Switched from CPAP to APAP last night.

[Cuda]

One thing I like is don't need the ramp feature anymore. I had a 10cm and ramp can be bothersome when it starts too low anyway, even when adjusted its not as nice as APAP without ramp. With APAP mode (autoset) I set it to 7-12 and noticed it kept the 7 until I fell asleep, even better than ramp! To me 7cm feels natural, lower I feel I need air and my mask feels bad as I mask test leak for the maximum pressure setting, so if pressure is 5cm and I tested for 12cm the mask digs in until I hit pressure.

From looking at my charts my pressure hit the max of 12cm right away and pretty much kept it all night with some ever so slight drops here and there. My AHI went from 10-15 to ONE, yes...ONE. In fact it only recorded one central, one obstructive and a few hypops. I am thinking of changing to 7-14 tonight to view results.

But its nice not to fiddle with the ramp. The place I got the sleep study was only able to test to 9cm as it was a split study and the doc prescribed 10cm CPAP. I received the machine not setup to my prescription and was treated so poorly I came here to take matters into my own hands. Glad I did, I feel MUCH better.

Since I did see some slight dips below 12cm I am thinking I am close.

[brazospearl]

Congratulations, Cuda! Sounds like you're on the right track!

[Muse-Inc]

Great results! I assume you are using the mask fit feature...right? Welcome to the group of us who do better using APAP

[Cuda]

I always use mask fit and have leaks well under control but the mask gets uncomfortable after 4 hours or so. Keeping my face shaved really helps with a full face mask. I have yet to find the balance between not worrying at all about leaks and comfort. Maybe I just need to try some different masks. For testing reasons I have the mask rather snug to eliminate leaks.

As far as pressure I will try 9-14 tonight as last night I stayed at 12cm, the max setting almost all night. 9cm does not feel like much to me now and with EPR at 2 is easy to fall asleep to. My AHI is plummeting to zero so once I know my pressure its a matter of finding a mask thats comfortable for a good 8 hours and then some serious sleep is in my future.

Without cpaptalk.com I would still be suffering and waiting.

[linagee]

I've seen many sleep technicians hate APAPs. (Maybe they are afraid of losing their job?) But I have read about so many cases like this where APAP is used and then you get a lower AHI. (Including myself.) What is easier? Firing your doctor, or finding one that agrees with the most recent APAP vs CPAP studies? (That says APAP is more effective in sample groups.) If you are on APAP and don't see results in your AHI yet, the studies seem to indicate that benefit may come after 3-4 weeks.

[Cuda]

Much lower. Last night I had some strange results but it looks like I pegged 15cm but still had flow restrictions, triggered a few OWA events and woke. Despite not doing as well as the night before my AHI was 3.1.

With straight CPAP it was never under 10.

[jlk]

You are the envy of the newbies. You are doing excellent, don't worry about a night or two that shows a slight climb in your numbers, I bet everyone has them, I do. You are figuring out how to interpret data and adjust to your advantage, you will soon be having zero events on most nights, I hope. You need to try different masks until you find one that you really like. There is a thread here that for $7 you can test a mask for 7 nights, then clean and return to supplier, that may be a good source for you if your dme is not being helpful. Search for "mask free loan program" good luck. john

[Cuda]

Note the APAP screaming for more power. She'll get it too.

[Muse-Inc]

Where's the leak graphic? Add that to see if the leaks might be triggering pressure increases (even runaways) or lead to events...no way to tell unless ya can see 'em all on the same graphic. I have an S8 so don't have all the data the S9 records, but I show leak, events, and pressure...that's all I need to watch for trends and correlations. Not sure if the other S9 data would be helpful at this point in my therapy.

[tschultz]

I've seen many sleep technicians hate APAPs. (Maybe they are afraid of losing their job?) But I have read about so many cases like this where APAP is used and then you get a lower AHI. (Including myself.) What is easier? Firing your doctor, or finding one that agrees with the most recent APAP vs CPAP studies? (That says APAP is more effective in sample groups.) If you are on APAP and don't see results in your AHI yet, the studies seem to indicate that benefit may come after 3-4 weeks.

Could you please provide me with some links to recent studies showing APAP is more effective than CPAP?

I have been looking for such information but continue to dig up older studies that show it to be no more effective than CPAP. These older studies are used by the Ontario government guidelines here in Canada to make getting an APAP more difficult then just CPAP. From what I can see in some of the studies I found their goal was to improve compliance and did not concentrate on the real issue of more effective treatment. I also don't think the studies accounted for tweaks being done based on ongoing data to provide the optimal impacts.

[Emmy1]

These older studies are used by the Ontario government guidelines here in Canada to make getting an APAP more difficult then just CPAP.

I'd like to see this info too, as I'm having the same problem. Can't get APAP even though I was doing much better on it. I was able to tolerate the machine a lot better and I don't think my settings are right yet either. I need something to show the doc to help convince him to APAP is best for me. The problem with funding here is that they'll only fund CPAP, and won't let me pay the difference in price between CPAP and APAP. This doesn't seem fair. If its not going to cost the government more money and I'm willing to pay out of pocket, why can't I have an APAP? I just don't get it.

I'll probably have to buy my own APAP online here, on top of buying the CPAP that the gov will partially fund. This is getting really expensive!

[Hawthorne]

Emmy1 - If you look at auto prices on cpap.com ( or other online suppliers), you will see how much less expensive they are than in Canada. I got my auto that way. They will accept a cpap prescription for an auto.

Cpap.com ship via the Postal Service and that is what you want since, with a courier, you have to pay a brokerage fee. If you shop other than at cpap.com, check out that they will ship it via the Postal Service.

I bought my backup auto on cpapauction.com and, again, had to ensure that the seller would ship via the Postal Service and get a shipping cost up front before I bid at all.

None of the online suppliers nor the auction site are allowed to ship Resmed equipment to Canada. Unless you can get it shipped to someone in the US who will ship it on to you- or have a friend who goes to Florida for the winter and can bring it back for you, you are out of luck for a Resmed online. Other machines can ship to Canada.

[linagee]

I've seen many sleep technicians hate APAPs. (Maybe they are afraid of losing their job?) But I have read about so many cases like this where APAP is used and then you get a lower AHI. (Including myself.) What is easier? Firing your doctor, or finding one that agrees with the most recent APAP vs CPAP studies? (That says APAP is more effective in sample groups.) If you are on APAP and don't see results in your AHI yet, the studies seem to indicate that benefit may come after 3-4 weeks.

Could you please provide me with some links to recent studies showing APAP is more effective than CPAP?

I have been looking for such information but continue to dig up older studies that show it to be no more effective than CPAP. These older studies are used by the Ontario government guidelines here in Canada to make getting an APAP more difficult then just CPAP. From what I can see in some of the studies I found their goal was to improve compliance and did not concentrate on the real issue of more effective treatment. I also don't think the studies accounted for tweaks being done based on ongoing data to provide the optimal impacts.

http://content.karger.com/ProdukteDB/pr ... lNr=100364
"However, taking just the 1st titration night into consideration, we could detect a better sleep quality (higher TST and sleep efficacy) during APAP in comparison to CPAP. Based on the selected study population and considering the cost-effectiveness of nocturnal positive-pressure ventilation, we can conclude that a single-night laboratory study using the APAP mode is more effective than the manually titrated CPAP mode."
" It can be speculated that APAP may contribute to the stabilization of the upper airway under long-term treatment."

Look at Table 2. It shows that APAP titration / APAP group, got more REM sleep on average, a higher sleep efficiency, lower "falling-asleep latency", lower spontaneous arousals, lower average AHI, etc.
Under "Course of the Study". you see the pressure range they used was 4 to 16 cmH2O. (4 is a bit low of a min pressure.) Also, they used a REMstar Auto CPAP. (Respironics is not the best APAP. An APAP review I read shows that ResMed has a better algorithm.)

[LoQ]

Note the APAP screaming for more power. She'll get it too.

The graphs you showed in this post are not really compelling. Check out your minute ventilation. It was wildly oscillating all night for the CPAP graph, yet only at the end for the APAP graph. If you had had the same kind of night on APAP, your AHI on APAP would have been higher, too. Possibly not as high as on CPAP, but almost surely higher than the one APAP graph you show.

The real test is over many nights, does the APAP stay consistently lower than when you were doing CPAP, how is your oxygen, and how do you feel?

[Cuda]

The pressure keeps maxing out and last night AHI was its highest under APAP at 5 which is still less than half of anything on CPAP. Of course CPAP may produce much lower AHI numbers by simply being turned up to be closer to APAPs maximum. Something like 15cm and use ramp.

I never said these graphs were scientific, I am mostly going by how I feel. EPR was also at a different setting which could be a big deal, I will try a night with similar EPR settings. Or maybe straight CPAP at a higher setting.

Still messing with the settings until I have another doctor Jan 10th. Until then I am on my own.