Straight cpap vs. auto

[Paula J]

I've been noticing that not too many people on here use a straight cpap. I asked my doctor last week about it and he told me to stay on straight cpap. What is the advantages or disadvantages of straight cpap over auto?

[apneawho]

I am not sure of disadvantages or cases where you would not want a person on Auto. I am sure there are advantages for some people. My doctor does not like auto and would not write script for auto. Although there are instances where the DME will issue an auto, the ones in my area would not issue without a specific script for the auto machine. I have a fully data capable machine, ResMed S9 Elite, and am doing very well with it at my prescribed pressure of 14, so I decided not to fight city hall right now.

[Emilia]

Many doctors don't like apaps because they don't trust their data, but they also prefer to keep patients at a steady pressure and then redo a sleep study for more accurate data (and make more $$). Remember, an apap machine can run in BOTH cpap or apap modes. A cpap machine can ONLY run in straight cpap mode. This is why we suggest you try to get a fully data capable apap machine, regardless, because there will, most likely, be times when you will want to run it in apap mode to check the efficacy of your therapy. It is a way to self-titrate your pressure. Many of us prefer to use apap mode with a pressure range to allow the machine to 'catch' events and adjust accordingly to the pressure needed to do that. We usually tighten the pressure range in to a allow that to happen easily and effortlessly.

You will need to do a lot of reading and research here to learn all of this... it is a learning curve for sure. We advocate cpap users to become empowered and knowledgable so they can manage their own therapy. Doctors, DME's, and RT's are fine, up to a point.... When problems arise, you want to get results quickly, and waiting for appointments and not getting answers make it very frustrating. Learn all you can about the machine you get. We can help guide you to the appropriate manuals, software, and other resources to make your therapy your OWN to understand, adjust, and succeed.

Please take a minute to go up to the User Control Panel (under search, top left) and then to your Profile and then Edit Equipment. Choose your gear from the pull down menus and the choose to show those in TEXT, not pictures. This will put your equipment at the bottom of every post your write automatically, like mine below. Those with the same equipment can help you better than having to constantly ask you what you use!

[Paula J]

Hi Emilia, my info. is at the bottom of my post. Is it not showing up? It shows up on my post.

[cowlypso]

Reasons to use auto mode:
-you have a range of pressure needs (depending on your position or sleep stage)
-you are trying to determine the best pressure to use
-it works well for you and you like it

Reasons to use straight CPAP mode:
-you do fine at a single pressure all night
-the variations in pressure in auto mode disturb your sleep
-it works well for you and you like it

I have an auto machine but run it in straight CPAP mode. I did run it in auto mode for a few days, which showed me that I could lower my pressure a bit. But during those few days, the auto mode disrupted my sleep and I tended to have more events because the lower end of my range wasn't enough to prevent events, but my events were infrequent enough that the pressure kept dropping down to the low. If I raised the minimum pressure on my auto range, it would probably help this, but I do just fine on straight CPAP mode so I don't even bother messing with the auto. But I'm glad that I have the auto machine, because if my pressure needs do change, I can use it to figure out what's up.

[archangle]

Your doctor has his head up his ...uhhh stethoscope.

Doctors are members of the medical mafia and want to maximize the number of office visits for them and other members of the "family". They don't want patients "meddling" in their own treatment. The capos feed the rank and file a lot of propaganda designed to keep the business within the family.

An auto machine can occasionally come up with the wrong pressure or will tend to run away to a high pressure. Sometimes you will find the best treatment at a single fixed pressure. If you set it up badly, which many doctors do, you can end up getting poor treatment at the start of each session because the pressure is too log. Neither of these things is necessary. You can set an auto machine to start at a good pressure and limit the upper pressure. There's no reason to not start with an auto machine and set it to manual or a lower range if auto doesn't work out.

Sometimes you don't get good "numbers" at any pressure. The machine may keep hunting for the right pressure and bother the patient due to the pressure changes.

There's also a fear of high pressure generating central apneas. I think some of these concerns are overblown because the machine can't see O2 concentration and may indicate a "central apnea," when it's really not a central apnea because your O2 sat didn't drop.

All of this can be handled by checking the recorded data and limiting the range of the auto machine.

Some dumb doctors or sleep specialists do use auto machines badly. They will set the machine to 4-20 pressure level and never bother to come back and narrow the pressure range. If you normally need 10 cmH2O, you start the night with too little pressure and have to breathe badly for a while before the machine autos up to 10. You should always look at the results and then adjust the minimum pressure to a level where the patient isn't getting many apneas at the start of the night.

You might claim that it would be better to only adjust pressure when you have an in-lab sleep test. Doing an extra sleep test to adjust pressure is expensive. Many patients don't sleep well in a sleep lab. Even if they don't have trouble falling asleep, they may not sleep in the same position, or the same stress level and the results in the lab may not match what happens in the home. The auto machine gives you the option of titrating at home. Even if you do go in for a sleep test, a competent doctor would probably run an auto titration at home and compare the results. He could even set the machine to do auto pressure over a narrow range around what the sleep test came up with. Why not take advantage of a second set of therapy data in the patient's real sleeping environment? If you can't get good treatment by adjusting at home with an auto machine, you still have the option of a in lab sleep test.

Many patients will not be willing to do another expensive and unpleasant lab test. They may even drop out of CPAP because of the sleep tests when they would have kept using an auto machine with a competent doctor managing their care.

Even though I have an auto machine, I'm essentially running it in manual mode. It would auto adjust me to about 10. I've found I have some problems if I leave the pressure at 10, so I've set the minimum pressure to be either 11 or 12. I leave the maximum pressure at 20, because my pressure never seems to "run away." The machine seems to want to blip it up by 1 cm or two several times a night, but it almost always seems to drop back in a minute or two. Even though it says "11-20," I spend 99% of the night at 11 cm.

If I ever did find my machine adjusting to a higher pressure or running away, I'd take this as an indication that something is wrong and I need to check my data more carefully and see what's going on.

[Emilia]

Yes, Paula.... I see your equipment now. I didn't see it earlier... wonder if we crossed at that point. You have a great, but complex machine..... I will leave it to those with the same one to help you, if needed.

[Paula J]

Thanks to all for the replies. Archangle, I did have 2 sleep studies, one without and one with the mask. Doctor set my machine so I can ramp it to 8 to start off, and within 30 min. it goes to 18 and stays there. It doesn't bother me and my AHI stays around 2, so guess I'll just stay with it.

[Shilohcane]

I like an APAP since it adjusts to events. If I have been drinking I need more air than normal. If I add or lose body weight it could change my pressure. My sleep study put me at 13 CM but my APAP has me at 0.6 AHI on only 11.4 CM. There is no reason I need 13 CM.

The two nights I spent at the sleep study were bad nights. I am sure the last night when they set my pressure at 13 it wasn't a normal night for me. It was the first time I had a mask on. I started with a full face mask and I switched to a nasal masks in the middle of the night since the 1st one didn't fit me. I didn't like the new nasal mask either but they wanted me to stay with it to set my pressure. Now I use a pillow mask. They will never get me back in to do one of those sleep studies and my APAP will Auto titrate my condition.

I just got a 2nd machine for travel and I was going to save some money and get a CPAP but the APAP was worth the extra money to me. I also got a new pillow mask this week that was a new style and it dropped my pressure from 11.4 to 10.8 on my first two nights since it makes the best seal I have ever had.

[dsm]

I like an APAP since it adjusts to events. If I have been drinking I need more air than normal. If I add or lose body weight it could change my pressure. My sleep study put me at 13 CM but my APAP has me at 0.6 AHI on only 11.4 CM. There is no reason I need 13 CM.

The two nights I spent at the sleep study were bad nights. I am sure the last night when they set my pressure at 13 it wasn't a normal night for me. It was the first time I had a mask on. I started with a full face mask and I switched to a nasal masks in the middle of the night since the 1st one didn't fit me. I didn't like the new nasal mask either but they wanted me to stay with it to set my pressure. Now I use a pillow mask. They will never get me back in to do one of those sleep studies and my APAP will Auto titrate my condition.

I just got a 2nd machine for travel and I was going to save some money and get a CPAP but the APAP was worth the extra money to me. I also got a new pillow mask this week that was a new style and it dropped my pressure from 11.4 to 10.8 on my first two nights since it makes the best seal I have ever had.

Shilocane,

Yours is a good example of the benefits of the Auto. If you know your circumstances will change from time to time it is a great help in keeping the delivered pressure just that bit lower while getting effective therapy.

DSM