CPAP vs. APAP (Again)

erik67 · Post by **erik67** » Tue Apr 17, 2007 6:52 am

A while back I posted about the merits of CPAP vs. APAP. I had decided that I wanted an APAP, so contacted my Doc. She had concerns about APAP, specifically what algorithm a given manufacturer uses in their machine. Also, her take is that with CPAP, you're always being treated (even if pressure is higher than needed), and is more conservative. As an engineer, I understand overdesign to be on the safe side, but what is the CPAP/APAP user community's thoughts about this?

I guess that her response really discouraged me. Thought about a second opinion, but would like your thoughts first.

Thanks!

Erik

TXKajun · Post by **TXKajun** » Tue Apr 17, 2007 7:00 am

Good morning, Eric.

I've been using a PB 420E for a bit over 2 years now. For the first 2 years, I used it in APAP mode. I was titrated at 16 cm and that was pretty tough to breath out against, so I figured an APAP would be my best choice. It turned out that my 90% pressure was between 13 and 14 cm on the APAP. I wasn't feeling as good as I thought I should feel, so a few weeks ago, I changed over to straight CPAP at 14 cm. That seemed to work better than the APAP settings (9-15 cm).

Sooooo, I guess what I'm trying to say in all this is that with an APAP, a person has the option of checking and optimizing the settings to obtain the best treatment possible at the lowest pressure possible. I've always thought that basing a lifetime of treatment on a split-night or even a one night study is a bit "optimistic", to say the least. For me, the APAP worked great to fine-tune my treatment setting, but CPAP mode seems to help me feel my best.

Kajun

P.S.
Having the ability to monitor my treatment and results with the software was essential!!!!!

DreamStalker · Post by **DreamStalker** » Tue Apr 17, 2007 7:34 am

The machines are expensive IMO.

I would say ... but doc, didn't you know that an APAP can be run as a CPAP? ... and if I have to shell out all this money, would it not be more cost efficient for the patient to have the option of having both APAP and CPAP in one machine.

What if you gain/loose weight and it affects the OSA? What if you have aerophagia and need some pressure relief? You can anticipate you doc's answers to be along the lines of ... well we will just have you come in and "pay" for another titration or we have "drugs" you can buy for stomache gas issues.

Your current machine doesn't even collect efficacy data ... she is trying to keep you in the dark and dependent on your insurance because she is dependent on her Jaguar payments.

Did your doc sell you your machine? In other words, is she somehow affiliated with the sleep lab and/or the DME that provided you with your PAP equipment? ... (you know, one of those one-stop shop sleep clinics)

sleepylady · Post by **sleepylady** » Tue Apr 17, 2007 7:35 am

Erik,

I also use a PB 420e APAP and can say that for me, APAP was the best option. I began my treatment at my prescribed pressure of 14 after a split night sleep study. After a month, I was still exhausted so my dr. had my pressure increased to 16. After a month of that and still being exhausted, I requested an APAP. After finally getting it (another long story), we first tried the range of 12 - 17. I felt better, but still had exhausted days half the time. Sooo, I upped it to 13 - 17. I had another spurt of feeling better, but had a couple bad days a week. After a month I thought, heck my pressure was originally at 14 so I put my range from 14 - 17 and BINGO, that was the perfect range. I know some people do well on one pressure, but for me I do better with a small range. I do have the software and monitor it on occasion. Actually, since I'm feeling GREAT I don't download much.

Yes different manufacturers have different algorithms for their APAPs. I'm sure if you search, you'll find debates on what is the superior APAP in terms of the algorithm.

Best of luck.

Guest · Post by **Guest** » Tue Apr 17, 2007 8:39 am

Did your doc sell you your machine? In other words, is she somehow affiliated with the sleep lab and/or the DME that provided you with your PAP equipment? ... (you know, one of those one-stop shop sleep clinics)

Yes, I do go to one of those "one stop" clinics. However, I don't think that the Doc is jerking me around, I think that she's just being conservative. With that said, I intend to set up another appointment with her to push my case for a C-Flex or something similar. I am really looking for a way to record my data and view it on the computer (I'm a geek, what can I say?). I may be better suited for CPAP than APAP, but how do I know without the data? Another sleep study is not a desirable option for me right now (insurance would pay, but I hate being hooked up to all the electrodes).

Thanks again for the input!
Erik

DreamStalker · Post by **DreamStalker** » Tue Apr 17, 2007 8:45 am

I guess I should provide my experience in getting my APAP script.

Upon my follow-up visit I asked the doc if he would change my script from a CPAP to an APAP. He said that “the auto algorithms were not very good and that CPAP was the gold standard”. So I asked him which of the auto algorithms? … he looked at me puzzled … and I continued … the ResMed or the Repironics algorithm? He said he “was not aware of a difference between the auto algorithms for those two manufacturers”. Then I said that the ResMed algorithm was more aggressive at responding to events than the Respironics but that I did not know how either of them would affect my specific OSA condition. He looked at me even more puzzled and asked me “where I had learned that”. I told him I had read up on it on the internet (I didn’t really understand much of this stuff at the time and still don’t but he was obviously not that much more informed either). I then proceeded to remind him that I was overweight and that I intended to lose weight for better health and hoped to avoid another titration. Then I pointed out to him from the sleep lab study report which he had just gone over with me that my OSA was much more severe in supine position than on my side and that an adjustable pressure might improve my chances for using the new contraption. He looked at me again this time in amazement and said “sure, no problem”. He filled out a new script and told me to give it to the receptionist and that she would help me get it filled. My experience was with one of those one-stop-shop sleep clinics BTW.

True, some indeed do better with CPAP than on APAP and many do quite well w/ CPAP alone ... but again an APAP can be set to work in CPAP mode very easily ... and as you say, how will you know which works best for you until you give it a try and have data to back it up?

Goofproof · Post by **Goofproof** » Tue Apr 17, 2007 9:50 am

DreamStalker wrote:I guess I should provide my experience in getting my APAP script.

Upon my follow-up visit I asked the doc if he would change my script from a CPAP to an APAP. He said that “the auto algorithms were not very good and that CPAP was the gold standard”. So I asked him which of the auto algorithms? … he looked at me puzzled … and I continued … the ResMed or the Repironics algorithm? He said he “was not aware of a difference between the auto algorithms for those two manufacturers”. Then I said that the ResMed algorithm was more aggressive at responding to events than the Respironics but that I did not know how either of them would affect my specific OSA condition. He looked at me even more puzzled and asked me “where I had learned that”. I told him I had read up on it on the internet (I didn’t really understand much of this stuff at the time and still don’t but he was obviously not that much more informed either). I then proceeded to remind him that I was overweight and that I intended to lose weight for better health and hoped to avoid another titration. Then I pointed out to him from the sleep lab study report which he had just gone over with me that my OSA was much more severe in supine position than on my side and that an adjustable pressure might improve my chances for using the new contraption. He looked at me again this time in amazement and said “sure, no problem”. He filled out a new script and told me to give it to the receptionist and that she would help me get it filled. My experience was with one of those one-stop-shop sleep clinics BTW.

True, some indeed do better with CPAP than on APAP and many do quite well w/ CPAP alone ... but again an APAP can be set to work in CPAP mode very easily ... and as you say, how will you know which works best for you until you give it a try and have data to back it up?

I was going to add something, but you have it all covered. I don't worry about auto algorithms, anymore than the brand of bus I get on to go to the store, the important thing is where they are going. Most of the fight over algorithms is smoke and mirrors, if we didn't hear about them, 95% of the people would find either will get the job done. I like remstars, but I'm sure if I had a Resmed, I could get close to the same treatment results from it. Jim

Wulfman · Post by **Wulfman** » Tue Apr 17, 2007 10:15 am

Anonymous wrote:
Did your doc sell you your machine? In other words, is she somehow affiliated with the sleep lab and/or the DME that provided you with your PAP equipment? ... (you know, one of those one-stop shop sleep clinics)
Yes, I do go to one of those "one stop" clinics. However, I don't think that the Doc is jerking me around, I think that she's just being conservative. With that said, I intend to set up another appointment with her to push my case for a C-Flex or something similar. I am really looking for a way to record my data and view it on the computer (I'm a geek, what can I say?). I may be better suited for CPAP than APAP, but how do I know without the data? Another sleep study is not a desirable option for me right now (insurance would pay, but I hate being hooked up to all the electrodes).

Thanks again for the input!
Erik

Tell your doctor that it's YOUR therapy.....not hers! Tell her you want the best machine you can get. (they're going to collect the same amount of money for the machine......they make more profit if it's the cheapest)

Make sure you have a copy (preferrably the original) of you prescription.
You can get an Auto from CPAP.COM with a CPAP prescription.

She's only being "conservative" with the machine you're getting.....not with the money they're trying to take from you.

Stand your ground.

Den

erik67 · Post by **erik67** » Tue Apr 17, 2007 11:15 am

Thanks everyone for weighing in on this. I will set up an appointment with the Dr. to make my case.

Of course, if she says "no", that will be all I need to find another sleep center....

Erik

brackstone · Post by **brackstone** » Tue Apr 17, 2007 11:17 am

I had CPAP with CFLEX for 6 months and I couldn't do it.

First night on Auto Bi-Pap with Bi-Flex I slept for at least 3 hours and now I'm doing full nights after about a month oof training.

BadThad · Post by **BadThad** » Tue Apr 17, 2007 12:05 pm

DreamStalker wrote:I guess I should provide my experience in getting my APAP script.

Upon my follow-up visit I asked the doc if he would change my script from a CPAP to an APAP. He said that “the auto algorithms were not very good and that CPAP was the gold standard”. So I asked him which of the auto algorithms? … he looked at me puzzled … and I continued … the ResMed or the Repironics algorithm? He said he “was not aware of a difference between the auto algorithms for those two manufacturers”. Then I said that the ResMed algorithm was more aggressive at responding to events than the Respironics but that I did not know how either of them would affect my specific OSA condition. He looked at me even more puzzled and asked me “where I had learned that”. I told him I had read up on it on the internet (I didn’t really understand much of this stuff at the time and still don’t but he was obviously not that much more informed either). I then proceeded to remind him that I was overweight and that I intended to lose weight for better health and hoped to avoid another titration. Then I pointed out to him from the sleep lab study report which he had just gone over with me that my OSA was much more severe in supine position than on my side and that an adjustable pressure might improve my chances for using the new contraption. He looked at me again this time in amazement and said “sure, no problem”. He filled out a new script and told me to give it to the receptionist and that she would help me get it filled. My experience was with one of those one-stop-shop sleep clinics BTW.

True, some indeed do better with CPAP than on APAP and many do quite well w/ CPAP alone ... but again an APAP can be set to work in CPAP mode very easily ... and as you say, how will you know which works best for you until you give it a try and have data to back it up?

Oh man, that is GOLD! Like you, I'm finding out most of these doctors and techs don't know much about the machines! They are transfixed on just a couple and that's what they prescribe 99% of the time. This is really no surprize, just like a regular medical doctors are known for only prescribing a handful of drugs because those are the ones they're familar with, a "sleep doctor" is apt to do the same.

rested gal · Post by **rested gal** » Tue Apr 17, 2007 12:19 pm

Kind'a interesting old thread:

Feb 19, 2005 subject: "Sleep Doctor" doesn't like autopaps
viewtopic.php?t=1461

erik67 · Post by **erik67** » Tue Apr 17, 2007 12:40 pm

Whoa....

Two year later and things haven't changed!
I thought that there was something strange about her dislike for APAP.

I have learned recently (due to other unrelated medical conditions I have) that you cannot get the care you need in this country without advocating for yourself. I am incredibly grateful for forums like this to help me stay educated and better able to get the care that I need.

Thanks Rested Gal!

hayeswildrick · Post by **hayeswildrick** » Tue Apr 17, 2007 2:33 pm

Really, it pays to do your homework, and it's sad when you know more than the "professionals."

When I went for my second sleep study I was casually chatting with the tech and said, "What are your feelings about APAP machines."

"Oh," he said smugly. "You mean CPAP."

"No, I mean APAP -- auto adjusting CPAP machines."

"Well, there are only CPAP and BiPap machines."

"Really?" I asked? "I wonder where I picked that up?"

And then I stopped asking, because I figured I knew more than him -- and I was right. Turned out he didn't know how to fit a mask, didn't know how to properly hook up the EEG, and the list goes on.

Do your homework, be polite, and be firm!

Press on!
Jeff

snoregirl · Post by **snoregirl** » Tue Apr 17, 2007 3:58 pm

And while you are advocating for your own heathcare be sure to count your pills from the pharmacy every time. I just got was shorted 5 pills in a 3 month supply. Last quarter it was a couple. I always count. I can't ever remember being given TOO MANY pills.