Should I give up APAP and just go with CPAP?

[alexander]

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[Julie]

You're limiting the auto mode's abiilty to work properly by setting the higher # (e.g. immediately above the lower one's (7., rather than setting it higher, e.g. 11, or 15 or even 20. The whole point of auto is to give the machine a chance to address (and track for your later perusal) events - and see how many occur - out of the low range setting, which gives you a better picture of how you're doing and why. Cpap mode at one setting may be the way to go for you, but you're not giving the machine a chance to properly gauge things now.

[alexander]

Edited out.

[Jay Aitchsee]

APAP isn't necessarily better than CPAP. What works best for you (AHI, comfort, disturbance, etc,) is better. In theory, the 8-8 setting should be equivalent to CPAP of 8, but it is a different machine and the humidity setting could influence the results. Why not try straight CPAP at 8 until you become accustomed to the new machine and then try auto if you wish. But just because you have APAP capability doesn't mean you have to use it, or that you will feel more rested with it. Many are disturbed by the pressure changes of an auto machine,

[alexander]

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[ChicagoGranny]

The pressure was around 11.0–12.0 for 30 minutes, and I felt like I could barely breathe.

This is just something that happens when you are awake and thinking intently about your breathing and trying to control that breathing. Once you fall asleep, your autonomous system takes control of breathing and you have no problem breathing with these pressures.

While awake, the key is to try to think of pleasant things that distract your mind from breathing. Thinking of being young on a tropical beach works for me.

[Jay Aitchsee]

Jay Aitchsee wrote:In theory, the 8-8 setting should be equivalent to CPAP of 8, but it is a different machine and the humidity setting could influence the results.

The pressure was slightly different, and it was the same machine (AS10) – I didn’t change the humidity settings. But it probably doesn’t matter that much – no one (except me, that is) uses APAP with low and high set to the same pressure. My plan was to start with 8.0–8.0 and then incrementally expand the range during a week or so, and watch the AHI closely. I just like fine-tuning stuff. Maybe I’m bored.

Yes, I meant compared to the S9 you had been using. Actually, sometimes people do use the same high and low settings in the apap mode because some machines report a little more detailed data in the auto mode compared to the cpap mode.

[OkyDoky]

Were the EPR settings the same on both machines?

[Guest]

The pressure was around 11.0–12.0 for 30 minutes, and I felt like I could barely breathe.

This is just something that happens when you are awake and thinking intently about your breathing and trying to control that breathing. Once you fall asleep, your autonomous system takes control of breathing and you have no problem breathing with these pressures.

I was probably not in a deep sleep, but I think I was sleeping. I wake up about 1:00 AM, the pressure was 8.0 at that point, and felt that my chest had worked really hard. But I only had one hypopnea event during those two hours – which is pretty good – so maybe my body needs to adjust to the higher pressures. But my question remains – do I need APAP with higher pressures when my AHI is consistently at 0.5 with CPAP at 8.0? Is there a long-term benefit to that?

While awake, the key is to try to think of pleasant things that distract your mind from breathing. Thinking of being young on a tropical beach works for me.

I think of all sorts of wonderful things while I’m about to sleep. I’m not using the ramp function, but since my starting pressure usually is 8.0, I manage to breathe fine until I reach a state where I’m sleeping. I will add the tropical beach to my list of things to think about.

[alexander]

Edited out.

[alexander]

Edited out.

[ChicagoGranny]

But my question remains – do I need APAP with higher pressures when my AHI is consistently at 0.5 with CPAP at 8.0?

If you go by the numbers the machine provides, the answer is you don't need higher pressure.

But how do you feel? How many hours per night do you think you sleep? What is your energy level during the day? Any sleepiness during the day? Is your condition preventing you from doing some things you want to do?

Do you ---->

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Practice total abstinence of caffeine including sources like chocolate
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Optimize emotional stress in your life

?

If you have any health issues besides sleep apnea, what are they?

[Pugsy]

I didn’t use EPR on the S9. At least I don’t think so – I’m not 100% sure. I started out using EPR on my AS10, but my mind got stuck in trying to follow its «rhythm» – and I’ve read something about that it can possibly cause centrals, so I try to avoid it. Maybe it’s safe when using setting 1?

The chance of EPR use actually causing centrals is very remote as it is not something that is a common occurrence among cpap users who want to use exhale relief. It's very rare for that to happen. The majority of cpap users who use EPR (or another brand's form of exhale relief) don't have centrals pop up just because of exhale relief and can use whatever setting feels the best for them.

do I need APAP with higher pressures when my AHI is consistently at 0.5 with CPAP at 8.0? Is there a long-term benefit to that?

Probably not needed and of no great benefit to you in your situation. Varying pressures can come in handy when there are significant pressure needs differences for whatever reason. The 2 most common reasons for perhaps needing a markedly different pressure during the night are supine sleeping vs side sleeping or REM stage sleep pressure needs. Not everyone will see a marked difference in pressure needs though so if there is no real need to allow the machine to go higher then there's no need to use APAP mode.
Example...my REM stage sleep is where my OSA is markedly worse and sometimes during REM sleep I have seen some rather significant pressure changes being needed to keep the airway open. Like for most of the night I can use 8 to 10 pressure but during REM sleep I might need 18 cm...so for me there is a big need for the machine to be able to go to 18 cm for those periods of time because I sure wouldn't want to use 18 cm all night just to deal with 2 or 3 REM stage sleep pressure needs. So for me APAP mode is a great benefit. Now if my REM sleep didn't need such a pressure difference then APAP mode wouldn't necessarily be that great of a boon to me. My AHI at 8 cm cpap was roughly around 8.0 because of the clustering of events that would happen during REM sleep and those were some nasty clusters but other times during the night not much was happening at all. By allowing the machine to go to 15 to 18 during REM my AHI was cut down to less than 2.0 and more importantly I felt the difference as a big improvement.

In your situation your AHI is already really low even on cpap mode at 8.0...so there doesn't appear to be much happening in terms of supine sleeping (if you are sometimes on your back) or REM stage sleep maybe needing more pressure....so if there is no need for more pressure then there is really nothing to gain by using apap mode.

There are times when apap mode comes in handy for some people but it isn't always a huge need for everyone and some people find that apap mode causes more sleep disruptions than it might be fixing some other problem.

Use whatever mode and settings that allows you to sleep the best and give you the AHI that you are happy with. That's the important thing....good sleep and not which mode is "better" because "better" is what lets you sleep the best and feel the best.
So use cpap mode if that means you sleep better and feel better. Don't worry about doing apap mode every so often unless you find that your situation changes and there might be a need to evaluate pressure needs...and your AHI or how you feel will tell you if you need to re-evaluate your pressure needs.

[OkyDoky]

Were the EPR settings the same on both machines?

I didn’t use EPR on the S9. At least I don’t think so – I’m not 100% sure. I started out using EPR on my AS10, but my mind got stuck in trying to follow its «rhythm» – and I’ve read something about that it can possibly cause centrals, so I try to avoid it. Maybe it’s safe when using setting 1?

I was just thinking that Epr settings might have contributed to the feeling of pressure differences when you had the auto set at min=max. I use bilevel along with a lot of other people which is greater I/E differences than the maximum 3 that EPR gives you. Are you monitoring your data with software? That would let you know what types of events are included in your AHI and also what is driving your pressures higher. If centrals became a problem that way you would know. Here is a link to help you understand and download Sleepyhead. https://sleep.tnet.com/resources/sleepyhead If you have questions just ask.

[Jay Aitchsee]

But my question remains – do I need APAP with higher pressures when my AHI is consistently at 0.5 with CPAP at 8.0? Is there a long-term benefit to that?

If your apnea is controlled and you are rested, as CG implies, it doesn't matter how you get there. There is no advantage to a higher pressure if you don't need it.
APAP is great for people who have significantly differing pressure needs throughout the night, for example, while sleeping on the back or during REM, some people may need a pressure increase of 5 cm or to control events. Others may sleep through the night with unchanging pressure needs.
Bloating and mask leaks are the greatest disadvantages of higher pressures while some people are disturbed by the changing pressures of an APAP. If these things affect you, resulting in less than restorative sleep, then you must compensate. Only you can know that.
Keep in mind that a small incremental change in AHI doesn't necessarily directly relate to better sleep. Sometimes, one must give up a little AHI for more comfortable and restful sleep.
The goal is to rid the body of the stress of Apneas (clinically an AHI of less than 5) AND obtain restful, restorative sleep.
I see Pugsy has posted a similar response while I was composing, but I will leave this in concurrence with her post, anyway.