Autopap more risk of apneas?

BobH · Post by **BobH** » Fri Mar 03, 2006 4:54 pm

My repiratory therapist told me that with an APAP theere is more chance of apnea or hypopnea at night, because the machine will not always sense in time when an apnea is occuring. Does this make sense, or am I understanding how an APAP works?

Wulfman · Post by **Wulfman** » Fri Mar 03, 2006 5:01 pm

AAARRRRRGGGGGHHHHH!!!!!

If that's what your RT told you, then he or she has it BACKWARDS!!!!
The APAP senses the apneas and alters the pressure to help prevent them.

Best wishes,

Den

Guest · Post by **Guest** » Fri Mar 03, 2006 5:26 pm

BobH,

That's of course the worry that comes to mind when you think about an automatic pressure setting. The whole idea is to get lower pressures most of the time and only the higher pressure when you need it but what if it isn't there when you do need it.

The clinical trials I was able to find (going back to about 1996) seemed pretty clear in finding absolutely no residual apneas/hypopneas with APAP beyond what they found with full-effective pressure CPAP. And they were monitoring with full PSG gear.

And on top of that, I'd expect that today's APAP machines are even better than the ones ten years ago. So my conclusion is not to worry too much about it. I think if you're in a special condition where that's a higher likelihood your sleep doc would inform you.

Linda3032 · Post by **Linda3032** » Fri Mar 03, 2006 5:30 pm

I would suspect that your DME wanted to sell you a cpap since his profit is greater for a cpap than an apap. Unfortunate if that is true.

BobH · Post by **BobH** » Fri Mar 03, 2006 7:10 pm

Sooo....I'm not sure if I should ask for an APAP. I was thinking that most people that use those have higher pressures. Mine is 8.

I've only had the CPAP one night, so I can't really say I've tried it very long. At the same time, if an APAP is just as effective and easier to use, then why not? I there some insurance hurdle that I don't know about?

clanrat- · Post by **clanrat-** » Fri Mar 03, 2006 7:19 pm

For some reason, I can't login this afternoon.

Anyway, at my recent PSG I told the therapist that I was using an APAP, and she too expressed concern that it "might not respond fast enough to prevent apnic events."

She further suggested that I run it in CPAP mode, or with a vary narrow window of pressures. She suggested +/- 2cm from my 'effective' pressure.

I haven't had the titration study yet, instead have been using data from the APAP to determine where I should be.

regards,

-Cam.

Snoredog · Post by **Snoredog** » Fri Mar 03, 2006 9:06 pm

if the autopap is NOT set-up correctly it can allow more hypoapnea and apneas to get by. The problem is most RT's have no idea how your machine should be programmed, neither do the doctors. Most patients that program their own machine learn what works best for them and can quickly spot and resolve problems.

the machine is always going to let a few events go by (it first has to see one pattern, store that pattern in its memory then when it sees that pattern again respond based upon its algorythm).

Your RT's response is typical, I guess they figure if you have to come back to them for every adjustment, hose, mask or band-aid answer they get to keep their jobs.

Goofproof · Post by **Goofproof** » Fri Mar 03, 2006 9:20 pm

To get the best treatment 2 Cm +/- usually, however the Dr.s and DME's put them in use at 4 to 20 cm, and then they can blame the APAP's for their poor treatment. Setting at 2 cm +/- CPAP pressure, then monitoring progress with the software is the best way, With a little Lab Rat Work for tweaking the system.

Too low pressure and too wide a range are the downfalls of the Dr's and DME's not the machines. Worse comes to worse you can still use it in the CPAP mode. Be sure to get exhale relief as a option, it can be turned off if desired, it pays to have options.

WAFlowers · Post by **WAFlowers** » Fri Mar 03, 2006 9:45 pm

BobH wrote:Sooo....I'm not sure if I should ask for an APAP. I was thinking that most people that use those have higher pressures. Mine is 8.

My titrated pressure was 8 also. I use an APAP. It is set for 6.5-9.5.

At 6 I have snores. At 10 I have central apneas. This range works well for me even if my allergies are acting up, or if I've had a drink (or two) in an evening (not a common occurance, but every once in a while ...), or if I'm extra tired, or ...

Most of time on most nights I'm down around 7.

And loving it!

ozij · Post by **ozij** » Fri Mar 03, 2006 11:04 pm

Get an APAP, get the software, and follow your own results.

There are some kinds of breathing patterns, with hypopneas, that the APAP will not respond to automatically. Take a look at the following link, Discussions with -SWS - you'll find the subject discussed in some of the 420E threads as well as where it's in the subject name.

I usually have more hypopneas than apneas, my APAP does not respond to them automatically, I learned how to set up a range that will keep them low, and give me good treatment.

Your RT probably has very little experience with people monitoring and controling their own therapy - APAPs are still considered diagnostic (not therapeutic) equipment by many, which is why, as goofproof noted, people are sent home with the machines set up on 4-20. An APAP with the software is a very therapeutic machine, and if you RT blanches at the thought of self titration, you can alway mention insuline pumps controlled by patients.

Don't accept any equipment that does not have the capability to report your breathing disturbances. You can buy the software at https://www.cpap.com, hosts of this forum - and it will cost you $200 at the most. DMEs have been known to tell clients that the software costs thousands.... not so.

And, since and APAP can always be run as a CPAP, you need not worry that you won't get proper treatment if you find out that constant pressure is the best for you.

Good luck!
O.

Linda3032 · Post by **Linda3032** » Fri Mar 03, 2006 11:16 pm

Bob, get the Auto. My pressure is 7, and I have my auto set at 5 to 9.

Remember: An Auto can be set for straight Cpap, but a Cpap cannot be set as an Auto.

You are the boss, get what you want - and you should want an Auto.

The Youngs · Post by **The Youngs** » Sun Mar 05, 2006 2:51 pm

Bob,

The really neat thing about the APAP is that it gives you just what you need. My husband was titrated at 9cm. At that pressure at the sleep lab, he had 0 AHI. However, we bought an APAP and the software to monitor it. I have been very interested to see that he spends the vast majority of the night at less than 8cm, (we have it set 6-14cm for now), but if he'd been set to 9cm, about 15% of his events wouldn't have been resolved. His actual 90% pressure is right at 10cm. If we'd gone the way of the straight CPAP, he wouldn't have gotten proper treatment and he'd have been spending the night at a higher than necessary pressure.

Hope that helps--

Sleepless on LI · Post by **Sleepless on LI** » Sun Mar 05, 2006 3:39 pm

If I were you, I'd get a machine that can do both. If you don't want to use it on auto, you don't have to. But why not give yourself that option of a machine that can be run in auto or straight cpap mode? Then you decide which one you feel works best for you, if you find there is a difference.

dsm · Post by **dsm** » Sun Mar 05, 2006 4:04 pm

Lori,

Dunno how you did it allowing for the size limitations, but 'clever girl'

am most impressed

D

dsm · Post by **dsm** » Sun Mar 05, 2006 4:07 pm

Bob,

If you are willing to put some time into monitoring your sleep (software & data downloads) then go for an AUTO.

It can always be run in CPAP mode. I ran my own Remstar AUTO in cpap mode fore the 1st moth while participating in a group study.

The AUTO is the best device for anyone wanting to do a home sleep study and who can ask the right questions here & who can download their data & print off the reports.

Go for it.

Cheers

DSM

Autopap more risk of apneas?

Autopap more risk of apneas?

APAP

Re: APAP

Get the APAP!