CPAP VS APAP

[Tim1956]

I've been using my machine for about 2 or 3 months now. I've always let it stay in the APAP mode. At first everything was ok. Last week I started feeling really bad, no energy and my chest had started hurting. Hurting in a way that made me feel like my lungs were bruised. I started keeping track of the pressure and AHI and found out that the machine was putting out anywhere from 18-19.6 cmh2o. The AHi was running between 2.6 and 0.2. Those are the only two reading I can get off my
escape Auto. I switched over to CPAP mode and set the pressure to start out at 8cmh20 and ramp up to 13.0. The last 3 days I've felt a lot better and my AHI has been 0.3 each time. Is this common with the aPAP machines?

[apneawho]

Do you think your machine was chasing mask leaks?

[chunkyfrog]

Aonther newbie stuck with a dumb brick--my condolences.

[Lizistired]

What was your titration pressure?
I seem to do better on CPAP. I think I fight the machine in my sleep and it fights back by raising the pressure.

[GumbyCT]

I've been using my machine for about 2 or 3 months now.

I started keeping track of the pressure and AHI and found out that the machine was putting out anywhere from 18-19.6 cmh2o. The AHi was running between 2.6 and 0.2.

Tim were are you getting these numbers? And what machine are you using? It should be written right across the top of the machine.

Last I knew the Escape Auto in your profile did NOT produce any useful data such as leak or AHI. Are you listing the wrong machine?

This is why I always ask that people type in their post which make/model mask or machine they are using.

[Pugsy]

According to ResMed informational page the S9 Escape Auto DOES provide AHI and pressure.
AHI and pressure is all that it will provide though.
http://www.resmed.com/us/products/s9_se ... patients#s Plug in S9 Escape Auto and compare. I just did.

Does not have mask fit or smart start/off or settling. No flow, no AHI breakdown into centrals, hyponeas orobstructive apneas and no leak.

[jamiswolf]

Hi Tim,
Like you, I'm about 3 months into cpap. My machine is the Respironics S1 apap. I also found that the pressures would swing wildly.

Sometimes, as Apneawho suggested, it's because of leaks. And sometimes it just seemed my machine developed a mind of it's own.

Ideally your auto pressures should be a couple points above and below target pressure. So if 12 is your number...10 to 14 might be good.

But if your apnea is positional like mine, while on your back you may need those high pressures and if you limit ypur machine to 13, your OSA treatment may not be adequate for at least part of the time.
Cheers,
Jamis

[GumbyCT]

This is what Tim has in his equipment profile - https://www.cpap.com/productpage/3342 - S9 Escape™ CPAP Machine with EPR™

Apparently he has the auto model which I think shows an AHI value on the screen but does not breakdown the AHI or write it to the SD data card. Is that correct?

[Cat Lady]

I am a new user of about 6 weeks - my first Respironics System One APAP was replaced because the pressure seemed to have changed by itself, going from the initial 6 to 10 and the DME could not reset it as the machine seemed to be stuck on 10. None of my variable pressures during the night have been over 9 so starting out at 10 seemed really high to me and I was having to use the ramp feature to bring it down initially. I spent a couple weeks trying hard to get used to the setting of 10 before I said something to them and my machine was replaced. They could not explain how it got to be set on 10.

[nanwilson]

Tim
I get the same results in auto, the machine ramps up and it wakes me up and I have one "HHHH" of a lousy night. I set it on cpap mode and my results are down, plus I sleep like a log and feel great in the morning. Some of us cannot tolerate the up and down pressures of apap but do great in straight pressure. I would check to see where your median pressure is and set your machine in cpap mode at that pressure. Every month or two, I will set my machine back to auto and run it like that for a couple of nights, that way I can be sure my straight cpap pressure is spot on. Good luck.

[pap4life]

I, also, have a APAP and used it in that configuration when I first got it. As others have posted, the machine seemed to raise the pressures (as designed) up chasing the apnea events that kept waking me up all night. I believed it also raised my centrals doing the higher ramping. I have changed it to the CPAP mode and although it may miss an occassional apnea event, it allows me to sleep more comfortably thru the night.

[TheLankyLefty]

Not sure what your APAP settings are, but this may provide an explanation.

http://www.youtube.com/watch?v=GudrKX8n8dI

[GumbyCT]

Not sure what your APAP settings are, but this may provide an explanation.

http://www.youtube.com/watch?v=GudrKX8n8dI

While that can be a helpful video - he is promoting his website (and forum) and I think it is clear he is NOT a cpap user. The reason I say that is his apparent RT attitude that patients don't need data, any data, he claims it just confuses them and keeps them awake.

He then says if you have leaks "you need to do something". But never says What would that something be?

He says you can tell if your having leaks if you have a dry mouth. My personal experience tells me that you can have a dry mouth with out any significant leaks just from the high pressures used.

Do I "need to do something"? And what would that something be?

While I agree it does take some learning to understand the data collected, I would NOT buy (or use) any machine without at least AHI (breakdown), including leak data and software. He later concedes that leak data is helpful. An average leak number on the screen is not helpful at all. It so much easier to determine if your leak rate is satisfactory by looking at a graph of the leak line.

I have a dream that one day the manufacturers will only produce machines that are data capable AND include the software AND a DC cord for that machine, I have a dream.

[TheLankyLefty]

I too have a dream. It's that all PAP users can get the most out of their PAP therapy. Jesus...first I feel like I have to defend myself. It is me in that video.

The video has promotional material so that if a person likes the video and finds it helpful, they know where to go to find more and get their questions answered (for free) as well as finding information that doesn't translate well into video. There are also unbiased reviews of equipment. The forum was so that I wasn't answering the same email questions constantly.

Free information is great, which is why I posted them to YouTube instead of just locally on my server. I could've also advertised on a Giant Billboard in Times Square, but my "free" budget, that model doesn't really work.

You are correct, I am not a regular PAP user yet, but does that somehow make my ideas less relevant? I do use CPAP about 1-2 months out of the year when testing masks. Many of my family members are on CPAP, and as it's anatomically hereditary, I feel it's best I get used to the idea now.

I don't at all think that too much information is too much for a PAP user to handle. Quite the opposite. I think that (and have dedicated a good portion of my life to the cause) PAP users should know everything about the sleep medicine field so that they can manage their treatment better. As much as they care to learn anyway. I learned long ago not to force information on people that they don't ask for or seek out.

With data capable machines the problem that I have is that the "data" is by definition not accurate and so it is nothing more than frustrating. With this I am referring to anything involving any respiratory data. It's called sleep apnea because you need to be asleep when it is occurring. With data capable how do you know you're sleeping? You don't. During sleep studies the respiratory signals are compromised with position changes, sighing, and farting. (still paying attention? ) That is just a fact.

The only respiratory signal that is of any relevance at all would be back to back notches (in the data) for Central Apneas. This is a tip off that Cheyne-Stokes or Periodic Breathing may be present and then Auto BiPAP SV would be necessary.

Leak value is also important for obvious reasons. I didn't concede it. It wasn't a debate. No, I didn't mention what to do in the video because that isn't what that video is about. I have another video for what to do with leaking and what the possible causes are. Will I tell you where to find it? No....because I don't want to come across as "promoting my website (and forum)". I will tell you that any mouth leak is a significant leak. You really don't need it graphed out for you. Once the seal is broken it's not going to go back together with air coming out of your mouth.

So I don't use CPAP...what the hell do I know. I'm a Registered Polysomnographic Technologist. I've been one since 2003 but started in 1999 because I was trying to afford Med School but couldn't. I'm the lead technician at my lab. I give presentations once a month to a packed house of doctors and new PAP users so they know how to navigate this horribly organized field of sleep medicine. I set people up on Auto CPAPs for long term diagnostic treatment use if we need more titration data (so I'm intimately aware of the APAPs capabilities. I became frustrated with the lack of communication and follow-through, so I started the website with videos that I apparently accidentally promoted by posting an anonymously titled YouTube video. These videos generate about 300-400 views a day which generates about 20 thank you emails daily. My website now has 200-300 unique visitors per day from around the world. (and I charge nothing) I worked in sleep research for Stanford for 3 years. I now own my own sleep scoring business as well.

Then, in my spare time (newborn and a 4 year old and a VERY understanding wife) I try to help people because it literally keeps me away at night knowing that I didn't help educate as many people as possible today. Occasionally I'll check out a forum because I drives me nuts seeing users argue in circles because there are key pieces of information that they are missing. (believe me...I've learned quite a bit from patients in return)

All this to have someone say "....meh....he doesn't use PAP, his attitude is that he wants to keep information from us."

Quite the opposite. I want PAP users to have ALL the information. I just want the information to be the correct information. Otherwise it is much more damaging.

"BLANK" you got me ticked.....

[GumbyCT]

Jesus...first I feel like I have to defend myself. It is me in that video.

That comes from those guilty feelings.

The video has promotional material so that if a person likes the video and finds it helpful, they know where to go to find more and get their questions answered (for free) as well as finding information that doesn't translate well into video.

Free information is great,

You do know that where you posted this is FREE, right?

You are correct, I am not a regular PAP user yet, but does that somehow make my ideas less relevant?

Of course not. It's just the way it comes across. So your idea is for us to disregard the ONLY nitely info we have available cuz you say to?

I do use CPAP about 1-2 months out of the year when testing masks.

THAT can be dangerous you know. It has to be true cuz I read that on the internet.

With data capable machines the problem that I have is that the "data" is by definition not accurate and so it is nothing more than frustrating.

MY sleep doc said it is 100% accurate or she wouldn't use it. She is a doc, I/we don't have a clue who you are.

With data capable how do you know you're sleeping? You don't.

Should we sleep in the lab each and every nite? It's the best we have.

I have another video for what to do with leaking and what the possible causes are. Will I tell you where to find it? No....because I don't want to come across as "promoting my website (and forum)".

Which is exactly what you did before and after the video. Is that where the guilt feelings come from?

You really don't need it graphed out for you.

(Referring to leaks). I disagree. It is much easier to tell IF you leak is interfering with your data when you can see the graph. That is something you learn when YOU are the user and not the schoolbook RT. That is something you obviously would NOT permit on "your server" where you want people to gather. It is true whether you agree or not, NOT even you, an RRT, can change the math.

So I don't use CPAP...what the hell do I know. I'm a Registered Polysomnographic Technologist.

That, my friend, should have been in your introduction. You do introduce yourself when meeting people don't you?

I've been one since 2003 but started in 1999 because I was trying to afford Med School but couldn't. I'm the lead technician at my lab. I give presentations once a month to a packed house of doctors and new PAP users so they know how to navigate this horribly organized field of sleep medicine.

And you do refer them to cpaptalk.com, right? And you have that reference on "your server" too, right?

so I started the website with videos that I apparently accidentally promoted by posting an anonymously titled YouTube video.

That was anonymous?

I worked in sleep research for Stanford for 3 years. I now own my own sleep scoring business as well.

You should prob stick with that.

Then, in my spare time (newborn and a 4 year old and a VERY understanding wife) I try to help people because it literally keeps me away at night knowing that I didn't help educate as many people as possible today.

And you should spend more time with your family, instead of trying to steal visitors from the competitions website and forum.