Yet another Apap VS Cpap post

[hades161]

Hi guys & gals

I finally went to a sleep doctor the other day and thanks in large part to the info and people here my Doctor was fairly impressed with how well informed I was and complimented me on my first full year of 100% Pap complience and AHI as we went over the data logs I brought in. He also seemed up to date and know what I was talking about. BONUS ! !

My treatment of my OSA has been going well but there still where a few issues that I was conserned about and I brought them up to my Doctor. I have an AHI of sub 3.0 most nights or lower and even though everything else looks good, I still have issues with tiredness, daytime sleepyness, short term memory issues, and confusion.
My settings are fairly high for most, 16-20 and I have only dipped to a flat 16cm 2 times in this past year.

After talking with him about these leftover issues he raised a very interesting point to me and I immedately thought I should share it with you all and get your take on it.

He didn't seem to have a bias toward Apap or Cpap but he said that in his experience with treating OSA he felt that the leftover issues could be from the apap's auto adjustments. Some people just react differently to them.

He admitted that he didnt know of any study to prove or disprove what he was saying but his theory was that the auto adjustments of the Apap pressures could be causing very slight arousals that would be effecting my treatment. These arousals might impair my ability to stay in the deeper more restful levels of sleep, where as the Cpap's straight pressure wouldn't cause them. Hence I would have good numbers but still wake up tired due to the adjustments during the night.

I have noted in other posts here, that some people said they respond better to a straight cpap setting and so I was thinking this might be a good point. I am going to get a lab titration(needed 1 on record anyway) and then try a straight setting for awhile and see how I feel in a month or two. It might just be BS but I figure it wont kill me to try. It might make things better and if it doesn't well, I can always change it.

[ozij]

Get a bi-pap titration while you're at it, your pressure level justifies it.

O.

[kteague]

Gee, I remember when you were a newbie. Glad to hear you're still hanging in there even with the residual problems. Hopefully the study will give you some clues to your tiredness.

I don't understand all the technicalities on the machines, but it has been said that even between like types one's breathing patterns might be more compatible with one brand over another. Then add apap to cpap differences - I guess one never knows until they try out their options.

Good to hear from you. Let us know how the study goes.

Kathy

[JeffH]

I've been saying for several months that apap changes of pressure were waking me up. That's why I went back to straight cpap and haven't looked back since. I think you have a pretty smart doc.

Also with varying pressures, you are more likely to get leaks with the rising pressure and leaks can wake a person up also.

JeffH

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, APAP

[Wulfman]

He admitted that he didnt know of any study to prove or disprove what he was saying but his theory was that the auto adjustments of the Apap pressures could be causing very slight arousals that would be effecting my treatment.

That's been my theory too. In my opinion, the "arousals" from the pressure changes could be from the extreme of waking a person up to creating a reflex action in one's breathing mechanism that would be somewhat disturbing to their sleep on the other end of the spectrum.

For myself, I prefer straight pressure, but each person needs to determine the therapy that works best for them.

Den

[Country4ever]

Hi Hades,
Its nice you have such a good doctor! Its always nice to find out that our docs are actually thinking about things!
I'm at a similar point......wondering if its the APAPs changes in pressure that disturb me. I've closed up the distance between the 2 pressure settings, but at some point it seems like they're so close together, you might as well be on CPAP and avoid the changes that might be disturbing us.
I tried straight CPAP for a short time and felt awful, but someone here mentioned to me that she had trouble with it too, until she added EPR, and then did fine. So don't forget about using that feature too.
Also.....there might be other things in your life/body going on that could be causing your continued tiredness. And I do wonder if our bodies have been irreversibly injured, by having osa for so many years before it was discovered.
Good luck to you and let us know how you do on the cpap.

[DreamStalker]

Congrats on your doc/patient relationship ... if only more could be so lucky.

Yes ... some are more sensitive to arousals due to pressure changes. Others are less sensitive and may benefit from the lower overall pressure offered by adjusting pressure through the night, exhalation relief, and or both.

In any case, having the auto machine provides the option for many people to find and use the best method to treat their condition ... be it CPAP or APAP, plus or minus exhalation relief. People are different that way, including doctors and patients

Best-o-luck with your therapy!

[Guest]

Thx for the happy thoughts all.

Well, I made the pressure change 5 days ago and things seem to be getting a little better. I set my Apap to a straight Cpap mode, 17cm with Cflex at 2. My average range from the past years worth of Data was 16.2 - 16.8. My first weeks worth of data, and so far I haven't seen any large changes in my AHI. AHI 1.9 avg for the week, well within my normal ranges of 3.0 and under.

The funniest thing I have noticed is with my dreaming. I was dreaming before but it seemed strained or muddy somehow, not in focus. After the change I have noticed they have gotten more clear? less muddy? Very hard to discribe dreams but I have been less tired and sleepy this week. I am a lucid dreamer and have been since my teens, so I notice changes in my dreaming fairly easy.

I know its only 1 week so its not really a solid test as yet but I will continue to monitor the change. I am also very curious as to what my Lab titration will show but I have to wait till Feb 20th to get in.

On the whole Apap Vs Cpap thing goes I was more talking about the modes then the units themselves and what my Doc related to me. As far as Apap/Cpap/Bi-pap/Vpap thing goes, I am of the mind that whatever unit gives you the most options, the best ablilty to monitor and adapt, and treats your OSA effectlively, is the best unit. So Apap's for me PLEASE unless I find out I need a Bi-pap ... sigh hehe.

[hades161]

I was logged in darn timers.

[Lee Lee]

Straight CPAP works better for me. I had AHIs in the 8's and was feeling sleepy during the day.
I changed to CPAP with EPR and now have pretty much below 3's and almost 0 AI.
I feel kind of strange about this, because I love gadgets and technology and thought the APAP was really kinda cool.
Sometimes, just the plain ole thing is better.

[RipVW]

Been using my auto in APAP mode since I got in October, prefer that mode. Most nights the pressure doesn't fluxuate dramatically, but occasionally it will rise to the upper limit to address a more stubborn event. Everyone's comfort preferences are different I guess.

[RosemaryB]

Did you have runaway pressures sometimes? (I got the runaway pressures on apap and they did wake me). Straight pressure or 8.5-9.0 worked best for me.

Did you have lots of flow limitations on the autopap? (These aren't measured on the straight cpap). If so, these might be UARS, an additional reason for a bipap (in addition to your high pressures). Just a thought. I'm not knowledgeable about bipaps, but you can read Dr. Krakow's posts for a better understanding about daytime sleepiness even with a low AHI, particularly at the higher pressures.

I don't use a bipap, but plan to check into it at some point.

I'm assuming you don't have any mouth or mask leaks, but wanted to put the thought there anyway.

[TossinNTurnin]

I can certainly see how some people could be sensitive to the changes that happens with APAP. Everyone is different.

I've been playing with my new APAP, and I'm starting to have a sneaking suspicion that straight CPAP will be best for me, or at least a very narrow range of APAP.

I think that's why it's important to have a machine that will give you as many options as possible. Conditions change, your needs can change.

For instance. I think when I'm worried about life ... I could very well too sensitive to the changes that happen as the APAP adjust to events.

Other times... I'm sleeping steady, and they don't bother me a bit.

But, I'm really new to this, so what the hell do I know. I'm still working things out.

Just putting it out there...

[hades161]

Flow limitations are good and for the past 6 months or so b4 I changed to Cpap mode and a straight 17 I was at 16-20 and peeked at 20 only 2 or 3 times when I first made the change. Other then that I normally stay within the 16-18 range with 17 being my 90% mark. So I doubt I am getting run away pressures. I'll look up UARS, and his post and I am getting a new study done soon so I will ask if a BI-pap would be better for me at my pressures. I have wondered about a Bi-Pap and it was one other the factors that made me go in for a new study. My Swift does get leaky but I have a new one coming soon. At 16 + they seem to wear out fast even with daily cleaning with a non-reactive soap.

[Suz-E-Q]

I am echoing others, it might be valuable to look at BiPAP with that pressure. I am at 14 and have BiPAP (14/11) and it has been successful. I don't think the change from exhale to inhale is enough to wake me (well I do feel soooo much better it must not wake me). You actually get into a rhythmic breathing pattern and if you get M Series it responds to when you change from inhale to exhale, it doesn't make you follow it.

Best of luck with this.