APAP vs CPAP

[spitintheocean]

I believe that the only difference between a Resmed Elite II and a Resmed Autostart II is the ability to change air pressure on the fly as needed during the night. Both have all the bells and whistles like data recording, EPR, etc. If one were trying to convince their sleep doctor on the real merits of prescribing any APAP machine versus a comparable CPAP with all the same options, what arguments would you use to justify the benefits for your personal situation? ie:

1. reduced air pressure for a good part of the night reduces gas and bloating (aerophagia)
2. personal need/intention to lose large amount of weight when energy levels are restored through better sleep thus enabling lower pressure settings without the delays and cost of returning for additional sleep study.
3. regular shifting sleep positions through the night result in different pressure requirements from side to back positions.
4. prescribed pressure of 16 causes mask leaks and blowouts, with resulting noise; constant fussing about with strap adjustments greatly contributing to patient's quitting treatment ...... currently affecting 66% of new users. (is this percentage supportable?)
5. generally lower settings may reduce the likelihood of pressure induced central apneas for most of the night. (is this a stretch?)
6. If Medicare/private insurer will only provide financial assistance once every five years, require a machine flexible enough to meet changing requirements up to five years from now.

Does anyone have additional justifications for APAP therapy that I can add to the list?

Paul

[danw61]

Paul,
You said that rather well. I can't think of anything to add.
-Dan

[rested gal]

Very good reasons, Paul. I agree with you that #5 is a stretch and might better be left out. All the others make a good case for autopap.

A clincher, imho, that you might want to add is this:

If it turns out that one straight pressure gives better treatment, an autopap can always be set to operate in straight cpap mode.

[Captain_Midnight]

SIO asks...Does anyone have additional justifications for APAP therapy that I can add to the list?

You have a pretty good list. And, you kind of touched on this, but pressure needs vary from night-to-night. For example, if you happen to catch a cold, have a couple of glasses of wine, sleep in a different bed, or (as you said) just sleep in an odd position, your pressure needs will change.

My sleep doc was entirely supportive of my changing from CPAP fot APAP. (Although I had to pay for it myself, as the insurance only buys a new one every 5).

The time will come when only APAPs are prescribed, and patients will be instructed on how to fine-tune the pressure range; or to change to straight constant pressure, as the nightly data support.


.

[riverdreamer]

One thing I added in my justification, is the need for daily changing amounts of medications that affect my sleep. Anything that would affect the central nervous system, especially. Can cause a significant change in pressure needs from night to night.

Second thing I had that you didn't: The Autoset is the only one with Easybreathe, which is significantly more quiet. They claim 75% more quiet. If you tend to have a large number of arousals, the noise difference could impact your sleep. If you have a higher pressure, it is also supposed to the most like the natural breath, which would make compliance easier. They both have EPR, but it is not exactly the same on the two machines. See the Resmed site for details.

Third, the possibility that titration was incorrect, which was absolutely the case for me. This COULD backfire, though, if the doctor takes it as a criticism. Depends on how sure they were that they got the right number. With mine, they ran out of time to go any higher, so were not completely sure. I only had 3 minutes of REM during the titrated pressure.

These may not be issues for you, but they helped me get an Autoset II with Medicare.

[ozij]

Good list. And great point by everyone.

I agree 5 is a stretch - too much pressure causing central apnes is a danger of autos - should never happen if you're properly titrated in your PSG.
I 'm not sure 6 is such a good argument either:
Fexibility is an asset if you need it during the night. If your need for fixed pressure changes as the years go by, you can raise your pressure on the fixed pressure machine based on its data. Self titration can be done fine on fixed pressure machines.

It's the auto's ability to supply higher pressure when needed during a period in the night, or to vary the pressure from one night to the other that is critical.

O.

[Wulfman]

The problems I see with your arguments is that IF your NEEDED pressure is in the vicinity of 16 cm., the ResMed Auto is not for you.....because of their A10 algorithm. The ResMeds won't pursue an apnea above the pressure of 10 cm., UNLESS it's preceded by snores or flow limitations. Consequently, straight CPAP would be more beneficial in your case. Or, another brand of Auto may serve you better.

However, all things being equal.....for ME, I'd only need ONE argument......"It's MY therapy and I want to choose the machine I'm going to be sleeping with every night."


Den