Why CPAP over APAP?

[shaner]

So after years of using a straight CPAP machine that really wasn't helping me much at all, I switched to an APAP machine, and things are finally so much better. My pressure is down around 7.5 for 95% of the night, whereas my straight CPAP machine was set much higher. I sleep so much better these days, it truly is night and day.

So I'm wondering why anyone uses a straight CPAP machine these days. I guess I could understand if the reason was cost, but it seems like APAP machines are right around the same price. Without my APAP machine, my pressure would still be way too high and I wouldn't be sleeping well at all.

[Pugsy]

Because not everyone will see a need for higher pressures for some of the night and not other parts of the night.

Because some people find that the auto adjusting pressure changes throughout the night cause sleep disruptions or low level arousals which impacts sleep quality in general and thus they don't feel so great during the day.

Because some people don't know how to optimally adjust apap and think wide open should let the machine "find" the right pressure and deliver it immediately and it simply doesn't work that way....so they get sub optimal therapy and blame it on apap instead of sub optimal settings...so they think apap doesn't work and cpap does.

Because some people have based their conclusions on older machines with older algorithms that did things a little differently back in the day they were the latest and greatest and maybe not the best when compared to how things are done now and don't understand that these newer machines go about things a little differently.....like they don't go trying to fix a leaks with more pressure like the older machines would sometimes do.

Because some people have doctors that don't understand the apap machines either...so the doctor says "no" and we all know that doctors walk on water (at least some people think their docs do).

That's all I can think of at the moment. I am sure there are other reasons.

[palerider]

Because Because Because Because Because I am sure there are other reasons.

one of the things I just love about you, Pugsy, is your dedication to providing balanced, fair, 'both sides' advice and information.

anybody that's read your stuff for a while knows you're a DIE HARD APAP lover, due to your differing needs throughout the night because of REM... but you still know, and understand, and offer up the alternative view.

[Pugsy]

Thanks PR. I have always maintained that I really don't care which machine or mode of operation someone uses (assuming that the machine is correct for the condition) nor do I really care which mask someone uses as long as they are happy with it.
My job isn't to tell people which machine or mask or mode of operation to use ...my job is to help someone make the best of whatever they have been given or they simply want to use ...if at all possible.
My way doesn't work for everyone...I know that and that's why I always try to offer pros and cons and both sides to anything.
I am not anti full face mask like some people tend to think I am...what I am for is whatever mask a person wants to try to use and if and when that choice simply cannot be made to work out...then offer up alternatives along with pros and cons.
Same thing with apap mode vs cpap mode. If someone wants to try to make it work...then lets try to help make it work if we can..either way. Doesn't really matter to me...all that has ever mattered is that people use a mask (I really, really don't care which mask) and machine and use it as effectively as possible and if that means a few compromises need to be made then we make them but they are educated compromises made knowing all the pros and cons.

I do think that people read about apap and automatically assume it is "better" and for some people it is and for some it isn't but they get it in their head that it is "better" and the mind is a powerful drug...both good and bad.
So some people are hell bent on "the best" and if that's what makes them happy to try...then I will try to help.
Someone wanting something or to do something is good enough reason in my book to at least try to make it work if at all possible. Might not always be the smartest of "wants" but hey...not my place to judge. I figure they will see the light sooner or later and if they don't...I can't fix or save everyone.

I don't really like to "tell" someone what to do or which mask to use. I really prefer to educate and offer options and pros and cons and let someone make an educated decision on their own. There's a much greater chance of success when someone chooses to do something over being told to do it with no understanding.
That's why my posts sometimes are short novels....that's both good and bad I suppose but it's me and I am not likely to change anytime soon.

[Guest1]

We need Den to chime in here. He is our spiritual leader (PAPers who chose CPAP over APAP ).

[bwexler]

I wish I had the patience and knowledge to give the great advice backed up by references to support my suggestions as some of the folks here like Pugsy and Roby sue and a bunch of others. I just read here and learn and try to pass on a few pearls of wisdom by presenting my interpretation of what I have learned.

[Wulfman...]

We need Den to chime in here. He is our spiritual leader (PAPers who chose CPAP over APAP ).

Ya think? Thanks for your vote of confidence.
Actually, I think Pugsy covered it pretty well. Seems like she's finally coming around to my ways of thinking.......
I really don't care which mode people use if they're getting good quality sleep.
What jumps out at me and usually when I comment or make suggestions is when a person is complaining about being on therapy for months or years and not feeling any benefits (at times that seems to be frequently). Their "numbers" may be good, but maybe their sleep quality is not. Their pressure lines on their reports look like mountain ranges and they frequently have to stop their machines to let the pressure start over......and their leak lines can be dramatic, too. They may be getting bumped out of their deep or REM sleep stages and spending most of the night in lighter stages.

I just think it's important for users to be able to recognize what works best for them. Lots of machines (Bi-Level, ASV and whatever) use varying and higher pressures, which may or may not affect their sleep quality, but they may need that type of therapy and have to deal with what goes with it. I would imagine the sleep studies which would need to be taken before some of those machines are prescribed would be able to gauge the sleep quality during the study.

But, I always recommend users getting an APAP if at all possible because they have more options to choose from......and they also have a CPAP mode (in one form or another.......as do the bi-level machines). If an APAP is not an option, then get something that's fully data-capable.

Most of us on the forum relate from our own experiences about this therapy.......or what others have experienced and posted about.
For me, I sleep much better with straight pressure. That's it. I've tried ranges of pressures and kept waking up frequently, which I didn't like. Maybe I didn't give it enough time, but in the week of time I actually used the range, I couldn't wait for the week to be over (self-imposed time limit). My therapy isn't all that complicated. Maybe if it were, I might think differently, but I think lots of users have the "garden variety" of OSA and can do fine and sleep better with straight pressure. In reality, the use of APAPs for regular nightly treatment is fairly recent, and straight CPAP was the norm for a long time before that. Heck, even 10 years ago when I started, the heated humidifier was pretty much of an option and usually had to be specifically prescribed.
And, I really think that forums like this have been a driving force in the auto-adjusting and other advancing technologies. The manufacturers read this forum and may glean ideas from the conversations we have.

Hope I didn't disappoint you or your expectations.


Den

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[shaner]

For me, I sleep much better with straight pressure. That's it. I've tried ranges of pressures and kept waking up frequently, which I didn't like. Maybe I didn't give it enough time, but in the week of time I actually used the range, I couldn't wait for the week to be over (self-imposed time limit). My therapy isn't all that complicated. Maybe if it were, I might think differently, but I think lots of users have the "garden variety" of OSA and can do fine and sleep better with straight pressure. .

I guess that's the kind of answer I was looking for. As I can only relate to my experience, buying a machine that limits your therapy just didn't make a lot of sense to me (except for cost reasons), especially when an APAP can do a fixed pressure. I guess I didn't take into account that some people don't sleep well with a varying pressure.

[sc0ttt]

I guess I could understand if the reason was cost, but it seems like APAP machines are right around the same price.

I think cost is a reason... 40% more for APAP.

PR System One REMstar 60 Series Plus CPAP Machine with C-Flex
$449.00

PR System One REMStar 60 Series Auto CPAP Machine
$639.00

[Pugsy]

I think cost is a reason... 40% more for APAP.

Only if buying out of pocket. If it's an insurance thing with copays...insurance doesn't pay different amounts for cpap vs apap...only different when you move up to the bilevel devices.
Insurance uses HCPCS codes..not model or brand.

[chunkyfrog]

Since any APAP can be set to run on CPAP mode, it baffles me that they make single pressure machines at all!
Any small difference in cost would be absorbed many times by avoiding just ONE unnecessary re-titration.

[ChicagoGranny]

I think cost is a reason... 40% more for APAP.

Could be in many cases.

A bigger reason is that many doctors, even sleep doctors, don't understand the machines and what it is like to use a CPAP machine.

[yaconsult]

It's all trial and error, isn't it? What seems to work best for me is a high minimum pressure of 13.5 with apap. This is enough to stop most events from happening yet I still get an increase typically a few times a night when I need it. These settings would be horrible for many people, but for me, I sleep well and have an AHI between 0 and 0.5. What more could I ask for?

[palerider]

I guess I could understand if the reason was cost, but it seems like APAP machines are right around the same price.

I think cost is a reason... 40% more for APAP.

PR System One REMstar 60 Series Plus CPAP Machine with C-Flex
$449.00

PR System One REMStar 60 Series Auto CPAP Machine
$639.00

where are you getting your prices?

pro: 569$ https://www.cpap.com/productpage/pr-sys ... chine.html
auto: 639$ https://www.cpap.com/productpage/pr-sys ... chine.html

[Wulfman...]

I guess I could understand if the reason was cost, but it seems like APAP machines are right around the same price.

I think cost is a reason... 40% more for APAP.

PR System One REMstar 60 Series Plus CPAP Machine with C-Flex
$449.00

PR System One REMStar 60 Series Auto CPAP Machine
$639.00

where are you getting your prices?

pro: 569$ https://www.cpap.com/productpage/pr-sys ... chine.html
auto: 639$ https://www.cpap.com/productpage/pr-sys ... chine.html

PR,
He listed the "Plus" and not the "Pro". Yeah, there's a fair amount of difference between the bottom and the top of the line.


Den

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