CPAP vs. APAP

[BlowingWithTheWind]

So I had my one month visit today. Everything is going well. AHI hovers in the 2's. My machine is running in CPAP mode fixed at 10. Asked my MD if he thinks it would be a good idea to change to APAP mode to get the AHI down a bit. He said in most cases, he is very much against APAP unless absolutely needed. Since I am tolerating the pressure without issues, he feels moving it to APAP mode will just have me chasing events all night. His discription of how the APAP works seems to make sense.

That seems to go against the prevailing thought here on this board. Your thoughts?

[Julie]

The thing is that Apap machines can almost always be run in Cpap mode if you want them to, but the reverse is not true, and having the option of switching whenever you want, even if only to experiment at certain times, puts you way ahead. Some people will do better and be happier in just Cpap mode, but the majority probably do well on Apap and have greater control over more detail in their treatment.

[LSAT]

I agree with your doctor...at one month if you are sleeping well and your AHI is under 5...leave your setting alone!!!

[bwexler]

Doe he still hand crank his black Ford?
Does he still use the rotary nob to tune his TV?
Is his name Ward Cleaver?

How did you get an APAP from this doctor, and which one do you have?

I would look at my charts in SleapyHead or ?? And see what type of events I was experiencing.
If they are when you first go to sleep or when you are waking up, they are different from those scattered or clustered throughout the night.
After I reviewed the charts I might consider a range of 8-12 to see how the machine reacted, then adjust from there depending on what I saw in the charts.

[LSAT]

Doe he still hand crank his black Ford?
Does he still use the rotary nob to tune his TV?
Is his name Ward Cleaver?

How did you get an APAP from this doctor, and which one do you have?

I would look at my charts in SleapyHead or ?? And see what type of events I was experiencing.
If they are when you first go to sleep or when you are waking up, they are different from those scattered or clustered throughout the night.
After I reviewed the charts I might consider a range of 8-12 to see how the machine reacted, then adjust from there depending on what I saw in the charts.

His S9 autoset is shown in his profile...he says everything is going well.....Your post makes no sense.

[Wulfman...]

So I had my one month visit today. Everything is going well. AHI hovers in the 2's. My machine is running in CPAP mode fixed at 10. Asked my MD if he thinks it would be a good idea to change to APAP mode to get the AHI down a bit. He said in most cases, he is very much against APAP unless absolutely needed. Since I am tolerating the pressure without issues, he feels moving it to APAP mode will just have me chasing events all night. His discription of how the APAP works seems to make sense.

That seems to go against the prevailing thought here on this board. Your thoughts?

Well, the APAP (in a range of pressures) WILL chase events all night......that's what they do. Then, you will most likely wake up frequently and go through the day feeling unrested. Not all of the events they chase are worthy of chasing. They increase pressures on Flow Limitations and Snores. Neither of which are ALWAYS predecessors to Apneas and the pressure increases may bump the user out of their needed sleep stage.

Just because a person has an APAP doesn't mean they have to run it in a range of pressures all the time. They were originally designed to help "titrate" people who didn't do well in a full-blown sleep study. From the downloaded data, the sleep professionals were (usually) able to come up with a titrated single pressure. Somewhere along the way, they were sold as being able to allow people to be more compliant. It works for some but not all. It's important to be able to decide which mode works for the user. So, while HAVING an APAP is desirable, it's also important to be able to figure out what works best for them.

At this point in your therapy, you need GOOD, SOUND SLEEP. If you're sleeping pretty well, leave it where it's at. If you're monitoring your therapy with software (and you should be), that's great.


Den

.

[robysue]

So I had my one month visit today. Everything is going well. AHI hovers in the 2's. My machine is running in CPAP mode fixed at 10.

And how are you feeling? If you feel as though you're getting a good night's sleep and you've got the energy to do what you need and want to do in the daytime, I'd say leave things alone: If it's not broke, don't fix it.

Yes, a lot of people on the board use Auto ranges. (And I'm one of them.) But there are a lot of people who don't. My hubby is uses a fixed pressure of 8cm on his APAP. He's sleeping well and his AHI is better than mine. So why change things?

I'm using an Auto range because I could NOT tolerate my titrated pressures. On BiPAP, my titrated pressure is 8/6, but if I use that all night long, I wake up with miserable aerophagia and my sleep is even worse. (But my AHI was better back when I used fixed pressure at 8/6.) So I use an Auto range as a way of providing relief for my stomach so that I can sleep better (but I don't sleep as soundly as hubby) while also having the machine increase the pressure to 8/6 when I really need that much pressure.

If I could tolerate 8/6 all night without the aerophagia, I'd switch back to fixed pressure BiPAP.

[hyperlexis]

Does the S9 have a 'split night' setting? That may be one way to help determine which may give you better results, aside from just doing several days/weeks on apap and compare to time on straight cpap. Otherwise your clinician is correct to an extent. APAP, especially on a PR, will hunt upward to test if it improves airflow. That can cause arousals and less restful sleep.

[bwexler]

I was referring to the doctor not the OP.
I too may be old fashioned but I think APAP mode can serve many of us well even if only for a longer self titration study of a week or two to verify the one night titration.

Doe he still hand crank his black Ford?
Does he still use the rotary nob to tune his TV?
Is his name Ward Cleaver?

How did you get an APAP from this doctor, and which one do you have?

I would look at my charts in SleapyHead or ?? And see what type of events I was experiencing.
If they are when you first go to sleep or when you are waking up, they are different from those scattered or clustered throughout the night.
After I reviewed the charts I might consider a range of 8-12 to see how the machine reacted, then adjust from there depending on what I saw in the charts.

His S9 autoset is shown in his profile...he says everything is going well.....Your post makes no sense.

[Drowsy Dancer]

I see that no one else has mentioned yet that if you take your PR System One APAP and set the maximum and minimum range to the same number, your machine will give you a little more data than it would otherwise--you get flow limitations and your RDI.

So I will.

This may or may not be of value to you as a sleep geek.

[flyingwithoutwings]

I for one have been doing so much better since I switched from APAP to CPAP and sleeping straight thru the night, which wasn't happening on APAP. I even had an AHI of .30 night before last.

[Pugsy]

I see that no one else has mentioned yet that if you take your PR System One APAP and set the maximum and minimum range to the same number, your machine will give you a little more data than it would otherwise--you get flow limitations and your RDI.

So I will.

This may or may not be of value to you as a sleep geek.

OP has a S9 machine...the data gathered doesn't change with it like it does with the PR S1 machines. There's no advantage data wise with apap vs cpap. The S9 still reports it's crappy little Flow limitation graph in cpap mode just like it does in APAP mode.

Does the S9 have a 'split night' setting?

Resmed machines don't have the split night setting available that Respironics APAP machines have.

And how are you feeling? If you feel as though you're getting a good night's sleep and you've got the energy to do what you need and want to do in the daytime, I'd say leave things alone: If it's not broke, don't fix it.

And I agree with Robysue...if it ain't broke there's no need to fix it.
Just because we have apap mode available doesn't mean that the best therapy in the whole world is going to happen if we use it....and doesn't mean that cpap mode is sub optimal.

APAP mode can benefit some people...I am one of those who saw rather high pressure needs for short periods of the night (most likely REM sleep where my OSA is worse) and it was much nicer using 10 to 11 for most of the night and letting the machine go to 18 for 15 minutes here or there as needed. The pressure changes never bothered me. Slept right through them and never knew they happened until I would see the software report. Other people find that the least little pressure change can disturb sleep.

If a mode is working well...there's no urgent need to change the mode (cpap or apap) right away just because we can. For newbies...if things are working well...sleeping great...feeling decent...don't get in a rush to fix something that doesn't need fixing right now. Maybe experiment later when you have a better understanding of your body and the software and what you expect to see with any changes you make.