APAP for dummies

This discussion is going on in several places, and I've got folks trying to talk me into APAP (I'm about halfway there).

However... perhaps I'm just slow (hey, apnea will do that, eh?), but I'm having a really hard time understanding all the different aspects of APAP.

It sounds like APAP isn't as simple as just saying "Hey, I'll buy an APAP instead of a CPAP". There's talk of the different algorithms, and the HI and AI and other numbers, and I really want to understand.

Is there an "APAP for Dummies" somewhere that I could read and get a better sense of all of this?

I'll say one thing for CPAP, it's a lot easier. Put it on, start it up, and you pretty much have two settings to deal with: 1) Do I want heat/humidity and how much, and 2) Do I want to start with the ramp-up feature.

Do I need to understand all of the information out of the APAP? Do I need to tweak and play with all of the settings to make sure I get optimal treatment?

And is it relatively easy to accomplish all of that, or is it one of those "crap shoot, constantly tweaking and hoping you got it right tonight" kinds of things?

There's a lot of information out there, and I feel like all of these questions have been answered, but I just can't seem to wrap my head around the information I'm finding, and maybe if I ask in dummy fashion, someone will take pity on me and use small words.

Thanks,

Liam, who really does have a pretty good vocabulary, but who just doesn't seem to be able to USE it today.

Liam,

Have we got you in apap information overload? Sorry, I'll take the blame. Auto-pap is just as easy as cpap. You put it on one leg at a time just like a cpap. It's just that the auto-pap has a "zipper" on the front in case you need to use the restroom.

All the tweaking mentioned is only in the RARE case that machine does not understand a RARE breathing pattern. As said in my earlier post when I say tweak, we're talking about pushing a button on or off.

As far as APAP for dummies, cpaptalk is working on an encyclopedia of terms and information. I'm sure that will be a prominant topic.

Gotta rush out...hope this makes sense without my re-reading it.

wading thru the muck! wrote:It's just that the auto-pap has a "zipper" on the front in case you need to use the restroom.

Hmmmmm. I have enough trouble with the humidity from my heated humidifier, I really don't think I need to unzip my APAP and .... (this thought terminated so as not to violate good taste).

OK, that makes me much happier. I was starting to get the sense that APAP users had to download their nightly information every night, and then tweak some more, repeat ad nauseum, and I have to admit to the personal failing of laziness. The first day, it'd be a new toy and I couldn't play enough. The first week, it'd be novel, and I'd enjoy the playing. After that, it'd be boring and I'd lose interest.

Sort of like what happened with my first wife.

Liam, who hopes his CURRENT wife doesn't hold that last crack against him.

Liam:

The APAP machines can be set to function in CPAP mode. A regular CPAP will not, however, function in APAP mode.

If you can afford the APAP machine, buy it. It will give you data regarding treatment that the CPAP-only machines can't give and, if you want to just have straight CPAP, an APAP can give it to you.

The glory of APAPs is they CAN be tweaked a bit for those rare cases of heavy Central Apneas or other events. CPAP doesn't care what your brain or body is doing, it is going to blow that gale no matter what. APAP figures out what your really need. The 420E is unique in that it can be adjusted for those who have shallow breathing, which many machines will interpret as "events", it also detects central apneas which the others don't. This is very important if you have these as you do NOT need the pressure increased when you have them. I'll let christinquilts elaborate on that


Janelle
Who can't wait to see what kind of avatar Liam eventually uses.

Janelle wrote:The glory of APAPs is they CAN be tweaked a bit for those rare cases of heavy Central Apneas or other events.

This is actually incorrect. No AutoPAP, the 420e included, can cope with heavy central apneas. AutoPAPs relate to "incidental" rates of central apneas in one of two ways: 1) by removing obstructions and very likely restoring respiratory drive blood gas triggers in only some patients, and 2) by avoiding "runaway" central apneas believed to occure from pressure. Two different physiological mechanisms involved here relating to two different scenarios of "incidental" rates of central apnea occurrence. Heavy or significant rates of central apneas are almost always treated with BiLevel machines.

Janelle wrote: The 420E is unique in that it can be adjusted for those who have shallow breathing, which many machines will interpret as "events"...

Those IFL1 and IFL2 trigger parameters were originally targeted for UARS/RERA type events. I think you had accurately mentioned in another post that there seems to be quite a few pressure responsive and pressure unresponsive respiratory conditions that fall in this category. I agree with that statement, as UARS/RERAs patients are likely haphazardously diagnosed with a whole variety of distinct conditions: from obstructive hypopneas, to central hypopneas, to hypoventillation, to asthma, to allergic rhinitis-stricken patients to God knows what. These mimicking breath-flow conditions seem to get diagnostically lumped together out of sheer lack of the typical sleep tech to adequately differentiate in a PSG. Some of those conditions respond great to pressure, some respond horribly. That's where IFL1 and IFL2 do come in handy! A therapist can attempt four IFL1/IFL2 treatment modes. This manual approach allows genuine obstructive apneas and hypopneas to be dealt with, as they should, while pressure unresponsive lesser flow restrictions can be precluded from causing the AutoPAP to trigger a pressure hike. Only downside is that almost no one practicing sleep medicine seems to know how or when to use IFL1 and IFL2 properly.

Janelle wrote: ...it also detects central apneas which the others don't.

The Remstar Auto is also capable of cardiac oscillation detection toward guaging short-term efficacy of its three-unresponsive-pressure-increment technique. With a central apnea sensitivity rating of exactly 62%, the 420e misses 38% of the central apneas that come down the CPAP tube. However, with a specificity rating of virtually 100%, that means that those detected central apneas are, indeed, central in nature. The 420e thus relies more heavily on the "command on apnea" parameter as it's primary means of central apnea avoidance. That cardiac oscillation technique with a 62% sensitivity rating and a 100% specificity rating is still a very handy technique, however. Which is why the Remstar Auto also employs cardiac oscillation detection with its highly sensitive pneumotach sensor.

The 420E is unique in that it can be adjusted for those who have shallow breathing, which many machines will interpret as "events"...

That was me above, once again losing my login in the middle of a post.

The IFL1 and IFL2 are triggers that do not alter event detection or interpretation. They simply cause pressure to be delivered/undelivered (IFL1=on/IFL1=off) in response to a run of flow limitations, or they cause pressure to be delivered/undelivered (IFL2=on/IFL2=off) in response to a hypopnea that is concomitant with a flow limitation.

I know the term "shallow breathing" is used here a lot to describe why IFL1 and IFL2 are great, but "shallow breathing" most often describes hypoventillation and respiratory-drive type issues. PB originally purported IFL1 and IFL2 to be more an issue of dealing with airflow "restriction"---which tends to relate more to airway constrictions and lesser obstructions. Shallow breathing waveforms tend to manifest differently than constricted and obstructed waveforms. IFL1 and IFL2 were designed to trigger with these last two waveform types in mind. I'm sure in some cases they get misinterpreted, and that's one scenario when it is very handy to be able to turn them off if they cause a ruanawy pressure response.

-SWS

-SWS wrote:...by avoiding "runaway" central apneas believed to occure from pressure.

Let me see if I understand you correctly, because it might explain something I've noticed...

As I start to fall asleep with the CPAP on (but not, as far as I can tell, without it), I catch myself forgetting to breathe. I'll suddenly realize it's been about 20 seconds since I last took a breath.

I think this is part of why I can't sleep with the CPAP machine on. I can't relax and stop focusing on my breathing, because I feel like if I do, I may stop breathing all together.

Liam, who really does rather fancy oxygen. Maybe he needs a 12 step program.

Liam, I hope Christine can chime in on that one. I really don't know that centrals occur before we're actually asleep. She would know, however. Perhaps that is CPAP anxiety affecting your breathing while you are still awake???

-SWS wrote:Liam, I hope Christine can chime in on that one. I really don't know that centrals occur before we're actually asleep. She would know, however. Perhaps that is CPAP anxiety affecting your breathing while you are still awake???

Well... I never knew before I joined this board what they were called, but it's not an unfamiliar situation for me. I remember when I went through a stint in my life where I was trying to learn to meditate, they'd say "Relax, don't focus on your breathing. Just let it happen. You don't have to MAKE it happen." But I do. I can't NOT focus on my breathing at some semi-conscious level, or I DON'T.

This is not all the time, but with the exception of "as I fall asleep with a CPAP on", I haven't really figured out when it happens. It did happen during meditation.

However, I do think there's something to the CPAP anxiety angle as well. I just can't stop focusing on the fact that I've got all this equipment in and around me. I can't relax enough to sleep, for the reasons above and just anxiety ones.

Liam, who's wondering how many nights without sleep the human body can take before it snaps.

Liam, some patients fare better with a short-term prescription of Ambien or other sleeping pill when they're first on CPAP. Have you and your doctor considered this as a possible short-term measure until you learn to sleep comfortably with CPAP?

Do push for a trial on AutoPAP. A RemStar Auto with C-Flex can be set up identically to your current Remstar Pro 2 should AutoPAP expectedly or unexpectedly prove incompatible. Essentially your doctor is making you stick with something that is clearly not working so that you can avoid an AutoPAP which he thinks may not work. Can't say I follow his logic!