jbstarks3 wrote: ↑Tue May 15, 2018 12:16 pm
It is better to know the pressure that is going to "fix" your sleep apnea.
This is only reliably known with data obtained at several pressures over time in the patient's own home. Otherwise what you "know" is an educated guess based on one night. Lab/center titration is valuable for seeing reaction to pressure and whether other sleep issues are unmasked. But it is not as encompassing for evaluation of pressure needs as the information from many weeks of APAP efficacy data. In other words, if one night of titration information has some value for finding effective pressure, then the information from many nights of titration is of much greater value. A good titration in a lab/center involves a titration that explores different pressures in different positions and different stages of sleep, but few one-night lab/center titrations are successful at having enough time to do that.
Furthermore, there is no way a lab/center titration can learn what happens with upcoming colds and allergies when sinus issues occur. There is no way a lab/center titration can learn how a heavy meal or glass of wine would affect the patient's needs. What about when the patient is seriously sick, fatigued, or has gained a few pounds? Docs commonly add a few cm to a titration finding to make up for the lack of data on those matters when prescribing a pressure. That is an act based on an understanding of the limitations of the test itself.
jbstarks3 wrote: ↑Tue May 15, 2018 12:16 pm
The problem with AutoPAP is the change in pressure throughout the night.
I agree that some patients are unable to get used to changing pressures and may eventually find that they prefer straight CPAP for themselves. But there is no way to ascertain that fact for that patient without allowing him to use APAP modality over time in order to see if he has any problem with it or in order to see if he gets used to it. Otherwise, the patient has arbitrarily been barred from trying something that may turn out to be very useful to him, over time.
jbstarks3 wrote: ↑Tue May 15, 2018 12:16 pm
If you had a CPAP titration study completed, you already know the pressure needed to treat.
No you don't. You know a pressure that seemed to work at some point during one night. Maybe.
jbstarks3 wrote: ↑Tue May 15, 2018 12:16 pm
The change in pressure with autoPAP (if the machines can truly detect a respiratory event) can cause masks to leak.
Do you have evidence that APAPs miss events? And anything can cause a mask to leak. Like, breathing, for example. Or moving. Or being alive. If pressure rises too high by running away for one patient using APAP mode, you just limit the max. Ain't rocket science.
jbstarks3 wrote: ↑Tue May 15, 2018 12:16 pm
The same reason a RAMP type feature on a machine can cause more problems than it can solve.
Good example! So would you then never give a machine with a ramp feature to a patient because machines that can run with a ramp are inferior to machines without ramp?
Of course not. If ramp causes a problem for someone--which you would never actually know unless the person
used the ramp feature for a
while, right?--then you simply disengage the ramp feature. No problemo! Same with APAP. If it doesn't come in handy at some point, no one forces you to use it all night every night. It can, instead, then, be used
occasionally to get titration info, then set
back to CPAP mode. Just like ramp,
having the feature does not mean the feature
has to be used
every night.
jbstarks3 wrote: ↑Tue May 15, 2018 12:16 pm
The advantage to an autoPAP machine is for those whose insurance company denied an in-lab sleep study and approved a portable home sleep test. The insurance company can save money by only paying for a home sleep study then skip the CPAP titration study and go straight to the home with an autoPAP machine.
In some circumstances, that IS quite an advantage, yes. But that is only one of
many, many advantages to constantly-titrating machines that are allowed to titrate every night or on occasion. Another advantage is that it is a valuable comfort feature available for those who only need a high pressure for a few minutes a night. Another is that APAP mode allows for pressure variation to match those with a degree of positional OSA. Another is that APAP adjusts to the patient's weight changes, health changes, and sleep habits. Another is that . . . well, on and on and on.
I find from what I read that almost all people in the industry--at least, those who don't somehow feel that APAP is taking money out of their own pockets--absolutely
love the features available in APAP machines. Those who feel their own wallets are somehow being impacted negatively seem less enthusiastic about the benefits patients are receiving from the amazing technology found in APAPs. How surprising!
