Is APAP really "better" than CPAP?

[TossinNTurnin]

My primary "defense" of CPAP machines on this forum is:

If all you can get out of your prescribing physcian/insurance/DME is a data-collecting CPAP......don't feel like a 2nd class CPAPper. I HATE it when "APAP users" tend to make the new users feel like they can't do this therapy unless they have an APAP......and if they don't have one, they're SOL. That's just not necessarily true.

90+% of this therapy is getting the right mask.

APAPs are more expensive. (depending on insurance coverage and other economic factors, many people may not be able to afford them)

Going through the "normal" physcian/insurance/DME route could be an exercise in frustration to get one. Sometimes it's hard enough to get a data-capable machine out of some of these folks.....which should be considered a "crime" to deprive the users of the capability of monitoring their own therapy.

Den

Well, I AM lucky enough that I've been able to get my sleep lab call the DME and request a MSeries PRO (I had an MSeries Plus). So I WILL have the AHI, Leak, snore data.

But, I started to think, IF I'm going to upgrade, perhaps I should try and talk them into an APAP.

Thank you everyone for your replies. I was trying to gauge how persistent I should be and where I should draw the line.

You all have given me the perspective I need.

I'm leaving shortly to the sleep clinic to pick up my sleep study. I will be asking why the doctor would object to APAP especially since I CAN use it as a CPAP if needed.

But, my pressure IS set at 14 on CPAP. And I believe it would help me be more compliant if I could have a "range" of pressures so that on my relatively "good" nights, I might be able to have a lower pressure.

I've settled on the IQ mask, and I think it's about as close as I can get to comfort, the freedom to toss and turn and reduction of leaks.

[Wulfman]

I agree with most of what you say Den (especially the part about finding the right mask) and would agree with you 100% if the intital thread question was "can you do this therapy without an APAP?".

The question however was ... which is better? A vague question since we don't know if TossinNTurnin meant better therapy or machine. I tried to answer both possiblities.

The last paragraph in my previous post was not meant to imply that new users without an APAP are SOL ... but that new users who don't educate themselves about their condition and treatment (including options) and instead rely on the sleep healthcare system are ... well, you have been there-done that right?

The actual "title" of the thread is:

Is APAP really "better" than CPAP?

To THIS question I have to answer....."MAYBE" (maybe "yes" and maybe "no").
I don't believe I've ever discounted the benefits of having an APAP.....Hell, I have 3......but only one has ever been set to a range of pressures. I've also had the urge to try one of them again with a range of pressures, but when I'm looking at the numbers I'm getting from mine, I would hate to mess them up....

IF a person can fanangle a way to get an APAP, that's GREAT. It's always good to be able to test with different settings and modes to see which actually DOES work best. I just have a feeling that there are those who think "Well, I have an APAP, so therefore I need to use it in a range of pressures."
I also have a feeling that there are some who have an APAP and don't have the software to be able to see how they're REALLY doing and where the events are occurring.
We've all seen stories of the APAPs that are being used in the 4 - 20 range.

And, if you leave your therapy up to the "healthcare professionals", you probably WILL be SOL.

Den (probably got up on the wrong side of the bed this morning)

[DreamStalker]

Den (probably got up on the wrong side of the bed this morning)

oky doky .... make sure you didn't accidentally knock your APAP out of CPAP mode so you can wake up on the right side tomorrow ... or the left side, which ever

[Wulfman]

Den (probably got up on the wrong side of the bed this morning)

oky doky .... make sure you didn't accidentally knock your APAP out of CPAP mode so you can wake up on the right side tomorrow ... or the left side, which ever

RIGHT side......

Sometimes I wake up "Grumpy" and sometimes I let her sleep.

Den

[TossinNTurnin]

I agree with most of what you say Den (especially the part about finding the right mask) and would agree with you 100% if the intital thread question was "can you do this therapy without an APAP?".

The question however was ... which is better? A vague question since we don't know if TossinNTurnin meant better therapy or machine. I tried to answer both possiblities.

The last paragraph in my previous post was not meant to imply that new users without an APAP are SOL ... but that new users who don't educate themselves about their condition and treatment (including options) and instead rely on the sleep healthcare system are ... well, you have been there-done that right?

The actual "title" of the thread is:

Is APAP really "better" than CPAP?

To THIS question I have to answer....."MAYBE" (maybe "yes" and maybe "no").
I don't believe I've ever discounted the benefits of having an APAP.....Hell, I have 3......but only one has ever been set to a range of pressures. I've also had the urge to try one of them again with a range of pressures, but when I'm looking at the numbers I'm getting from mine, I would hate to mess them up....

IF a person can fanangle a way to get an APAP, that's GREAT. It's always good to be able to test with different settings and modes to see which actually DOES work best. I just have a feeling that there are those who think "Well, I have an APAP, so therefore I need to use it in a range of pressures."
I also have a feeling that there are some who have an APAP and don't have the software to be able to see how they're REALLY doing and where the events are occurring.
We've all seen stories of the APAPs that are being used in the 4 - 20 range.

And, if you leave your therapy up to the "healthcare professionals", you probably WILL be SOL.

Den (probably got up on the wrong side of the bed this morning)

_________________

Your right the question was vague and I suppose, as a newbie, I was asking BOTH... are APAP machines better, and is APAP therapy better.

All of you have done a fantastic job of explaining it all to me.

In the end I won't feel I'm not being sufficiently treated if I end up with the Pro... but I do like the idea of the OPTIONS that APAP could afford me.

Apparently, (according the RT), the doctor prefers CPAP therapy over APAP.

But, if there's anything I've learned from this forum, there's a lot of "tweaking" that goes on in order to get the best results and gain the highest percentage of compliance.

If in a few weeks, for instance, there is concern that the 14 pressure (straight CPAP) I've been given, is making it difficult for me to comply... maybe APAP would be a better choice for me, ... maybe not. But, I like the idea of having that option. If I don't have the APAP, I certainly won't ever have that option.

But you're right, at the very least, I need a machine with more than "basic compliance" info.

[Wulfman]

Here's another thought.
At some point in time, if you're like some of the rest of us, you may want to have a backup machine (you just never know....). If you get the Pro model now, maybe you can get the Auto down the road aways after you get settled in with your new-found statistics. Or, if you can fanangle the Auto now, the Pro would be a less expensive backup machine.

Best wishes,

Den

[rhowald]

I started off with an M Series Plus at 19. Bought an Auto from CPAP.COM and have it set at 14-20. Rarely do I get to my titrated pressure level of 19. Usually hover around 16 or so.

With the straight CPAP I was not having much luck at all. With the Auto I am fully 100% compliant. Have some bad nights due to other factors (sick, etc) but nothing that is the machine's fault.

I now have my plus sitting in the bag waiting as a backup machine should my AFLEX machine fail.

[lifeartist59]

I think my reasoning for apap was because I have been working hard at weight loss and the sleep tech told me I would need a new test for every 10-15 pounds of weight loss... and I did not want to pay out 4k every time I lost 10 pound ( over 30 lost so far, last 3month between dr visit I lost 6). I am sure my insurance would rather have paid for one apap machine instead of retesting too. Anybody else have an opinion or thoughts on this?

[rhowald]

Sounds like a good plan. Congrats on the weight loss.

[rested gal]

APAP can be set to work in CPAP mode.

CPAP canNOT work in APAP mode.

APAP is two machines in one. That alone would make me choose APAP over CPAP.

Well, this too (if you're interested in monitoring your own treatment) -- all APAPs can record full data whether you're using them in APAP mode or CPAP mode.

With just a CPAP machine, you have to be careful selecting which model of CPAP to get, since some CPAPs record full data (AHI and leak info) and some don't.

[GrizzlyBear]

Holey moley,

Did I read right? You guys have to pay 4 grand for a sleep test?

Crikey, what have I been complaining about?

Regards,

GrizzlyBear

[Slinky]

If you have both a sleep evaluation study and a titration study that doubles the cost. Usually once you are on CPAP you would only need an occasional titration study which would half that cost. And if one has a split-night study, half the night for evaluation and half the night for titration the cost again is half. However, not everyone can do a split night study.

And then costs of the studies whether evaluation, titration or split-night varies due to region and type of sleep facility. Those affiliated or part of a hospital usually being more expensive.

My studies were billed at $1500 each (evaluation one night, titration another). This was at an independent but accredited sleep lab run by accredited sleep pulmos that you actually got to see and talk to.

[Hiitsmepam]

How did everyone learn to set their own pressures? I didn't know I could do that. I thought the DME had to do that according to the script by my neurologist??

[Wulfman]

How did everyone learn to set their own pressures? I didn't know I could do that. I thought the DME had to do that according to the script by my neurologist??

First of all, there are no laws that prevent YOU from changing your own settings.

Many of us purchased our equipment from CPAP.COM and the setup instructions come with the machines.
For some years, various sellers have been peddling the setup instructions on Ebay......mostly by the DME equipment providers who removed them from the packages before they gave them to the users.
There are various places on the internet that list the instructions to do so and we've been doing that on this forum for about 3 years.

Here's another one:
http://www.cpap-supply.com/Articles.asp?ID=130

The more you know about your therapy, the more successful it will be.

Welcome to the forum.

Den

[Velbor]

As already pointed out, a APAP machine is more versatile than a CPAP machine. It also costs more.

However, whether APAP or CPAP is "better" as a mode of therapy involves issues which have not yet been fully explored in this topic. The following does not pretend to be comprehensive, and some statements may be controversial (and perhaps that is intentional). Perhaps stimulating more conversation will be helpful.

First, we must remember that APAP is not "just one thing." Each APAP manufacturer utilizes a different, proprietary algorithm for modifying pressures through the night. One brand of APAP machine may provide better results for a particular person than will another manufacturer's machine. So the question is not simply APAP vs. CPAP, but rather WHICH APAP vs. CPAP. (Not even getting into issues of A-flex or C-flex or any other flexes.)

Reasons why APAP therapy (with appropriate settings) may be better: (a) Pressure needs vary through the night. You may need a higher pressure when on your back than you do on your side. APAP arguably provides optimal therapy at the lowest overall pressure. (b) Pressure needs vary from night to night. You may need a higher pressure if you've ingested alcohol. Again, APAP arguably provides the optimal therapy at the lowest overall pressure. (c) The notion that there is one perfect pressure for a person, which can be figured out by a well done "titration" study, contains a heavy dose of myth. Titration studies are useful to find a "best practical" single pressure which will knock out most apneas. APAP arguably not only is useful as an alternative way of determining this "best practical" pressure, but on an ongoing basis it can actually deliver the "best" pressure from moment to moment. The notion that there is even a need to know "one best pressure" already assumes a preference for CPAP rather than APAP. (d) Presuming that APAP will provide adequate therapy at "the lowest overall pressure", that lower pressure may arguably be more comfortable, and THEORETICALLY may provide a long-term safety benefit.

Reasons why CPAP therapy may be better: (a) As already mentioned, different APAP brands work differently. There's no guarantee that a particular APAP machine will optimally or even adequately treat your particular OSA. (b) APAP algorithms do not necessarily address all respiratory events. ResMed's algorithm, for instance, will not increase pressure to over 10 simply in response to apnea, regardless of the maximum pressure setting. (c) Even if APAP works well, there is no DOCUMENTED evidence that it's provision of "the lowest overall pressure" provides any benefit in terms of long-term safety, let alone comfort. (d) APAP may not prevent apneas when operating at low pressures, and may under certain conditions "run up" to higher pressures than needed. On the other hand, a single "best practical" pressure all night every night can generally be relied upon to treat your OSA.

Economic issues, both in terms of our individual situations, and in terms of public health risk/benefit balances, cannot be ignored. No simple solutions. Knowledge is our best asset.

_________________

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