Interesting Side-Effect in Switch from CPAP to APAP

[Amigo]

Let me start out by saying that this "problem" is very probably just part of my personal weirdness, and your mileage may vary.

For five years plus, I have been on straight CPAP at an initial pressure of 14, and then after a little over two years, reduced to 12 based on the results of two weeks of at home APAP use/statistics.

In January I took possession of my new machine, which is an M-series APAP. I had long ago decided that my next device would have the flexibility that APAP provides, and that I could always use it as a straight CPAP if needed.

My pressure range on this machine is set to 10 - 14.

What I find interesting is that I have been having trouble falling asleep, which is unheard of for me, and for three nights in a row gave up and read for a few hours before returning to bed at which time I was really dead tired, fell asleep quicky, and had my usual good night's sleep.

My sleep habits, routine, diet, stress level, etc. have not changed in any way except for the new APAP. Last night, for the first time on the new machine I didn't have to get up. I came very close, but obviously fell asleep. As usual, I felt completely rested in the morning.

My stats show that I'm averaging a pressure of 11.3 during the night, and I'm guessing that my body may be readjusting from an all night pressure of 12, to one that starts out at 10, and then increases just enough to keep my airway open. Because I'm so used to the immediate pressure of 12, I appear to be having "problems" falling asleep at a pressure of 10.

Sorry to ramble on so, but I'm curious to know if anyone else has experienced anything like this.

I'm not about to give up and return to CPAP mode just yet, and take it as a good sign that I was able to fall asleep relatively easily last night. After several more weeks, and assuming that my pressure continues to average above 11, I may change the settings to 11 - 14, if I continue to have any problems falling asleep.

Comments appreciated. Thanks.

[BabetteISOffline]

I'd believe that your lower pressure of 10 is causing some anxiety to your body. Why not make your base pressure your old straight pressure - 12?

Cheers,
Barbara

[Lee Lee]

I started out on APAP. Stayed on it for 2 years.
I changed to straight CPAP, and I sleep much. much better. I was having a lot more events on APAP. I'm not sure why APAP is such a great thing.
If it ain't broke, don't fix it, as my Grandpa always said.

[Wulfman]

Hey, you guys! Amigo just got his new "toy" and he has to play with it.

Den (thinking Amigo will eventually switch back to CPAP mode, too.)

[john_dozer]

I'd believe that your lower pressure of 10 is causing some anxiety to your body. Why not make your base pressure your old straight pressure - 12?

Cheers,
Barbara

Maybe Start with a pressure range of 12-14, then switch to 11-14, then switch to 10-14 over a period of a month or two.

Heck, you could even start with 12-12 (CPAP) and go 11-12,11-13,10-13, and then 10-14.

[mindy]

Mindy, like Den, also thinking Amigo will go back to CPAP mode.

The sleep issues may not be caused by the pressure level itself but rather by the changing pressures, especially after you've used CPAP for a relatively long time.

But I agree - it's a new toy so have fun with it. Have you tried ramp?

Mindy

[billbolton]

Let me start out by saying that this "problem" is very probably just part of my personal weirdness, and your mileage may vary.

There are significant numbers of users who find that APAP treatment is not effective for them, and that CPAP works better, so there's nothing at all weird about your experience.

APAP was developed for users who had difficulty coping with CPAP, but if you have been using CPAP successfully then there's not really any benefit likely to arise for you in using APAP.

Cheers,

Bill

[RipVW]

Guess I'm the "weird" one here, but I love my APAP mode, been using it since I got my M Series about 15 months ago. Now, I can't imagine going back to CPAP--but, who knows, I might eat my words in the future. We're all so different!

[mindy]

I wouldn't call you "weird", Rip -- sleepy yes, weird no

That we're all different just makes for a much more interesting world!

Mindy

[RipVW]

I wouldn't call you "weird", Rip -- sleepy yes, weird no Mindy

Thanks, Mindy! That's what I keep telling everyone :<)

[Jeeper]

I am another weird one. I was on cpap for three years before buying an apap. I now have two years on apap. I fine tuned the cpap as much as possible and tried the apap on cpap mode for a while at a pressure of 10. I am now using apap mode with a setting of 9.5 to 12. My AHI is now consistently below 1.0. The software and reader paid off big time for me.

Jeeper

[jnk]

It makes sense to me that some might never get completely used to the changes in pressure of an APAP, that the changes in pressure might continue to cause them arousals. (It is tough for a machine to be prompt with pressure changes while not startling the patient--that, in my opinion, is why some autos respond gradually to the precursors of events instead of suddenly to the events themselves.) But I think many sleeping minds would eventually learn to tune out the pressure changes after a while.

[JeffH]

I stayed on cpap for eight years and then got an apap. Fought the damn thing for seven months before giving up and switching it to cpap mode at my original pressure of 12. No real troubles since. After getting repairs in december I even turned the c-flex off when I got the M-series back.

We're all strange in some way...

JeffH

[kteague]

Hi Amigo - good to hear from you, it's been a while. I'll throw my 2 cents in... Five years is a long time to sleep a certain way and then have the brain adjust to a change. No surprise it isn't automatic. One thing I wondered is if you used exhalation relief when on cpap, and not now that you are on apap? Seems to me that would be quite an adjustment.

"Back in the day" when I went from cpap to apap, my bare bones machine didn't have exhalation relief, so I didn't have that adjustment. My guess is in time your brain will see this as normal. Maybe increasing the lower number will help.

Have fun with your new toy. Now you won't have to get a loaner if you feel you need retitrated. Last year I went back to cpap to see if the changing pressures were waking me up. Didn't see a difference either way, as my limb movements were the main culprit. Let us know how this pans out for you.

Kathy

[Amigo]

Hey, thanks everyone for taking the time to give my your thoughts on my "weirdness:"

I'd believe that your lower pressure of 10 is causing some anxiety to your
body. Why not make your base pressure your old straight pressure - 12?

Cheers,
Barbara

Well, Barbara, I thought about that, but my stats show that I'm averaging 11.3, during the night so
apparently I don't "need" a pressure of 12 to keep my airway open.

I started out on APAP. Stayed on it for 2 years.
I changed to straight CPAP, and I sleep much. much better. I was having a lot more events on
APAP. I'm not sure why APAP is such a great thing. If it ain't broke, don't fix it, as my Grandpa always said.

I'm keeping an eagle-eye on my stats, Lee Lee, and if my AHI's start to look flaky, I'll abandon
APAP.

Hey, you guys! Amigo just got his new "toy" and he has to play with it.

Den (thinking Amigo will eventually switch back to CPAP mode, too.)

Damn right, Den. I haven't had this much fun since I was 11, and discovered another "toy" that was
fun to play with.

Maybe Start with a pressure range of 12-14, then switch to 11-14, then switch to 10-14 over a
period of a month or two.

Heck, you could even start with 12-12 (CPAP) and go 11-12,11-13,10-13, and then 10-14.

Ah, a man after my own heart...let the fun begin.

...Have you tried ramp?

Mindy

Hmmm, hadn't thought of that since my assumption was that ramp only made sense if you needed a
lower pressure to start with. What I apparently need is a "ramp" that starts at 12, stays at 12
for 15 minutes, or so, and then the default of 10- 14, takes over. I'll re-read the ramp section of the
Provider's Manual.

...

There are significant numbers of users who find that APAP treatment is not effective for them, and
that CPAP works better, so there's nothing at all weird about your experience.
APAP was developed for users who had difficulty coping with CPAP, but if you have been using
CPAP successfully then there's not really any benefit likely to arise for you in using APAP.

Cheers,

Bill

Thanks, Bill, and believe me I thought long and hard about switching to an APAP. However, the
bottom-line was that it could be used as a straight CPAP, if needed, provided important usage data
without a card reader, and most importantly, since my pressure needs have been decreasing, I was
drawn to a machine that could adapt to those needs seamlessly.

I stayed on cpap for eight years and then got an apap. Fought the damn thing for
seven months before giving up and switching it to cpap mode at my original pressure of 12. No real
troubles since. After getting repairs in december I even turned the c-flex off when I got the M-series
back.

We're all strange in some way...

JeffH

Thanks, Jeff, but I'm curious as to what you mean by, "fought the damn thing for seven months...".
What kind of problems were you having?

Hi Amigo - good to hear from you, it's been a while. I'll throw my 2 cents in... Five
years is a long time to sleep a certain way and then have the brain adjust to a change. No surprise it
isn't automatic. One thing I wondered is if you used exhalation relief when on cpap, and not now that
you are on apap? Seems to me that would be quite an adjustment.

"Back in the day" when I went from cpap to apap, my bare bones machine didn't have exhalation
relief, so I didn't have that adjustment. My guess is in time your brain will see this as normal. Maybe
increasing the lower number will help.

Have fun with your new toy. Now you won't have to get a loaner if you feel you need retitrated. Last
year I went back to cpap to see if the changing pressures were waking me up. Didn't see a
difference either way, as my limb movements were the main culprit. Let us know how this pans out
for you.

Kathy

Thanks, Kathy, and it's nice to be back.

I used C-Flex (setting '2') on the "old" machine, and have the same setting on the new APAP so
there's no difference on that front. I'm more convinced than ever that the "problem" is the lower
starting pressure. My "brain" is used to a steady 12, and it's having some difficulty adjusting to
starting at 10.

I'm going to give it several more weeks, perhaps tweaking the starting pressure gradually. If all else
fails, it's back to CPAP mode for me, and I'll only use the APAP feature for checking my titration. Still a "win-win" as far as I'm concerned.