CPAP vs APAP and quality of sleep.

[paul85]

Went from the Fisher and paykel 234 cpap that was set to a pressure of 19 to a respironics apap unit that varies from 8-19. The first few nights I slept like a baby and my pressure was at 13.4, 14.5, 13.4, 14.5. Since then, I've been waking up to a pressure of 16. I use a couple different masks, either the mirage FX or the Swift FX. depending on if I have a stuffy nose or not. The best part, aside from a full nights sleep, is no dry mouth. Why would the pressure level out at 16 though now repeatedly when it was at 13-14 for the first few nights?

I went back to the F & P after trying the Respironics and slept miserably. I had set the F & P to a pressure of 16, but woke up repeatedly with dry mouth. Is the reason I'm opening my mouth because of the way the pressure is applied? I had the humidifier on with both units, a 2 on the respironics and a 3 on the F & P.

I'm now trying a Resmed S9 Autoset unit and will see how that works out. It has the heated hose and with the cooler evenings, should make it more comfortable. (No rain out)

[Sheriff Buford]

I can never get any data after a few nights. When on autoset, the machine will ramp up as needed to treat an apnea. I am not familiar with the fisher machine, but what were your AHI's during the period? From your note, it looks like you have gone thru 3 machines in a short period of time. To me, that's too much "switching" to gather a consensus in my mind. Some people respond better to straight cpap therapy than they do autoset therapy. It's a personal thang'. Don't be alarmed at the pressure an autoset is using to treat the apnea. Its doing what it's suppose to do. Stick with one machine for a while and let your body adjust.

Sheriff

[Todzo]

Went from the Fisher and paykel 234 cpap that was set to a pressure of 19 to a respironics apap unit that varies from 8-19. The first few nights I slept like a baby and my pressure was at 13.4, 14.5, 13.4, 14.5. Since then, I've been waking up to a pressure of 16. I use a couple different masks, either the mirage FX or the Swift FX. depending on if I have a stuffy nose or not. The best part, aside from a full nights sleep, is no dry mouth. Why would the pressure level out at 16 though now repeatedly when it was at 13-14 for the first few nights?

I went back to the F & P after trying the Respironics and slept miserably. I had set the F & P to a pressure of 16, but woke up repeatedly with dry mouth. Is the reason I'm opening my mouth because of the way the pressure is applied? I had the humidifier on with both units, a 2 on the respironics and a 3 on the F & P.

I'm now trying a Resmed S9 Autoset unit and will see how that works out. It has the heated hose and with the cooler evenings, should make it more comfortable. (No rain out)

Hi paul85,

OSA tends to get worse as the night progresses. You have an event, ratchet up the nervous system a notch, breath harder (dries out the airway passage BTW) which along with the changes in the nervous system tends to flow blood away from extremities (like your nose for example) and may be part of rostral shift of fluids (from feet to nose so to speak) which all sets you up for another event, and another ... The constant higher pressure makes the events tend you toward breathing instability as the night goes on - so the dry mouth. With the Auto-PAP there are less events total - so less dry mouth etc...

To help with this fight those things which make breathing unstable:

Stress
Lack of sleep
Carbs before bedtime
Raise the head of your bed a few inches (concrete brick2 from building suppy place - <$5)
Violent media before bedtime (perhaps anytime)
Lack of aerobic and interval training exercise.
Lack of anti-inflammitory foods
Too much processed food in the diet.

Then you sort of give yourself "headroom" for the night. It also helps, I find, to make very quiet breathing part of my go to sleep ritual.

May you find great sleep!

Todzo

[SleepingUgly]

Went from the Fisher and paykel 234 cpap that was set to a pressure of 19 to a respironics apap unit that varies from 8-19. The first few nights I slept like a baby and my pressure was at 13.4, 14.5, 13.4, 14.5.

I'm confused. Are you saying that your 90th or 95th percentile for the night was 13.4, 14.5, etc. or the maximum was?

Since then, I've been waking up to a pressure of 16.

Is this the pressure it's at when you wake up, or your 90/95th percentile or your maximum pressure?

[Sheriff Buford]

[quote="Todzo"]

With the Auto-PAP there are less events total - so less dry mouth etc...

Todzo: I found your thread informative and interesting.... but the statement that "with autopap there are less events..." is wrong in many ways. Some folks respond to straight cpap therapy much better than autopap. Every six months (or so) I challenge folks here to see if they do. More often than not, its a "comfort thang'" or there may be a medical reason to use auto-pap therapy. Remember, it takes time for an autopap machine to detect an apnea event, to respond to the event and treat the event. In most cases, it could be 5 - 15 seconds, or so. All the while, your body is experiencing an untreated event. This may be small (and it is), but don't discount it and don't think your body doesn't feel it. My challenge is for folks to switch modes once a year or so, to see how they respond. I find my numbers are about the same in both modes, but I can definitely tell you that I feel much better using straight cpap therapy vs autopap therapy. Just sayin'

Sheriff

[paul85]

Sorry, I wasn't clear in my original post. Let me address some of the questions.

My highest for the night is 16 starting on the 4th or 5th night. My sleep study showed I should be set at a 19, but I think that was high due to a higher than normal AHI and the uncomfortable sleep study conditions. My DME echoed the same sentiments and so far, the APAPs I've used back this up.

I had the F & P since early April and used it until September 10th. I went in to try a different mask since the F & P 407 I was using just wasn't sealing and I had mask farts that would constantly wake me up, along with severe dry mouth. I went to a different DME who deals with resmed and respironics gear and I tried a few different masks I ended up liking and borrowed the respironics unit for a couple weeks and then last night tried the S9 autoset which I like a lot also. I have no dry mouth problems with either APAP unit and sleep well. Insurance has given the green light to get an APAP unit, even though I just got the CPAP, due to the quality of sleep I've been getting now. For grins I tried my F & P 234 cpap machine on Sunday night with the new mask and woke up 5 times, each with dry mouth, and felt horrible when I woke up in the morning.

My AHI is .3 across the board so I have very little mask leakage now with the new mask and an APAP unit. I'm still on the fence between getting the Respironics or the S9 though, and my new DME really likes the resmed stuff and is easy to work with.

[nanwilson]

Ditto what the Sheriff said.............
I use cpap mode because I find the "pulsing" disrupts my sleep. In cpap mode I set my machine at straight 11 with no flex, every few months I will put it back into apap mode (10 to 15, with no flex) for about a week to check to make sure I should still be set at 11. When I read this thread earlier this morning, I remembered it was time to do a pressure check, so I set it back to apap mode and will leave it there for about a week to make sure all is okay. Its a matter of choice, no mode is "better" or "worse"...its what you prefer to give you the best therapy .
Cheers
Nan

[Sheriff Buford]

my comments are in blue

Sorry, I wasn't clear in my original post. Let me address some of the questions.

My highest for the night is 16 starting on the 4th or 5th night. My sleep study showed I should be set at a 19, but I think that was high due to a higher than normal AHI and the uncomfortable sleep study conditions. I the autoset mode, my 95 percentiloe pressures fluxuate due to current (and unforseen conditions).

I wouldn't worry about the fluxuation. My interest peaks at why you were recogmended a pressure of 19, when the machine only has to put out 16 to treat the apnea. Still, have comfort that you are getting low AHI readings with a lower pressure rating. It would be interesting if this is true a few months from now.

I had the F & P since early April and used it until September 10th. I went in to try a different mask since the F & P 407 I was using just wasn't sealing and I had mask farts that would constantly wake me up, along with severe dry mouth. Know that the dry mouth is not really machine-related, but more of a mask issue and is a result of opening your mouth during the night and mouth breathing. This will "reduce" therapy, but it appears you have "time" to deal with it because your AHI is low.

I went to a different DME who deals with resmed and respironics gear and I tried a few different masks I ended up liking and borrowed the respironics unit for a couple weeks and then last night tried the S9 autoset which I like a lot also. I have no dry mouth problems with either APAP unit and sleep well. Insurance has given the green light to get an APAP unit, even though I just got the CPAP, due to the quality of sleep I've been getting now. For grins I tried my F & P 234 cpap machine on Sunday night with the new mask and woke up 5 times, each with dry mouth, and felt horrible when I woke up in the morning.

My AHI is .3 across the board so I have very little mask leakage now with the new mask and an APAP unit. I'm still on the fence between getting the Respironics or the S9 though, and my new DME really likes the resmed stuff and is easy to work with.

I would get the Resmed S9 autoset. Be sure you don't get the Elite or Escape. Get the Autoset. You can use the autoset in the autopap mode or the cpap mode... whichever you prefer.

[paul85]

Is the elite a cpap only machine?

I think thats what I got, not an autoset, but an elite. It also appears, from looking at my literature, that The respironics model I had was a remstar pro 450 system 1 cpap with automode.

Are none of these true apap machines?

Also, regarding the dry mouth, it only occurs with the F & P machine, doesn't matter what mask I use. From what I've read, it might have to do with the way the pressure is applied. I can use the resmed masks with the f & P machine and have horrible dry mouth, but use them with the resmed or respironics machines and there is no dry mouth at all.

[Pugsy]

Is the elite a cpap only machine?

I think thats what I got, not an autoset, but an elite. It also appears, from looking at my literature, that The respironics model I had was a remstar pro 450 system 1 cpap with automode.

Are none of these true apap machines?

The Elite and the PR S1 Pro (model 450) are both straight cpap only machines. Neither has an APAP mode with variable pressures.
The only offer a fixed pressure though the Elite does offer EPR exhale relief which drops the pressure on exhale but the pressure on inhale never varies.

Dry mouth even with a full face mask can just happen. Mouth breathing even with a full face mask involves a lot of air movement through the mouth and the humidifier was really designed to add moisture to the nasal cavity and not the oral cavity.
Sounds like the PR S1 or ResMed machines are better able to deliver the added moisture that your body needs than the F & P machine can deliver. You are lucky...some people the new PR S1 or ResMed machines aren't able to keep up with their needs (even with settings maxed out) and they have to use one of the Biotene products to help hydrate the mouth or even use a chin strap to help keep mouth closed to prevent the dryness.

[archangle]

Don't be surprised if a lot of tinkering and trial and error is necessary to find the best treatment for your apnea. One man's cure is another man's poison.

All the holistic hoohah stuff has small effects if any, but if you find that your teddy bear helps, use it.

[Todzo]

With the Auto-PAP there are less events total - so less dry mouth etc...

Todzo: I found your thread informative and interesting.... but the statement that "with autopap there are less events..." is wrong in many ways. Some folks respond to straight cpap therapy much better than autopap. Every six months (or so) I challenge folks here to see if they do. More often than not, its a "comfort thang'" or there may be a medical reason to use auto-pap therapy. Remember, it takes time for an autopap machine to detect an apnea event, to respond to the event and treat the event. In most cases, it could be 5 - 15 seconds, or so. All the while, your body is experiencing an untreated event. This may be small (and it is), but don't discount it and don't think your body doesn't feel it. My challenge is for folks to switch modes once a year or so, to see how they respond. I find my numbers are about the same in both modes, but I can definitely tell you that I feel much better using straight cpap therapy vs autopap therapy. Just sayin'

Sheriff

Hi Sheriff!

I think you may well be right about autopap. When I recently lost weight unstable breathing reared it's ugly head. Not finding good medical help I decided to self titrate. My first thought was to use Auto-PAP set to my original titration (13 cm/H2O) and my current setting (15 cm/H2O). During the couple of hour test I snored and the PAP kicked up to the high pressure. Well, I know that over breathing will likely produce snoring so this would not work for me!!!

I am still doing the titration (reduce pressure – look at data for at least a week – decide – reduce pressure – repeat until clear lowest has been found which is not yet for me (four days at 8 cm/H2O with AHI 0.76 last night!)). And I know that auto machines never get to zero AHI by design and documented by research.

My response to paul85 was simply to explain why he experienced less dry mouth.

Thanks for bringing this up!

Todzo

[paul85]

My S9 says Autoset near the power button so it looks like I'm golden. Pictures of the Elite online say elite in the same spot.

All I know is, when using the F&P 234, I always have dry mouth, no matter what level of humidification I use. When I use the respironics or resmed, no dry mouth. I don't even bring a glass of water to bed anymore!

[paul85]

my comments are in blue

I wouldn't worry about the fluxuation. My interest peaks at why you were recogmended a pressure of 19, when the machine only has to put out 16 to treat the apnea. Still, have comfort that you are getting low AHI readings with a lower pressure rating. It would be interesting if this is true a few months from now.

My titration paperwork shows that it took a pressure of 19 for me to get rid of all issues affecting my sleep. However, I had a lot of mask leakage that kept me awake at night as well. The entire study was poorly executed and nowhere near worth the 6k it cost my insurance and me. I sleep great at a max pressure of 16, and hopefully with weight loss, will get lower. I spend some time lower than 16, but 90% of the time I'm at 16.