Benefit of APAP over CPAP

Wife was prescribed CPAP for CSA/OSA just 4 months ago. Changed insurance plans, lost our doctor and had to buy a new machine. Picked up a ResMed AirSense 10 Autoset For Her, which should arrive today. I understand that it can be set up either with constant or variable pressure. Should we set it up just like her current CPAP (constant 11 mmHg), or variable ( x min / 20 max). Where should I set the minimum - trending towards her current setting of 11. Personally, I think I'd feel that I wasn't getting enough air with lower.

Thanks!

My feeling is that APAP is beneficial when a person is starting out and unsure of their most beneficial pressure. Once your best pressure is established a fixed pressure or a variable pressure makes little difference. In my case I use 12 as a fixed pressure or 11/14 as my variable pressure. My AHI runs very similar which ever I use. Some people have their sleep disturbed when pressures change and the fixed works better for them. I don't believe pressures change much over time.

CPAP has worked very well for her - Getting her average AHI to about 0.5. It might be interesting to see the stats after running variable though - for me as well as her, if I can convince her to let me try it for a few days.

Thanks!

APAP works for closing in on a therapeutic pressure. The minimum pressure is the one that is most important in preventing events. The maximum would cover times when more pressure is needed such as during REM or back sleeping. The machine will only raise pressure if it feels it is needed and may never go to the max.
Since She has the For Her mode I would start there. it is supposed to be a more gentle mode for women. Does she use EPR now? Her new machine has it and she may find it more comfortable but it will have to be evaluated along with her other pressures because it reduces pressure during exhalation. I would start with minimun 10cm and max 20cm. Then after a few days you could narrow it if you want.

To get her to try it The For Her Mode might be the selling point.

If you go back in time, you'll see where this forum has duked it out on the benefits of CPAP vs apap modes. Both sides feel they have won the argument. If your wife wants to try apap... fine.... If she rather stay with CPAP mode then that is also good. Either way, she is getting optimal treatment.

Sheriff

Having an Apap however is better than 'just' a Cpap because Apaps can be set to do Cpap alone, so you have the choice.

Julie wrote:Having an Apap however is better than 'just' a Cpap because Apaps can be set to do Cpap alone, so you have the choice.

This is what I figured. It was an extra $80 or so. We'll try the APAP for a week and compare the results to her current setting.

FishLips wrote:

Julie wrote:Having an Apap however is better than 'just' a Cpap because Apaps can be set to do Cpap alone, so you have the choice.

This is what I figured. It was an extra $80 or so. We'll try the APAP for a week and compare the results to her current setting.

Make sure to set the lower end close to her cpap pressure.

FishLips wrote:Wife was prescribed CPAP for CSA/OSA just 4 months ago. Changed insurance plans, lost our doctor and had to buy a new machine. Picked up a ResMed AirSense 10 Autoset For Her, which should arrive today. I understand that it can be set up either with constant or variable pressure. Should we set it up just like her current CPAP (constant 11 mmHg), or variable ( x min / 20 max). Where should I set the minimum - trending towards her current setting of 11. Personally, I think I'd feel that I wasn't getting enough air with lower.

Thanks!

Make sure you're using software (like Sleepyhead) before and during the pressure experiments to monitor the results.
You need to use it anyway.


Den

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BlackSpinner wrote:Make sure to set the lower end close to her cpap pressure.

I set it to the pressure she was using.

Wulfman... wrote:Make sure you're using software (like Sleepyhead) before and during the pressure experiments to monitor the results.

I have Sleepyhead on my laptop and ResScan on hers, and I just updated both machines with everything up through last night. Ready to get all analytical.

For some reason, my laptop won't run ResScan. But I wanted to see how it compared to Sleepyhead.

Thanks.

Sidenote: I woke up last night, and realized that my machine was off (not sure how/why). My mouth was extremely dry and I was pulling hard through the mask. It probably took me about 10 minutes of half-wake/sleep to figure out there was a problem. It got me wondering though, if a "reverse ramp" would make sense for some people. My sleep study yielded a prescribed pressure of 10; but when first going to sleep, I feel like I'm not getting enough air, so I bumped that up to 11. When I've settled down and I'm actually asleep though, I don't think I require that high of a setting.

My pre-PAP AHI was 27. With CPAP, it's ~0.8
Wife: 48/~0.38

I'm a convert to APAP. My prescription pressure is 13.
My current APAP pressures are 12.4 to 17.2. I spend most of the night comfortably at the lower end with 2 or three higher pressure periods for REM or supine sleeping. Works for me

I started with a CPAP machine and then upgraded to APAP.

APAP is not just good for identifying the ideal fixed pressure during the night: pressure requirements are also changing during sleep cycles, and APAP will identify some upcoming issues and raise pressure proactively. It will then decrease pressure during stages like REM when a lower pressure is less disruptive.

Pressure requirements are also changing for the same person between nights, when losing/gaining weight etc.

As all APAP machines can be also set in standard CPAP mode, I would recommend to go for APAP.

To clarify, we have already purchased the APAP, a ResMed AirSense 10 Autoset For Her.

The price difference between the CPAP and the APAP was small enough that it made sense to get the more versatile machine - the one that would do both.

My original question was mostly in regards to the programming, and why some prefer or require APAP.

Thanks to all those who helped.

FishLips wrote: Sidenote: I woke up last night, and realized that my machine was off (not sure how/why). My mouth was extremely dry and I was pulling hard through the mask. It probably took me about 10 minutes of half-wake/sleep to figure out there was a problem.

Make sure The Auto Off in the setup menu is off or disabled.
Auto off is designed to shut the machine off when you remove the mask. It's possible a large mask leak could trigger it to turn off during your sleep.
I also recommend that you make sure the Auto ON in the setup menu is on or enabled.
Auto on is designed to turn the Machine on when you take a couple of breaths with the Mask on.
This way if the off button get hits during your sleep your breathing will turn the machine back on.
It's also possible that your Electrical service dropped out momentarily during the night and caused the machine to shut-off.
Auto on would turn it back on.

jtravel wrote:

FishLips wrote: Sidenote: I woke up last night, and realized that my machine was off (not sure how/why). My mouth was extremely dry and I was pulling hard through the mask. It probably took me about 10 minutes of half-wake/sleep to figure out there was a problem.

Make sure The Auto Off in the setup menu is off or disabled.
Auto off is designed to shut the machine off when you remove the mask. It's possible a large mask leak could trigger it to turn off during your sleep.
I also recommend that you make sure the Auto ON in the setup menu is on or enabled.
Auto on is designed to turn the Machine on when you take a couple of breaths with the Mask on.
This way if the off button get hits during your sleep your breathing will turn the machine back on.
It's also possible that your Electrical service dropped out momentarily during the night and caused the machine to shut-off.
Auto on would turn it back on.

Jtravel, In the ResMed Airsense 10 there is only one setting for the automatic on/off. It can't be set separately.

SmartStart™ Enable / disable the SmartStart feature. If you enable the SmartStart
feature, the device will start automatically when the patient breathes into
the mask and then stop automatically when the patient removes the
mask.