Can you use APAP nighlty or is it a temporary thing?

[Dazzles]

I've yet to have a conclusive titration study so I am on APAP permanently -- according to my doctor. Every time they'd get close to a pressure that would help, I'd start the leg twitching or have a central. My range is 7-14. Either my doctor is lying or yours is lying! With other responses here, I think yours might not be telling the truth.

Of course, I disagree that you don't need another sleep study -- after 10 years things may have changed! How will they know what to prescribe if you don't have the sleep study?

[RipVW]

Been using my APAP nightly for years--I'll never go back! Pressure needs change throughout the night, night to night, month to month . . .

Can't remember where I found this, but I think it makes a good case for using APAP--


What is an Auto-Adjusting CPAP?
Auto Adjusting CPAP machines, also known as APAPs, have the ability to provide the right amount of pressure to keep your airway open. A sleep study to determine optimum pressure is not normally needed if an APAP is prescribed. An APAP is designed to deliver your ideal pressure, on a breath by breath basis, increasing pressure when it's too low and decreasing pressure when it's too high. An APAP can be run in CPAP mode, where the machine blows one constant pressure, or in Auto mode, where it adjusts the pressure to meet your specific needs. These machines are typically software capable, or 'smart' machines, which can help you and your doctor fine tune your Obstructive Sleep Apnea therapy and monitor for effectiveness.
For more about the benefits of using software as a part of your sleep therapy, see our previous Software Newsletter.
________________________________________
Why Would My Pressure Needs Change?
Your pressure needs can change, either in the same night or over a period of time, depending on many factors. These factors include:
• Weight gain or loss. Even a small increase or decrease in your body mass can change the amount of pressure you need.
• More tired than usual. Worked a 15 hour shift when you are used to 8 hours? Help a friend move one Saturday? Spend all day playing softball in the heat? Or maybe you're just plain worn out? Being more tired than normal can affect your pressure needs.
• Changes in your sleeping position. Do you move around in your sleep a lot? Sleep on your back, then change to your side? Curl up and then later stretch out? The position you sleep in can change your pressure requirements.
• Alcohol consumption. Throwing back a few cocktails before bed can easily lead to a need for a slightly higher pressure requirement than usual.
• Medications with sedative effects. Certain medications may have sedative effects and could alter the amount of pressure required to prevent apneas and hypopneas.
• Congestion from illness or allergies. Having stuffy sinuses or congestion in your lungs may modify how much pressure is essential to keep your air passage open during sleep.
• Different stages of the sleep cycle. Pressure needs might be different during the various stages of the sleep cycle. For instance, you may need more pressure in the deep sleep phase compared to the REM sleep phase.
• Slight mask leaks or different masks. If you have a slight mask leak, an Auto-Adjusting CPAP machine can increase the pressure to compensate for the leak Also, different masks have different “leak rates” also called “vent flow rates”. Each mask leaks a certain amount of air through the exhaust or exhalation port. This is normal and is supposed to happen. The mask “leak rate” is usually published in the literature that comes with the mask. If the “leak rate” you see in your therapy data (using software) is above the published “leak rate”, then you know you are having issues with getting a proper seal.
• Altitude. The higher up in altitude that we sleep, the harder the machine must blow to keep the airway open. While most CPAP machines have Manual or Automatic Altitude Adjustment that will work for altitudes typically up to 9000 feet, you can feel confident with an APAP that you are getting enough pressure to ensure your air passage is kept open.
• Various other factors. Stressed? Jet-lag? Sleeping in a strange place? Super-relaxed lately? Frequent Naps? All of these, and other circumstances, can lead to the need for different pressure requirements.
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Benefits of Using an APAP Machine
The most obvious benefit is that an APAP machine can deliver the “right” amount of pressure at the “right” time and can respond to your ever-changing pressure needs or events, preventing them or adjusting as necessary. Ultimately, this should lead to less apnea and hypopnea events and a more effective therapy. Another added benefit is that you only get the minimum amount of pressure necessary at a given moment, which is quite nice if your “normal” pressure setting is on the high side.
An Auto Adjusting CPAP can sometimes help to eliminate or reduce aerophagia. Aerophagia is the swallowing of air which often leads to uncomfortable gassiness or bloating. The fact that APAP machines can be run in CPAP or APAP mode, and have advanced therapy tracking with the optional software, is another reason these machines are so popular. This is especially true for CPAP users who take an active role in their own therapy.
Lastly, using an APAP machine may reduce the need for subsequent and expensive sleep studies. The software data can be given to your doctor or Respiratory Therapist for a professional interpretation and then used, perhaps in conjunction with a Pulse Oximeter, to determine therapy effectiveness and the best course of action for each particular individual.
While APAP machines are slightly more expensive than the straight CPAP machines, we believe the benefits are worth the extra money for many CPAP users.

[chunkyfrog]

Our sleep doc was a bit surprised when we told him we both have APAPs.
After we showed him our data, he was on board.

[avi123]

nanwilson, I was posting to ptisme17.

Thank you..you are telling me to shut up and its none of my business. I saw that you answered to ptisme17 with an answer that I did not understand...I only wanted clarification, but I guess I am not to get it, and yes your reply was to answer my question, or why else did you quote it. Fine...I'll shut up and not try to help!

No, I am not telling you to shut up. Could you please ask your questions more clearly. Notice that ptisme17 does not have an Rx for APAP. But he/she insists that an APAP is good for him/her. I posted several medical conditions in which an APAP should not be used. What if ptisme17 suffers from any of these conditions but goes ahead on APAP while his/her Doc does not know about it, and then becomes sicker and sues the Doc?

[avi123]

nanwilson, I was posting to ptisme17.

Thank you..you are telling me to shut up and its none of my business. I saw that you answered to ptisme17 with an answer that I did not understand...I only wanted clarification, but I guess I am not to get it, and yes your reply was to answer my question, or why else did you quote it. Fine...I'll shut up and not try to help!

No, I am not telling you to shut up. Could you please ask your questions more clearly. Notice that ptisme17 does not have an Rx for APAP. But he/she insists that an APAP is good for him/her. I posted several medical conditions in which an APAP should not be used. What if ptisme17 suffers from any of these conditions but goes ahead on APAP while his/her Doc does not know about it, and then becomes sicker and sues the Doc?

I am repeating those underlying medical conditions for which an APAP should not be used:


Rules from the American Academy of Sleep Medicine

(5) certain
APAP devices may be initiated and used in the self-adjusting mode for
unattended treatment of patients with moderate to severe OSA without
significant comorbidities (CHF, COPD, central sleep apnea syndromes,
or hypoventilation syndromes); (6) certain APAP devices may be used
in an unattended way to determine a fixed CPAP treatment pressure
for patients with moderate to severe OSA without significant comorbidities
(CHF, COPD, central sleep apnea syndromes, or hypoventilation
syndromes); (7) patients being treated with fixed CPAP on the basis
of APAP titration or being treated with APAP must have close clinical
follow-up to determine treatment effectiveness and safety; and (8) a reevaluation
and, if necessary, a standard attended CPAP titration should
be performed if symptoms do not resolve or the APAP treatment otherwise
appears to lack efficacy.

[ptisme17]

Hey everyone..thanks for all the comments. Just to clarify..It hasn't been 10 years since my last sleep study..its been 3.5 years...my Cpap is 10 years old but I have had 3 or 4 studies in that 10 year period with minimal changes in pressure. I figured the sleep Dr's office was full of it when they told me APAP is temporary...didn't make any sense to me but I wanted some accounts from real people not just internet sites who are trying to push their products . In fact the whole repetitive sleep study thing makes no sense as pressure needs can change minute to minute...so even when the study "determines" your pressure..it could change from position to position and throughout the evening and night to night . ..therefore making the need for routine studies nothing more than a money making scheme (unless there is some major change in health status.). I appreciate the reply with the reasons not to consider the Apap but I do not have any of those conditions. I have an appointment with my family Dr. who hopefully will be willing to write the script for me...If not than I guess I am out of luck as even if I switch sleep Drs I will likely still be forced to have a useless test.

[2 B Sleeping Soundly]

RipVW,

Thanks for posting that information about APAP's! I have a very intelligent friend who has successfully treated his OSA for years with straight CPAP and wondered why I would need or even want something other than a CPAP. I can now send him this information as it is certainly much better than what I struggled to explain about my APAP

John

[2 B Sleeping Soundly]

ptisme17,

If I could explain the benefit of my APAP to me, by boiling it all down to one word, it would be the word 'options'. APAP can give you options in your current therapy, and also down the road if or when your therapy needs change. As others have mentioned it can also be run in straight CPAP mode, which also adds to the 'options' of APAP. Like most of us on this forum, I will be a PAP user for the rest of my life and that's alright with me, just don't ever take away my ability to get an APAP with it's 'options'

John

[Pugsy]

Here's another reason some of us use APAP range.
For me it was the fact that in REM stage sleep my OSA was "worse" but more important than the significant increase in the number of OSA events was the fact that sometimes those events needed a much higher pressure to be prevented.

I used APAP 10 min and 20 max. Pressure variations never bothered me. Most hours my pressure would stay around 12 to 13 but sometimes I would see pressures up to 16 or 18 and not related to leaks.
I sure wouldn't want to use 16 or 18 all the time and I sure wouldn't want to use 12 all the time and have some clusters of events happen because pressure wasn't adequate.
My doctor is actually on board with what I came up with after I showed what happened with straight cpap vs apap.

[Spinory]

My doctor also refused to give me an Auto script; I just asked for the script they wanted me to have, just a straight up CPAP at pressure 11 and then bought one off of secondwindcpap.com with that script. You don't need to have an Auto script to get an Auto machine; I think our forum sponsor also does it (if I read it right). My insurance was only 50% co-insurance so I spent about the same out of pocket as I would have with insurance.

I use the Auto every night-found out here how to program my own pressure (cpaplibrary.com) and it's been going great.

I think Auto machines are more expensive than CPAPs in general so they don't make as much money. Seems like it is all about money sometimes.

From what I've read, I'll have my machine for 5+ years, so I made sure I got exactly what I wanted. I don't plan on going back to that sleep center.

Good luck and PM me if you want!

Heather

[ems]

The sleep specialist I use switched me from a CPAP machine to a VPAP machine without another sleep study. Maybe things are done differently in different parts of the country??