auto vrs standard machine

Could someone tell me what constitutes the need for a auto machine vrs a machine that does not adjust your pressures automatic??

I can see why a doctor would not want to give a auto, because you would have to come back to him to be tested again for pressure adjustments. Is this right or wrong??

I'm curious to see the responses to this question. I'm new to cpap, been on my machine for almost 3 weeks now, and was issued the standard REMstar from my DME. I'd love to have a better unit capable of collecting data, but I'm not sure if an auto is called for. What are the pros/cons of an auto machine?

A Auto is always called the better option, it's all about options. Auto can be turned into CPAP, if you think it's better, but you always have more options.

Jim

I'm pretty new myself, and am in the process of trying to upgrade my machine to an APAP. I probably should just read the advice of the forum "elders", but can't keep my mouth shut sometimes...

The Auto-PAP can operate as a straight CPAP. So there is the possibility of using the APAP just like you're using your current CPAP.

However, if you run it in APAP, it will run between the minimum and maximum set pressures that you have set on it. When it senses a flow limitation, it will increase the pressure until the flow is restored, up to the maximum pressure you have set. It has the ability to sense and try to stop snoring (try being the operative word).

With this setup, you can determine where your optimum settings should be. Often the pressure changes with your body position and the sleep stage that you're in.

Others can correct me if I've said anything incorrect.

AutoPAPs are nice, especially for control freaks or those stuck w/inattentive doctors.

However, the IMPORTANT issue is DATA CAPABILITY. In my personal opinion (and I think most everyone here will agree w/me) no patient should be given anything LESS than a fully data capable xPAP. Except perhaps those who must self-pay for their machine and are of limited means who would have to go w/o.

i understand how a automatic machine is the better choice for a enduser,

but what are some of the reason a doctor would precribe auto over a standard pressue machine.

One reason a Dr might prescriba an APAP is if you are in the process of a really serious long-term weight loss effort where you forsee a large weight loss over the following year. An APAP would tend to keep you at the right pressure during your weight loss.

A reason a Dr might NOT want to prescribe an APAP for you is if you have a snoring problem that is not directly tied to your apneas and not correctable by CPAP pressure. I have heard that in such cases, the Respironics APAPs will detect your snores and keep kicking up the pressure till you are at the max side of the APAP pressure range. This is not a concern for me as normal CPAP completely controls my snoring.

I have heard people mention this as a problem with Respironics APAPs if you are one whose apneas are controlled, but snoring is not.

Havent heard any comment about ResMed S8 Vantage in this regard. (don't know if they have snore detection)

I have considered an APAP for my mild sleep apnea (only sixty days on the hose, so far) purely for the best comfort. However, I have held off from getting one for two reasons. I now use a ResMed S8 Elite with EPR of 3, 9in H2O and no ramp. I love the EPR pressure relief for the entire length of the exhale cycle, even on a very long exhale. The ResMed APAP does not have EPR in the APAP mode, so am very doubtful of any advantage for me.

On the other hand, the Respironics APAP does have CFLEX in the APAP mode, however I understand the CFLEX only provides pressure relief on the very first part of the exhale cycle. So am in a quandary about going on up to an APAP. Probably will, eventually.

Would be interested in hearing comments from someone who has both a ResMed S8 Elite and a Respironics APAP concerning how EPR and CFLEX compare comfort-wise.

I get asked this question a lot. I think autos should only be used as a diagnostic tool. Here is the problem as I see it. The autoset will adjust the pressures whenever weakness is detected in the upper airway. This is done with a pressure transducer built into the machine. As soon as it detects this weakness it will increase the pressure. This means that you actually have to begin having an apnea before it will increase the pressure. Another thing is that the machine is never happy. Once it feels that the airway is completely open it will begin to decrease the pressure until the airway weakens again. This is why the machine is best used when trying to find an optimal pressure. We will use this machine for that purpose. I will send the machine home with a patient for a period of one week. I get it back and download the data. The software that looks at this data basically interprets the information as one long night. It can then calculate where the absolute best pressure is. Works very well and is comparable to in-lab studies. We only use this on patients who have been on CPAP for awhile and begin to suddenly have problems. We never use it on somebody with no CPAP experience.

On the ResMed S8 Elite, EPR doesn't work at all in APAP mode, that speaks volumes. Jim

DP,

It is my experience (and the experience of others here) that autos can be quite effective when they are not set wide open at 4-20. If the lower pressure is near the titrated pressure, they seem to do quite well. I use an auto myself, and have 0 apneas most nights. You might be interested in this thread: viewtopic/t19012/A-Zero-AHI-Really-IS-Possible-D.html

It shows my EncorePro report for a typical night, and discusses how autos work (at least, how some of us understand them to work. Obviously, no one knows the exact algorithms the manufacturers use).

I love my auto, because on nights when I need more pressure (on the rare occasions I've had a drink that night, etc), the auto bumps my pressure up just a little bit to keep me from having apneas that would have otherwise occurred if I had a straight, fixed pressure.

Thanks!

I know there are a lot of people who do use Auto's and like them. We have just elected not to use them that way. I always say if it is working and you feel good then that's great!

Don't you go picking on those Resmeds, GoofProof!!! Besides, it is the Vantage that is the AutoPAP, not the Elite.

Slinky wrote:Don't you go picking on those Resmeds, GoofProof!!! Besides, it is the Vantage that is the AutoPAP, not the Elite.

A Rose by any other name, wait that ain't no stinking Rose. Jim

Sorry, I didn't take time to memorize the Restmed Product Line, as they don't interest me. I found my Rose. Not a thorn, on the stem.

DP wrote:I know there are a lot of people who do use Auto's and like them. We have just elected not to use them that way. I always say if it is working and you feel good then that's great!

Many of us on this forum use APAP machines and hopefully you won't take our disagreements regarding patient use of them personally. Some of us feel that xPAP machines are expensive medical equipment but are willing to pay for the "best" treatment we can get.

As you pointed out, the auto machines are very good at determining optimal pressure. Furthermore, when we are titrated at a lab, the sleeping environment is "not" optimal and I think it is great that you provide patients with an APAP to collect data and tweak their pressure after they have been diagnosed with OSA and/or titrated in a lab setting.

Having said that, the auto machines are not that much more expensive than the standard CPAP machines (for those with insurance, they actually cost patients the same as CPAPs). Since OSA is generally a lifetime condition, many of us feel that it is a much better value for the patient to be provided an APAP from the very start (since after all an APAP is easily capable of being used in CPAP mode). I and others feel that patients can not only participate in their treatment but should actually take a responsible and proactive leadership roll in their treatment (not unlike diabetic patients do with their condition). Of course this requires that the OSA patient be educated about their condition and treatment ... that is where many of us feel the health professionals are failing most of the non-compliant OSA patients.

Our forum's main purpose is just that ... educating OSA patients ... many of whom were failed by the health professionals (basically getting nothing more than a couple of handouts stating that OSA is bad … use this machine and all will be better). I for one am glad that you have joined our forum and look forward to learning from your experience. I will however forewarn you that your view/policy towards providing patients with APAPs will be a lightning rod to many antagonistic comments … please bear with our point of view and as I said previously, not take these comments personally.

Welcome to our forum and hope you enjoy your stay.

Thank you dreamstalker. The APAP vs CPAP debate has been a going on for a long time and you will find arguments on both sides. I take no offense at all. Like I said I know plenty of people how love their APAP's.