What are reasons to NOT get an Auto machine?

MandoJohnny wrote:It's not just the extra expense. It is that the extra expense doesn't get you anything you need and could have a negative effect. According to my sleep doc, who is very good and who I trust, while APAPs are necessary for Central Apnea and some other conditions, they are no more effective for Obstructive Apnea and in some patients, they are worse. Sometimes APAPs can't keep up with the changes in required pressure fast enough, so people get too little pressure during critical times. It is better to keep a constant pressure at a level that is proven to keep the airway open.

MandoJohnny, that is just plain wrong. Your sleep doc, who you proclaim to be very good, says APAPs are necessary for Central Apnea? That is absolutely false. Rather than relying on your doctor's opinion or the opinions of anyone here, research the scientific evidence. There are many studies proving APAPs are equally as effective as CPAPs, (not worse) in treating OSA and they are effective in doing so at an overall lower pressure than CPAP. The benefit of an APAP is you aren't getting more pressure than you need or less pressure than you require throughout the night. Your contention that "people get too little pressure during critical times" is also incorrect. APAPs are able to assess your needs and raise your pressure during "critical times". A CPAP can't do that. With CPAP you are more likely to be getting too little pressure during critical times, because it is incapable of assessing and responding to your needs.

MandoJohnny, the studies show that your doctor is incorrect. The results show that autos treat apnea events just as well as fixed pressure CPAPs and they do it at relatively lower pressure levels during the sleeping period, making for better comfort and greater compliance.

I'd like to see those studies. If you have references, please pass them on. I have seen one that shows that C-Flex works as well as non-C-Flex, but I haven't seen one on full auto.

As far as someone's earlier point about self-titration goes, there is a study that has been posted here a couple of times before that shows you can do self-titration with straight CPAP and you don't even need software. The article says that using subjective measures, such as symptom identification and mitigation and the Epworth Sleepiness Scale is as accurate as sleep lab titrations. BTW, my doc encourages that and we have changed the settings on my machine twice as a result. You don't need an APAP and software to help manage your own care.

Having said all that, I do think having that stuff would be fun and interesting and I may take the APAP/software plunge at some point. I like playing "Mr. Science!" I am fortunate that I can afford an APAP any time I want and my doc would write the scrip. But I want to get my apnea under control first and I think all that would just muddy the waters right now. It's how I feel that counts, not what my computer is telling me.

MandoJohnny wrote:It's how I feel that counts, not what my computer is telling me.

That's a good point but I would have been very frustrated with just a subjective sense of my therapeutic efficacy if that is all I had relied on to understand that my sweet spot is very narrow - just 1cm. Under by 1 my AHI goes up, over by 1 my AHI goes up and I was able to correlate those numbers to how I felt subjectively and that was very reassuring. There many complex things going on with my health and physical sense of well being so I have a hard time connecting it just to my OSA therapy. Being obese and having several relatively mild, but chronic health problems like arthritis, mood disorders and a recurring viral condition that is "permanent" sometimes I am not clear as to why I do, or don't, feel like crap.

So APAP is good if you can afford it. It's never bad, or wrong, if used correctly like almost anything else in life.

David

Snoozin' Bluezzz wrote: There many complex things going on with my health and physical sense of well being so I have a hard time connecting it just to my OSA therapy. Being obese and having several relatively mild, but chronic health problems like arthritis, mood disorders and a recurring viral condition that is "permanent" sometimes I am not clear as to why I do, or don't, feel like crap.

Well said. I'd feel like I was flying blind without my software. There are so many other factor affecting how I feel physically, it's nice to have a method to view how effectively my APAP therapy is treating my OSA.

Johnny,

There are other studies, but here is one:

http://www.sleepsolutions.com/clinical_ ... 230508.pdf

Paul

Use of Conventional and Self-Adjusting Nasal Continuous Positive Airway Pressure for Treatment of Severe Obstructive Sleep Apnea Syndrome

The results of this study demonstrate that selfadjusting nCPAP proved to be as effective as conventional nCPAP in suppressing respiratory disturbances. The improvement of sleep structure was comparable in both treatment modalities, although a more pronounced increase of slow-wave sleep and suppression of arousals were achieved with the selfadjusting device. Therefore, the pressure changes during the night even seem to have a positive influence on sleep structure and frequency of arousals.

Improvement of mean apnea duration was significantly more pronounced with the self-adjusting device.

"getting an autopap, you will be stealing money right out of your doctor's wallet, how will they ever be able to make their Mercedes and Porsche payments"

They don't make payments; they just pay cash up front.

Paul B.

Thanks for that study. Very interesting. It does mention in the summary, however, that other studies have shown that some OSA patients do not do as well on APAP as they do on CPAP. I am sure my doc was mindful of those other studies when he said what he said. I was also interested to read in the study that even though APAP compliance was higher than CPAP, and therefore the patients using APAP spent more time on the machines than the CPAP patients did, thier actual improvement was not better than those on CPAP, but only about the same. Let's see, I get the same improvement for less time "on the hose?" I'll take it.

MandoJohnny wrote: Let's see, I get the same improvement for less time "on the hose?" I'll take it.

Ur an amusing man MJ, u really r.

These studies were a bit dated. It would be interesting to know if improvements in algorithms have improved efficacy.

Like you, I run straight CPAP but I have options, can make choices , can run auto if I desire and I can self-titrate. I like options. In general they are good things. I like choices, in general they are good things. I'm willing and able to pay for options and choices (I feel bad for those who can't). I don't like folks telling me I should not have those options and choices (not implying that you did MJ, just a general comment).

There were other things brought up in those studies that were interesting if inconclusive. It might be possible that a lower overall pressure is easier on the system than a higher sustained pressure, interesting idea. A couple of references took me to places where I got a better idea of Hypercapnia, what it means and why it is problematic. The posts by -SWS, Snoredog, Chuck and Guest were interesting but difficult to follow and digest. I would still like -SWS to translate into "lay" terms for a dimwit like me.

David

Hi Johnny,

You are misreading what the study is saying. People on CPAP spend less time with it because they don't tolerate the higher pressures as well and therefore stop treatment with the CPAP, thereby endangering their life while they sleep without it. With the APAP and lower pressure, they tolerate the therapy longer, basically until they wake up well rested.

Previous post was mine.

Johnny

Here's another study:

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=12406840

No, I got that Paul. I don't disagree that it seems APAP keeps people from quitting XPAP altogether and that is a great thing. But I was interested that of those who did basically comply with XPAP in the study, the CPAP'ers and the XPAP'ers got the same level of results, even though the CPAP'ers used thier machines less overall than the APAP'ers. Also, my comment was half facetious anyway.

Who are you guys trying to convince???
JCraig made up his mind in the third post in this thread.....

As long as a person has a machine with recording capabilities and the ability to view the nightly results (software or screen display), they can do a pretty decent job of monitoring their therapy......APAP or CPAP.

I don't put a lot of stock in these OLD studies. Every time I've tried to find any of that kind of documentation, it's OLD, OLD, OLD. They need to do some more current studies with the newer equipment. Another flaw with those studies (in general) is that we have no idea of the "DETAILS". Did they use the APAPs in wide-open (4-20) pressure settings or narrow bands (2 up - 2 down)? Did the people have problems with the masks? (look at the changes in the masks in the last few years). Look at how many variables there are on this forum between users..... I wonder if they could do a study using THIS "compliant" group???
What they REALLY need to be able to do is to track the actual users from the doctors and DME records to see WHO has actually been compliant. Unfortunately, there's the doctor/patient confidentially problem (unless they could get releases from them to track the patients).

Den

Wulfman wrote:Who are you guys trying to convince???
JCraig made up his mind in the third post in this thread.....

Ah, we're just indulging in that time-honored pastime of "shooting the bull" and listening to ourselves talk.

MJ would know it as scuttlebutt as do I.

David