Sleep Medical Report: AutoCPAP who can/cannot use them

Auto CPAP and who can and cannot use them.

Practice Parameters for the Use of Auto-Titrating Continuous Positive Airway
Pressure Devices for Titrating Pressures and Treating Adult Patients with
Obstructive Sleep Apnea Syndrome
PRACTICE PARAMETERS
An American Academy of Sleep Medicine Report

Are we allowed to post links:

http://www.aasmnet.org/PDF/autotitratingpp.pdf

if not, just replace the "dot" word by a real dot.

http://www.aasmnet.org/PDF/autotitratingpp"dot"pdf

Maybe this article is over cautious, but I found it an intresting read.

The one thing that stuck with me is if someone does not snore they should not be using a AutoPAP.

Of course there are other reasons not to use an Auto CPAP.

I think everyone who has bought an AutoCPAP, without Drs advice should read the article. Either way, still a good read for all.

keep in mind that document is over 4 years old now. Much of the references contained in it are even older, some over 10 years old.

There have been a lot of changes to autopap algorithms since that publishing (excluding Resmed autopaps).

I think the lab PSG is a good idea at least for initial diagnosis. You learn much more from the PSG such as if you are at risk of central or CSDB events, data absent from all of today's autopaps.

But if the patient does not have medical insurance and/or cannot afford a full PSG then they should still be offered some kind of treatment such as with a recording autopap.

You have weigh out which is worse for the patient, going on with untreated OSA or using a autopap which may not be set up ideal settings. With today's autopaps and recording ability it is much easier to obtain ideal therapy settings from the autopap than it was 4 years ago.

I would have to agree with SnoreDog on this. 4 years has seen a lot of changes.

Based on my own experiences, I am interested in any investigation that shows that setting an Auto to min 4 and max 20 is a problem (I certainly believe it to be).

There have been a number of discussions here where the topic of cpap vs auto results have shown that some people benefit from straight cpap (show lower AHI) while others show better results with an Auto.

My guess at the cause of Auto problems for some people is that changing pressures if the change is too great and too soon, can induce Apneas & hypopneas.

I can show tests I tried on my self relating to BiLevels where any pressure gap greater than 3 cms when applied at say 10/13 starts to increase the apnea hypopnea count, the bigger the gap the greater the ahi. I know that BiLevels aren't Autos but I suspect some of the dynamics of changing pressures may be similar.

This is based on my own tests so is presented as a personal set of observations.

DSM

Well I am glad there have been improvements to the APAPs.

I wonder if Auto Paps, stop at an upper level set by the user other then the max of the machine.

[quote="SelfSeeker"]Well I am glad there have been improvements to the APAPs.

I wonder if Auto Paps, stop at an upper level set by the user other then the max of the machine.

I must say ... I am learning a lot on this and Ellen's "pressure rising" threads.

Thanks for the technical details.

- roberto

yes they do if YOU set them up correctly while in Setup mode.

I agree w/DSM, they should not be used with default 4-20cm settings. Max. should be set to any titrated pressure found in a lab PSG.

in a Lab setting you have EEG information which is absent from the autopap's decision making tree, the lab tech can observe that EEG information and determine if events being seen are central vs. obstructive and "manually" avoid pressures that trigger such events.

In a lab setting, a tech will see the central events occurring in real time (autopaps cannot see these don't care how good they are), they can then control pressure to avoid them even if a snore persists for example.

When completed, you are then given a recommended "cpap" pressure that presented the best sleep architecture while avoiding central based events. That may be 9.0cm for example.

I'd like some speculation. I was prescribed 6 cm, got a RemStar M Plus from the DME, and returned it after 3 months to buy the RemStar M Auto from cpap.com, because it wouldn't cost any more.

They set it up at 4-20 cm. I tried it for 2 nights and it was worse, with AHI of ~12 and trouble sleeping.

I went one night back at straight CPAP at 6, which was great. Last night, I went to 4-11 cm, which was better than my initial experience, but not as good as the straight CPAP at 6.

Would a better starting point be 6-8 or 6-10, then?

Two nights are too short to come to conclusions, however, some people do better on a narrower range, since the pressure change itself can cause hypopneas, or sleep disruptions.

So, I would say try 6-8 for about a week or two, and if you're happy, leave it like that. If not, fiddle around some more.

By the way, there also people who do better on a constant pressure.

O.

ozij wrote:Two nights are too short to come to conclusions,...

I agree. I'm only asking for an initial recommendation; everything after that will be determined empirically.

ozij wrote:So, I would say try 6-8 for about a week or two, and if you're happy, leave it like that. If not, fiddle around some more.

By the way, there also people who do better on a constant pressure..

Thanks for the suggestion. I'm suspecting that I may be one of those people.

I am bumping this post up again.

There are many new people here, buying there own autos, so maybe they can read the links.

I know the info is old.

I would love new info on what contradictions there are for using autos.

GREAT INFO in this thread.

I read an article, by a Pulmonologist, written in late 2004 stating we might be better off not doing the expensive sleep studies (wonder who HE works for??) and just letting the majority of people auto-titrate with a machine. It was an interesting read, and my wife's experience in the sleep lab supports it the idea that the auto-titration is more accurate.

BUT my experience in the sleep lab would indicate he is probably wrong. Rarely would you see two such opposite sleep lab reports as we have. Since I have other severe problems, I would have been in the group the above mentioned Dr. would send to the sleep lab. They titrated me at 4/20 and a top notch pulmonologist agreed. Those of you who read my sleep study probably agree too. My other problems are so severe I am just happy to breathe all night, therefore AHIs are not that important to me at this moment. To me, at this moment an AHI of 20 is a five cent item when I have hundred dollar things going on. If you can breathe, you are lucky.

But my wife is different. Her only medical problem in this realm is Sleep Apnea. She was titrated at 6.0. I have mentioned this on other threads, she was using my backup machine which Encore Pro showed her IPAP stayed around twice their titration number of 6.0. Being good professionals, they want her data to try to understand why they were so far off.

SO...my opinion is that the sleep study is very important. I think a good sleep study is like having a physical, even if you don't think you need one.
A sleep study might catch a potentially serious problem before it gets worse.
I vote for the sleep study for the majority of us.

I love the debate on this concept. Please continue, I learn a lot from your ideas.

I just wanted to clarify in case someone else who doesn't snore comes across this thread. I barely snore at all, but I've had a lot of success with the auto. That study is definitely outdated.

HOWEVER, I do want to put some info out there. This is from the Respironics User Guide for the Auto:

"Studies have shown that the following pre-existing conditions may
contraindicate the use of positive airway pressure therapy for some patients:
• Bullous Lung Disease
• Bypassed Upper Airway
• Pneumothorax
• Pathologically Low Blood Pressure
• Pneumocephalus has been reported in a patient using nasal
Continuous Positive Airway Pressure. Caution should be used when
prescribing CPAP for susceptible patients such as those with: cerebral
spinal fluid (CSF) leaks, abnormalities of the cribriform plate, prior
history of head trauma, and/or pneumocephalus.
(Chest 1989; 96:1425-1426)
The use of positive airway pressure therapy may be temporarily contraindicated
if you exhibit signs of a sinus or middle ear infection. Contact your
health care professional if you have any questions concerning your therapy."

These seem to be contraindications for using CPAP therapy in general, not just the Auto. However, I have also learned from this board that autos should not be used for people who have Central Sleep Apnea or Mixed Apnea, and that they should not be used for people who have a certain kind of heart condition/disease - though I can't remember what it is off the top of my head.

Can someone who knows what that condition is please post? I think it'd be great to have a list of things people can read before they consider buying an auto.

Don't get me wrong - I love autos. I just would hate for someone to get one based on this forum's recommendation and then not be able to use it.