by CPAPtalk member sleepinginseattle
This rebuttal is offered as a counter-point to the article "Reasons to Use Auto CPAP or APAP". It is my belief that the author's advocacy of auto-adjusting CPAP (APAP) is primarily anecdotal. As such, the author's "Reasons" are a collection to observations drawn from personal experiences and the experiences of others. While this is helpful, it does not provide a thorough investigation of APAP equipment or an accurate picture of its role in the treatment of OSA.
Here is a collection of facts regarding APAP equipment:
1) Some users have reported that an APAP machine may be more comfortable than a conventional CPAP in the treatment of OSA but there is no research that supports this finding conclusively. Compliance is the most important part of the successful treatment of OSA. Research has not shown that you are more (or less) likely to stay compliant with APAP therapy.
2) APAP may offer a two-fer (they can be set to a fixed pressure mode as well as auto-adjusting mode) but the use of auto-adjusting pressure in the treatment of OSA has not been shown to be advantageous.
3) There is no evidence to support a conclusion that wrong pressure settings are or should be a concern for users of conventional CPAP equipment.
4) Many conventional (fixed-pressure) CPAPs offer the same data reporting capability that some APAP machines offer. Data reporting CPAP machines give the same advantages without the added cost or complexity of similar APAP machines.
5) There is no evidence that supports the conclusion that OSA treatment is more effective if the pressure is adjusted based on body position, sleep stage, nasal congestion, fatigue, etc.
6) Disruptors, such as alcohol and sedatives, will mitigate the successful treatment of OSA regardless of your equipment choice.
7) APAP equipment is not intended to be a tool in the fit and sizing of masks. Furthermore, APAP equipment has not been shown to offer any advantages in this area.
8) There is no evidence to suggest that patients, in general, may need a lower pressure than was determined in the PSG titration or that there might be a long-term therapeutic benefit to lower pressure.
9) Self-titration has only been shown to be as effective as conventional sleep lab titration when combined with educational instruction in a laboratory setting.
10) There is no reason to believe that APAP-based therapy will reduce (or should) reduce the number of office visits a patient has. Self-diagnosis, as an approach for managing treatment, has not been proven to be more effective than traditional physician-based treatment. Furthermore, the software available for event reporting is not designed (or intended) to be tool for self-diagnosis.
11) Aerophagia has not been found to be less (or more) likely with APAP equipment.
The author's comments: Reasons why your titrated pressure may be wrong.
The author's comments are a broad advocacy of self-titration versus PSG titration and should be clearly identified as such. There is no evidence to support the author's conclusion that self-titration is more effective than PSG titration.
I suggest that readers do their own research on the subject of self-titration and talk with their doctor.