CPAP, APAP, Bi-PAP? What does it all mean?

[quote="Rastaman"]Yep, I think I might've answered my own question there. It would seem that certain patients would require a range of settings throughout the night. Just one might not work for them. So depending on what they need throughout the night CPAP might not work. My question becomes how do you know if you're one of these people? Is the sleep clinic going to tell you or am I going to have to find this out myself after a year of having THIS particular machine. It would seem that you would want to maintain the option of upgrading.

As has been said, there is no right answer to this. It's a combination of individual circumstances and personal preferences and I think the important thing is healthy debate so that people can make an informed decision on what is best for them. The experiences and possible biases/preferences of health professionals, suppliers and other patients can all be taken into account.

Personally, following discussion with my doctor and after listening to people in this forum, I decided an auto was the right choice. Originally prescribed and loaned a CPAP at 11cm, I struggled to adapt, even with the ramp feature. When I purchased an APAP my rate of acceptance improved dramatically as I found it easier to get to sleep and then to stay asleep.

In the subsequent 18 months of use of the APAP, I've noticed the following:

1) The typical pressure delivered for most of the night is 3 or 4cm below 11, providing more comfortable but still effective treatment (eg average AHI around 1)

2) Within each week, there is often a difference between the range of pressure and the length of time spent at each pressure from night to night. Sometimes I can guess why, but mostly I've no idea why. I expect factors like sleeping position, food or alcohol consumption, minor seasonal nasal congestion etc play a part. With the APAP, I don't have to try to predict them.

3) Longer term, there are other noticable trends. I have a perennial weight problem and during the 18 months my weight has moved (in both directions) within a range of approximately 30 lbs. At the heavier end of the scale, both the typical pressure and the AHI edge up slightly and the APAP can deal with this without the need for further visits to the sleep clinic.

A positive feature of OSA is that it's a condition that can be managed effectively with relatively simple equipment and without eg invasive surgery or drugs. Therefore, whether or not you have insurance, I believe it is the responsibility of the patient to listen to all of the advice available and then to take responsibility for decisions about their treatment and their own health.

littlebaddow has summed it up well. We each have our comfort level and that is *critical* to maintaining xpap compliance.

He gets satisfaction from his AUTO running typically 3 cms or so below what he would have to put up with from a cpap fixed at 11.

I have a Bilevel fixed at 15 cms in & 8 cms out so I feel that works for me & is a comfort level I have found after trying all types of machine (except the Bipap AUTO - can't justify the cost )

For me, aerophagia at my higher cms requirements (15) was one factor that steered me to trying a bilevel, plus I had found my therapy deteriorating after 3-4 months - my wife pointed out that I had resumed stopping breathing and this totally coincided with me becoming increasingly distressed at the backward effectiveness of my therapy after 3 or so excellent months of what seemed like the answer to my prayers.

My Bilevel is what is called a 'timed' mode Bilevel. These differ from standard Bilevels by incorporating a feature that checks if you stop breathing & mine, within 4 seconds, will flip up from the low pressure to the high - if I don't resume breathing within 10 seconds of that it flips back down & 4 secs later flips up again. It actually works very very well & almost always gets me breathing 1st go.

Almost from the day I switched to this Bilevel my therapy success has gone back to being very good and I am no longer distressed that I had 'lost' the benefits & that cpap was just a temporary success. This has been over 6 months so it has worked very well.

DSM

Rastaman wrote:Yep, I think I might've answered my own question there. It would seem that certain patients would require a range of settings throughout the night. Just one might not work for them. So depending on what they need throughout the night CPAP might not work. My question becomes how do you know if you're one of these people? Is the sleep clinic going to tell you or am I going to have to find this out myself after a year of having THIS particular machine. It would seem that you would want to maintain the option of upgrading.

Astute observations, Rastaman. Some of us have found that we do indeed have varying pressure needs throughout the night. Some of us have also found that it takes a while to sort things out. As a practical matter, sorting all this out can't be done during a one or two night titration.

So no, the sleep lab won't tell you. (Even if they know some of this, they can't tell you. That's not part of the rules of engagement.) It has already been amply pointed out by Bingo, et. al., that providing you the best therapy possible, or even worrying about your comfort level is not their focus. As a physician recently explained to me, they start with the minimum protocol first to see if that works. If it doesn't, then they try the next level up, and so on. One of the fallouts of this approach is that many folks simply tire of it first and give up, because they don't have the patience or the wherewithal to fight the system until they get the therapy which would benefit them. That helps explain the 50% drop-out rate for CPAP therapy.

From a patient perspective (and from an insurance perspective, if anyone took the time to think this through), the ideal therapy would be one that was effective in as short a time as possible, and with the highest success rates possible. I believe that is the reason many here recommend starting out with an APAP, and monitoring your own therapy.

Apnea is tough business. It often takes determination to get one's therapy under control. Good luck. Keep asking questions and keep contributing to the knowledge pool here.

Regards,
Bill

NightHawkeye wrote:It has already been amply pointed out by Bingo, et. al., that providing you the best therapy possible, or even worrying about your comfort level is not their focus. As a physician recently explained to me, they start with the minimum protocol first to see if that works. If it doesn't, then they try the next level up, and so on.
...
From a patient perspective (and from an insurance perspective, if anyone took the time to think this through), the ideal therapy would be one that was effective in as short a time as possible, and with the highest success rates possible.

Just to make sure I'm not taken out of context

I never actually stated that they don't want to provide the best therapy possible nor that they don't care about comfort level.

In fact, I believe exactly the opposite is true for the vast majority of sleep labs.

I HAVE stated the second paragraph there is very true. However, I think that concept and what WE think is most comfortable often are at odds with each other and hence the difficulties.

Bingo

Well, depending on my experience and reports back to the doc, should probably give them an idea if this CPAP machine is working with a fixed setting of 13.

One would think they would send you home with an APAP first and use software to monitor you and figure out what works best for you. If a constant pressure worked best, then a basic CPAP might be preferred. But I guess they go the other way around. One thing I assume, atleast in my case, is that they had plenty of time to determine what settings worked well for me. I went to bed at 10:15pm and they put the CPAP machine on at 11:30pm. I woke up about 6:10am.

However, time will tell. I'm left wondering if renting would be the better option because I could probably rent something else if needed. If I buy, then I might be stuck with a CPAP when I really need a APAP. On the bright side though, I've noticed that over time I'm preferring the C-Flex feature on my CPAP. I'm able to adjust the setting 1, 2 or 3 for exhale pressure. 1 was fine some of the time but I've gone with number 2 now. It seems better.

Rastaman wrote:One would think they would send you home with an APAP first and use software to monitor you and figure out what works best for you. If a constant pressure worked best, then a basic CPAP might be preferred.

You're on the mark there, Rastaman. That's what my doc did in the UK.

Seems to me you're approaching this in exactly the right way. Ask questions, experiment, learn what's best for you and work with your (or around!) your doc to find the best solution.

Good luck to you.

That's what they did here in Israel too.

O.

Rastaman wrote:One would think they would send you home with an APAP first and use software to monitor you and figure out what works best for you.

You should certainly push for that, but many in this country have found getting an APAP is not possible initially unless they pay out-of-pocket (which, depending upon individual circumstances, might be worth considering). It's good to hear that other countries aren't always as constrained about this as is customary in the U.S.

Rastaman wrote:However, time will tell. I'm left wondering if renting would be the better option because I could probably rent something else if needed. If I buy, then I might be stuck with a CPAP when I really need a APAP.

Depending upon your insurance, you may actually be required to rent for some period of months. That's the way my insurance works, although it allows outright purchase if one buys the machine online, which is what I did initially. If you're already sold on C-flex though, your choice of machines is limited at this point, so you really should consider buying online. Just determine whether buying online or using a local DME results in lower out-of-pocket expense for you.

Regards,
Bill

Rastaman wrote:One would think they would send you home with an APAP first and use software to monitor you and figure out what works best for you.

A lot seems to depend on the Sleep Specialist and how comfortable they are with the results from a Sleep Study/Titration Report..

If the Sleep Lab seems to have been able to dial in a good pressure where everything was stable, most MDs will not order a 1 month Auto-Pap trial.

If the Lab was unable to dial in a good pressure many MDs will go ahead and order the AutoPap for 1 month.

Then some doctors will basically never order an Auto unit for whatever reason, just as some will ALWAYS order it.

Bingo

Except for a sore neck, it's been wonderful going on the CPAP. I was always sleeping through the night before CPAP but just not getting very good sleep and never dreaming or remembering dreaming. Apparently, with CPAP and hose, I'm not moving as much as I used to, which wasn't that much to begin with. But since I've had a neck-ache for 3 or 4 nights out of 7, my wife is ready to pick up a pillow for me and take over my old pillow until we can afford getting better pillows for both. She seldom complains about a sniff neck. But she's younger than I am anyway.

Thanks for everyone's input on this subject. It's all been a very big help!

Check this out https://www.cpap.com/downloadVideo.php?VGID=18

Okay! Thanks! I also have a dvd that came with my unit. I guess I need to pull that out and pop it into the computer and watch it