Please Help CPAP vs Autoset CPAP

[dirtydog26]

Please help! I just spent a week in a hospital with multiple blood clots in my lungs. During that time I saw 2 pulmonologist (lung dr's and 3 repertory specialist). Every single one of the were appalled that I was using my res med Autoset CPAP. They wanted to know who authorized it & why. Then tried telling me how bad they are and how I need to stick with just a regular cpap unit. Now I recently upgraded to this unit about 4 months ago & LOVE IT! I am sleeping better, longer, with lest wake ups & apnea's throughout out the night. Does any one know what the big difference is or why so many doctors seem to such issues with autocpaps?

Thanks,
Dirtydog26

[walkman8080]

So, as a Respiratory Therapist myself (and current CPAP/APAP user for OSA), this is what I can offer (and by no means should this replace advice from your sleep doctor or general physician):

I have been using fixed CPAP of 15 for the past 2 years. I have a machine capable of APAP and have lately been curious as to the differences it offers in terms of comfort and overall "better rest". As it is now, I sleep just fine on fixed but if I don't need the 15 all night, I'd rather use a lower pressure (will help with leaks, mainly). So, I found this study from 2001 and read through it earlier. http://www.journalsleep.org/Articles/250204.pdf I would welcome you to read it but the short of it is there is not much difference between CPAP and APAP and in a few cases the mean pressure with APAP was 3-4cmH2O lower than fixed (based on ESS - subjective answers from patients on their sleepiness).

Now, why would a pulmonologist and an RT give you grief with using APAP over CPAP? My guess is ignorance. Most pulmonologists I know in our hospital do not deal with OSA and certainly most RTs do not, either. If you had blood clots in your lungs I would assume you were on an acute floor of the hospital (or possibly ICU, based on severity). OSA is not dealt with in these situations - although if one DOES suffer from OSA and requires CPAP, the hospital staff would certainly welcome the use of it. That doesn't mean they know or understand your particular issues with it.

Was there a diagnosis given to you as to why you ended up with PE (pulmonary embolism)? Do you have a history of CHF, suffer from DVT, or something else chronically? With the way APAP works - by titrating up and down pressure delivery based on machine algorithims - you could be susceptible to things like oxygen desaturation, which can cause constricted pulmonary circulation (although this would be a very rare thing and you already would have known if you had it).

I apologize for length, and probably rambling. My opinion is as I said: ignorance. I really doubt using your APAP had any issue with your PE - although, again, I don't know your medical history - and if APAP has been working for you I would keep using it. Cheers

[BlackSpinner]

Ignorance. Most people are put on APAP's with them wide open 4-20 pressure. That is only a setting for titration. They need to be set around your 95% level.

The big thing is - do you sleep better and do you get better therapy? Since you say yes then it is the machine for you.

[StuUnderPressure]

Please help! I just spent a week in a hospital with multiple blood clots in my lungs. During that time I saw 2 pulmonologist (lung dr's and 3 repertory specialist). Every single one of the were appalled that I was using my res med Autoset CPAP. They wanted to know who authorized it & why. Then tried telling me how bad they are and how I need to stick with just a regular cpap unit.Thanks,
Dirtydog26

Try to get a "real" reason(s) why they think an APAP is bad for you or anyone else. And don't settle for that general statement that they "are bad for you".

[hyperlexis]

Now just a cotton picking second here -- unless someone here is an MD who knows your specific medical history, NO ONE here can competently answer that question. Smoking and drugs feel great too but that doesn't mean they are beneficial.

You obviously have some sort of serious lung problem and/or other serious health problems. For those problems, an APAP machine may be contraindicated. Constant pressure, possibly even with no exhalation relief, as good as it feels, may be contraindicated.

The right people to ask the reasons for the doctors' concerns are ...the doctors.

[Wulfman...]

Please help! I just spent a week in a hospital with multiple blood clots in my lungs. During that time I saw 2 pulmonologist (lung dr's and 3 repertory specialist). Every single one of the were appalled that I was using my res med Autoset CPAP. They wanted to know who authorized it & why. Then tried telling me how bad they are and how I need to stick with just a regular cpap unit. Now I recently upgraded to this unit about 4 months ago & LOVE IT! I am sleeping better, longer, with lest wake ups & apnea's throughout out the night. Does any one know what the big difference is or why so many doctors seem to such issues with autocpaps?

Thanks,
Dirtydog26

If they're improperly configured, APAPs can/will deliver substandard therapy. With a wide range of pressures or if a person's breathing is absent the "triggers" an APAP needs (Flow Limitations or snores) to raise pressures, it takes too long for the pressure to reach the needed pressure......or it never gets to the needed pressure. Consequently, the hypopnea and apnea events occur at will. The pressure changes can also disrupt the user's sleep and leave them feeling unrested.

It's absolutely mandatory that someone using an APAP in a range of pressures use software to monitor their therapy.


Den

.

[dirtydog26]

1st thank you to everyone who responded. The information this forum has provided myself and others has been invaluable. While I know this is not official medical advice, I have gathered great information from this forum, from mask, and machine questions, to questions to ask my DR. Personally I can say I have slept 100% better with more energy when I wake while on APAP vs CPAP. That is the only reason I question the "SPECIALIST" insistence that cpap is better than apap. My API has never been over 1.0 since being on apap. I originally believed I had a bad sleep study for my original cpap which set the pressure at 6. With poor results and suggestions that I try an APAP, I was able to fine tune the settings where my sleep has improved. My pressure now averages between 10-12. If most people have insurance like mine that only covers 1 sleep study every 5 years, I recommend using an apap. This helps make adjustments in between sleep studies as everyones bodies continue to change. Rather its stress, weight, or other medical conditions, I have seen my pressure level adjust. Common sense suggest apap is the best way to go. Just curios why most medical doctors disagree?

Thanks again to everyone who helps make this such a great forum!!!
Dirtydog

[robysue]

You obviously have some sort of serious lung problem and/or other serious health problems. For those problems, an APAP machine may be contraindicated. Constant pressure, possibly even with no exhalation relief, as good as it feels, may be contraindicated.

If this is true, then the doctors should be able to say something to dirtydog26 other than "APAPs are bad for you, CPAPs are good for you."

The right people to ask the reasons for the doctors' concerns are ...the doctors.

The problem is the doctors were NOT letting dirtydog26 in on those concerns. And that's a problem. How do you get the docs to actually talk to you about what their concerns actually are when all they are willing to say is "APAPs are bad, CPAPs are good"?????

[BlackSpinner]

Now just a cotton picking second here -- unless someone here is an MD who knows your specific medical history, NO ONE here can competently answer that question. Smoking and drugs feel great too but that doesn't mean they are beneficial.

You obviously have some sort of serious lung problem and/or other serious health problems. For those problems, an APAP machine may be contraindicated. Constant pressure, possibly even with no exhalation relief, as good as it feels, may be contraindicated.

The right people to ask the reasons for the doctors' concerns are ...the doctors.

There were studies done before AHI on machines were available. People were allowed to titrate them selves using the "feel good" principle - most of them figured out something close to their official titration.

Most doctors, unless they are on a cpap, know fuck all about the therapy, the machines available or how it feels.