APAP/CPAP Please don't flame me!!

I think it is really important that patients view options analytically and objectively so I'll try this again.

And for the record, all of my equipment is ResMed. They have great equipment and customer service and I talk to them about a variety of stuff a lot. Nevertheless-

All I was saying is that in 2001, during a sleep study, it was clearly shown that my own ResMed AutoSet T spiked erroneously high pressures causing significant arousals. My current sleep lab, and the lab which had performed my first sleep study and provided my AutoSet T, concurred with the same opinion that APAPs had some work to go. Someone posted that algorithms have recently been improved, however at this TalkAboutSleep web site, ResMed states:

"Starting with the same AutoSet® algorithm that made the AutoSet TTM the pinnacle of OSA treatment, ResMed has created the AutoSet Spirit with an optional integrated humidification system, new patient data display, and a smaller, lighter, and more attractive design."

http://resmed.com/portal/site/ResMedUS/ ... nPNum=null

This doesn't sound like an improved algorithm to me.

To be really objective, don't look up references manufacturers use in their blurbs. Of course they are going to pick and choose those which back up their claims. To be really informed, go to the U.S. Library of Medicine, where every medical article in the world which has ever been peer reviewed and published is archived.

1. Go to;

http://www.nlm.nih.gov/

2. Click on the PubMed link on the right.

3. Type in autotitrating CPAP in the search field.

Clearly, APAPs deliver lower mean pressures. However, several studies show that compliance between CPAPs and APAPs are actually statistically the same. For me, this article substantiated the high spikes I experienced,

J Clin Neurophysiol. 2003 Jul-Aug;20(4):291-5. Related Articles, Links

Evaluation and comparison of Tranquility and AutoSet T autotitrating CPAP machines.

Husain AM.

Department of Medicine (Neurology), Duke University Medical Center, and Neurodiagnostic Center, Veterans Affairs Medical Center, Durham, North Carolina 27710, USA. aatif.husain@duke.edu

These studies take the insurance/reimbursement variable out of the equation and provide science driven data. I only read the abstracts and not the complete articles. But, you can get an idea of how large the data sets are and how the studies were done.

I was called to task because I stated that APAPs wait for an apneic event to occur. The poster(s) said that was not the case. Apparently, it can be as I was told by my docs and stated at the following http://www.ResMed.com site:

"The AutoSet algorithm responds according to the severity of the event: the greater the event, the greater the response. Most devices respond in an incremental fashion until the event is resolved."

From ResMed's web-site-ResMed's AutoSet T measures, inspiratory flow limitation, snore and apnea. They also state that:

AutoSet devices act preemptively by increasing pressure in response to inspiratory flow limitation, which typically precedes snore and obstruction. This early intervention prevents snoring and obstructive apneas, thereby reducing respiratory arousals.

Apneas may occur suddenly, without being preceded by flow limitation or snore. These sudden apneas are generally associated with sleep onset, change in body position, or REM onset. Following a sudden apnea, AutoSet devices will increase pressure relative to the severity of the event. If no further events occur, AutoSet devices reduce the pressure back to a minimum level.

So how can I interpet this any other way than an apneic event may occur before it is compensated?

I honestly believe that APAPs and CPAPs both have their places. But I strongly oppose the view that one instrument should always take priority over the other and I passionately advocate patient knowledge, resourcefulness, objectivity and ability to analytically assess options.

VickiZssPlease

VickiZsPlease wrote:I honestly believe that APAPs and CPAPs both have their places. But I strongly oppose the view that one instrument should always take priority over the other and I passionately advocate patient knowledge, resourcefulness, objectivity and ability to analytically assess options.

I don't recall anyone on this forum stating that APAP works for everyone. I do believe that the straight CPAP machine is obsolete. I do not believe that fixed pressure therapy is obsolete, but this can be delivered with an APAP machine. I agree that APAP does not work for everyone. There are many examples of posters on this forum discussing irregularities. Many have been able to "tweak" their settings to get good treatment, but for those that cannot, their APAPs can be switched to fixed pressure mode.

As far as whether or not the APAP algorithms are missing treatment of "apneas may occur suddenly", this is true, but for most of us using APAP this occurs only once per hour. This leaves a residual AHI of 1 +/- which is WAY below any threshold of satisfactory maximum allowable residual AHI.

You are always welcome to post your opinions and supporting data. All of us here welcome it. Please don't feel as though you are being "flamed" if you receive responses that contain passionate disagreement. We enjoy a lively discussion and welcome disagreement. It would get a little boring around here if we were all just patting each other on the back. Some people think we do a little too much of that.

A couple of things, though...

First, "an apneic event MAY occur before it is compensated" is a whole lot different than "an auto doesn't respond until after the apnea has started". The second is the argument that we hear most often. If anyone doesn't get the difference, it's the difference between saying "Oh, you should never use a hammer, because hammers hit thumbs" and "Be careful when you use a hammer and be aware that your hammer MAY occasionally hit your thumb".

The quotes you posted clearly indicate that there are elements of the treatment which are designed to preemptively stop apneas. I would take away from reading what you wrote that these "as you're falling asleep apneas" might also happen with a straight CPAP, the only difference being that a straight CPAP wouldn't increase the pressure to try to deal with them, and then drop back down later when it was no longer needed. Plus, I've STILL not heard anyone tell me that an aborted apnea (stopped before O2 sats can drop and before arousal occurs) is any more damaging than no apnea.

Look, I'll be the first one to admit that Autos aren't perfect, and in fact I'm astounded they can do what they do as well as they (reportedly) do based solely on the very limited set of bio-sensors they have available. BUT... the "straight pressure is better" argument totally ignores the counter argument, which goes like this:

In my sleep study, I barely slept. I was uncomfortable. I was in an alien bed, with more wires attached than if I were undergoing torture interogation techniques. I was nervous, making it hard to fall asleep, and I couldn't really get to any of my most comfortable positions, because again of the electrodes.

As a result of this, my titration study was done under highly unusual circumstances, and on top of that, was a snapshot of that one day of my life. What if I had a cold that day, and was congested? What if the hospital (being a hospital) was much cleaner than I keep my house, so my dust allergy didn't come into play? What if what if what if? The down side of an Auto is that it doesn't have all of the sensors that the titration study had, and doesn't have people to interpret things (computers are wonderful at interpreting sciences, and piss poor at interpreting arts). The up side of the Auto is that it can adjust over time to changes in a person's body weight and other factors, it can adjust day to day based on the person's sleep that night.

Now, as to the spikes you saw, there are three different manufacturers, and it's clear that each's argument is going to be the more appropriate one for a certain segment of the population. The PB 420e apparently even has some switches to allow the user to turn off certain types of sensing, and if I understand it correctly, one of these is exactly aimed at stopping runaway pressure spikes in CERTAIN patients, like the ones you described.

And finally, there are still the issues of comfort and that Auto Titrating CPAPS can run in non-Auto-Titrating mode. So except for the added expense, there's really no reason not to buy one, even if you plan to run it in straight pressure mode for 3 weeks out of the month, and then use auto for a week just to see the data and see if anything has changed.

Liam, arguing in favor of a machine he's never had.

wading thru the muck! wrote:You are always welcome to post your opinions and supporting data. All of us here welcome it. Please don't feel as though you are being "flamed" if you receive responses that contain passionate disagreement. We enjoy a lively discussion and welcome disagreement. It would get a little boring around here if we were all just patting each other on the back. Some people think we do a little too much of that.

I certainly echo this sentiment. I'll disagree because I think it's important that anyone reading hear all sides of the argument and make their own decision, and in that light, I think it's really important that you (Vicki) post your points, and would never ask or expect you to withhold them. At the same time, if I disagree with them, or if I think I see holes in them, I'll point them out, because I think that's also important.

Because obviously, if we just shut down all opinion which didn't follow the party line, the board would consist of one canonical post on every topic, and no need for further discussion, it would already have been said.

Liam, way too wordy for 7am.

Hi All,

Need some technical help. This thread on my computer is about 2 pages wide and a real pain to read due to side scrolling. There have been a couple of others like this in some previous threads but sometimes just on the second page. This is very infrequent but annoying when it happens. I do not know if it's my computer or what I can do to fix the particular thread.

Sorry for going off topic.

Bob F

I'm having the same problem reading these threads, and it's driving me crazy.

me too.

Vicki, did you copy-paste some of your text at the top of this thread? I wonder if you unknowingly picked up some unusual "white space" characters in the copy-paste process that caused this thread's text to span such a wide right margin.

That's similar to what happens when a wide picture gets inserted into a thread. The right margin sticks way out.

The first reason I bought an AutoSet Spirit is because I was doing better with it when I used one (same model) from the sleep lab for a two week in-home titration study, after having used cpap for nearly five years. I needed higher pressures (as well as variable pressures) than what the sleep study five years ago suggested. I was often waking up choking and gagging. The Auto has resolved this for the most part. The second reason is to get feedback from the machine so that I know whether something is wrong. Knowing what my AHI numbers are, etc., has shown me where to direct my efforts in getting issues resolved with regard to my health, as opposed to guessing that it might be thyroid related or something else that might cause fatigue and mental alertness issues. Without this feedback, I cannot know, nor haven't known until now, that I still have some breathing difficulties. It was always assumed that the cpap was doing its job. Well, how do you suggest that it is doing its job correctly without having information about how I breathed in my sleep? The Auto tells me. Cpap does not. Therefore, I believe it is quite foolish indeed not to use Auto. The third reason was mentioned already, concerning the fact that sleeping in a sleep lab for some of us, especially me, was very poor sleep, and a reason why, I believe, that some of the breathing problems never showed up there. As for the "too much pressure" and "not enough pressure" issues, these are quite easily addressed by simply setting the minimum and maximum pressures correctly. What's so complicated about that? If cpap recorded breathing patterns and apneas and hypopneas, you might have a point. But I would suggest that such information would also indicate the necessity for Auto.

Tom

The width is due to that huge url...

I have to say that the ability to monitor your performance is an excellent reason to buy an Auto.

I know the AHI numbers aren't available on a straight CPAP, merely compliance numbers. I would imagine they ARE available on an Auto, even if you have it set to straight pressure mode.

So this, if for no other reason than to let you know when your treatment is not sufficiently helping you, is a perfect reason to buy an Auto.

Liam, wondering if the opposite to an auto is a manual, and how much he'd have to give up in order to convince his wife to sit up all night watching him with a bellows in hand.

Actually AHI is available on a straight CPAP. The Respironics Pro2.

The new REMstar Pro 2 is a powerful tool for promoting compliance with OSA therapy. It provides the comfort of C-Flex technology and also captures enhanced compliance data (AHI, leak, and snoring) with the Encore Pro SmartCard and Data Management Software. The older Remstar Pro does not record Apnea Hypopnea Index, Leak, or Snore. The two machines are otherwise identical.

Note that they are now terming AHI, leak and snore index as enhanced compliance data. Gee, I could have told them that!!

How do you tell the difference between the REMstar Pro and the REMstar Pro 2

santacruz wrote:How do you tell the difference between the REMstar Pro and the REMstar Pro 2

It says "REMstar Pro 2" on the top of the machine.

Mikesus wrote:The width is due to that huge url...

I suppose the url can't be broken and still work, right?

But it doesn't matter anyway, since the poster was a guest,
and only registered members can edit their posts.

The same happens if you import a very wide photo or graphic.