Is a CPAP machine better than a APAP machine

[dexter_go]

Dear Friends,


I have a RESEMD S8 AUTOSET II. Is this an AUTOPAP machine?

I found a response here from OZIJ below:

The experience of most of us on this forum is that even on a self adjusting machine, the minimum pressure must not be set too low if you want good therapy. The reason is simple: the automatic machines are often not as good at preempting breathing obstructions as they need to be. With the minimum pressure set too low you will have obstructive events, the machine will raise the pressure after the fact, and then, when your pressure stabilizes, drop it again. So you get into a vicious cycle of having far too many breathing interruptions.


After reading this... I asked myself, aren't we better off with the CPAP setting which gives constant pressure?

My next question.... Isn't a AUTOPAP better since it can adjust to a higher pressure requirement if need be?

Am I correct to assume in order to have the best of both worlds... Set my AUTOPAP machine to my CPAP pressure so that at least it won't go down in pressure anymore and set a higher pressure range (in case needed). Is this assumption correct, that this is how to take advantage of a AUTOPAP machine?

[Babette]

An APAP machine is preferable to a CPAP only machine, since it allows you to move between Auto and straight CPAP.

Each person's therapy requires different settings. Some people respond better to straight CPAP, some to Auto. If your machine can do both, you have the best possible array of choices.

Cheers,
B.

[Slinky]

Yup, Dexter, the APAP is the best of two worlds: a choice of CPAP or APAP settings, if pressure range is properly set an at-home titration study when wanted .....

[Paul56]

Dear Friends,


I have a RESEMD S8 AUTOSET II. Is this an AUTOPAP machine?

I found a response here from OZIJ below:

The experience of most of us on this forum is that even on a self adjusting machine, the minimum pressure must not be set too low if you want good therapy. The reason is simple: the automatic machines are often not as good at preempting breathing obstructions as they need to be. With the minimum pressure set too low you will have obstructive events, the machine will raise the pressure after the fact, and then, when your pressure stabilizes, drop it again. So you get into a vicious cycle of having far too many breathing interruptions.


After reading this... I asked myself, aren't we better off with the CPAP setting which gives constant pressure?

My next question.... Isn't a AUTOPAP better since it can adjust to a higher pressure requirement if need be?

Am I correct to assume in order to have the best of both worlds... Set my AUTOPAP machine to my CPAP pressure so that at least it won't go down in pressure anymore and set a higher pressure range (in case needed). Is this assumption correct, that this is how to take advantage of a AUTOPAP machine?

It is very important to have the minimum pressure set correctly with an AUTO machine... that pressure should be the one that will cover the majority of your events.

I operate my AutoSet in CPAP mode at pressure 12. I get great therapy, have low numbers and never wake up to massive leakage and the mask wanting to achieve orbit. If I was to go back to AUTO mode I would set my range as 11 to 14.

[Wulfman]

Dear Friends,


I have a RESEMD S8 AUTOSET II. Is this an AUTOPAP machine?

I found a response here from OZIJ below:

The experience of most of us on this forum is that even on a self adjusting machine, the minimum pressure must not be set too low if you want good therapy. The reason is simple: the automatic machines are often not as good at preempting breathing obstructions as they need to be. With the minimum pressure set too low you will have obstructive events, the machine will raise the pressure after the fact, and then, when your pressure stabilizes, drop it again. So you get into a vicious cycle of having far too many breathing interruptions.


After reading this... I asked myself, aren't we better off with the CPAP setting which gives constant pressure?

Maybe. It depends on the person.

My next question.... Isn't a AUTOPAP better since it can adjust to a higher pressure requirement if need be?

Maybe, but in many/most cases, not reliably. With the exception of leaks and snores, Autos adjust pressures pretty slowly. If your minimum pressure is 9 and you need a pressure of 15 to clear an event, you're going to have that event and then probably some more events before the pressure gets there.....if it does at all.

Am I correct to assume in order to have the best of both worlds... Set my AUTOPAP machine to my CPAP pressure so that at least it won't go down in pressure anymore and set a higher pressure range (in case needed). Is this assumption correct, that this is how to take advantage of a AUTOPAP machine?

That's a good approach. Works for many people.

I'm another one who started out with single-pressure CPAP before getting an Auto.....but then discovered that the pressure changes disturbed my sleep and my numbers were higher with a range of pressure because more events were happening before it could respond.
I have all of my Autos configured like my original CPAP......12 cm. CPAP mode.

Den

[DreamStalker]

Dear Friends,


I have a RESEMD S8 AUTOSET II. Is this an AUTOPAP machine?

I found a response here from OZIJ below:

The experience of most of us on this forum is that even on a self adjusting machine, the minimum pressure must not be set too low if you want good therapy. The reason is simple: the automatic machines are often not as good at preempting breathing obstructions as they need to be. With the minimum pressure set too low you will have obstructive events, the machine will raise the pressure after the fact, and then, when your pressure stabilizes, drop it again. So you get into a vicious cycle of having far too many breathing interruptions.


After reading this... I asked myself, aren't we better off with the CPAP setting which gives constant pressure?

My next question.... Isn't a AUTOPAP better since it can adjust to a higher pressure requirement if need be?

Am I correct to assume in order to have the best of both worlds... Set my AUTOPAP machine to my CPAP pressure so that at least it won't go down in pressure anymore and set a higher pressure range (in case needed). Is this assumption correct, that this is how to take advantage of a AUTOPAP machine?

Depends cuz everybody is different. If your condition is highly variable such that your apneas are worse in one sleeping position over another and you toss around alot sleeping in many positions, then an APAP setting may be better for you. If on the other hand you sleep mostly in one position or you are easily awaken by changes in APAP pressure (which can be mitigated with a narrow min/max pressure setting), a CPAP setting may work better for you.

The thing to keep in mind is that an APAP can be used in CPAP mode but a CPAP cannot be used in APAP mode. Furthermore, a CPAP and an APAP have the same insurance code so that if you get your machine through your insurance, it the cost is the same ... unless a lying DME tries to add a surcharge for the APAP (but they lie to abuot that stuff to up their profits).

So bottom line is if you settle for CPAP it may work just fine for you ... but if you get an APAP, you get same benefits as CPAP plus more.

[rested gal]

Am I correct to assume in order to have the best of both worlds... Set my AUTOPAP machine to my CPAP pressure so that at least it won't go down in pressure anymore and set a higher pressure range (in case needed). Is this assumption correct, that this is how to take advantage of a AUTOPAP machine?

What you described is exactly how I've used autopap for several years now, Dexter. Using it that way treats me very well.

Other people may find that a completely different machine, or different settings for autopap work better for them.

[Mike@TibroMedical]

you need to keep in mind the benefits to having that low setting, if you have an 85 yr old women who has shallow breathing, there's no way she could exhale against a high constant pressure it has to drop enough for her to get that breath out, and the machine determine's how much to drop the pressure depending on the rate at which the pt is exhaling. same goes for inhaling the machine determines the pressure to increase to depnding on the rate at which the pt is inhaling and by doing so its helping the normally shallow breathing to improve cause the machine is increasing with the Pt. also the M series W/Aflex is at full pressure before your inhalation peaks thats how quick they are, RESMEDS aren't as high tech just yet, but they are BUILT LIKE TANKS! much more reliable and durable. In most my exp's.

[ozij]

you need to keep in mind the benefits to having that low setting, if you have an 85 yr old women who has shallow breathing, there's no way she could exhale against a high constant pressure it has to drop enough for her to get that breath out, and the machine determine's how much to drop the pressure depending on the rate at which the pt is exhaling

That description of helping a person by dropping the pressure on exhale has nothing to do with how the automatic algorithm functions on any machine.

An automatic machine, be it Respironics', ResMed's or Puritan Bennett's analyses a sequence of breaths in order to change pressure. Respironics' C-Flex, and ResMed's EPR both give exhalaltion relief for fixed and automatic machines.


O.

[JRI]

This is exactly what I am going through now. I just left the DME without picking up my machine. The doctor prescribed a ResMed S8 Eclipse II but I want him to change the prescription to an S8 Auto Set II. The DME is contacting him to see if he will approve the change so now I'll have to wait until monday.

I read a lot of the comments on this board and others and read the manufacturers tech sheets. It seems to me that the auto is the way to go and as previously stated, in an earlier post, is "the best of both worlds." Other then a cost issue I can't see the benefit of a straight CPAP over the ACPAP. If you need the straight pressure you can turn the auto off but you can't turn the auto on if you have a CPAP.

I just hope the doctor goes along with my wishes and doesn't get "territorial" on me.

[DreamStalker]

you need to keep in mind the benefits to having that low setting, if you have an 85 yr old women who has shallow breathing, there's no way she could exhale against a high constant pressure it has to drop enough for her to get that breath out, and the machine determine's how much to drop the pressure depending on the rate at which the pt is exhaling. same goes for inhaling the machine determines the pressure to increase to depnding on the rate at which the pt is inhaling and by doing so its helping the normally shallow breathing to improve cause the machine is increasing with the Pt. also the M series W/Aflex is at full pressure before your inhalation peaks thats how quick they are, RESMEDS aren't as high tech just yet, but they are BUILT LIKE TANKS! much more reliable and durable. In most my exp's.

In that scenario, the pt should be placed on a bi-level ... not an APAP.

[dexter_go]

Thanks for all the response.

I have a follow up question. If my prescribed pressure is 8 and I set it to auto at minimum 6 and maximum 15. When the machine detects the need to increase pressure say 8 in order to stop the apnea event, when does it go down to 6 again? Does it go down to 6 right away? Or does it do this in increments and how long?

If the machine detects that a higher pressure is needed, how does it go to 8? Does it do this by increments? And how long? A few seconds or minutes?

[Wulfman]

Thanks for all the response.

I have a follow up question. If my prescribed pressure is 8 and I set it to auto at minimum 6 and maximum 15. When the machine detects the need to increase pressure say 8 in order to stop the apnea event, when does it go down to 6 again? Does it go down to 6 right away? Or does it do this in increments and how long?

If the machine detects that a higher pressure is needed, how does it go to 8? Does it do this by increments? And how long? A few seconds or minutes?

You might want to watch this video:

http://www.resmed.com/us/multimedia/aut ... 40x380.swf


Den

[rested gal]

Thanks for all the response.

I have a follow up question. If my prescribed pressure is 8 and I set it to auto at minimum 6 and maximum 15. When the machine detects the need to increase pressure say 8 in order to stop the apnea event, when does it go down to 6 again? Does it go down to 6 right away? Or does it do this in increments and how long?

If the machine detects that a higher pressure is needed, how does it go to 8? Does it do this by increments? And how long? A few seconds or minutes?

Dexter, as far as I know (and I'm sure no machine expert) autopaps go slowly, gradually, in both directions -- up and down. But how long it would be, I don't know. I don't think they go galloping up in full cms or in just a matter of seconds. They are responding to flow limitations, which are subtler, lesser restrictions of airflow than a sudden apnea would be. I think (not sure) that they go up (and down) in increments. Going up slowly, pausing along the way to check to see if any limited airflow is getting better with more pressure.

Also, I don't think they try to "stop the apnea event" if by that you mean would they increase pressure to try to blow an apnea open. When they sense no air flow (or so little airflow that it might as well be none) from you, each autopap has a different way of responding, in case it might be a central apnea (more pressure would be useless then since the airway is already open during a central apnea -- brain just hasn't yet sent a signal to "breathe now.")

As I understand it, when an apnea is sensed Puritan Bennett and Covidien autopaps are trying to also sense if there are oscillations from heartbeats in the airflow that would denote an open airway. If "heartbeats" are sensed, those two brands would figure it's a central apnea and would not increase pressure for that. They'd wait that one out.

ResMed, if already using 10 cm or more pressure at the time, will wait it out. Not raise pressure at all if an apnea is sensed. After waiting for the apnea to clear on its own, the machine will resume increasing pressure in response to flow limitations to try to prevent more apneas from occurring.

Respironics tries a couple of small pressure nudges, pausing after each nudge, to see if the apnea responds to slightly more pressure. If not, the apnea is presumed to be a possible central, the pressure is dropped back to "pre-nudge" level, and that machine waits it out, too. Resuming response to flow limitations after the apnea has cleared on its own.

This is oversimplifying considerably, and I may have been stating some it wrong. At any rate, I do think it's better to set the minimum pressure on any brand of autopap high enough to try to prevent most apneas in the first place -- as you said earlier.