Why return to CPAP from auto-CPAP?

[Guest]

Hello,
I am still new to CPAP therapy and am looking for feedback on my sleep doc's advice that I turn in my rented Remstar Auto-CPAP with C-flex and return to using a regular CPAP (Remstar-M with A-flex). She advises that the regular CPAP remains the gold standard and that the steady pressure will over time be better in helping me to achieve a steady, low AHI.

My concern is that I already used the Remstar-Pro with A-flex, for about 8 months two years ago, and while I got some relief, with AHI's down to 5-7, I never felt rested nor comfortable and gave it up for good during a prolonged illness. The pressure was set to 8 after a difficult and inconclusive titration and perhaps was not high enough. Now, one-year later, I determined to succeed with the CPAP. Fortunately, I also learned about the auto-CPAP, which I rented and have used for the past 2 months. It became comfortable quickly, with respect to breathing naturally, and I sleep well with it. I set the max pressure initially at 12, lowered to 9.0, then raised to 9.5 - although the 90% level seems always to be 9.0 or 8.9. My AHI levels have steadily declined over 8 weeks to about 2-3, with an occasional spike to 8 or drop to .5.

The doc said that now that I have determined an effective pressure, of 9, I should now shift back to the regular CPAP. I can always go back to an auto-CPAP if the reg. CPAP is not effective or comfortable. She said auto-CPAPs are really best used for titration, not for long-term use. I just hate to see the progress I have finally made get undone. Is she right? I would greatly appreciate the views of this forum on auto versus regular CPAP for the long-term.

[RipVW]

Hmm. Some folks here prefer straight CPAP, others prefer APAP (me). I think it is really a matter of comfort and results (which setting is most comfortable, provides the best uninterrupted sleep, and results in the lowest AHI). I'm sure some of our wise old timers will jump in here with some advice as well. Good luck!

[JimW]

Sooner or later someone's going to say, "Your APAP can be configured to run as a CPAP." Or something like that. With the APAP as an option, you can always open up the pressure range again, should a given fixed pressure no longer prove to be adequate.

I've been running APAP for 2 1/4 years now, with AHI varying between 0.4 and 2.4 for most nights. Some time I might consider going to CPAP mode, but I'm not in a hurry in that regard.

[SleepyNoMore]

Welcome,

Well, with your AHI being lower on the Auto (almost half) of what it is on the Pro, I would keep the Auto, not to mentiom you sleep much better.

I titrated with the Pro for the first few weeks and had to use the auto for the remaining 2 weeks, the Pro made my lungs & back hurt, the auto put a stop to all of that and i've been on therapy since Sept. 2007. I would NEVER use the Pro, I just can't take the same constant level of pressure but like RIP said, to each his own. I set my auto on 6.5 to 15.5 so that I always have what I need when I need it, my AHI goes no higher that 2.2, averages around 1.2 to 1.8. I find the auto to be the very best on the market, I would not give mine back for nothing, fight them if your comfortable with the auto by all means stand up for your rights and let them know that you sleep better with it and that your AHI is much lower.

Goodluck & keep us posted!

SleepyNoMore

[Wulfman]

Hello,
I am still new to CPAP therapy and am looking for feedback on my sleep doc's advice that I turn in my rented Remstar Auto-CPAP with C-flex and return to using a regular CPAP (Remstar-M with A-flex). She advises that the regular CPAP remains the gold standard and that the steady pressure will over time be better in helping me to achieve a steady, low AHI.

My concern is that I already used the Remstar-Pro with A-flex, for about 8 months two years ago, and while I got some relief, with AHI's down to 5-7, I never felt rested nor comfortable and gave it up for good during a prolonged illness. The pressure was set to 8 after a difficult and inconclusive titration and perhaps was not high enough. Now, one-year later, I determined to succeed with the CPAP. Fortunately, I also learned about the auto-CPAP, which I rented and have used for the past 2 months. It became comfortable quickly, with respect to breathing naturally, and I sleep well with it. I set the max pressure initially at 12, lowered to 9.0, then raised to 9.5 - although the 90% level seems always to be 9.0 or 8.9. My AHI levels have steadily declined over 8 weeks to about 2-3, with an occasional spike to 8 or drop to .5.

The doc said that now that I have determined an effective pressure, of 9, I should now shift back to the regular CPAP. I can always go back to an auto-CPAP if the reg. CPAP is not effective or comfortable. She said auto-CPAPs are really best used for titration, not for long-term use. I just hate to see the progress I have finally made get undone. Is she right? I would greatly appreciate the views of this forum on auto versus regular CPAP for the long-term.

For the record, the M Series Pro doesn't have A-Flex. It has C-Flex. A-Flex is only available in one model of the Auto.

Nothing wrong with having an Auto.....I have several.....but use them all in single-pressure (CPAP) mode. I found that the changing pressures disturb my sleep and I get lower AHI numbers with straight pressure. Autos can only respond to an event and they raise pressures rather slowly.....thereby allowing too many events to happen before the pressure can get to where it can be beneficial. In the case of an Auto being set to the default range of 4 - 20, she's absolutely correct. As you've found out, the minimum pressure needs to be high enough to take care of almost all events.

She's right that CPAP is the "gold standard". BUT, an Auto/APAP is STILL a CPAP.....so, in that respect, her statement still encompasses the Autos.


Den

[JeffH]

What Den said.

I used straight CPAP for eight years. Had to have and auto and tried to make it work for seven months. Some of the more miserable nights I've spent in a long time. The end of July last year I set my auto in cpap mode and on my Rx'ed pressure. Been sleeping pretty good ever since. The pressure varying drove me nuts,

This is just my experience...FWIW.


JeffH

[GumbyCT]

Hello,
I am still new to CPAP therapy and am looking for feedback on my sleep doc's advice that I turn in my rented Remstar Auto-CPAP with C-flex and return to using a regular CPAP (Remstar-M with A-flex). She advises that the regular CPAP remains the gold standard and that the steady pressure will over time be better in helping me to achieve a steady, low AHI.

My concern is that I already used the Remstar-Pro with A-flex, for about 8 months two years ago, and while I got some relief, with AHI's down to 5-7, I never felt rested nor comfortable and gave it up for good during a prolonged illness. The pressure was set to 8 after a difficult and inconclusive titration and perhaps was not high enough. Now, one-year later, I determined to succeed with the CPAP. Fortunately, I also learned about the auto-CPAP, which I rented and have used for the past 2 months. It became comfortable quickly, with respect to breathing naturally, and I sleep well with it. I set the max pressure initially at 12, lowered to 9.0, then raised to 9.5 - although the 90% level seems always to be 9.0 or 8.9. My AHI levels have steadily declined over 8 weeks to about 2-3, with an occasional spike to 8 or drop to .5.

The doc said that now that I have determined an effective pressure, of 9, I should now shift back to the regular CPAP. I can always go back to an auto-CPAP if the reg. CPAP is not effective or comfortable. She said auto-CPAPs are really best used for titration, not for long-term use. I just hate to see the progress I have finally made get undone. Is she right? I would greatly appreciate the views of this forum on auto versus regular CPAP for the long-term.

Aflex is a much better machine - tell her you will set it to CPAP if that will please her. You sure can't set a CPAP to auto. Who knows what motivates this woman but I bet it is money. Is she some how connected to the DME?

I would find another sleep doc either way.

[Goofproof]

One the "M"eries APAP is the only one that has A-Flex, It would be the Gold Standard, because it offers more options than CPAP. So I guess I would be calling The CPAP the Silver Standard, as long as it used software and full data and had some form of exhale relief, which all, Do not have. Jim

Treatment for some is more stable on CPAP, some don't like a pressure change, mostly it's a matter of taste, but if you don't have a APAP, you don't have the option PERIOD.

[ozij]

Everything Den said, except for:

Autos can only respond to an event and they raise pressures rather slowly.....

Some companies' autos raise the pressure sooner and faster than Respironics. And while all Autos attempt to pre-empt events, how will they manage to do it depends very much on a person's breathing pattern. But that theoretical point doesn't change the fact that too wide a range, or any pressure change, may bother some people.

If you're renting an Auto and like it, you can buy any automatic machine you want from CPAP.com with your original cpap prescription - you do not need Auto Rx to buy an Auto online, CPAP on the Rx is enough. Check out the prices and do some comparison shopping, buying online frequently turns out cheaper than getting it from your DME through insurance.

And you will find that some insurance companies will reimburse you for buying the machine online, escpecially if you write to show them the incredible money they will save if they let you do it.
O.

[nobody]

I tried the straight cpap and I prefer to have a bit of a range so I went back to APAP. It's fine to use long term. I think for some people the pressure changes wake them up.

[kebsa]

I don't know enough about CPap and Apap to make a logical argument either way but it seems to me if you are getting better results with the auto and it feels better too, i would want to stick to that. I have read that some DME will push the straight CPAP as it gives them a better profit margin, you do wonder if the physician has some kind of axe to grind given your results. I may not know much about cpap therapy yet but as an RN with nearly 30 years experience (god, that makes me feel old) i know that Dr's are no different to the rest of the population, they do her personal preferances that do not always have any real evidence to back them up

just the thoughts of a newbie
karen

[Guest]

Thanks so much to everyone for sharing your opinions and experience, which helps me a lot in evaluating the doc's advice.

[Pineapple]

For the record I own an m-series Auto and run it as a CPAP. I did not tolorate the Auto mode well. But that said, I would never return my Auto for a lesser modle (AKA the Pro). The reason being very simple. Insurance only pays fro a new CPAP every 5 years - that's a long time, things can change in that time. Some time in the future I may need some of those Auto features, which would mean going out and purchasing a better machine (out of pocket if I can't get the insurance to pay for it)

It your case, if your more comfortable with the Auto mode, keep it. Successful threapy is the goal that matters.

[elader]

I hated aflex and when I swithced to apap, I gradually narrowed my window till I am back to essentially cflex - 10-12cM. I just couldnt take the runaway pressure changes with a broad range.

[KengEsq]

Thanks so much to everyone for sharing your opinions and experience, which helps me a lot in evaluating the doc's advice.

Like everything related to OSA, what works for one does not work for all and certainly what works well for you is better than what did not work well for you and cause you to discontinue treatment.
I used a CPAP (ResMed S8 Elite II) and could not get my numbers to anything near 5.0 or lower. I switched to an APAP (ResMed S8 AutoSet II) recently and I have very low numbers, good and uniterrupted sleep and feel much better. So for me the APAP works much better. My CPAP was set at 8 cm H2O. My APAP is set from 6 to 17 and my 95% pressure with the APAP is between 12 and 16 (95% means equal to or less that the maximum pressure during sleep) so I expect my CPAP was set too low. However, once I get my card reader and ResScan software (should arrive today or tomorrow) I will be able to see what pressure is being provided throughout the night and I expect that for most of the night my pressure is less than 8.
Good luck. By the way, APAP is an accepted alternative treatment to CPAP to fit the needs of the patient. You should tell your doctor about your experiences with CPAP compared with APAP to see if your doctor changes his or her mind. I know my DME provided told my primary care doctor that APAP was not for treatment but only used for diagnosis. However, when I saw my sleep doctor, he thought the APAP would provide better treatment for me and changed my prescription to the ResMed S8 AutoSet II and I love it.