Documented Case for APAP?

I am on an APAP machine right now and will be going to a CPAP trial.

My doctor says there is no medical justification for APAP. I feel like he is a warehouse worker pushing a small list of machines at me.

Could anyone recommend medical resources I might refer to that make a case for APAP? Is it useful?


I'm in Ontario and I fear I might have little or no choice in machine.

If you know of good references I'd appreciate reading them.


Sigurd

-positional sleep changes (sleeping on your side vs. back or supine).
-aerophagia or swallowing of cpap air due to a compromised or defective LES from having GERD.
-suspicion pressure is not high enough and/or that the titration was flawed.
-compliance; autopap use generally results in a lower cpap pressure, making the machine quieter to use and increasing compliance.

you may only spend 30-40 seconds per night at the maximum needed pressure of cpap, use of an autopap can reduce the impact of aerophagia since it would only run at the higher pressure when needed then drop back down.


contradictions:

-Central Apnea (CA) or Mixed Apnea (MA) as seen on a PSG report.
-Chronic Snoring. Chronic snoring can cause the machine to increase pressure even higher than pressure(s) found during a titration, this can sometimes create a problem if you are at risk of CA events.

Even with CA present you can use an autopap if you know the trigger and set the machine up properly. I actually sleep better on an autopap, the lower pressure seems to trigger fewer CA events. I limit the Max pressure to the threshold were more CA events were seen.

You might also remind him that an apap machine can be set in cpap mode. The apap can be used for a new home titration if needed and/or save the cost of a machine upgrade in the future if apap becaomes medically indicated. Also remind him that it is not his money that is being spent.