How long on Auto CPAP
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Guest-IllinoisRRT
How long on Auto CPAP
I know that most of you are big Auto PAP fans. However, I have very few patients who are actually on it. While I understand the point and how it works, I have heard (I don't think it was through here) that it is a mode that you should not be on indefinitely. Rather, once a patient has been on Auto CPAP for a while, they should be able to find their optimum pressure. Now, I saw a patient today who has been on AutoPAP for 5 years, and his settings are 4-20. Is it typical for someone to be on such a large range of settings for such a long period of time? He is starting to have trouble now and will probably need another sleep study anyway, but I wanted to be able to give him some more information. Thanks!
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
What kind of trouble is he starting to have?
How long has he been having "trouble"?
Has he ever felt "good" during his past 5 years of autopap use?
Has anyone downloaded the data from his smart card - ever?
How many times has the smart card been downloaded over the past five years?
When was the most recent download anyone has done, and what did they see in his past five nights of data ...not the over all "trend", but his last several individual nights?
Just curious.
How long has he been having "trouble"?
Has he ever felt "good" during his past 5 years of autopap use?
Has anyone downloaded the data from his smart card - ever?
How many times has the smart card been downloaded over the past five years?
When was the most recent download anyone has done, and what did they see in his past five nights of data ...not the over all "trend", but his last several individual nights?
Just curious.
Optimum pressure for what?
The outside barometric pressure goes up and down all the time. The
pressure needed to keep an airway open may depend if I am sleeping
on my side versus on my back. It may depend on the position of my
head and neck, and also on how congested my sinuses are. So why
put someone on CPAP and torture them at one pressure, when they
can enjoy a customized pressure for all the different combinations
which they get into during each night? I would like to see all CPAPs
outlawed immediately as unusually cruel. Just buy and APAP and set
the low and high pressure range to be the same, if you don't think
your pressure needs are different when sleeping on your back versus
your side versus your tummy. If we all switched to Autos, the price
would drop dramatically, and the vendors could concentrate on getting
some better features built into their units.
pressure needed to keep an airway open may depend if I am sleeping
on my side versus on my back. It may depend on the position of my
head and neck, and also on how congested my sinuses are. So why
put someone on CPAP and torture them at one pressure, when they
can enjoy a customized pressure for all the different combinations
which they get into during each night? I would like to see all CPAPs
outlawed immediately as unusually cruel. Just buy and APAP and set
the low and high pressure range to be the same, if you don't think
your pressure needs are different when sleeping on your back versus
your side versus your tummy. If we all switched to Autos, the price
would drop dramatically, and the vendors could concentrate on getting
some better features built into their units.
I've been on auto for 3 years. I don't understand the logic of your arguement. While 4-20 may work for some most of us do a better job of tweaking our machines to get optimum results. My Titration was 11cm 3 years ago. My mean pressure is 5.5 to 6.5 depending on my allergies. I presently have the minimum set at 6 and the high 13.
Many raise their lower pressure to prevent snores and hypopnias. Everyone is different. Thats the plus of an auto. If I sleep on my back it adjusts . Side , it compensates for that also. Breath by breath.
Many would say thay they have a titration every night because they are using an auto unit !
A sleep study is fine for the initial diagnosis but for retitration. WHy? I'm on an auto.
You didn't mention any other problems your patient may have or the Auto unit he is using. Has he gained weight.? Is it a modern unit or old and crusty ? (the cpap not the patient).
Others may offer a different opinion.
Cheers,
Chris
Many raise their lower pressure to prevent snores and hypopnias. Everyone is different. Thats the plus of an auto. If I sleep on my back it adjusts . Side , it compensates for that also. Breath by breath.
Many would say thay they have a titration every night because they are using an auto unit !
A sleep study is fine for the initial diagnosis but for retitration. WHy? I'm on an auto.
You didn't mention any other problems your patient may have or the Auto unit he is using. Has he gained weight.? Is it a modern unit or old and crusty ? (the cpap not the patient).
Others may offer a different opinion.
Cheers,
Chris
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
oooh, good point, chrisp - yes, what brand/model autopap is that five year old auto the man has been using?
Heated humidifier, or not?
What mask?
Does he consider the mask comfortable?
Does he leak treatment air out of his mouth?
In his sleep study, were his apneas mostly obstructives and/or hypopneas. Did he have any/many central apneas?
Any other sleep disorders other than OSA?
Any new health problems other than OSA?
In my previous post, I was asking about downloads from a smart card. But he may be using a different brand of autopap - not Respironics - so, regardless of how downloads are done from his machine, the questions about "how many downloads" and "when was the last one" still stand.
Could be a lot of reasons why he's having trouble now, other than the machine itself.
Heated humidifier, or not?
What mask?
Does he consider the mask comfortable?
Does he leak treatment air out of his mouth?
In his sleep study, were his apneas mostly obstructives and/or hypopneas. Did he have any/many central apneas?
Any other sleep disorders other than OSA?
Any new health problems other than OSA?
In my previous post, I was asking about downloads from a smart card. But he may be using a different brand of autopap - not Respironics - so, regardless of how downloads are done from his machine, the questions about "how many downloads" and "when was the last one" still stand.
Could be a lot of reasons why he's having trouble now, other than the machine itself.
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wading thru the muck!
- Posts: 2799
- Joined: Tue Oct 19, 2004 11:42 am
Christine,
The statement you quote regarding only using an auto for a short time sounds eerily just like the standard statement offered by the Respironics Rep I talked to. That rationale is how they currently market the Auto machine, IMO, to justify use of the Auto to their "customer" the DME/Sleep Docs. Unfortunately this does not take into account the best interest of their "customer" the apap user. We have stated the benefits of the apap many times here but for the sake of the discussion I will offer them again.
1.) Many problems associated with tolerating the use of cpap are related to pressure. The more pressure, the harder it is to adjust and the more likely that mask leaks and aerophasia will occur. Because the apap stays at a minimum pressure until need to resolve an obstructive event, the resulting mean pressure is lower. The figure I've heard quoted is 30% lower. If you have 30% less pressure, you are 30% less likely to have these problems.
2.) The pressure determined in a two night or split night PSG is just a "snap shot" of a person's sleep profile. Many factors can make the pressure requirements of a patient vary from night to night, in fact from minute to minute. The apap has the ability to account for these variations. No other machine can do this.
My final point has been addressed before on the forum and touched upon above, but I will repeat it here. In the current world of the local DME, the pice charged for equipment is not based relative to the cost. Since there is not seperate billing code for the apap, DMEs can get paid just as much for the basic cpap as they do for an apap. The "evil" ones take advantage of this and offer only standard cpaps to maximize profits at the cost of better treatment for their patients.
The statement you quote regarding only using an auto for a short time sounds eerily just like the standard statement offered by the Respironics Rep I talked to. That rationale is how they currently market the Auto machine, IMO, to justify use of the Auto to their "customer" the DME/Sleep Docs. Unfortunately this does not take into account the best interest of their "customer" the apap user. We have stated the benefits of the apap many times here but for the sake of the discussion I will offer them again.
1.) Many problems associated with tolerating the use of cpap are related to pressure. The more pressure, the harder it is to adjust and the more likely that mask leaks and aerophasia will occur. Because the apap stays at a minimum pressure until need to resolve an obstructive event, the resulting mean pressure is lower. The figure I've heard quoted is 30% lower. If you have 30% less pressure, you are 30% less likely to have these problems.
2.) The pressure determined in a two night or split night PSG is just a "snap shot" of a person's sleep profile. Many factors can make the pressure requirements of a patient vary from night to night, in fact from minute to minute. The apap has the ability to account for these variations. No other machine can do this.
My final point has been addressed before on the forum and touched upon above, but I will repeat it here. In the current world of the local DME, the pice charged for equipment is not based relative to the cost. Since there is not seperate billing code for the apap, DMEs can get paid just as much for the basic cpap as they do for an apap. The "evil" ones take advantage of this and offer only standard cpaps to maximize profits at the cost of better treatment for their patients.
Sincerely,
wading thru the muck of the sleep study/DME/Insurance money pit!
wading thru the muck of the sleep study/DME/Insurance money pit!
Re: How long on Auto CPAP
ARE YOU SERIOUS? Answer this question then, WHY DO THE MANUFACTURERS WHO SUPPORT DME"S ALL OVER THE WORLD, make AUTOPAPS...........CASE CLOSED.
Can't we ever convince someone, guess not.....oh well.
Can't we ever convince someone, guess not.....oh well.
Guest-IllinoisRRT wrote:I know that most of you are big Auto PAP fans. However, I have very few patients who are actually on it. While I understand the point and how it works, I have heard (I don't think it was through here) that it is a mode that you should not be on indefinitely. Rather, once a patient has been on Auto CPAP for a while, they should be able to find their optimum pressure. Now, I saw a patient today who has been on AutoPAP for 5 years, and his settings are 4-20. Is it typical for someone to be on such a large range of settings for such a long period of time? He is starting to have trouble now and will probably need another sleep study anyway, but I wanted to be able to give him some more information. Thanks!
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Zees Pleez
- Posts: 77
- Joined: Tue Mar 01, 2005 9:08 pm
on wide open APAP temporarily
I am on the 4-20 setting right now. It was to gather more info before deciding to set the pressure as indicated by sleep study or vary it. The suggestion coming backis to vary it. It turns out that I occasionally need 13, spend most of the time at around 7, but would need at least 9 (sleep study said 10) if it didn't vary. Based on this, my doc is planning to order an auto with a narrower range like 6-14 and then have my card read every few months. All that setting that range will do is keep some oddball event from spiking it too far and make the changes less abrupt when the apnea first occurs. At 4, there is some noise when I inhale. At higher pressures there isn't. That is because I use a cannula and at 4 I am "outrunning" it when I take a deep breath and the outlets are designed to be silent when air is going out, but make a slight noise when it comes in. So I am looking forward to starting it a little higher. But that is the only "trouble" I have encountered.
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
Hi Zees Pleez (great nickname, btw!)
Sounds like you have a very good doctor that understands what autopaps can do. I'm not a doctor, but I really like the range he intends to set for you, and his reasons for that range. You are very, very lucky to have come across that doctor. Hang on to him!!
Hope all goes well for you.
Sounds like you have a very good doctor that understands what autopaps can do. I'm not a doctor, but I really like the range he intends to set for you, and his reasons for that range. You are very, very lucky to have come across that doctor. Hang on to him!!
Hope all goes well for you.
Though Autopap's where initiallly used for diagnostic purposes, there has been research that clearly states that using an autopap for an extended amount of time is not a problem.
People who are gaining and losing weight can greatly benefit from using an autopap, due to the fact that a 10% shift in weight can make a change in optimal pressure.
People who suffer allergies and at times become congested. The machine will follow them and give them the perfect amount of pressure when needed.
I feel that autopap's have been largly missunderstood by many in the medical world. As technology marches on, improvements will be made and the fixed pressure machine will eventually become a dinosaur. Just my opinion
Titrator
People who are gaining and losing weight can greatly benefit from using an autopap, due to the fact that a 10% shift in weight can make a change in optimal pressure.
People who suffer allergies and at times become congested. The machine will follow them and give them the perfect amount of pressure when needed.
I feel that autopap's have been largly missunderstood by many in the medical world. As technology marches on, improvements will be made and the fixed pressure machine will eventually become a dinosaur. Just my opinion
Titrator
CPAP vs. autopap
IllinoisRRT,
I was on straight cpap for 1 and 1/2 years. My titrated pressure during my sleep study was 16, so that is what I was on. I questioned it at the time, as I had gotten a copy of my report, and it seemed to show the most improvement between 10-12. At 12, I only had 8 hypopneas and no apneas per hour, but the sleep technician felt that a pressure of 16 was necessary to get me below 5 hypopneas, which is what they were aiming for. I felt somewhat better initially on cpap, but then reached a stage where I still needed naps 3-4 days a week, still had little extra energy, etc. Sometimes it was a bit better, sometimes a bit worse. Finally got a doc to listen to me and look at the sleep results (my pulminary doc - I've had asthma all my life). Since he knew that too HIGH a pressure can actually be worse for asthma, and cause nocturnal asthma attacks, he agreed to the autopap trial that I wanted to do. I got my autopap (RemStar auto w/c-flex) and started tracking. We initially set it at 10-16. I spent 90% of the night under 12, and went up to 14 only a couple of times a night. In a month of tracking, I only hit 15 twice. We tried a couple of other settings for a couple of nights (6 was much too low, many snores and felt miserable the next morning) and have settled on 9-15 for now. I have to keep checking on a regualar basis, and let him know if there are any major changes. For instance, if I start running into allergy problems over the summer, we might have to change the settings. My sleep study was done in the summer, which might be one reason why they had my pressure so high. Anyway, I'm feeling much better, and have almost completely eliminated naps (tried to get one in Sunday, because well, it was Sunday, and really couldn't sleep, then got about half an hour, and was up late Sunday night because I wasn't tired.)
So, you could say that now I could go back on straight cpap set at 12, but that still won't tell what I'm going to need in the summer or what I'm going to need when I go camping, or visiting relatives or anything or anyplace else other than my bedroom in the winter. And I've shown that too much pressure is not good for me.
So I'll stay with the autopap from now on. I have the software and I'll check it regularly. And if anything major changes, I'll call my doctor.
For me, it's autopap all the time from now on.
Debbie
I was on straight cpap for 1 and 1/2 years. My titrated pressure during my sleep study was 16, so that is what I was on. I questioned it at the time, as I had gotten a copy of my report, and it seemed to show the most improvement between 10-12. At 12, I only had 8 hypopneas and no apneas per hour, but the sleep technician felt that a pressure of 16 was necessary to get me below 5 hypopneas, which is what they were aiming for. I felt somewhat better initially on cpap, but then reached a stage where I still needed naps 3-4 days a week, still had little extra energy, etc. Sometimes it was a bit better, sometimes a bit worse. Finally got a doc to listen to me and look at the sleep results (my pulminary doc - I've had asthma all my life). Since he knew that too HIGH a pressure can actually be worse for asthma, and cause nocturnal asthma attacks, he agreed to the autopap trial that I wanted to do. I got my autopap (RemStar auto w/c-flex) and started tracking. We initially set it at 10-16. I spent 90% of the night under 12, and went up to 14 only a couple of times a night. In a month of tracking, I only hit 15 twice. We tried a couple of other settings for a couple of nights (6 was much too low, many snores and felt miserable the next morning) and have settled on 9-15 for now. I have to keep checking on a regualar basis, and let him know if there are any major changes. For instance, if I start running into allergy problems over the summer, we might have to change the settings. My sleep study was done in the summer, which might be one reason why they had my pressure so high. Anyway, I'm feeling much better, and have almost completely eliminated naps (tried to get one in Sunday, because well, it was Sunday, and really couldn't sleep, then got about half an hour, and was up late Sunday night because I wasn't tired.)
So, you could say that now I could go back on straight cpap set at 12, but that still won't tell what I'm going to need in the summer or what I'm going to need when I go camping, or visiting relatives or anything or anyplace else other than my bedroom in the winter. And I've shown that too much pressure is not good for me.
So I'll stay with the autopap from now on. I have the software and I'll check it regularly. And if anything major changes, I'll call my doctor.
For me, it's autopap all the time from now on.
Debbie
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Guest
Re: How long on Auto CPAP
[quote="gailzee"]ARE YOU SERIOUS? Answer this question then, WHY DO THE MANUFACTURERS WHO SUPPORT DME"S ALL OVER THE WORLD, make AUTOPAPS...........CASE CLOSED.
Can't we ever convince someone, guess not.....oh well.
Christine RRT here...
Gailzee, are you referring to my post or someone else's? There is no need to "yell", although your attitude is generally against me regardless of what I say to defend myself. I came to this board to learn more and find that I am constantly defending, defending, defending. Your remark above about not being able to convince someone...yeah, well, it's hard to learn anything from someone who is constantly yelling at you and acting like you're an uneducated idiot. I am telling you all that in my area with the sleep docs that see my patients, I very rarely see an order for auto-pap. I don't know much about it. Obviously, it's very favored among members of this board. That's fine. And most people here are very gracious and helpful. And not to underestimate my patients, but most of them are not nearly as proactive about their health as you all seem to be. The majority of them don't even know their settings. So my opportunity to learn from them is usually minimal. Which is why I'm here. But since I don't see these people until after they've had an order from the doctor, and I have no contact with the physicians myself, pushing for an auto-PAP once I've seen the patient is usually going to be futile. I just asked a simple question about an existing patient. Thank you to all who have given constructive advice- I'm waiting to hear back from the doctor.
Can't we ever convince someone, guess not.....oh well.
Christine RRT here...
Gailzee, are you referring to my post or someone else's? There is no need to "yell", although your attitude is generally against me regardless of what I say to defend myself. I came to this board to learn more and find that I am constantly defending, defending, defending. Your remark above about not being able to convince someone...yeah, well, it's hard to learn anything from someone who is constantly yelling at you and acting like you're an uneducated idiot. I am telling you all that in my area with the sleep docs that see my patients, I very rarely see an order for auto-pap. I don't know much about it. Obviously, it's very favored among members of this board. That's fine. And most people here are very gracious and helpful. And not to underestimate my patients, but most of them are not nearly as proactive about their health as you all seem to be. The majority of them don't even know their settings. So my opportunity to learn from them is usually minimal. Which is why I'm here. But since I don't see these people until after they've had an order from the doctor, and I have no contact with the physicians myself, pushing for an auto-PAP once I've seen the patient is usually going to be futile. I just asked a simple question about an existing patient. Thank you to all who have given constructive advice- I'm waiting to hear back from the doctor.
Hi Christine,
You are more than welcome here. As you can see, this is a pro-autopap crowd. The autopapers are on the virge of starting their own political action commitee. lol.. Sorry had to throw that one in.
Everyone is welcome here. I can see we have rather spirited debates about equipment and treatment. At least people are talking about it. That is the key.
When working as a sleep tech, I can honestly say that the majority of my patients did not care about learning or the technology behind the treatment. The people of this forum should be admired for that.
But you should be admired too. You work an honest job and you try to help people as much as possible. Just you comming to visit and interact is very positive and is an admirable position to take.
It is very easy to criticize the local DME. I think price has quite a bit to do with it. That is something that is out of yours, mine and everyone elses scope of responisibility.
I am sure that knowone here means ill will toward you. I just think that being compliant is hard. Being understood or listened to means a lot to people who suffer from any illness.
Regards,
Ted/Titrator
You are more than welcome here. As you can see, this is a pro-autopap crowd. The autopapers are on the virge of starting their own political action commitee. lol.. Sorry had to throw that one in.
Everyone is welcome here. I can see we have rather spirited debates about equipment and treatment. At least people are talking about it. That is the key.
When working as a sleep tech, I can honestly say that the majority of my patients did not care about learning or the technology behind the treatment. The people of this forum should be admired for that.
But you should be admired too. You work an honest job and you try to help people as much as possible. Just you comming to visit and interact is very positive and is an admirable position to take.
It is very easy to criticize the local DME. I think price has quite a bit to do with it. That is something that is out of yours, mine and everyone elses scope of responisibility.
I am sure that knowone here means ill will toward you. I just think that being compliant is hard. Being understood or listened to means a lot to people who suffer from any illness.
Regards,
Ted/Titrator
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wading thru the muck!
- Posts: 2799
- Joined: Tue Oct 19, 2004 11:42 am
Christine,
Ted is right and Gailzee just got a little over-excited. I don't think any critisizm was meant your way. This type of reaction is in response to the frustration we all feel with a system that seems to ignor a mode of treatment that many of us think is superior.
As I said in a previous post on this thread, I know exactly where you got the statement regarding the intended use of the apap that promted this thread.
The important point to learn from this thread is that the apap is an important tool in resolving many of the issues cpap users face in being compliant with therapy. The current state of insurance reimbursement for such machines discourages their use. This is something you will have to overcome if you are to avail your patients of the benefits of the apap. It's an uphill battle, but worth the effort.
BTW, how did your open house go. I would have loved to attend, but it was the same day as the AWAKE meeting in Schaumburg. I hope you were happy with the way things went.
Ted is right and Gailzee just got a little over-excited. I don't think any critisizm was meant your way. This type of reaction is in response to the frustration we all feel with a system that seems to ignor a mode of treatment that many of us think is superior.
As I said in a previous post on this thread, I know exactly where you got the statement regarding the intended use of the apap that promted this thread.
The important point to learn from this thread is that the apap is an important tool in resolving many of the issues cpap users face in being compliant with therapy. The current state of insurance reimbursement for such machines discourages their use. This is something you will have to overcome if you are to avail your patients of the benefits of the apap. It's an uphill battle, but worth the effort.
BTW, how did your open house go. I would have loved to attend, but it was the same day as the AWAKE meeting in Schaumburg. I hope you were happy with the way things went.
Sincerely,
wading thru the muck of the sleep study/DME/Insurance money pit!
wading thru the muck of the sleep study/DME/Insurance money pit!