APAP or CPAP? Very confused

[Luthie2006]

Hello, I am a new (2 week) APAP user and am confused and tired and barely functioning at work. My machine is CPAP capable as well. Res Med Escape S 9. The machine pressure is set at 4. It goes to 20. (I had a home-sleep study test, so no sleep lab with CPAP) They did read the results of the home sleep study. I have mild apnea (9) (however with tachycardia upon awakenings) and after 2 weeks have used the WISP nasal mask with my APAP Machine and a chin strap. I finally got the mask and chin strap down very well in a matter of less than 2 weeks and can use it all night. I am proud of myself that I don't throw it off at night. I don't have a problem falling asleep, but I am up every hour just about waking up looking at my pillow for "no reason" with vivid dreams/nightmares. Sometimes the need to go to the bathroom, sometimes to fix a leak, but most of the time, "for no reason." My sleep clinic supervisor seems to think that perhaps an APAP machine does not work for me because the higher pressures that kick in during REM sleep when my airway is restricted, is waking me up. She wants to look at the data card next week and will download it for me. She thinks that maybe continuous pressure at a higher setting (CPAP) would be the way to go. I always thought that the APAP machine was the best and newest! Has anyone out there had this problem and had to switch to CPAP from Auto-Pap? Thank you so much.

[chunkyfrog]

If your machine is an Escape Auto, it will run in either auto or single pressure mode.
Your machine has been set for a maximum range, practically guaranteeing failure.
It can be set for a tighter range, but since it lacks pressure data, there is no way to tell what range that should be.
I presume you were not titrated in the lab? You have been sold a brick, I am sad to say.
Go over the therapist's head, to your doctor, and insist on a script for an Autoset, like mine, and many here.

[The Latinist]

If your machine is the S9 Escape Auto, then there's not much the data card can tell your provider about your therapy. It can tell her what your AHI has been, but nothing about what pressures you've been using, etc.

[hyperlexis]

You are doing the right thing -- have the DME's respiratory therapy people look at the chip. Your machine is set wide open, which isn't good because every single night it has to hunt, up and down, for an ok pressure. That's less than effective and can definitely wake you up. Doing it every single night makes it worse. Getting a tighter pressure range figured out, or possibly one good pressure, would be better because of less pressure changes during the night.

If your machine has no data capability you should get a more precise titration study done. Possibly your insurance will cover it. Or borrow a data capable auto machine from the DME for a while to see your data and determine what your pressure ranges should be. Then your existing machine's settings can be re-adjusted.

[Pugsy]

Look on the top of your machine....does it say Escape or Escape Auto?

BTW...I am one of those people whose OSA is much worse in REM stage sleep and I often need MUCH higher pressures in REM stage sleep and APAP mode means that I could use 10 cm most of the night and let the machine go where it needs to only in REM sleep (and I have seen 18 cm on the reports)...otherwise I would have to use 18 all night...duh. Guess which one I prefer?

Yes, for some people the changing pressures when using APAP mode can disturb their sleep (never did me) and when that happens there are things we can do to limit the changes.

For now...let's figure out exactly which model machine you have.
The Escape models....
The S9 Escape...zero data to help you figure out what problem, if any, you might be having. All it records is hours of use.
The S9 Escape Auto...hours of use, generic AHI (no event category breakdown) and average pressure used in auto mode...no graphs..no way to see when it might have increased the pressure like in REM stage sleep...no leak data...nothing but generic AHI which doesn't tell anywhere near the whole story.

If you have the S9 Escape...that 4 to 20 thing is just available settings...it won't auto adjust.
If you have the S9 Escape Auto and using it in auto mode...that 4 minimum could be your problem...it may not be optimal pressure minimum for your needs.

It's always better to have a full efficacy data APAP machine...in this case with ResMed the S9 AutoSet because it can be set in APAP mode or CPAP mode....like 2 machines in one. Plus it gives you all the data you need to help evaluate your therapy.
DMEs don't push them because they make more money on the Escape models.
The straight cpap full efficacy data model is the S9 Elite.

[Luthie2006]

Thank you to all of you! I will call my DME provider when I get the next break from work and find out exactly what they gave me. I do know that the therapist told me that this machine can change from Auto-Pap to CPAP which is the "nice" feature of this machine and that there is a data card which can tell all. And when the supervisor clinician reads the data card next week, that they will be able to tell what is going on in my REM sleep that wakes me up. The doctor wanted the pressure to be set at 4 because I have mild apnea and it can change pressures throughout the night. They said it would rarely go above 9. (allegedly).
So is it the consensus of this wonderful group that the pressures are set wrong? And that CPAP would be better for me?

[Pugsy]

And when the supervisor clinician reads the data card next week, that they will be able to tell what is going on in my REM sleep that wakes me up.

IF you have the S9 Escape Auto it will NOT be able to tell you anything about REM Sleep....nothing, nada, zilch.
The Escape Auto offers...hours of use....a generic AHI number and average pressure used...nothing else.
There's not a cpap/apap machine in the world that can tell you anything about REM stage sleep. Heck, they can't even tell the difference between awake time and asleep time.

Now what the full efficacy data machine can do that the Escape Auto can't do is give your graphs showing breathing pattern and potential event clustering and we can loosely correlate REM stage sleep times based on normally occurring REM sleep patterns.

So is it the consensus of this wonderful group that the pressures are set wrong? And that CPAP would be better for me?

My consensus is they gave you a machine that won't come close to doing what you want if you need to have any idea what might be going on in REM stage sleep....no graphs mean you can't see anything to even remotely guess what is happening in REM sleep. If they told you they could...they are lying. Plain and simple.
There is zero way to prove if cpap would be better than apap.

The S9 Escape machines use the older technology...they don't/can't tell a central from an obstructive apnea...they do blow air though.

Go here and compare the S9 Escape Auto with the Escape with the Elite and the AutoSet and see what is available in terms of data. The S9 Escape Auto ....is hours of use...AHI (just a number without breakdown into central, obstructive or hyponea which is kinda important) and average pressure. Note at the bottom..no central event detection.
http://www.resmed.com/int/products/prod ... nc=dealers

Would CPAP mode be better for you? Maybe...maybe not. There's nothing to base it on except how you feel. For me that isn't enough to make any recommendations. At this point all we can say is try it and see how you feel.

You can use ResScan to see what little data your machine gathers. Can't use SleepyHead because it needs the full data files to do anything. Do you want it? Let me know via private message. Windows only software though...no Mac version.

Finally, I would be madder than hell at any DME person who told me a flat out lie about what my machine would do.
None of the machines can tell when REM is occurring...none of them even the high dollar fancy ASV machines. The best we can do to guess when REM (or even sleep in general) is happening is by careful correlation with known patterns for breathing and normal REM stage sleep patterns ...which is normally first REM occurring about 90 minutes after sleep onset and then more frequently as the night goes on and lasting longer BUT...that normalcy gets tossed out the window if you report multiple awakenings for any reason because then the sleep cycles get to start all over again.

[Julie]

Hi - for the record, whether you tested as having mild or severe apnea is not related to how much pressure you need to keep y your airway open - everyone's anatomy and obstructions are different and you can have mild apnea but need a high pressure to do the job, or have severe apnea and need only a low pressure to work. But no one can breathe at 4 (it's the default low setting of the machine) and not a normally scripted pressure. The bare minimum might be 6 or 7, more often ends up being around 10 for most.

[Luthie2006]

Thank you Pugsy and Julie and everyone else very much. I spoke with the sleep clinician and she spoke with the doctor and they want me to bring the whole macine in to them tomorrow morning including the data card. He is going to make "changes" to it. The problem is that I did not go to the sleep lab at the hospital, but did the home sleep study for 2 evenings (totalling 10 hours of sleep total for 2 evenings) and they received data from there. It was my choice to do at home because I could not sleep in a lab. I am going to call my DME at lunch time because now I am very curious what model I actually have.
Thank you very much.

[Pugsy]

No titration in a lab...you for sure need a machine that will flag and record centrals.
Neither of the Escape models will do that.

There's a small minority of people who develop centrals as a by product of cpap therapy itself. Kinda important to know if that is happening or not. Most likely would/should show up on an in lab titration study but if none has been done...gotta have a machine that will flag centrals just in case you are one of the 10 to 15% of the people who develop centrals just from cpap pressure and it doesn't have to be high pressures that cause them. I have seen it happen with as little as 5 cm pressure.

[Luthie2006]

Again, thank you so much for all the comments. Turns out I have the "cheaper" S9 Escape Auto". When I called the DME he said that's what they order in bulk.
But I can have it changed if I wanted to. Great. So the top cadillac model is S-9 Autoset? Thank you again

[Pugsy]

But I can have it changed if I wanted to. Great. So the top cadillac model is S-9 Autoset?

Yep...get the AutoSet if you can. You won't be sorry. It's like having 2 machines in 1 plus you get all the new technology that goes along with it. Improved algorithm and all that along with all the detailed data available.
See my SleepyHead tutorial link in my signature line to give you and idea what is available. Lots of examples.

[Luthie2006]

PUGSY and Everyone else: I cannot tell you how much I appreciate your advice!! I called up my sleep clinician and she was appalled that I did not have the
S9 AUTOSET!!! She thought I did. It was the DME that gave me the cheaper version, even though insurance will pay for either machine. I was told by the DME purchasing department, that they order the Escape in BULK. When I told my sleep clinician, not only was she appalled, but she said she may even cancel my 6:00 am visit tomorrow morning (before I start work) because the data card is useless to her especially since I did not do a sleep lab and did the home sleep study. She was angry. She assumed I had the Autoset, and she is going to now try and switch out my machine for me with the DME.

[Luthie2006]

Again, I don't know what I would do without all of you, and this is my first day on this site!!
The sleep clinician called me back, and as I stated in my last email, she agreed, that they are going to get zilch, zaddo, from my data card if I have the Escape!
She wholeheartedly agreed with this. She told me to bring in my Escape Auto machine tomorrow morning as I was going to do before, and she is ordering me a brand new S-9 AUTOSET machine which I will pick up tomorrow evening at 5:00 pm. I never EVER would have known this information that the Autoset was so much better if it was not for this website and I thank all of you so much!!! AND NOT ONLY THAT, she is going to tell the doctor that on all his orders from now on he should specifically write S-9 AUTOSET. And this is as large teaching hospital out of Chicago!! They assumed that everyone was getting the AUTOSET.
So you guys helped me, I contacted my sleep technician and she contacted the physician that on his orders it should state, AUTOSET, and now MORE PATIENTS will be helped by all of you! Thank you again. By the way, since I will receive no training on the AUTOSET, is it the same dials as the Escape? I will not have availability to be trained. They are going to set the pressure though on this one maybe a little higher and actually she even said it's almost a waste of time to download its card, but she will anyways because I have to bring it in to be exchanged. Thank you guys! Love you!

[The Latinist]

That's great news! I'm glad you didn't even have to fight with them about it. I think you'll be very happy with the S9 Autoset, and it will give your doctor all the information she needs to know exactly how well your therapy is going. After you've got your new machine and used it for a few days, get yourself the free SleepyHead software created by forum member jedimark and take some screenshots of your daily results. There are some great people around here who can help you analyze your data. And, while you should always consult your doctor, people around here can give you an idea about whether your doctor is on the right track (believe it or not, doctors are fallible; and sometimes those who have struggled with problems can offer some insight your doctor can't).