode to determine what kinds of pressures I really needed (I barely slept during my sleep study). Now I have my machine in CPAP mode and am actually having much better and more consistent "results" in terms of AHI and leak consistency and the amount of pressure I need is tending to be lower. I am grateful, however, that I have the APAP to obtain info for changes as needed.

Research studies are often like baby steps ... it takes a study (or studies) to actually figure out the questions to ask and how to frame them. I'm not defending all research but I do know there are many, many researchers out there who are very dedicated to finding evidence-based data to help inform patient care. Are they perfect? Of course not! At least they are working on it.


Ok - somebody else can take the soap box
Mindy

[mindy]

Hi Mindy,

Can you please show me the web-link address to the article as this is related to the research that I am involving in Homeostatic over cpap treatment in OSA. Thank you.

Mckooi

HI McKooi,

I don't think that the full-text of the paper is available outside institutions with paid access to the journals. The abstract is posted in the previous thread referred to earlier.

Mindy

[Guest]

Hi Mindy, Norzy and All,

So far I have not seem any posting of positive and negatives of both cpap, apap and bipap....it would be excellent to know the algorithms of each of how it works and it's limitations. I think the algorithms that is switchable from the touch of the button makes it flexible to change your therary requirements is crucial to have better if not correct treatment. So,

1) Positive and Negatives on CPAP, APAP, BiPAP.
2) Limitations of CPAP, APAP, BiPAP.
3) Flexibility to upgarde from APAP to Straight CPAP, C-Flex and A-Flex is built in but the Bipap algorithms would be teh next level to have.
4) A Climate adaptive humidifier would be event better....just to name a few.

Mckooi

[rested gal]

Every time there's a study done which involves "autopap" I wonder.... what was the setting range used with the autopap? Was it set at 4 - 20? Four, or even five as the minimum pressure is not a good idea, imho, and is almost setting the autopap up for failure to treat as effectively as it can.

I firmly believe that the best way for most (not all..."most")people to use an autopap is to set the minimum pressure up high enough that you're using it almost as if it were a straight cpap. In other words, setting the minimum pressure high enough to prevent most events (apneas/hypopneas) right from the start. Then set the maximum pressure wayyyyyy up there, giving plenty of unused ceiling that's available IF needed.

That begs the question, "Hey, if you're gonna use the autopap as if it were a straight cpap, why even get an autopap at all? Why not just use a straight single pressure?"

My answer -- if you can prevent MOST events with, say a pressure of 10, but you need 13, 14, and 15 for a few minutes on most nights to handle "worst case scenario" events (like the greater number of apneas that are likely to occur when you turn onto your back AND happen to go into REM), why subject yourself to a straight 15 all night long just to take care of brief "worst case scenario situations? The higher the pressure, the more trouble people have with some masks leaking. And the more possibility of aerophagia for some.

Using less pressure than "worst case scenario straight cpap pressure" -- as long as that minimum pressure is high enough to take care of MOST events -- can make treatment more comfortable. Setting a high enough maximum pressure to handle occasional events that need more pressure....well, that's why I use an autopap.

I doubt that's the way autopaps are set in trials and studies. 4-20 or 5-20 seem to be the only way the medical world thinks of using "autopap."