Switched from APAP to CPAP mode

[Minky]

I'd been trying to optimize my therapy and hadn't been having much luck. I have UARS, so AHI was never an issue, but FLs were really bad and I was having 2-3 hours' worth of large leaks. I was also waking up several times per night to either readjust my mask or take a sip of water because my mouth was so dry from jaw dropping. I had also resigned myself to having to use a FFM, which I really hate.

I read through many posts here and found that many people have issues with an APAP and do better with one pressure. For the last two nights I've set the minimum and maximum pressures both at 9. Wow, what a difference. The 2-3 hours' worth of large leaks have gone away. I've gone back to wearing the P10 . My FLs have gone down a lot. They're still really bad, so I'm going to start increasing the pressure little by little each night until they've reduced to an acceptable level, but they are much better.

I now know that the constantly changing pressure was my problem. It was causing me to both wake up and open my mouth.

Thanks very much to everyone here for providing such a wealth of information. I'm sure I never would have figured this out myself.

[Tatooed Lady]

Uh-oh...you just fueled MONTHS of Den's "I told you so!"

Kidding, Den! (Sorta )

Congrats finding something that seems to be working better for you! this is why I am wholeheartedly behind the idea of helping our own therapy.

[Minky]

Yup, I have been listening to Den.

[Wulfman...]

Yup, I have been listening to Den.

Hi Minky.

So glad to hear your good news.

Keep at it and keep us informed on your progress.

I'm really NOT an "APAP hater" as SOME people have tried to imply (I own four of them myself). But, I know their limitations and advantages......when used "properly".


Den

.

[palerider]

Yup, I have been listening to Den.

Hi Minky.

So glad to hear your good news.

Keep at it and keep us informed on your progress.

I'm really NOT an "APAP hater" as SOME people have tried to imply (I own four of them myself). But, I know their limitations and advantages......when used "properly".

I would, however, submit that what you don't know, and don't have experience with, are *modern* apaps.... which are better programmed and act differently than what you've got.

[Wulfman...]

Yup, I have been listening to Den.

Hi Minky.

So glad to hear your good news.

Keep at it and keep us informed on your progress.

I'm really NOT an "APAP hater" as SOME people have tried to imply (I own four of them myself). But, I know their limitations and advantages......when used "properly".

I would, however, submit that what you don't know, and don't have experience with, are *modern* apaps.... which are better programmed and act differently than what you've got.

Not from what I've seen over the last few years. They all still respond to Flow Limitations and Snores primarily.

But, I'll take that under advisement..........


Den

.

[Guest1]

I too have gone the CPAP route after APAP for 5 months. Seems like I sleep much better even if my AHI is a bit higher than when I was on APAP. Over the last 30 days, my PRS1 60 series Auto would just keep doing its hunt-n-peck dance so I took the plunge and made it an APAP with max=min=8cm h2o. I must say, I sleep much better than on the APAP, and I stay much more "awake" and "present" during the whole day. My RDI is similar on both APAP and CPAP (always below <0.5).

I am sure there are some pressure change induced respiratory microarousals involved here that even these modern APAPs can't monitor or fix.

I have read Den's views on APAP vs. CPAP; and I have finally accepted the wisdom of experience over mindless AHI chasing of a newbie.

[Wulfman...]

I too have gone the CPAP route after APAP for 5 months. Seems like I sleep much better even if my AHI is a bit higher than when I was on APAP. Over the last 30 days, my PRS1 60 series Auto would just keep doing its hunt-n-peck dance so I took the plunge and made it an APAP with max=min=8cm h2o. I must say, I sleep much better than on the APAP, and I stay much more "awake" and "present" during the whole day. My RDI is similar on both APAP and CPAP (always below <0.5).

I am sure there are some pressure change induced respiratory microarousals involved here that even these modern APAPs can't monitor or fix.

I have read Den's views on APAP vs. CPAP; and I have finally accepted the wisdom of experience over mindless AHI chasing of a newbie.

Thank you for your kind words.

Best wishes for success with your therapy.


Den

.

[perasso]

you might find this article interesting. It explains what auto paps actually do and it's not what you might expect. and all the algorithms aren't the same and all depend on snoring or flow restrictions to drive the algorithm.

http://www.sleepreviewmag.com/2009/09/a ... -pressure/

auto pap is derived from those titrating machines that they used to send us home with so the doctor could figure out what pressure to set on our CPAPs. Well, the doctors and the sleep industry have figured out that in most cases the auto pap will wander around close enough to the optimum pressure so that the patient gets improved sleep. But not always!! In many cases it is best to use the auto pap to explore how you breathe at different pressures and then pick the one (or a narrow range) that works best for you. I'm doing the same with mine, i.e. using it to find my optimum pressure.

Of course there are cases where an auto pap is absolutely the best thing because your pressure needs vary during the night, just not always.

[Wulfman...]

you might find this article interesting. It explains what auto paps actually do and it's not what you might expect. and all the algorithms aren't the same and all depend on snoring or flow restrictions to drive the algorithm.

http://www.sleepreviewmag.com/2009/09/a ... -pressure/

auto pap is derived from those titrating machines that they used to send us home with so the doctor could figure out what pressure to set on our CPAPs. Well, the doctors and the sleep industry have figured out that in most cases the auto pap will wander around close enough to the optimum pressure so that the patient gets improved sleep. But not always!! In many cases it is best to use the auto pap to explore how you breathe at different pressures and then pick the one (or a narrow range) that works best for you. I'm doing the same with mine, i.e. using it to find my optimum pressure.

Of course there are cases where an auto pap is absolutely the best thing because your pressure needs vary during the night, just not always.

Thanks for that link. I've seen similar ones over the years but this one's a little more current, although still a little bit dated as the manufacturers have rolled out a couple more generations of machines since 2009.

And, you're exactly right. And, something I've been saying (in various ways) for years. Somewhere along the way, they went from "auto-titrating" to "auto-adjusting" and were marketed as an "end-all, be-all machine" for effective therapy. Well, the "auto" function works for some people but not for others. However, since they're multi-mode machines, they do serve the best of both CPAP worlds. It's just that the user needs to experiment to find which options work best for them.


Den

.

[perasso]

if you find a more recent article, please post it. I'd love to read it.

As for the 2009 article I posted, I can verify that respironics still works as described in the article. I don't know about the others.

I don't snore, so my APAP is not able to adjust my pressure effectively. It simply doesn't detect any events (snoring, flow limitations, hypopneas) before I suddenly have an apnea event. It takes the respironics 10 minutes to respond, some of the other brands are faster, but still take 5 minutes.

The respironics is, however, very useful for giving me data on what my optimum pressure will be because it ramps the pressure every 10 minutes or so, looking for a pressure at which the air resistance is at a minimum. One or two more nights and I'll have enough data.

If I were beginning my CPAP journey again, one of the first questions I would ask a practitioner is to explain the algorithm of the APAP he/she is prescribing and why that will work for me. If he/she couldn't do that, I would look for another provider. Problem is, I doubt that very many sleep doctors have a clue.

[reader2580]

I switched sleep clinics recently. The first thing the new doctor did was to up the minimum pressure on my APAP significantly. A week or two after I first saw him I was getting dangerously tired so he ordered a new sleep study. After the study he had me increase the minimum pressure again to 12. The doctor says that too low a minimum pressure means the pressure can change dramatically during the night causing sleep issues,

I will ask about just making the machine a CPAP at my next appointment.

[Wulfman...]

I switched sleep clinics recently. The first thing the new doctor did was to up the minimum pressure on my APAP significantly. A week or two after I first saw him I was getting dangerously tired so he ordered a new sleep study. After the study he had me increase the minimum pressure again to 12. The doctor says that too low a minimum pressure means the pressure can change dramatically during the night causing sleep issues,

I will ask about just making the machine a CPAP at my next appointment.

It's really very easy to do.

viewtopic.php?f=1&t=101747&p=951212&hil ... ng#p951212


Den

.

[perasso]

reader2580: too high of a pressure can also cause apnea events, they are a different kind than obstructive apnea.

I don't know what kind of an APAP you have, but I'm pretty sure that all of them have an SD data card and anything made in the last few years records a TON of data each night. Consider installing some software (e.g. sleepyhead) and uploading the data from your apap into the computer so you can see what is going on. In my opinion, your doctor should have asked you to bring in the card so he/she could look at all the data that is being collected before sending you for another (expensive) sleep study and then setting your minimum pressure higher. But what the heck do I know. I'm just a CPAP user, not a MD who knows everything.

If your MD can't understand the data from your APAP you can either seek another sleep professional or, better perhaps, share your data with this board and get help from other A/CPAP users.

BTW it is well within the bounds of normal to have to experiment around with a cpap/apap to discover the settings that work best for each individual patient, so don't be alarmed that there are problems.

The thumbnail below is too small to read, but you should be able to get the idea that there's a lot of data inside your APAP. There's a lot to be learned from it. I think you should be able to click on it to see it larger.

[reader2580]

reader2580: too high of a pressure can also cause apnea events, they are a different kind than obstructive apnea.

I don't know what kind of an APAP you have, but I'm pretty sure that all of them have an SD data card and anything made in the last few years records a TON of data each night. Consider installing some software (e.g. sleepyhead) and uploading the data from your apap into the computer so you can see what is going on. In my opinion, your doctor should have asked you to bring in the card so he/she could look at all the data that is being collected before sending you for another (expensive) sleep study and then setting your minimum pressure higher. But what the heck do I know. I'm just a CPAP user, not a MD who knows everything.

If your MD can't understand the data from your APAP you can either seek another sleep professional or, better perhaps, share your data with this board and get help from other A/CPAP users.

The MD was using the data from the machine when he said it needed to be set higher. I do have SleepyHead installed.

I switched sleep clinics because the other clinic was too far away and they started to have me see a PA because they had a doctor or two quit. I finally went to another clinic after I was getting more and more tired. I quit using CPAP for a while as I wasn't better when I used it. The new doctor wasn't going to do another sleep study initially, but I was getting so bad I couldn't even work I was so tired.