Effectiveness test of CPAP auto adjusting algorithms for 6 popular machines

[pcstud]

I invite you to read my last test. It cost me a lot of work. A dozen or so nights I slept with a polysomnography to test different machines. I hope you like it!
https://www.cpapblog.pl/2019/08/test-ra ... -cpap.html

[rcobourn]

I invite you to read my last test. It cost me a lot of work. A dozen or so nights I slept with a polysomnography to test different machines. I hope you like it!
https://www.cpapblog.pl/2019/08/test-ra ... -cpap.html

Very interesting work. It would be especially interesting to see this test repeated on a range of patients, but I suppose getting volunteers might be a challenge!

[chunkyfrog]

At least we can see how it goes for pcstud.
Congratulations.

[Goofproof]

Useless for the rest of us, too many variables, to make a good result. Jim

[Miss Emerita]

Thanks very much for doing this study and posting the results. I appreciate your clarity about the limitations (one subject, and one night on each machine), and I’m impressed by some of the design elements (especially the blind scoring by a professional).

One huge surprise is the difference between the AHI observed at the high end and the low end. That’s disquieting, to say the least. And one piece of advice you draw from the study that seems really sensible is to have titration on the same machine that the patient will be using long term. (Kaiser Oakland, I’m looking at YOU.)

I hope some medical school researcher will see this so that multiple subjects over multiple days can be observed.

[palerider]

And one piece of advice you draw from the study that seems really sensible is to have titration on the same machine that the patient will be using long term. (Kaiser Oakland, I’m looking at YOU.)

If you've got an auto machine, you don't *Need* titration.

[pcstud]

Useless for the rest of us, too many variables, to make a good result. Jim

That's not my last word!

[tsduke]

And one piece of advice you draw from the study that seems really sensible is to have titration on the same machine that the patient will be using long term. (Kaiser Oakland, I’m looking at YOU.)

If you've got an auto machine, you don't *Need* titration.

You do when an auto cpap was the wrong machine and a bipap was really needed.

[NoOnesPerfect]

And one piece of advice you draw from the study that seems really sensible is to have titration on the same machine that the patient will be using long term. (Kaiser Oakland, I’m looking at YOU.)

If you've got an auto machine, you don't *Need* titration.

You do when an auto cpap was the wrong machine and a bipap was really needed.

Even if you DID get an in-lab titration, you could end up with the wrong machine for optimal therapy - for example, AHI could be close to zero, but you might still need bipap because of significant flow limitations. The techs and the doctor might also be satisfied with a less-than-optimal AHI result or a problem with compliance that could benefit from one of the other machines. To your point though, I agree you probably are more likely to get the correct machine after an in-lab titration if you have pre-existing central/mixed apnea issues or some other problem that is not corrected by regular xPAP.

From my own experiences, I don’t put much faith in the sleep doctors or techs. I really count on and trust the auto machine and this support group more.

[tsduke]

I agree. I have very little faith in sleep doctors, techs or dme. My doctor won’t adjust a thing until my 6 week follow up even though I said I typically feel lest rested since treatment started even though my AHI is down from testing levels. Although it averaging above 8 at 5 weeks in. I wish my doctor would have done an auto bipap instead of the ST. He just says my apnea is complex and needs he ST.

[Miss Emerita]

I have probably been misunderstanding the term "titration." I thought it meant changing pressures to maximize treatment effectiveness. I've seen the experts here often advising people to raise their minimum pressure to improve treatment, occasionally to lower the maximum, and sometimes to change pressure support. But I guess that isn't titration? Maybe the technical term is "tweaking"!

[Pugsy]

I have probably been misunderstanding the term "titration." I thought it meant changing pressures to maximize treatment effectiveness. I've seen the experts here often advising people to raise their minimum pressure to improve treatment, occasionally to lower the maximum, and sometimes to change pressure support. But I guess that isn't titration? Maybe the technical term is "tweaking"!

When I think of titration I think of 2 kinds....one the typical in lab where they systematically try different pressures and watch the results and the second one is where we let the auto adjusting mode try to find the optimal pressures and then sometimes we help it out a little with the "tweaks" after watching the software reports and also factoring in how we sleep and feel.

Nothing is ever totally perfect for 100% of the people 100% of the time. We simply have way too many variables that can factor in.

Titrations are just experiments that are hopefully more than random experiments. The results give us a starting point for optimizing therapy based on the results we see and feel.

In lab formal titrations....not all they are cracked up to be either. I had one myself and while they got a good pressure setting for non REM sleep they didn't for REM sleep where my OSA is worse. Combination of factors led to that failure but they were common problems associated with an in lab sleep titration study.

Nothing is ever perfect for any number of reasons.

[tsduke]

Pugsy - No kidding on the REM. WTH can ranyone each REM sleep in a sleep center?!?!? I wasn't real happy with mine and made it be known to them and doctor office. The had a door that exited to the hall that every time it opened a bell went off. Doctor said, "realy, techs are not supposed to be going in and out". Well...then did and it kept waking me up. Plus I could hear them talking to each other.

I do think there is merit in the in lab titration study, but from my experience the setting and environment were not condusive to good results.

[Pugsy]

Pugsy - No kidding on the REM. WTH can ranyone each REM sleep in a sleep center?!?!? I wasn't real happy with mine and made it be known to them and doctor office. The had a door that exited to the hall that every time it opened a bell went off. Doctor said, "realy, techs are not supposed to be going in and out". Well...then did and it kept waking me up. Plus I could hear them talking to each other.

I do think there is merit in the in lab titration study, but from my experience the setting and environment were not condusive to good results.

I refer to my 8 hour in lab sleep titration study and the sleep study from hell.
When I left in the morning my BP was 180/110 and I had a massive headache from the lack of sleep and all the stress and the idiot tech.
I got 6 minutes of REM and 156 minutes of sleep in total for the entire 8 hour period. Waste of my time and money to have it done.
When I got my apap machine it took me 2 nights to get the tweaks done to optimize my therapy. Much better use of my time.

Yes...sometimes we do have to have in lab anything done but I am of the opinion that in lab is to be used when home trial fails or there are special circumstances going on that need much closer monitoring. Why not try easy and cheap first? Most of the time it will work out just fine. Save the in lab stuff for special needs.

[palerider]

And one piece of advice you draw from the study that seems really sensible is to have titration on the same machine that the patient will be using long term. (Kaiser Oakland, I’m looking at YOU.)

If you've got an auto machine, you don't *Need* titration.

You do when an auto cpap was the wrong machine and a bipap was really needed.

So you can end up with the wrong machine? yeah, good plan.