confused over cpap prescription- opinion please ?

[dakota07]

I am looking for some opinions regarding machine choice as i am confused.

Results of polysomnogram: no apneas but hypopneas and RERAs, diagnosis: moderate sleep apnea.

Titration: First half of evening CPAP was used. Second half of night BPAP was used. No REM sleep was achieved.

CPAP was titrated to 6cm and one hypopnea appeared; when BPAP was used (11/6cm) hyponeas, OA's and CA's appeared. Sleep doctor said results of titration were confusing and recommends BPAP auto biflex and another titration in 2 months.

Got a second opinion. Second sleep doctor said CPAP pressure wasn't put up high enough and that the BPAP resulted in OA's and CA's. Says start with simple approach like a CPAP before jumping to BPAP. Says get re-titrated in 1 month. Doctor writes prescription for an APAP as per my request.

I found the prescription for an auto BPAP confusing in that 90% of people with sleep apnea use CPAPs or APAPs as opposed to BPAPs , yet first doctor is considered the "best" sleep doctor in town. It also seems that the tech didn't go high enough with the cm of pressure because titration report says "Increasing IPAP to 12 cm did not relieve events."

My thought is to start an APAP and use the auto feature and then read the machine reports. Then maybe machine will tell that I need a higher pressure than what was done in lab.

I have read that complex sleep apnea occurs with using CPAP but that that complex sleep apnea is a small percentage of overall apnea sufferers.

My question is, was the first doctor correct, or the second? An auto BPAP is very expensive and may be overkill.

Or, do I really have complex sleep apnea and the BPAP is the correct machine?

Or, do I need to use the APAP as a titration device or request a re-titration in the lab?

Opinions gratefully appreciated.

[WindFlyer]

I've always used a CPAP and get along with it just fine. Most people here have some other kind of PAP going, though, and they have more information about that aspect of it. My opinion is to keep it simple and just run with CPAP. [ducking to avoid shoes getting thrown at me]

[Kiralynx]

I had enough apneas and hypopneas... more hypos than apneas... to qualify as moderate. When they put me on CPAP, the incidents increased, and I added 32 centrals.

The pulmonologist who read my study recommended one thing; the RT at the DME recommended a Bipap Auto SV (expensive!) which has proved to be the right machine for me. I do have complex sleep apnea.

I was titrated at 10 and 14, and it was set to EPAP = 10, MinIpap = 10, and Max IPAP = 14. I couldn't tolerate that high an EPAP and started having centrals, struggling to breath out against the EPAP. When my EPAP was lowered to 6, almost all apneas went away. (I may have one or two a month.)

Something to consider is that a bipap can be a good thing for something like this.

[tomjax]

Windflier,
Not to throw shoes, but you are fortunate to have a machine that you are pleased with.
Many, if not most pepple on CPAP will do fine IF THE PRESSURE IS CORRECT.

APAP has very definit advantages and allows users to regularly check their sleep architecture.

They can then adjust it to make it optimal.

I would never try to evaluate a machine I was not using.
Just moi

[jnk]

Different doctors have different approaches, especially when titrations aren't particularly successful. Seeing what happens over time with any efficacy-data machine would give more info to see where to go from there. So if the titration was confusing, I would hesitate to call any doctor's initial approach with a prescription "wrong," since looking at data from treatment over time can be part of the diagnostic process with sleep disordered breathing.

Personally, I wouldn't second-guess a doc who arranged for a machine rental for a month to see what data it gave, whether it was an APAP or an auto BPAP. The doctors may have had in mind seeing how you react over time in order to see if the centrals go away. If the centrals go away, problem solved; if they don't, on to the next machine or approach. Part of that approach should be looking for the cause of the centrals in they are numerous and persistent, though, in my opinion.

If my problem was mostly obstructive hypopneas, I would want a bilevel so that the obstructive hypopneas could be addressed without as much pressure. However, if most of my events were non-obstructive (central in nature), I would prefer straight CPAP for a while to see how low my estimated-event count went. If CPAP didn't resolve most of the events, I would start thinking about the need for an SV. But I also have no argument with starting out on BPAP and seeing how the data goes over time. As long as the problems are being noted and addressed, let the doc you go with come at the problem his way as long as he is being reasonable and methodical.

But that is only my personal approach based on how my mind works and what I think I understand--I could always be wrong.

jeff

[GumbyCT]

Be thankful....most here have to use cpap (read that as struggle) for 1yr before insurance will pay for a bipap. Your bipap has ALL of the features many lust for esp. for exhale relief. The bipap can be set to cpap mode if required. ALL w/o a change of machines.

You haven't mentioned how you have been feeling? Or if you have other medical problems that can often complicate the use of cpap.

[joeb989]

I was also confused by my CPAP prescription.

After completing two PSG sleep tests, my sleep doctor prescribes a CPAP at pressure 6.

When DME gave me a CPAP set to 6, my average AHI was 12.0. I though this should be lower, so we then tried an APAP set to a pressure range of 5 to 10.

What surprised me is that the APAP selected a pressure of 10.0 for most of the time, and my AHI dropped to 5.6.

Could the sleep study have missed the fact that I needed a higher pressure?

I don't understand how Central Apneas play into my sleep studies. In my first sleep study without CPAP I had 1 Obstuctive, 16 Central, 0 Mixed Apneas, and 33 Hypnopeas (according to the Respiratory Analysis). In my titrated CPAP sleep study I had 0 Obstuctive, 2 Central, 0 Mixed Apneas, and 101 Hypopneas. Even though there were many Central Apneas, I was diagnosed with Obstructive Sleep Apnea. The sleep studies also showed that when I was sleeping on my back my AHI was high, but when on my side my AHI was zero. My AHI during REM sleep was around 30 in both tests.

I don't understand why the sleep doctor said I have obstructive sleep apnea, when I see mostly central apneas according to the Respiratory Analysis. Maybe this has something to do with the fact that the apneas went to zero when I slept on my side.

I booked an appointment with my sleep doctor to ask all these things, but I have to wait a month before I could see him again.

In the meantime my DME was wanting to figure out why the APAP selected a pressure of 10.0. I will soon bring in my machine to my DME to download the data, which hopefully gives more insight.

The APAP machine we are using is the ResMed S8 AutoSet II.