auto verses straight cpap

sleepie · Post by **sleepie** » Tue Oct 23, 2007 11:33 am

how, why? is auto BETTER than straight cpap? i have been looking on the net and all studies say" in the end its the same" as far as the therapy goes---thanks for looking -pat

DreamStalker · Post by **DreamStalker** » Tue Oct 23, 2007 11:44 am

Auto can be set to work in CPAP mode. CPAP only machines cannot be set to auto. SOoo ... with an auto you get two machines for just a little bit more money and you won't know if an auto works better for you until you try it. (BTW - if you have insurance the coding is the same so patient cost is the same for either ... cost difference is only for those paying out-of-pocket)

Besides that there are many other potential benefits. All autos collect useful data where as some CPAPs do not (the ones that most DMEs try to push on poor tired unsuspecting OSA victims in order to maximize their profits). You can run an auto at a lower pressure which may aid in reducing mask leaks and also reducing stomach gas.

sleepie · Post by **sleepie** » Tue Oct 23, 2007 11:52 am

if auto doe'st give me better therapy then why spend extra money---to have 2 machines that deliver the same results?---also the down side to lower pressure is ---once i'm strapped in to lower pressure {reguarding mask leaks}---then in auto the pressure rises and now i have mask leaks---i can't understand the extra cost----even though i have the auto and did spend the extra..----pat

DreamStalker · Post by **DreamStalker** » Tue Oct 23, 2007 11:58 am

Have you already compared both CPAP and APAP modes? What part of the therapy is not better?

In APAP the highest pressure is generally set to the what it would be on CPAP ... so you can either have that high pressure all night on CPAP or have it lower for part of the night on APAP. In other words APAP does not raise pressure anymore than when using CPAP and actually will use less pressure than if using CPAP.

If you already have an APAP what problems are you having with it?

sleepie · Post by **sleepie** » Tue Oct 23, 2007 12:12 pm

i'm having no problems---just trying to understand all of this--i was titrated at 11----i run in cpap---11---13.5----this is what the dr said to do--i read alot of studies on the net and they conclde that there is no theraputic difference in the auto vs. the straight---maybe its all for the less pressure thing--but then again i'm sleeping would i notice the difference??---thanks for responding --pat

fredpb · Post by **fredpb** » Tue Oct 23, 2007 12:17 pm

I switched from a Respironics Cflex to a Respironics Auto with Aflex.

There is no comparison, the Auto rocks. I have downloaded the data from it and its very interesting. My Rx is about 18 pressure. The auto data shows the machine is constantly adjusting and usually hangs around 11.
The aflex is wonderful.

Using the auto is like using no machine at all, just a mask and a tube. I LOVE the auto. I paid for it OOP and am glad I got it.

DreamStalker · Post by **DreamStalker** » Tue Oct 23, 2007 12:25 pm

I don't know how else to explain it again ... but I will try.

If you are currently set with APAP from 11 to 13.5 ... then your average nightly pressure is somewhere between those two values.

If you were to go to CPAP, you will likely have to endure a pressure greater than the nightly average on APAP.

Some people have problems with aerophagia (air in stomach) and a lowered nightly average pressure helps to reduce it ... obviously you did not have this issue.

Some people require more pressure while sleeping on their back than on their sides. One of these types of people would have to endure the higher pressure needed for sleeping on their back even when they may be sleeping on their side ... perhaps you do not sleep in both side and back positions.

Some poeple lose or gain weight over time which can affect the amount of pressure needed for preoper treatment. An APAP can more easily be used to find the correct needed pressure for someone undergoing weight change without having to go have another costly sleep study ... perhaps you have not and will not have weight change issues.

I hope this makes better sense.

In any case, having an APAP even if you have none of the issues stated above is sort of like insurance had you indeed had one of those issue ... you are lucky.

Best wishes.

sleepie · Post by **sleepie** » Tue Oct 23, 2007 12:32 pm

you are right i don't have these things---although i never know if i will over eat as i get older ---thanks for the explanation and i guess i'm glad i purchased the most versatile machine---pat

Panhandler · Post by **Panhandler** » Tue Oct 23, 2007 12:33 pm

Without reviewing the studies you've looked at, I'm just guessing, but maybe the clinical definition of "therapy" only covers the reduction in AHI below 5. I think that by and large, the medical profession tends not to grasp some of the subtility in xPAP treatment. AHI<5=success to them. Us users tend to see more shades of gray.

For example, I've been running in auto for several months, partly to deal with aerophagia. When I converted from a FFM to a nasal interface, I got better flow through my nose, but started having trouble with air in my stomach. By "playing" around with the pressures I was able to minimize that.

When I say "playing", I mean that my titrated pressure at the sleep study was 9, and with the FFM, that didn't seem to quite be doing the job, and even the humidified air blowing into my mouth was annoying. I really wanted to keep mouth closed, but couldn't get enough air through my nose. When I complained, my sleep doc OK'd a pressure increase to 12, so I felt comfortable doing a little experimenting.

In auto, I started with a range of (if memory serves) 8-13. After a week or two, and access to the data, I dropped the top to 12 and brought the bottom up to 8.5. Now I'm at 8.5 to 11, and the data shows that the machine gets to 11 every night, but spends most of its time at 8.5. My 90% pressure is 9.5 or 10 every night. (That means that I spend 90% of the night under those pressures. My AHI over the last month has averaged 1.2 or so, and has on occasion been under 1, so I'm getting good results at less pressure overall, reducing the aerophagia problem.

I do plan to try CPAP again at 9.5 sometime when I've got a couple of days off in a row, to see how it compares. Some people think the changing pressures wake them up. I do wake up, but usually to wrangle the hose as I change position.

mindy · Post by **mindy** » Tue Oct 23, 2007 12:42 pm

I agree that the auto is the way to go. Circumstances can change and it provides the greatest flexibility. I don't know if I would have lasted on this therapy with a straight cpap machine. The titrated pressure wasn't high enough.

Another issue that is not yet resolved but is the source of apparently much interest is whether or not CPAP is better than APAP for those with cardiac problems. Although I fall into that category and will probably set my APAP to do CPAP within the next month or two, by getting the APAP I can check my pressures periodically to be sure I'm still on track. That's invaluable to me!!

Mindy

smick · Post by **smick** » Tue Oct 23, 2007 12:59 pm

Another morsel for thought... my doctor mentioned that autocpaps can sometimes cause/worsen mouth breathing when using a nasal mask/pillows.

Essentially an airway collapse at a lower pressure can make breaking the tongue/uvula seal an easier exit route for the forced air. At that point, the apap increasing the pressure automatically is less effective at reopening the airway due to air rushing out your mouth. A cpap at a higher pressure would keep the airway open continuously and prevent airway collapses from putting more pressure on the tongue/uvula seal.

I was recommended to try cpap at my titrated pressure (11) versus the 8-12 auto cpap range I am using. Haven't done it yet, but will try it definitely as the 11 pressure doesn't seem that bad anymore...

DreamStalker · Post by **DreamStalker** » Tue Oct 23, 2007 1:11 pm

smick wrote:Another morsel for thought... my doctor mentioned that autocpaps can sometimes cause/worsen mouth breathing when using a nasal mask/pillows.

Essentially an airway collapse at a lower pressure can make breaking the tongue/uvula seal an easier exit route for the forced air. At that point, the apap increasing the pressure automatically is less effective at reopening the airway due to air rushing out your mouth. A cpap at a higher pressure would keep the airway open continuously and prevent airway collapses from putting more pressure on the tongue/uvula seal.

I was recommended to try cpap at my titrated pressure (11) versus the 8-12 auto cpap range I am using. Haven't done it yet, but will try it definitely as the 11 pressure doesn't seem that bad anymore...

Yes, some people do better on CPAP than APAP. If lower APAP pressure was indeed causing leaks as you describe, you could identify them within the data. The cool thing is that converting an APAP to CPAP is so easy ... converting CPAP to APAP would be very difficult even for an engineer.

BTW -

I notice that on occasion I do see a few blips in my nightly leak data (although my average is always within normal range) ... I may try CPAP mode for a while myself to see if I can tell any difference (now that I know what my optimal CPAP pressure should be ... about 1.5 cm more than what I was titrated at).

Wulfman · Post by **Wulfman** » Tue Oct 23, 2007 1:32 pm

smick wrote:Another morsel for thought... my doctor mentioned that autocpaps can sometimes cause/worsen mouth breathing when using a nasal mask/pillows.

Essentially an airway collapse at a lower pressure can make breaking the tongue/uvula seal an easier exit route for the forced air. At that point, the apap increasing the pressure automatically is less effective at reopening the airway due to air rushing out your mouth. A cpap at a higher pressure would keep the airway open continuously and prevent airway collapses from putting more pressure on the tongue/uvula seal.

I was recommended to try cpap at my titrated pressure (11) versus the 8-12 auto cpap range I am using. Haven't done it yet, but will try it definitely as the 11 pressure doesn't seem that bad anymore...

Too many doctors don't understand or know how to configure an APAP, so that might account for your doctor's opinion.

I suspect that mouth-leakers and mouth-breathers are going to do it whether they're using APAP or CPAP......it's just one of those things that a person has to know about themselves.....whether their mouth is going to fall open when they're asleep.

I'm one of those that does better on straight pressure (CPAP), but wouldn't try to talk anybody out of purchasing an Auto. I started out on straight pressure with a REMstar Pro 2 (which collects data) and eventually purchased a couple of Autos. I've only used one of them in Auto mode for a week and found out that I had my pressure right to begin with......now they're all in straight pressure mode because my "numbers" were worse in Auto mode.
Don't get too enamored with the mystique of the "Auto" and forget that it DOES give good therapy in single pressure mode.....for most of us.

Den

annie123 · Post by **annie123** » Tue Oct 23, 2007 9:14 pm

I have lost 89 lbs since the start of treatment. When I started mouthbreathing after 11 months of succesful treatment I called the RT. She said mouth breathing could absolutely be caused by a pressure that was too high for my current condition.
The pulminologist's nurse suggested I'd have to go in for another sleep study. I told her in no uncertain terms that I was NOT doing another sleep study that they were going to switch me to an Auto-PAP. (I have more weight to lose. Plus we all know what a pleasure sleep studies are.) They did give me an Auto-PAP and it's running at 6.1. That's almost 2 below what my initial pressure was set at.
My RT suggested in a roundabout way that they should prescribe Auto PAPs in the first palce!
Annie

DreamStalker · Post by **DreamStalker** » Tue Oct 23, 2007 9:18 pm

annie123 wrote:I have lost 89 lbs since the start of treatment. When I started mouthbreathing after 11 months of succesful treatment I called the RT. She said mouth breathing could absolutely be caused by a pressure that was too high for my current condition.
The pulminologist's nurse suggested I'd have to go in for another sleep study. I told her in no uncertain terms that I was NOT doing another sleep study that they were going to switch me to an Auto-PAP. (I have more weight to lose. Plus we all know what a pleasure sleep studies are.) They did give me an Auto-PAP and it's running at 6.1. That's almost 2 below what my initial pressure was set at.
My RT suggested in a roundabout way that they should prescribe Auto PAPs in the first palce!
Annie

Congrats on the weight loss and thanks for the input!