An APAP Shootout (sort of) on Academic Journal

What's next going to a half dozen Auto Dealers for a free test drive of a month, of all the brands of cars just to see which one rides better to you.

When, they all can haul your body to where you need to go. Not very cost effective, but it you want to buy one of each out of pocket, you have the right. Jim

So uhhh ... what happen to the concept of leasing?

DreamStalker wrote:So uhhh ... what happen to the concept of leasing?

In the US with the way the healthcare supply chain works, the 1st lease payment is sure to be equal to the same price cpap.com would have sold it to you for

DSM

dsm wrote:I think Sam's point is that trialling multiple Autos is impractical because of cost.

Cost is one thing, but the main thing is: although trial and error is itself scientific, asking everyone to be their own guinea pig is is hardly so.

I used the analogy of SSRI because doctors different SSRIs work slightly different but don't really know exactly why. (As for how, there are words of mouth.) This is similar to the case of APAPs.

A good doctor should be able to decrease the trouble to the patient as much as possible, the trouble can be related to the condition itself and the treatment. With enough research and/or clinical experience, doctors can at least determine the first choice antidepressent for most patients, changing it if it does not respond well.

The problem of sleep science is that we still can't divide, for example, OSA, into different subtypes, which meant, even we know every APAP work slightly differently, we can't even know how does that really apply to OSA patients. It is the first time I have heard that for any given doctor, the first-line treatment for a disease is indeterminate.

SamCurt wrote:

dsm wrote:I think Sam's point is that trialling multiple Autos is impractical because of cost.

Cost is one thing, but the main thing is: although trial and error is itself scientific, asking everyone to be their own guinea pig is is hardly so.

I used the analogy of SSRI because doctors different SSRIs work slightly different but don't really know exactly why. (As for how, there are words of mouth.) This is similar to the case of APAPs.

A good doctor should be able to decrease the trouble to the patient as much as possible, the trouble can be related to the condition itself and the treatment. With enough research and/or clinical experience, doctors can at least determine the first choice antidepressent for most patients, changing it if it does not respond well.

The problem of sleep science is that we still can't divide, for example, OSA, into different subtypes, which meant, even we know every APAP work slightly differently, we can't even know how does that really apply to OSA patients. It is the first time I have heard that for any given doctor, the first-line treatment for a disease is indeterminate.

SamCurt wrote:The problem of sleep science is that we still can't divide, for example, OSA, into different subtypes, which meant, even we know every APAP work slightly differently, we can't even know how does that really apply to OSA patients.

Sam, you summed up the problem beautifully. The field of "sleep", especially as it pertains to etiology of OSA, cortical arousals, fragmented sleep architecture, etc.... it's still such a young science.

You're exactly right, Sam. Even if the workings of the various black box APAPs were described completely by the manufacturers, that doesn't mean doctors would automatically (no pun intended!) be able to select the "right machine" for each patient.

Actually, even if doctors were able to prescribe the perfect machines for patients A, B, and C, those people are not going to get effective treatment as long as the masks they are given are uncomfortable and leaky.

The #1 ongoing problem (in my opinion) is in finding a mask that doesn't wreck sleep. Match people to the perfect machine...but then just hand them "a mask." Most will drop out. Eventually, if not right away.

Until mask COMFORT issues are addressed much better by the manufacturers and the DMEs than they have been to date, it's not going to matter how well the machine itself suits them, other than can they exhale ok with it.

For the vast majority of OSA patients, the mask is the real key to effective treatment -- much more so than which machine is chosen. Just my opinion.

Of course, even if machine and mask are both "perfect" for a person, when you throw other factors into the mix...other underlying health conditions that xpap can't really do anything about...you can still have people feeling worn out, awful; no matter how effectively their OSA is being treated. You can still have people dropping out of effective xpap treatment because they don't really feel better...for other reasons.

SamCurt wrote:

dsm wrote:I think Sam's point is that trialling multiple Autos is impractical because of cost.

Cost is one thing, but the main thing is: although trial and error is itself scientific, asking everyone to be their own guinea pig is is hardly so.

I used the analogy of SSRI because doctors different SSRIs work slightly different but don't really know exactly why. (As for how, there are words of mouth.) This is similar to the case of APAPs.

A good doctor should be able to decrease the trouble to the patient as much as possible, the trouble can be related to the condition itself and the treatment. With enough research and/or clinical experience, doctors can at least determine the first choice antidepressent for most patients, changing it if it does not respond well.

The problem of sleep science is that we still can't divide, for example, OSA, into different subtypes, which meant, even we know every APAP work slightly differently, we can't even know how does that really apply to OSA patients. It is the first time I have heard that for any given doctor, the first-line treatment for a disease is indeterminate.