When NOT to Get an Auto With Cflex

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Mikesus
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When NOT to Get an Auto With Cflex

Post by Mikesus » Fri Apr 15, 2005 4:47 am

I have noticed a trend as of late for guests and others to jump in and immediately suggest that folks ignore the recommendation of getting a BIPAP and just get an Auto with Cflex.

As I had quoted in a previous post:
Conditions Frequently Treated with Bilevel Devices &/or NPPV
Now, physicians typically use bilevel therapy to treat a broad range of conditions, including some conditions that require 24-hour ventilatory support.
o Respiratory muscle dysfunction (CO2 >45 mm Hg)
o previous poliomyelitis
o muscular dystrophies
o myopathies
o Neurological disorders (CO2 >45 mm Hg)
o neuropathies
o bilateral diaphragmatic paralysis
o spinal cord injury
o brainstem lesions
o primary alveolar hypoventilation
o Chest wall deformity (CO2 >45 mm Hg)
o scoliosis
o thoracoplasty
o Upper airway disorders
o severe OSA
o obesity hypoventilation
o Lung disease (CO2 >52 mm Hg)
o COPD
o cystic fibrosis
o bronchiectasis
o Acute respiratory failure (CO2 >52 mm Hg)
o hypercapnic respiratory failure
o hypoxemic respiratory failure

Bilevel therapy is not typically prescribed for OSA patients; however, OSA patients who require high treatment pressures, OSA patients that can not tolerate exhaling against the set pressure of CPAP or OSA patients that have another respiratory condition like underlying lung disease (COPD) may be candidates for bilevel therapy.


Yes the favorite is the Auto. But there is a reason for a BIPAP. (actually a number of them) If you have an underlying condition (such as one of the ones listed above) don't insist on an Auto.

Again, if the only reason that you are getting BIPAP is for COMFORT, the Auto with Cflex (if your pressure is low enough < 20) Would more than likely serve you better. Some folks can get very adamant about which machine to ask for, but there ARE other factors. I would hope that the suggestion of "Get a Remstar Auto with Cflex" will be tempered with, "as long as you don't have any underlying condition" and "if you were only prescribed BIPAP (BILEVEL) for comfort, you might want to try an Auto with Cflex".

Stock answers without qualifications can be dangerous.

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Liam1965
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Re: When NOT to Get an Auto With Cflex

Post by Liam1965 » Fri Apr 15, 2005 5:25 am

Mikesus wrote:Stock answers without qualifications can be dangerous.
Well, yeah, but I don't know about you, but most of the REST of us make our way towards 1000 through their judicious use. How the heck would I get there if every post had to be well thought out and carefully worded?

But I agree, there are lots of reasons why one therapy might be better for an individual than another. I think the INTENDED meaning behind the advice (and which definitely needs to be spelled out, because it's generally given to newbies) is that it's better to become acquainted with the various therapy choices available before going in to get your prescription, so you can discuss them with your doctor, and so you know if your DME is of the evil variety.

(I recall one poster a month or two back whose DME gave him/her an obsolete model of CPAP machine, no longer made, and insisted it was top of the line and there was nothing else that anyone would ever use.)

But yes, the point should be: Know the options. I do the same when going in for other procedures. When I was scheduled for an MRI, I spent a long time researching MRI and the disease they were specifically looking for, comparing it to CAT SCAN and other options, so that I was fully prepared to challenge my doctor if I felt the test he had ordered was incorrect. I also research all of my medications. The one time I *DIDN'T* (because I only heard of this site AFTER getting my machine from the DME), it didn't work out, and I am currently waiting until a relatively stressless portion of my life before buying a better option machine and trying again.

Liam, long winded and damn proud of it.

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Tampa Tom
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Post by Tampa Tom » Fri Apr 15, 2005 6:35 am

Ya know, Liam, you might get to 1,000 posts quicker if you post each paragraph as a separate entry

Again, this is all great information. And, when I have my ENT appointment on the 19th (IT'S COMING! IT'S COMING!), I'll have a better idea of what the doc's talking about - rather than stumbling in blindly...
Take off you hoseheads!
---- Bob McKenzie (Strange Brew - 1983)

Remstar Auto with CFlex (5 - 15)
Swift Mask with Medium Nasal Pillows

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wading thru the muck!
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Post by wading thru the muck! » Fri Apr 15, 2005 7:38 am

Mikesus,

Thanks for posting "the list" regarding Bi-level 'pap indications. I don't recall ever recommending an auto-pap for anybody other than those who have been moved from cpap to bi-level because they couldn't tolerate a high pressure. I even recall (I think before you arrived on the forum) going in to great detail on the theory behind suggesting that APAP is a better comfort alternative to CPAP than a Bi-level.

For the most part, I would like to put a disclaimer on all my "recommendations" stating that they only apply to people with moderate, run-of-the-mill, vanilla OSA and that if the have any "out of the ordinary" medical conditions or facial features or head size or sensitivity to noise or whatever else might apply here, that they should use their own judgement.
Last edited by wading thru the muck! on Fri Apr 15, 2005 8:36 am, edited 1 time in total.
Sincerely,
wading thru the muck of the sleep study/DME/Insurance money pit!

53now
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Post by 53now » Fri Apr 15, 2005 8:29 am

Certainly don't want to ruffle any "Autopap" feathers but I really like my Bilevel machine. According to my sleep study, "A therapeutic level of Cpap was not achieved until I was switched to Bilevel +18 cwp IPAP and +14 cwp EPAP" My AHI was 82.3 (above 5 is considered abnormal)
After my sleep study, I chatted with the tech in the lab. She said , I was still having problems with straight Cpap at a setting of 17. My respiratory events didn't even slow down until they switched me to Bipap.
I've used this machine for 5 years. I wouldn't consider switching. Hummmm reminds me of the Toby Keith Ford Truck commerical.......... when he says........... " I'm a Ford truck Mannnnn" Well , I guess I'm a ..............."Bipap Mannnnn" I know I know....sort of goofy


my stats
Sleep Study
282 Respiratory events
Supine AHI 100.7
OS 87.7 %
No REM during study
AHI 82.3
50 Apneas 232 Obstructive Hypopneas

*****Ask my Pulm Doc about using an Autopap........I thought he was going to jump off his chair. He said. Absolutely not....He said, with OSA as bad as I have it...the autopap would be running at the high end all night long.....so Bipap is the only therapeutic choice for me. He wondered who told me I should use an Autopap. I told him about the message boards. he said.....(surprise to me) "Autopaps are wonderful for many people BUT not for you."

Rich

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derek
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Post by derek » Fri Apr 15, 2005 8:37 am

You know, after 2 1/2 months with the Auto I have convinced myself that I would be just as well served with a CPAP (with C-Flex) at 9 cm. My nightly deviation of the Auto from the 9 cm minimum settings are small. I think the Auto is a great prescriptive tool but perhaps not necessary for many people once the appropriate level has been found.

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wading thru the muck!
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Post by wading thru the muck! » Fri Apr 15, 2005 8:46 am

Rich,

Sounds like you were switched from CPAP to Bi-level because CPAP was not working for you and NOT because you could not tolerate the high CPAP pressure. My disclaimer would apply to you seeing as you do not have "moderate, run-of-the-mill, vanilla OSA" as I stated in my disclaimer.

I only point this out for the benefit of those out there that seem to think "WE" are pushing APAPs for all who have OSA.

My perception of the collective agenda on this forum regarding APAPs is that for many of us they have worked remarkably well to facilitate compliance. Beyond that it is the responibilty of each individual to determine whether their own personal situation dictates using an APAP. All we "non-proffesionals" can do is relate our own successes and offer them as possible alternatives for success for others to consider.
Sincerely,
wading thru the muck of the sleep study/DME/Insurance money pit!

Mikesus
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Post by Mikesus » Fri Apr 15, 2005 9:16 am

Wader,

You have and most of the regulars have too. What I was referring to was a rash of guest posts and a few from registered folks (appeared to be fairly new) and I definately don't want to "name names", but I felt that I should bring that list back up, and stress the caveat of "if its for comfort ONLY then...."

Not trying to ruffle athers, just want to try to make sure newbies don't disregard other medical conditions in favor of APAP.

-SWS
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Post by -SWS » Fri Apr 15, 2005 12:28 pm

Very good point, Mike. As good as APAP with C-Flex is for so many who try it, there are plenty of reasons not to use one.

I agree with Derek as well----apparently so does Rappaport. I think the overnight sleep data typically yielded by APAP is indispensable. However, Rappaport recommended using fixed-pressure APAP in much the same way Derek just described. If a patient attains good treatment on fixed pressure, and they continue to monitor their data for changes in their own fixed pressure requirements---that's very viable therapy in my way of thinking. In fact, the shortcomings of APAP trigger and detection are then removed from the equation.

I personally sleep and feel better on APAP than fixed pressure. I think I'm a bit more cortical-arousal inclined than many, and perhaps the lower mean pressure yielded by APAP provides me with fewer sleep disturbances.

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loonlvr
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Post by loonlvr » Fri Apr 15, 2005 2:34 pm

I mainly would recomend the auto for ppl who usually are given a cpap. Its so versatile that if down the line conditiones change, so can the machine. From what I know now, if my sleep doc recomended a cpap, I would still push for an auto. You can always set it to a cpap mode. The big plus also is the software. A one nite study in a sleep clinic cannot guarantee a prescrpition right for me. I learned the hard way. I was on cpap for over a year , set at 10. I pushed my reg doc(sleep doc refused) for an auto. When I did my own cpap study with my auto, my AHI was through the roof.