Is APAP really "better" than CPAP?

[Slinky]

Ahhh, Velbor! Good to see you posting again! Many thanks for the pros and cons of CPAP vs APAP!

When I win the Lotto I'm gonna buy me a Puritan Bennett GoodKnight 420E just to experince the PB's algorhythm (gotta remember to buy the darn ticket, tho).

And, if I win the BIG lottery I might even try a Respironics M Series Auto w/A-Flex just to check out the A-Flex. (if I think to buy a ticket).

'Til then, I LIKE my Resmed S8 Elite. And my Resmed S8 Vantage when I use it.

Hmmmm. Today was my last day of pred (thank goodness!). Maybe I'll borrow that Respironics pre-M Series Auto w/C-Flex from my son-in-law if he's not gonna be working out of town this week and try it again for a week. Just 'cause on accountta ... EncorePro and MyEncore are still installed on my 'puter.

Just pouting 'cause on accountta RestedGal has had access to so many different xPAPs and I'm jealous.

I know, I know .... get that darn ResLink on my Vantage and ResScan installed on my desktop and start using it!!!

Its just that the Elite, Simplicity mask and AutoScan and I were getting along so well before hubby so generously opted to share the flu/cold I just never got up the ambition to change anything.

[TossinNTurnin]

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 12 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.

VERY helpful post. Thank you.

I didn't consider that different machines have different APAP algorithms ... and that one type maybe good for one person, and not as good for another.

So, at this point... since my doctor seems to support CPAP over APAP and C-flex over A-flex for me (he said he has prescribed APAP for certain people). I may just stick with the "MSeries Pro".

But, there is that part of me that figures that since, through the insurance, I'll be co-paying the same amount no matter which machine I get --- I should take advantage of the opportunity to get the APAP/A-flex. The APAP/A-Flex could potentially work best for me, and since I'm new to this, ya never know. It would be good to have those options.

[Gerald]

Tossin......

You are correct in your opinion that the AFLEX machine is best for you. There are a number of reasons why you're right.

An "M" Series AFLEX machine is actually a "four-in-one" device. It'll run in the following modes:

CPAP
Auto CPAP (APAP) with CFLEX/AFLEX turned "off"
Auto CPAP (APAP) with CFLEX
Auto CPAP (APAP) with AFLEX

Personally, I prefer APAP with CFLEX....but, you may find another mode is more comfortable or more effective.

The CFLEX and AFLEX features are simply different ways to make the machine more comfortable for the user.

To keep all this in perspective, one must realize that the whole reason for being on CPAP ("auto" or otherwise) is simply to be sure that blood O2 saturation levels stay at 93% or higher during the night....every night....while sleeping.

A straight CPAP machine that blows at only one pressure all night makes it a little more difficult for you to "self-titrate" yourself (find the lowest pressure that's most effective). An "Auto" machine makes this process easier....so long as it is used along with data gathering software.

Also, you may discover a "variable" that isn't discussed too often. Sometimes, we have sinus problems that result in a "sinus sludge" that obstructs our breathing. A straight (one pressure) CPAP machine might not be able to push this "sludge" aside.....and O2 levels would go down.

An "Auto" machine is able to raise pressure if it senses obstructions or snores.....and that helps keep the O2 level up where it should be. Most of us don't have "sinus sludge" every night....but, when we do, the "AUTO" machine is a big help.

If I were you, I would push hard for an "M" Series with AFLEX. That way, you get the "four-in-one" machine and you can be the judge of what's best for yourself.

Also, for a "doctor" to dictate to you whether or not you can have CFLEX or AFLEX is horse-poop. These are "comfort" features whose only real benefit is to help you be more consistant in your therapy. Whether they are good or bad for you....is purely a subjective opinion on YOUR part.....NOT his.

The difference in cost between an "M" AUTO with only CFLEX.....and the model with CFLEX and AFLEX....is about $20......the price of two or three movie tickets. Big deal!

Tell this guy what you want. You are his "customer".....and he puts his pants on just like you do in the morning. A "god" he ain't.

Gerald

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, auto cpap, cflex, CPAP, auto, APAP

[Slinky]

I agree. This xPAP your insurance is paying for (aside from your copay) and your copay is going to cost you the same whether you get the Pro or the Auto w/A-Flex. Since the doctor is willing to write the order for the A-Flex despite his "preference" for the Pro - insist you prefer the A-Flex. You can buy a Pro at another time for backup.

The same holds true for masks. Let insurance pay for the most expensive one that seems like it is going to work for you. You can then buy the cheapest one that seems like it might work for you outta your own pocket. I don't mean get THE most expensive mask, just 'cause it IS the most expensive mask. I mean the most expensive mask that FEELS like it is going to work for you. Your insurance is going to pay the same whether you get the cheapest or the most expensive and your copay is gonna be the same as well.

[rested gal]

Excellent post by Gerald!

An "M" Series AFLEX machine is actually a "four-in-one" device. It'll run in the following modes:

CPAP
Auto CPAP (APAP) with CFLEX/AFLEX turned "off"
Auto CPAP (APAP) with CFLEX
Auto CPAP (APAP) with AFLEX

Since an autopap IS a "CPAP" machine for insurance billing purposes, and insurance is going to pay the DME one set amount whether the DME gives you the simplest "CPAP" machine or this particular autotitrating "CPAP" machine.... I'd push hard to get the Respironics REMstar Auto with A-flex M series machine.

I'd want a separate heated humidifier (Fisher & Paykel HC 150 would be my choice) rather than using an M series integrated humidifier.

As Gerald pointed out, the APAP with A-flex can operate as "just a CPAP", with or without its other features turned on.

Actually, one can say it's five machines in one, since it can be used two ways in CPAP mode:

CPAP with C-Flex turned off
CPAP with C-Flex turned on

If your doctor absolutely, positively wants you to have "CPAP" (with or without C-flex turned on) he can still prescribe this specific machine. What he states on the Rx is how the DME will set it up.... e.g. CPAP @ 10 cm H20, C-flex 2 (or whatever.)

[Gerald]

Because I use the AFLEX machine as a "back-up / travel" unit, I hadn't read the User Manual.

Rested Gal is absolutely correct when she says that the AFLEX blower is actually a "five-in-one" machine. Soooooo, I'll try this again:

CPAP with CFLEX turned "off"
CPAP with CFLEX turned "on"
Auto CPAP (APAP) with CFLEX/AFLEX turned "off"
Auto CPAP (APAP) with CFLEX turned "on"
Auto CPAP (APAP) with AFLEX turned "on"

"AFLEX" is not available for use in straight CPAP mode.

Rested Gal always makes me more curious....and when I dug out the AFLEX User Manual.....I learned a little more about the difference between CFLEX and AFLEX.

"CFLEX" gives pressure relief upon exhalation to improve comfort.

"AFLEX" gives pressure relief that takes place at the end of inhalation AND at the start of exhalation to improve comfort.

The machinery is the same......it's just a "programming difference" that Respironics built into their "M" series. Different strokes for different folks.

Thank you again, Rested Gal, for making me think! You're the best!

Gerald

[rickbrown1]

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

[mindy]

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?

That's the exact reason my sleep doc gave me an APAP instead of a CPAP. Her original plan was to give me a CPAP until I mentioned that I was trying to lose weight - then she immediately changed her mind and said APAP. Worked out well for me.

Mindy

[TossinNTurnin]

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.

Just a little Tee Hee Hee ....

I got the APAP machine. The DME had to order it.

I think they forgot to go through the literature because they forgot to remove the provider set up instructions that actually tells the DME's to remove the instructions so that patients won't see it.

I just found it funny. Although, because of this forum... I had seen the M Series Auto with C-Flex set up instructions online... had I not had that ... that they left them with the APAP would've been a little gold mine for me to find.

Tee Hee hee.

FYI --- the CPAP-Supply.com site doesn't have the Auto A-Flex version, only the Auto C-flex. It's almost identical except for the additional A-Flex/C-flex options.

So, I scanned mine and uploaded it to photo bucket.

M Series Auto with A-Flex Provider Quick Setup Guide 1

M Series Auto with A-Flex Provider Quick Setup Guide 2

[rested gal]

I see the setup manual for 420g through the link above. Can anyone tell me how I can get one for the 420e?

Thanks,

Rick

Please PM me your email address, Rick.

[Patrick A]

Boy have you confused me this morning. A-pap, C-pap, C-flex, Bi-flex

CPAP with CFLEX turned "off"
CPAP with CFLEX turned "on"
Auto CPAP (APAP) with CFLEX/AFLEX turned "off"
Auto CPAP (APAP) with CFLEX turned "on"
Auto CPAP (APAP) with AFLEX turned "on"

Boy I am really confused, now

The machinery is the same......it's just a "programming difference" that Respironics built into their "M" series. Different strokes for different folks.

Thank you Rested Gal, Thank you Gerald..........I guess I better read my owners manual....again and again and again.........

No all kiddin' aside thank you both for the good information.

[TossinNTurnin]

That's right Patrick A. I don't know what I would've done without these generous folks that have been so patient and kind in this process.

They helped me gain the knowledge and confidence to be a strong self-advocate. I wouldn't have done it without their help!!!

[drewbryant]

I've had my APAP machine for over 4 yrs but have been using it in CPAP mode for all but the first month, during which I fought the machine nightly (or it fought me.) My respiratory tech finally set my pressure at a steady 9 cm and it was clear sailing after that. I have less apnea events now than even normal sleepers so my condition is very well controlled. I now usually sleep about 5 hours without waking whereas previously, when my machine was set on Auto, I would awaken every half hour or so as the pressure ramped up to maximum (20 cm), and as it turned out, unnecessarily.

[Rastaman]

I started off with a Phillips Respironics M Series CPAP Plus originally in 2006. Somehow I managed to get a Resmed S8 Autoset Vantage when I did enquire about an APAP, which I used faithfully until this year. It appears that we were no longer able to get data from the S8 so, I did a CPAP study and that was decided to be "inconclusive". Sounds like an autopsy, right? So, I did a Bi-Level Pap study and apparently did well with that. And now I'm using a Phillips Respironics System One Auto Bi-Pap. My AHI numbers have never been better.

Somehow the DME mis-set my machine though and I finally noticed it when I installed Sleepy Head and so I changed the pressures back to what my Sleep Doctor/pulmonologist meant it to be set for. For 3 days my average AHI was 4.34 but I did feel better. Originally, my set pressure was 13 so when I went to APAP my range was 10 to 16. I always thought I was getting great therapy for the S8. Most days it seemed that way. But over the past couple of years I notice just a bit of grogginess in the morning and sometimes during the day. Now, I'm set for ipap of 12 and epap of 7 with Bi-Flex set for x2. I noticed I was going through more water than normal with the new machine on a humidifier setting of 3 so I changed it to 2. And so far, so good!

I would say I have had good therapy all the way but most days I couldn't get my AHI below 5 on the S8. I did so once or twice during the 10 days prior to getting my most recent Bi-Pap. The average was below but 2 of the 3 days was 5 or above actually. And I had to write down my data before 12 noon daily in order to even know what the Redmed S8 Autoset Vantage was getting data wise. NOW, I can see everything for myself on Sleepy Head and I've been reading through Pugsy's Sleepyhead thread and learning all kinds of good things.

If I ever need to auto-titrate at home, I can. Otherwise, i'm basically using it in a CPAP-like mode except when I exhale the pressure goes down to 7 from 12. Not sure what the Bi-Flex is bringing me down to. (5?) But it's just for a moment. Once I start inhaling again, it's all good.

My older daughter (age 10) took a look at the new machine today and said "What's that?" I told her. She said "It doesn't look very much like a CPAP." I said "It doesn't look very much like the old one but it does look a lot like my original M series with C-flex. They're the same company." I said they all look different depending on the manufacturer. It really does look less medical than the previous machine. But that's also true about the newer Resmed's too. They look totally different between the S8 and the S9 APAP or the latest "10".

[chunkyfrog]

My new machine is the most fashionable looking item in the bedroom. (including me)