CPAPtalk.com

Liam,

Congratulations! You Prolific Pontificator of 'PAP Paraphernalia.

wading thru the muck! wrote:You Prolific Pontificator of 'PAP Paraphernalia.

Great, I've just been P'd on.

Liam, aliterative alien, always assinine

Liam1965 wrote:

wading thru the muck! wrote:You Prolific Pontificator of 'PAP Paraphernalia.

Great, I've just been P'd on.

Liam, aliterative alien, always assinine

What are you? The new version of Abbott and Costello??
"Wader and Liam"? (watch them fight for top billing!)

I was sent to a sleep doc by my reg doc. I didn t know much about the machines. He gave me the reg straight pressure machine. After 15 months I was tired of the mask leaks and not knowing how I was doing. So I requested an auto from my sleep doc. He flatly refused.

It is correct that the typical board certified sleep doc does NOT like APAPS for two reasons:

1) it allows you to have apneas and
2) the APAP's are NOT smart enough to respond to apneas and hypopneas. Smart means it cannot detect and/or respond to the respiratory disturbances fast enough in MOST cases. The empiracle data that they have shows this. Of course, everyone's experience varies so it is crucial to try different machines: autos, straight CPAP and CFLEX to find one that is best suited for you.

The empiracle data that they have shows this.

Guest, could you please point us to that empirical data? I've seen some studies comparing cpap vs autopap that were done in the past, but cannot remember exactly how they were conducted or which machines were used. I cannot help but wonder if earlier autopaps (which did have their share of problems) are not responsible for some prominent sleep doctors justifiably criticizing the earlier autopaps... perhaps resulting in doctors continuing to repeat some outdated criticisms on through today? Perhaps studies done now with present day autopaps might turn out quite differently?

Miko, did log-in not work for you when you posted as "Guest"? Seems to not work well for people from time to time. I did a search for the word "empiracle" in hopes of turning up the name of a study or journal with the data "Guest" mentioned, but found only this previous topic, where you mentioned what your sleep doctor said about autopaps:

Posted: Tue Dec 07, 2004 Post subject: Help!? Auto-Cpap

Perhaps the next time you talk with your sleep doctor, you could ask the doctor to give you more information about a specific study or source of data we could all look at, to understand better why some sleep doctors don't have a very high opinion of how autopaps work?

Guest,

1) I'm with rested gal, do doctors have sleep studies that show a standard cpap, that blows one constant pressure, does not allow you to have apneas?

2) Is there empirical data to show a standard cpap eliminates respiratory disturbances?

I don't see how. Especially with respect to how all sleep studies are performed.

I guess my logic is as follows. A Sleep Study takes a snap shot of one night’s sleep, which is different for every patient. In this titration, the pressure is adjusted by a sleep tech, the goal being the elimination of apneas and hypopneas. So either they get the Apneas as close to 0 as possible or they get the AHI as low as possible. That pressure during that study always varies, only speaking from the various sleep studies I have seen in passing, and is never on set pressure. So if during that study, a patient started off with a pressure of 10cm and an AHI of 5, wouldn't the sleep tech raise the pressure to see if 12cm would reduce the AHI? So really at the end of the titration the patient has used all sorts of pressures. The sleep study is reviewed and a pressure level is suggested based on the whole snap shot of that titration. Even if the patient used a pressure of 15 cm a 1/4 of the time, he could still end up with a recommendation and eventual prescription for a pressure of 10cm. So every sleep study is just a pressure based on percentages.

Ok, sorry I am being long winded here......

So why wouldn't every doctor want a cpap that would act just like a sleep study. The machine would adjust the pressure on a breath by breath basis, compared to a person mechanically turning a knob or pushing a button (like in the sleep study). So if you needed a pressure of 15cm for 1/4 of the night and 10cm for a 1/4, and 8 for 1/2 the night.....your treatment pressure would be changing and adjusting to give you the lower AHI and or the lowest percentage of apneas. I would think that treatment would be more convincing to a doctor that ordering a pressure of 8cm because that is what was needed for the longest period of time during that one snap-shot of sleep, during the study.

I understand the need for a standard cpap, but Apap's are the next step. The philosophies and ideas shared and grown on how to organize this field when it was brand new made sense. The need for guidelines for all sleep labs, doctors, insurance companies and DME's makes perfect sense. I think it is simply a time for review of ideas. If Apaps were the first machines invented instead of a standard cpap, this discussion would have never happened. Instead, cheaper models that blow only one pressure wouldn't be trusted.

It's late, hope this makes sense. Anyone agree? Comments?

Regards,
ICP

Well Muck and I have noticed on the Remstar Auto that if it gets busy logging snores it "misses" Apneas and Hypo's. I can set my pressure to 8 - 16 (which seems to be the range of my events, but my AHI is 6. If I lower it to 8 - 12 it will end up at 12 a lot but my AHI is between 3 and 4...

So, for some folks there might be something to auto's not responding quick enough. Maybe when SWS gets back and takes a look at it we can get a better idea of what is going on...

ICP said: I think it is simply a time for review of ideas. If Apaps were the first machines invented instead of a standard cpap, this discussion would have never happened. Instead, cheaper models that blow only one pressure wouldn't be trusted.

Exactly correct, it's simply a time for review of ideas. Maybe soon this logic will begin to make sense to those making the health decisions for most people.

My opinion is, that the "hold up" has nothing to do with healthcare and all to do with how it's paid for. Unfortunatly that's a tougher one to change. I bet you guys at cpap.com, on occasion, sit around scatching your heads and saying to each other "why do the insurance companies send people to a DME that charges them $2500 for a cpap when they could get it from us for $500?" The fact that this is "the norm" indicates there are major problems with the way we fund our healthcare.

Great to see your thoughtful posts.

rested gal wrote:

The empiracle data that they have shows this.

Guest, could you please point us to that empirical data?

Miko, did log-in not work for you when you posted as "Guest"? Seems to not work well for people from time to time. I did a search for the word "empiracle" in hopes of turning up the name of a study or journal with the data "Guest" mentioned, but found only this previous topic, where you mentioned what your sleep doctor said about autopaps:

Perhaps the next time you talk with your sleep doctor, you could ask the doctor to give you more information about a specific study or source of data we could all look at, to understand better why some sleep doctors don't have a very high opinion of how autopaps work?

I wish, I wish I had empiracle data for a lot of issues with both CPAP and OSA. I dunno when I will be seeing my sleep doc next time, but when I asked him before, we were running out of time in his office. But, I have learned from experience that the moment you ask your doctor for "proof" of what they say, you might as well as start looking for another doctor; afterall, they are the expert and you should always believe what they say. Of course, I don't. That's why I hope to get, one day, if I still have sleep apnea, a CPAP that is also an autopap.

Yeah, dunno what happened, the system didnt allow me to post with my user id.

Allow me to weigh in on this one:
After almost 2 years on my "RemStar Pro Cflex", I now realize from all of your discussion that there is a better "mousetrap" out there--apparently available even in 2003?? I plan on revisiting my doc soon to request/demand an APAP.

Here's my thought: Patients on APAP NEVER NEED TO HAVE ANOTHER SLEEP STUDY!!! The machine automatically adjusts to the proper pressure. No more retests!!

Fewer studies Sleep labs make less money (many are funded/operated by the docs); AND Docs make less money because they're not interpreting (reading and signing off) the lab reports.

I agree that APAP must become the NORM--not the exception!

...still waiting for that "perfect night on the hose"...
Grant

Mikesus wrote:Well Muck and I have noticed on the Remstar Auto that if it gets busy logging snores it "misses" Apneas and Hypo's. I can set my pressure to 8 - 16 (which seems to be the range of my events, but my AHI is 6. If I lower it to 8 - 12 it will end up at 12 a lot but my AHI is between 3 and 4...

So, for some folks there might be something to auto's not responding quick enough. Maybe when SWS gets back and takes a look at it we can get a better idea of what is going on...

Response time can be an issue as you and Derek have contended. The other issue is one of pattern recognition with respect to snore and flow limitation as predictive apnea/hypopnea precursors. Wave shape differentiation and event clustering or event sequencing factor in here. When you think about it, a long and hard apneic closure is easy to detect regarding both waveform shape and breath volume. Now compare that algorithmic task with differentiating subtle airflow precursors across an entire apneic patient population. Some pattern-recognition based against those subtle precursors will fall by the wayside for certain patients. That is the essence of "AutoPAP breathing pattern compatibility" that is much discussed on all the message boards.

Sometimes we tweak the AutoPAP's pressure range to compensate for these particular AutoPAP incompatibilities, other times we are forced to abandon treatment by that algorithm altogether.

-SWS wrote:Sometimes we tweak the AutoPAP's pressure range to compensate for these particular AutoPAP incompatibilities, other times we are forced to abandon treatment by that algorithm altogether.

See, and this is what's kept me from buying an APAP already: I wish there was some way of knowing which of the three major vendors' algorithm was best suited to my particular style of breathing.

I'll bet, if they put their minds to it, sleep labs could match patients up with the right apap, based on the measurements they take, but since my sleep lab doesn't seem to believe in APAP, they certainly aren't going to have that level of expertise.

But still, it feels like it'd be a bit expensive to just trial-and-error the thing until I find one that works.

Liam, too much the scientist to really buy into the "crap shoot" method of choosing.

Liam, that is why I am a proponent of sticking with CPAP treatment when it works well. However, sticking with CPAP treatment when it doesn't work well.... that AutoPAP crap shoot becomes a potentially rewarding gamble.

Ye old programmer's "life strategy": if something doesn't work, try something else...

-SWS wrote:Ye old programmer's "life strategy": if something doesn't work, try something else...

Ah, but see, I've always gone by the "If something doesn't work, see if I can get one of my smarter co-workers to program it for me" strategy.



Liam, a few bricks shy of a programmer's load.

Ah, but see, I've always gone by the "If something doesn't work, see if I can get one of my smarter co-workers to program it for me" strategy.

Well, I may not be smarter than you, Liam, but if you'll just drop ship your new AutoPAP to my house I'll be more than happy to program it for you.