CPAP vs Auto

I have been an amazed user for 2 weeks and I definitely feel great. I have read so much information that my brain cells are resisting any more data. My intelligence is 10% mine and 90% Google.
Maybe a dumb question but if an Auto machine detects your "needs" why would anyone be on a CPAP with a constant pressure? Don't your needs change during the different cycles of sleep?

some folks get their sleep disturbed while in Auto mode... so they use CPAP

some folks can't afford an auto or doc won't prescribe an auto and they can't persuade a DME to get them an auto on their script.

sheila1232 wrote:Maybe a dumb question but if an Auto machine detects your "needs" why would anyone be on a CPAP with a constant pressure? Don't your needs change during the different cycles of sleep?

Mostly pigheaded doctors who don't want the patient to know anything, want to charge for extra tests, office visits, etc. Plus DMEs (CPAP sellers) who want to give you the cheapest machine possible but still charge you the same price as a better machine.

However, sometimes the auto machine doesn't figure out the right pressure, especially if it's not set up and monitored by a competent medical professional. It may "hunt around" all night long and not find a pressure that works particularly well. Some people are bothered by the changing pressure. The changing pressure can cause your mask to leak once you fall asleep and the pressure increases.

Some people want to simply set an APAP to the maximum pressure range of 4-20. If you really need, for instance, 10 cmH20, you will spend the first part of your sleep cycle without enough pressure until your breathing problems convince the APAP to slowly adjust up to 10. Then every time you turn the machine off and back on, you start at 4 again. Most APAPs do NOT remember what pressure worked before after you turn them off.

Many people will do just fine on manual CPAP once they find the right pressure. You might have extra pressure during some parts of your sleep cycle, but that normally doesn't hurt.

Lots of people are afraid of central apnea, where increasing CPAP pressure makes your apnea worse for a small number of people. Sometimes an auto CPAP will "run away" and cause you to have central apneas.

All of these problems can be managed by monitoring and properly adjusting your APAP machine. Your APAP can be set to a narrow pressure range, or even set to manual CPAP.

Actually, I recall some "research" that shows that straight cpap was superior to apap in a test with apnea patients. Many physicians are aware of the study, but not of the study's flaws, so they (quite understandably) go with what is regarded as best medical opinion. This will eventually change, of course.

From memory, the test was flawed due to the fact that the apap range settings were wide open (5-20 cm, or some-such) which is an invitation for failure. IIRC, they didn't even compare the same brand of equipment, from one study group to another. (All from memory, corrections invited.)

For many folks, the apap works best when the lower pressure of the range is very near the titrated (or optimum pressure, if the titration is in error) pressure, and the upper range is only 3 or 4 cm higher. Thus, you have a cpap at optimum pressure for typical night breathing, that can increase its pressure slightly when you sleep on your back, have a cold, or a couple glasses of wine before retiring, or anything that might cause an event.

For many (if not most) folks, an apap would be superior to a cpap, if, and only if, the lower pressure of the range is set at the optimum pressure (at which a cpap would be set).

.

I have found that I feel better using straight cpap mode. I still try apap on occasion to see how my body reacts and to check the 95 percentile (which will confirm my straight cpap setting). It's a personal preference, but it is nice to have a auto pap machine that will offer the best of both worlds. The resmed S9 auto pap has it's flaws... but that is only my opinion.

Sheriff

I just started on APAP last night, and have it set with the low at my Rx pressure (which is lower than I typically need, of course LOL) and 20 as the high. AHI was 1.9, which is in-line with my CPAP numbers. One wake up in the middle of the night, otherwise no problems.

I'll be tracking over the next couple of weeks, as one night is no true indicator, but at least there didn't seem to be any new issues on the first night.

In my case, the DME was generous (I got a full-data machine) but not exceptionally so, as they didn't even explain that such a thing as an APAP existed.
I actually suspect that my doctor told them he wanted data capable, because it came with the cell radio that sends the data to ResMed for the doc to view online. Interestingly enough, I took that radio off for security reasons (if ResMed had regular software updates, I'd be happy to put it back on) and the doc hasn't seemed to notice yet...

I got the APAP because I noticed that at a fixed pressure I'd still get nights where there were high AHI numbers (4-6). Most nights I was fine, but some nights I had issues. Rather than raise the pressure overall, I went APAP to just bump the pressure slightly on those bad nights automatically, but keep the level lower on all other nights.

sheila1232 wrote: Maybe a dumb question but if an Auto machine detects your "needs" why would anyone be on a CPAP with a constant pressure?

I am one such case.

Back in 2008 I experimented for many weeks with the Auto but
could not achieve good results with the machine in Auto mode.

Moved over to cpap and slowly adjust the pressure such that good
results were achieved over a period of time.

I'm finding my results now slightly better with switching from the
Quattro FFM to Swift FX and may experiment again with the Auto
and the new (to me) mask type.

It is always good to have options so I have no regrets having an
auto machine. Given the price difference, at least on cpap.com,
it makes sense to pay a little extra and have that option.

Everyone one is different. For some folks a CPAPs constant pressure adequately controls their OSA. I prefer CPAP to APAP as the pressure changes interrupt my sleep. Also, an AUTO did not work for me at controlling my apnea. I have tried CPAP, Bilevel and AUTO and have the best results with CPAP.

TalonNYC wrote:I got the APAP because I noticed that at a fixed pressure I'd still get nights where there were high AHI numbers (4-6). Most nights I was fine, but some nights I had issues. Rather than raise the pressure overall, I went APAP to just bump the pressure slightly on those bad nights automatically, but keep the level lower on all other nights.

Talon: keep in mind that the resmed s9 won't respond to your apnea incident for 7 seconds... and it may take up to 12-14 seconds to ramp up enough air pressure to properly treat the event. This may have no effect on you and/or how you feel. It made me feel like crap, but it may not have that effect on you or other folks. Just keep a heads up about it.

ps: the Jets seem to be in real turmoil... I guess Buddy had to mail back the Super Bowl rings that were mailed to him. I hope he mailed them to the Texans!

Sheriff

@ Sheriff LOL

As for the ramp, I'm noticing that some nights overall are worse than other nights, so the low end of the APAP pressure is my RX pressure so that on most nights I'll just get regular therapy. But on those nights that are bad, it'll ramp up and keep the numbers down overall.

It's not a magic bullet, just one more weapon in the arsenal.

I was diagnosed recently and was using APAP for the last two weeks. I just got my report back from the data in the machine and I had ONLY one AHI event in the entire two weeks!! My sleep study showed I was having 43 AHI events per hour. APAP may not be for everyone, but it has worked for me. I will be getting my permanent APAP machine (PR System One REMstar Auto CPAP Machine) tomorrow. It would be good to get the humidifier also, I get really dried out if I don't use it. BTW, the APAP machine I'm getting has the capability to switch between APAP mode and CPAP mode, if for some reason you have to switch. I haven't had any problems getting used to the machine ramping up. I'm usually asleep before it ramps up very high, and it doesn't wake me up. I would advise you to do A LOT of research and be sure of the type of machine you need BEFORE you go to a DME. I would highly recommend you read the post below. It's got a lot of helpful information regarding choosing a DME.
What you need to know before you meet your DME http://tinyurl.com/2arffqx

porete

Fortunately, most (or all) APAPs will also run in CPAP mode--set what you need--reset any time.
What the suppliers hate is that many users can re-titrate at any time without an expensive sleep lab visit.
Good-bye, cash cow.

chunkyfrog wrote:Fortunately, most (or all) APAPs will also run in CPAP mode--set what you need--reset any time.
What the suppliers hate is that many users can re-titrate at any time without an expensive sleep lab visit.
Good-bye, cash cow.

The point chunkyfrog made can't be stressed enough.

You can always do as good or better with an Auto CPAP machine than a manual CPAP machine. Every auto machine available can be set to manual CPAP mode. It is almost NEVER in the patient's best interest to have a manual CPAP instead of an Auto CPAP.

For almost any problem that APAP may cause, you can adjust the pressure range to eliminate the problem and APAP IS an advantage to many patients.

Sheriff Buford wrote:Talon: keep in mind that the resmed s9 won't respond to your apnea incident for 7 seconds... and it may take up to 12-14 seconds to ramp up enough air pressure to properly treat the event. This may have no effect on you and/or how you feel. It made me feel like crap, but it may not have that effect on you or other folks. Just keep a heads up about it.

Sheriff

Sheriff, thanks for that information, I didn't know that but it may explain why my husband's AHI is always higher on Apap and he seems more restless. On Apap I set his pressure at 11-14 and he hits the max quite a bit with an AHI in the 3-4 range and doesn't sleep as soundly and has more leaks,but on Cpap I set it at 12 and his AHI is in the 2 range. His titration was 13cms but he never seems comfortable at that pressure. I don't get much input from him so I'm always guessing. BTW, I see your Apap setting but what setting do you use for Cpap?

DoriC wrote:Sheriff, thanks for that information, I didn't know that but it may explain why my husband's AHI is always higher on Apap and he seems more restless. On Apap I set his pressure at 11-14 and he hits the max quite a bit with an AHI in the 3-4 range and doesn't sleep as soundly and has more leaks,but on Cpap I set it at 12 and his AHI is in the 2 range. His titration was 13cms but he never seems comfortable at that pressure. I don't get much input from him so I'm always guessing. BTW, I see your Apap setting but what setting do you use for Cpap?

APAP can definitely give you more leaks. If he's uncomfortable at 13, you could try something like 10-12 or even 9-12 and see if he's more comfortable that way. While, of course, monitoring his AHI, and only dropping the minimum pressure slowly.

If you find manual CPAP works better, do it.