CPAP versus AutoPAP: are there really advantages to each?

[Goofproof]

I put my APAP away 10 years ago, went back to using my CPAP, Not because it was better, but to save my new APAP for when the CPAP gave out. Bad thinking, 13 years down the road the CPAP is working fine every night, my fault I forgot all three units are "TANKS", all still work fine, some day I'll have to look up where I stashed the other two, or maybe get a New one I'm sure it will stop working for me sooner. Jim

I laugh every time a new model of inferior XPAP comes out on it's way to the landfill.

[D.H.]

If you already own an auto-pap (or a bi-pap) and want a plain-old CPAP, you can set it to CPAP mode or put the min and the max at the same number.

[Hose_Head]

Hose_Head, did you try the regular auto mode or just the for her mode? The 2 auto modes respond differently. Are you looking at Sleepyhead to see what is happening and how long your pressures are at 15? Remember the 90% number means at or below and doesn't give information on how long you were at a pressure. Looks like your pressure settings were increased, were you hitting the top when it was set to 12 on your old machine?

I'm not trying to hijack the thread here but I feel I need to answer a couple of questions raised about my earlier post. First, let me note that I corrected a typo in that post. My 90% pressure on the resmed apap was 10.1 cm/H2O (not 13.1 as I had previously posted). This is more than 2 cm/H2O higher than I experienced with my PR apaps. It never the maximum 15 cm/H2O that the machine was set for - it maxed a little over 13 cm/H2O. The Resmed apap pretty much never allowed my pressure to drop below the high 9's, except when I had not yet fallen asleep or when I was waking in the morning. Same results with both the regular and the "for her" modes.

Pugsy and other here generally recommend that if a brand's algorithm is working for you, try and stay with that brand for a new machine because the algorithms vary among the different vendors.

That's a great idea when you have a choice. I would have bought a PR Dreamstation Auto if given the opportunity. But I'm in Ontario Canada and to get insurance to pay for a new machine, I have to abide by their rules. I was given a choice from a list of "authorized cpaps". For an unknown reason the cpap list included the Resmed Airsense Autoset 10 for Her as an approved cpap. Accepting the excellent reviews that this Resmed machine gets on this board (and having no experience with them, myself), I figured that one apap would be as good as another. So I opted for the Resmed. It's my loss because I can't tolerate it's apap algorithm; a victim of the vagaries that are insurance rules. (I've seen at least one other poster here who has the same issue).

For the time being, I'm stuck with the Resmed in cpap mode. And FWIW, cpap does work for me; it just doesn't allow me the other benefits of an apap that are well described by others in this thread. When my backup/travel apap (an old PR M-series model) comes due for replacement, I'll probably buy (out of pocket) a Dreamstation Auto and relegate my current Resmed Autoset to a backup/travel role. That's roughly $1000 CDN that I can't afford right now.


And to bring this post back into line with the topic of this thread: not all cpaps and not all apaps are equal, and one brand of apap (or cpap) may work well for you and not for others. Thus, this adds complexity to any examination of which is better, cpap or apap, or what are the pros and cons of each. That's my 2 cents worth, anyway.

[Pugsy]

It's my loss because I can't tolerate it's apap algorithm; a victim of the vagaries that are insurance rules. (I've seen at least one other poster here who has the same issue).

I know of more than one person who reports that they prefer the Respironics way of doing its apap job...so you aren't alone but you are definitely in a minority. Seems to be especially true for someone who used Respironics for many years as opposed to someone brand new to cpap/apap therapy and still in the initial adjustment process. The body and the brain just gets used to one way of doing something and doesn't like change. Some people adjust easily to something new and some people don't adjust so easily.

[zoocrewphoto]

It is better to know the pressure that is going to "fix" your sleep apnea. The problem with AutoPAP is the change in pressure throughout the night. If you had a CPAP titration study completed, you already know the pressure needed to treat. The change in pressure with autoPAP (if the machines can truly detect a respiratory event) can cause masks to leak. The same reason a RAMP type feature on a machine can cause more problems than it can solve.

Some people sleep differently at the sleep study, or not long enough to get *accurate* results for the pressure settings.

And some people, like me, have different needs during the night. When I am on my back, I need more pressure, at least 15, sometimes up to 17. But that's a very short part of the night. Most of my night, 11 or 12 would be enough. Should I really have to sleep with 17 ALL night so that I can have that needed pressure for 15 minutes? Or wouldn't it be more comfortable to have 11 or 12 for 7+ hours and 15-17 only 10- 20 minutes?

I think I will stick with my apap, thanks.

[jnk...]

It is better to know the pressure that is going to "fix" your sleep apnea.

This is only reliably known with data obtained at several pressures over time in the patient's own home. Otherwise what you "know" is an educated guess based on one night. Lab/center titration is valuable for seeing reaction to pressure and whether other sleep issues are unmasked. But it is not as encompassing for evaluation of pressure needs as the information from many weeks of APAP efficacy data. In other words, if one night of titration information has some value for finding effective pressure, then the information from many nights of titration is of much greater value. A good titration in a lab/center involves a titration that explores different pressures in different positions and different stages of sleep, but few one-night lab/center titrations are successful at having enough time to do that.

Furthermore, there is no way a lab/center titration can learn what happens with upcoming colds and allergies when sinus issues occur. There is no way a lab/center titration can learn how a heavy meal or glass of wine would affect the patient's needs. What about when the patient is seriously sick, fatigued, or has gained a few pounds? Docs commonly add a few cm to a titration finding to make up for the lack of data on those matters when prescribing a pressure. That is an act based on an understanding of the limitations of the test itself.

The problem with AutoPAP is the change in pressure throughout the night.

I agree that some patients are unable to get used to changing pressures and may eventually find that they prefer straight CPAP for themselves. But there is no way to ascertain that fact for that patient without allowing him to use APAP modality over time in order to see if he has any problem with it or in order to see if he gets used to it. Otherwise, the patient has arbitrarily been barred from trying something that may turn out to be very useful to him, over time.

If you had a CPAP titration study completed, you already know the pressure needed to treat.

No you don't. You know a pressure that seemed to work at some point during one night. Maybe.

The change in pressure with autoPAP (if the machines can truly detect a respiratory event) can cause masks to leak.

Do you have evidence that APAPs miss events? And anything can cause a mask to leak. Like, breathing, for example. Or moving. Or being alive. If pressure rises too high by running away for one patient using APAP mode, you just limit the max. Ain't rocket science.

The same reason a RAMP type feature on a machine can cause more problems than it can solve.

Good example! So would you then never give a machine with a ramp feature to a patient because machines that can run with a ramp are inferior to machines without ramp? Of course not. If ramp causes a problem for someone--which you would never actually know unless the person used the ramp feature for a while, right?--then you simply disengage the ramp feature. No problemo! Same with APAP. If it doesn't come in handy at some point, no one forces you to use it all night every night. It can, instead, then, be used occasionally to get titration info, then set back to CPAP mode. Just like ramp, having the feature does not mean the feature has to be used every night.

The advantage to an autoPAP machine is for those whose insurance company denied an in-lab sleep study and approved a portable home sleep test. The insurance company can save money by only paying for a home sleep study then skip the CPAP titration study and go straight to the home with an autoPAP machine.

In some circumstances, that IS quite an advantage, yes. But that is only one of many, many advantages to constantly-titrating machines that are allowed to titrate every night or on occasion. Another advantage is that it is a valuable comfort feature available for those who only need a high pressure for a few minutes a night. Another is that APAP mode allows for pressure variation to match those with a degree of positional OSA. Another is that APAP adjusts to the patient's weight changes, health changes, and sleep habits. Another is that . . . well, on and on and on.

I find from what I read that almost all people in the industry--at least, those who don't somehow feel that APAP is taking money out of their own pockets--absolutely love the features available in APAP machines. Those who feel their own wallets are somehow being impacted negatively seem less enthusiastic about the benefits patients are receiving from the amazing technology found in APAPs. How surprising!

[chunkyfrog]

It would not surprise me that doctors who know their hiney from a flower bed
would set a family member up with an apap.

[ChicagoGranny]

... should I try to persuade him to instead prescribe an AutoPAP machine?

Given what you posted exactly 20 minutes later,

When I did my sleep study, the technician told me that I have "moderate" sleep apnea, "especially" when sleeping on my back (the "supine" position). Ten years ago I had a sleep study that wasn't very well conducted, but it said the same thing.

This makes me wonder: Could I address my apnea problem by sleeping on my side? I have tried this, but I have discovered that even though it's easy for me to fall asleep while laying on my side, I almost always roll onto my back during the night. During my sleep study the same thing happened: I fell asleep on my side, and awoke on my back. (The sleep study data actually shows that I was on my side for quite a while before rolling onto my back, but FWIW it also says that all my REM sleep occurred on my back.)

But I'm wondering if there's a way to enforce side-sleeping, such as placing pillows behind me so I can't roll onto my back. Is this a plausible way to address moderate apnea? Or is this a rather silly idea?

... you may be an ideal candidate for an APAP. You would set a low minimum pressure which might be more comfortable, yet still effective, when sleeping on your sides. You would set a higher pressure which would kick in when you move to back sleeping.

It gets better --->

My sleep study results give my diagnosis as "moderate OSAHS, and severe REM-related OSAHS." They gradually increased the pressure from 4cm to 9cm. My 8cm stage lasted 35 minutes, 53% of which was REM sleep -- and my AHI was 17.0. My 9cm stage lasted 70 minutes, including no REM sleep, and my AHI was 2.8. That's a huge drop in AHI. Based on this, they prescribed 9cm constant pressure CPAP.

If I understand that correctly, you only used CPAP for 105 minutes during the sleep study. During real life, you are going to want to use it from 420 to 540 minutes. You are going to sleep in different positions, and your sleep stage profile will vary. You may hit REM sleep on your back - typically this is where the highest pressures are needed.

I wouldn't trust 9.0 cm straight CPAP to be anything but a wild ass guess. Get an APAP and treat yourself well.

[palerider]

It is better to know the pressure that is going to "fix" your sleep apnea.

(Devastating rebuttal.)

Ya know, it's newbie posts like that twaddle from jbstarks3 that make me think that newbies should be banned from offering 'advice'... questions sure, advice, no.

1 post, near complete garbage.

[chunkyfrog]

Initially, I was saddled with a straight cpap, set at 14 cm, which was WAY TOO HIGH,
and my sleep was less than ideal, plus I suffered from gas.
Once I had an Autoset, I quickly found my most effective AND comfortable settings.
BCBS would have saved a PILE of money, had they skipped the titration study,
and let me have an Autoset in the beginning--instead of letting Somnos dispense the Elite.
(Anything BUT "elite", by the way!)

[jnk...]

It is better to know the pressure that is going to "fix" your sleep apnea.

(Devastating rebuttal.)

Ya know, it's newbie posts like that twaddle from jbstarks3 that make me think that newbies should be banned from offering 'advice'... questions sure, advice, no.

1 post, near complete garbage.

I pick one such post once in a while just to take the opportunity to post what I consider to be useful information in reaction. Some may consider it a waste for me to say all that when it is stuck in the middle of a thread somewhere. But I enjoy taking the opportunity to take my mental/emotional reaction and structure a rebuttal in print when misstatements posted will give it added context.

The more inaccurate the post, the more misguided the attempted help, the greater the opportunity for one of us calmly to lay out something that may be useful to someone else who happens on the discussion, I think. Whereas, just calling the poster a name or saying the info is stupid may tend actually to give the statements made by the misguided poster more weight, to the eyes/ears of someone happening by.

Part of my reason for being here is to use posts by the trolls, the fly-bys, the lied-to, and the confused as opportunities to trigger something useful, if I can. It is my opinion that some of the fly-bys may be docs or RRTs associated with ignorant DMEs. They often sound just like 'em, anyway.

Hope that choice of mine doesn't irritate anyone too much.

[chunkyfrog]

Not at all.
First timers might learn.
Others . . .

[jnk...]

Not at all.
First timers might learn.
Others . . .

I don't expect others to read it. So don't feel guilty.

[chunkyfrog]

True that, jeff.

[prodigyplace]

The more inaccurate the post, the more misguided the attempted help, the greater the opportunity for one of us calmly to lay out something that may be useful to someone else who happens on the discussion, I think. Whereas, just calling the poster a name or saying the info is stupid may tend actually to give the statements made by the misguided poster more weight, to the eyes/ears of someone happening by.

Part of my reason for being here is to use posts by the trolls, the fly-bys, the lied-to, and the confused as opportunities to trigger something useful, if I can. It is my opinion that some of the fly-bys may be docs or RRTs associated with ignorant DMEs. They often sound just like 'em, anyway.

Hope that choice of mine doesn't irritate anyone too much.

That word CALMLY appears to be missing from the vocabulary of many old-timers here.