Who needs auto machines?

[fcaen]

Hello,

I just got my plain CPAP after a sleep study. Am I missing out by not having an auto-titrating machine? Or are those only for people who didn't go through a study?
I have a goatee and various amounts of leakage during the night, so I'm wondering if an auto machine would adjust for that.
Thanks!

[rested gal]

An auto-titrating machine compensates some for leaks, but nothing takes the place of a good fitting mask for handling leaks.

Full face masks can be tricky to fit right. The Ultra Mirage FF is a good one. I guess you've tried fiddling with the forehead adjustment vertical bar to get a good "tilt" of the mask to your face. You might try a different cushion shape too...e.g., if you are using a Medium Standard cushion, try the Medium Shallow. "Shallow" often works better on many people.

[dsm]

Hi

AUTO machines are about two things :-

1) To gain exhalation relief from the pressure of CPAP

2) For people who have the desire time & determination who want to
analyse / enhance their own therapy

They were invented largely for point 1) but have become very popular
for those of us interested in the point 2 aspects.

The downside of current AUTOs is their cost but if your health scheme
is covering or cost is not an issue, then AUTO is a good way to go for
people wanting to take some control of their therapy. To get the best
from an AUTO you need to also obtain the software that supports it and
need a way to get the data onto your PC so you can analyse it. Not
everyone with an AUTO goes this far but it is one of the reasons we buy
AUTOs, so we can do just that.

You don't really 'lose' anything but just going with a straight CPAP.
The primary goal of CPAP is to help resolve sleep apnea problems.
For the lucky among us they do so 100% with few side effects. But most
of us work through various challenges.

Some CPAPs also allow download and analysis of the nights data so
that benefit is not really an exclusive of an AUTO machine. For example
the RemStar Pro 2 CPAP & Resmed CPAP & PB420S CPAP also allow
us to download a nights detailed data.

Good luck

DSM

[another guest]

Depending on your CPAP machine, some will adjust to leaks. And on that same subject some of the Autopaps will do that as well, an auto pap machine can be nice in many ways but they are not needed to be treated effectivly. If you have a high pressure for example that is when an auto pap is handy for some.

[Linda3032]

fcaen, As RG stated, the auto machine automatically adjusts pressure as you need it. and from the sound of your other post regarding your doctor, etc., it sounds like you definitely need an auto.

Most people go to sleep clinics and have sleep studies. Some have knowledgeable doctors and or DMEs. Some don't. Some could care less about educating themselves or keeping up with their stats via software. And some of us buy the card readers, software, etc. so we can review our data on our personal computers.

If you haven't had your machine long, you should definitely try to get an Auto, as RG stated.

[fcaen]

AUTO machines are about two things :-
1) To gain exhalation relief from the pressure of CPAP

Oh really? Auto machines, even those without CFlex, offer some relief during exhalation?
(thanks for the reply by the way)

[Linda3032]

Hmmmm, I don't know about that. But the Remstar Auto with CFLEX would be the one I would recommend.

[rested gal]

AUTO machines are about two things :-

1) To gain exhalation relief from the pressure of CPAP

2) For people who have the desire time & determination who want to analyse / enhance their own therapy

They were invented largely for point 1) but have become very popular for those of us interested in the point 2 aspects.

Actually, I think (may be quite wrong) that autopaps were invented with the purpose of performing auto-titrations. A way of zeroing in on the single pressure needed to take care of most events. Or, in other words, as a diagnostic tool.

That's still the way many doctors view them - as a temporary diagnostic machine. Useful if there has been difficulty getting a titration pressure in the sleep clinic. Even the Respironics reps are often reported as telling people autopaps are for temporary use....for titrations, and are not intended as permanent treatment machines. Whenever I read that I think, "Hah...the reps are just trying to stay on the good side of their real customers." Just saying what the DMEs and the doctors want to hear. Many of whom are "against" autopap for their own reasons.

I don't know if comfort in exhalation relief was really a reason at all for developing auto-titrating machines, although that turns out to be a very pleasant side perk for many who might otherwise have gotten stuck with a single high pressure. Possibly some companies promoted that aspect later, but I'd bet that temporary use for auto-titration to arrive at a good single pressure was the primary reason for "inventing" the autopap.

I do agree with point "2)'. Autopaps are wonderful machines for many people who really want to understand their own therapy and especially for those who want to tweak it.

fcaen, although I'm as much a fan of autopaps as anyone can be, it's very possible to get every bit as good and comfortable treatment from a straight cpap machine.

Autopap and software can make tweaking easier to do, but it can be done with straight cpap in most cases unless an uncomfortably high pressure really is needed most of the time.

If there were no such thing as an autopap, or software, I could mess around with various pressures on a cpap and end up with equally good treatment as I get now.

Lest people think they are getting left behind in the dust or receiving inferior treatment if they don't have all the bells and whistles, here's a very thoughtful post by Grabraham. I think it's good to bring it out from time to time:

Sep 27, 2005 subject: A note to the new user

[wading thru the muck!]

AUTO machines are about two things :-
1) To gain exhalation relief from the pressure of CPAP

Oh really? Auto machines, even those without CFlex, offer some relief during exhalation?
(thanks for the reply by the way)

fcaen,

The answer to your question is YES!

An APAP can do this by ultimately lowering the average pressure it uses to treat your Apnea. Most people are experiencing an "event" for only short periods of time during the night. In my case they are clustered just after I fall asleep and just before I wake in the morning. This leaves the whole rest of the night in which I can be at the minimum pressure. Lower pressure = easier exhalation.

[rested gal]

Oh really? Auto machines, even those without CFlex, offer some relief during exhalation?

No, autopap machines without C-Flex do not offer any relief at all during exhalation. I think dsm was thinking about this kind of scenario:

Say your sleep study caused your doctor to come up with a prescription of 17 for a single pressure for you.

And say that you had great difficulty breathing out against a pressure of 17 on straight cpap.

It might be that you don't really need 17 during most of the night. Perhaps 10 or 11 takes care of you most of the time, preventing apneas and hypopneas from occuring MOST of the time. Perhaps you don't need 17 at all except for very brief periods scattered through the night...or not at all on some nights.

That's where an autopap can shine, using just the amount of pressure actually needed throughout your sleep session.

In that respect, not having a straight 17 blowing at you all night long...having a lower pressure most of the time...lower pressures that you can breathe out against more easily would mean that using an autopap was giving you "relief" in general. But that's not to be confused with relief for every exhalation a la C-Flex, or even the more precise exhalation relief of a bi-level machine like a BiPAP Pro 2.

My edit: LOL!! I was still writing and then hit submit before seeing Wader's good post. We gave opposite answers, but we agree!

What was the line in that old song before my time? "Yes, we have no bananas..."

[Guest]

Oh really? Auto machines, even those without CFlex, offer some relief during exhalation?

Yes really

What do you image AUTOs actually do ?

They *lower* the pressure to the lowest setting that appears to be working for the patient.

Why do they seek the lowest pressure ? because it is fun ? - no because it aids the patient's exhalation against pressure. And as RG has pointed out to help set a lowest level for a patient during titration(also for this fundamental reason of making it easiest for patients to breath against).

You are quite right about Cflex and add EPR & BiLevels & all xPAPs that try to make it easier for patients. The other factors are that lower cms also helps reduce other issues such as mask leaks, aerophagia, mouth pops etc: etc: etc:.

Cheers

DSM

[fcaen]

Oh, I see! Thanks for the explanation. Auto-titration is not exhalation-specific relief, it's all-around relief

[wading thru the muck!]

My edit: LOL!! I was still writing and then hit submit before seeing Wader's good post. We gave opposite answers, but we agree!

What was the line in that old song before my time? "Yes, we have no bananas..."

LOL! Opposite answers using the same rationale to get there.

Having corresponded with dsm many times, my guess is what be both describe is what he was getting at.

[NightHawkeye]

fcaen, I'm gonna go out on a limb here and say that since you just got started, you may want to keep your options open at this point. The wash-out rate for CPAP is about 50%. Many on this forum feel that could be reduced to much closer to zero if people monitored their own treatment (via software) and had the capability to adjust things themselves.

But really it's about how you feel. So, how do you feel, fcaen? Is your treatment helping you? Are you having trouble adjusting? Let us know. People here will try to help.

If you're feeling good and your treatment's working well for you, then count your blessings. Do remember though that conditions change and adjustments will almost certainly be needed within a few years, and judging from posts on this site, more likely within a few months. Do you want to go back for more doctor visits and pay for another titration, or do you want to learn how to do that yourself? Only you can decide.

If you want to do it yourself then you need a machine with monitoring software. This does not mean an APAP, but some APAP's do have monitoring software also.

Hope this helps.

Regards,
Bill

[Guest]

I'm confused. I thought only a Respironics machine with the C-Flex feature offered exhalation relief for a machine in auto mode. I know the ResMed EPR doesn't work in auto mode, so there's no exhalation relief on that one. I know the PB420e doesn't offer exhalation relief in any mode.

The question was, "Auto machines, even those without CFlex, offer some relief during exhalation?" DSM, how can you say the answer is yes, when neither the ResMed Auto or the PB auto have an exhalation relief feature? I hate to admit to being so dense, but I don't get it.