Will you listen to sleep techs.., that do not know........?

When I picked up my APAP A flex last nite what did the tech set it on? 4-20...seems like they are almost setting you up for failure. Once I get a card reader I will feel better about following the numbers myself. Then I can adjust the numbers....

Sarah

Nice explanation Rested Gal...........

Yes, that was good, RestedGal! Thanks.

In theory I agree with you and I had thought the APAP made more sense. However, for me the APAP pressure ranges never provided as good therapy as the single CPAP pressure. I'm on a pressure of 11.0 cm (with C-Flex 2) and my AHI is 2 and I'm feeling good. Leak rate is reasonable for my pressure and mask. When I was on APAP, I tried 9-13, 10-14, 10-13, 11-15, 11-13, and a few more (a week or more each) and rarely got below AHI=4, pressure almost always ranged up to the max and I didn't feel as well.

Do I understand it? Nope! So I'm just going with what works for me. I did have in the back of my mind that I would eventually try CPAP since I have heart problems but hadn't made up my mind. If I were on a higher pressure I might feel very differently!

Mindy

Oh yes ... and not all docs set APAP pressure range 4-20. I was titrated at 7 on my side and 8 supine. So the doc prescribed a range of 7-12.

m

rested gal wrote:That begs the question, "Hey, if you're gonna use the autopap as if it were a straight cpap, why even get an autopap at all? Why not just use a straight single pressure?"

YOU KNOW WHY!!! (because they were out of the Pro 2's)

As (almost) everybody knows, my first criteria is for the user to get a data-capable machine AND the software to monitor your therapy.
BUT.....IF you can get and Auto/APAP, you have a multi-mode machine.....which at least gives a person more options. I have no problem with people using a range of pressures.....if THAT is what works best for them. However, the user needs to be able to determine which mode/settings DO work best for them.

The studies mentioned and the questions rested gal raised have been hashed out long ago and I share her questions about how they were conducted......so I won't comment further on that.

I just have a problem with people getting Autos/APAPs and thinking that the range of pressures is the BEST therapy for everybody.
There are quite a few of us on the forum who determined that single-pressure/CPAP therapy is what works best for us.

It's just something that a person has to find out for themselves.

Den

rested gal wrote:Every time there's a study done which involves "autopap" I wonder.... what was the setting range used with the autopap? .....

Using less pressure than "worst case scenario straight cpap pressure" -- as long as that minimum pressure is high enough to take care of MOST events -- can make treatment more comfortable. Setting a high enough maximum pressure to handle occasional events that need more pressure....well, that's why I use an autopap.

........ I doubt that's the way autopaps are set in trials and studies. 4-20 or 5-20 seem to be the only way the medical world thinks of using "autopap."

My goodness.... as you know rested gal, I was "testing out" the APAP feature today on my new machine...

I was thinking these EXACT things. At this point, I KNOW a setting of 8 or 9 ain't gonna cut it for me, even on the best of nights...

I titrated out at 10 cm H20 back in November -- when I had been recently diagnosed with diabetes and had lost some weight in the effort to get healthier.

Then Thanksgiving hit... and, shamefully, I've been off and on in controlling my blood sugar and have gained some weight back. So, now it's two months later ....

I got the (first) machine on January 2nd (I was waiting for the new year to roll around .. deductible and all). And even though I was titrated at 10 cm H20 to stop most events in early November ... Whoever filled out the prescription mistakenly asked the DME to set the machine at 14 cm H20. So I was using that for a couple of weeks before I saw the doctor again.

And after my saying that the pressure was moderately high... he look confused as to why I would say that. When he found out the machine was set to 14 .... he said "there's been a mistake", took my smart card and changed the cpap pressure back down to 10 cm H20.

Guess what? Due to my poor eating habits and raised blood sugar levels... 10 didn't even come CLOSE to working. According to my husband... I was back to snoring quite a bit. And based on the first sore throat I've had since starting CPAP, I strongly suspect an mouth breathing ... which I did not experience at 14 cm H20.

In the meantime, I was able to "upgrade" to the APAP/Aflex machine. (Which I'm still using in straight CPAP/Cflex mode)

I called the doctor and the office "upped me" to 12 cm H20. And even without having gotten into the data yet I'm wondering if 13 would be better.

Because I'm still "snorting" quite often which woke me up quite a bit. It wasn't a full out snore, but the snort was strong enough to really disturb my sleep multiple times all night long. My sleep was still quite disrupted.

My point is... that anything below 10 AIN'T gonna work. no way no how. AT least until I start losing weight and managing my diabetes better. So why set the minimum below that??? If I need time to "get used to the pressure", why not just set the ramp # higher (like at eight (8)) ... work up to 10 and see where it goes from there. At least it won't be too long before the APAP finds an effective pressure.

EXCEPT.... that I ALWAYS "sniffle" for the first 10 minutes as my nose becomes accustomed to the nasal mask and the humidification does it's job. And I noticed that everytime I sniffled, the pressure went up. So the machine read my "sniffles" as "events".

So I was thinking it would be good to start one point lower, just to give myself time to adjust to the mask ... and then at that point, let the APAP take over.

I TRULY cannot understand the "ramp settings" or even "minimum setting" at 4 or 5. I have yet to read ANYONE here that doesn't feel like they are suffocating at those low pressures. (Maybe there have been some, but I have yet to read about them here)

So, why has 4 or 5 become the norm, when clearly that does not reflect most people's needs?

Wulfman wrote:

rested gal wrote:That begs the question, "Hey, if you're gonna use the autopap as if it were a straight cpap, why even get an autopap at all? Why not just use a straight single pressure?"

YOU KNOW WHY!!! (because they were out of the Pro 2's)

As (almost) everybody knows, my first criteria is for the user to get a data-capable machine AND the software to monitor your therapy.
BUT.....IF you can get and Auto/APAP, you have a multi-mode machine.....which at least gives a person more options. I have no problem with people using a range of pressures.....if THAT is what works best for them. However, the user needs to be able to determine which mode/settings DO work best for them.

The studies mentioned and the questions rested gal raised have been hashed out long ago and I share her questions about how they were conducted......so I won't comment further on that.

I just have a problem with people getting Autos/APAPs and thinking that the range of pressures is the BEST therapy for everybody.
There are quite a few of us on the forum who determined that single-pressure/CPAP therapy is what works best for us.

It's just something that a person has to find out for themselves.

Den

Agreed. I can see how, once I find that "sweet spot" straight CPAP would be the best for me.

But, I personally think that conditions can change more quickly than people or doctors think they can. There was a DEFINITE change in my needs between early November (sleep studies) and early January (when I acquired the equipment).

For instance.... a couple of glasses of wine one night...

TossinNTurnin wrote:Agreed. I can see how, once I find that "sweet spot" straight CPAP would be the best for me.

But, I personally think that conditions can change more quickly than people or doctors think they can. There was a DEFINITE change in my needs between early November (sleep studies) and early January (when I acquired the equipment).

For instance.... a couple of glasses of wine one night...

OK.....so you may have ONE night or even two or three that are out of the norm......so what? One of the things I've noticed about single pressure is that I can see my trends coming and going. It's been awhile, but I could go from a 0.0 to a 1.5 or 2.5 (or more) in a night or two.....and back again. I'm not THAT concerned about a few nights of varying stats.
After this much time on the hose, my numbers are much more consistent than they used to be. I also THINK that in my case, the single pressure has "trained" my system to breath better or more consistently than before.

Den

TossinNturnin..........I was on APAP pressures of 4/8 for about 6 months, and the "4" setting never bothered me. I'm realizing now that it does nothing for my hypopnea events, but I never felt like I couldn't get enough air from it. I've been hearing the same things as you are saying from lots of people about low settings. I must just have small lungs?

Hi Rested Gal,

Very well explanations. That is one of the reasons, why I wondered that are the doctors and the sleep techs knowledgable enough to do their roles and responiblities. Very higher questionable (wher do they get their certifications and timely updates to do their roles)! Left alone all the research and cpap/apap/bipap hardware functioning and know how for better real time treatment. In this case, we are way above the curve. The doctors and sleep techs dont event know what are the algorithms, paramaters, physio consequences, psychological impact and adhenrences for all the OSA sufferers.

I demand all of them for periodic re-certification from both sleep medicine and hardware suppliers.

Best Regards
Mckooi

Interesting ... I was just catching up on some journal reading I had been meaning to do. Some of the research indicates the possibility that APAP machines may be more cost effective than CPAP due to the potential reduction in sleep lab studies.

I also found one that was a "bench" study that compared 7 different APAP machines and got into detail about the algorithms in each. They are *very* different. The time to increase a set amount of pressure ranges from 3 minutes to somewhere around 11 minutes or so. Some machines will respond to snores as if they are events, some don't. The PB seemed to be the fastest *if* I deciphered the coding correctly.

The APAP settings in the studies I just read were typically 4 - 15, apparently on the theory that if pressures higher than 4 are needed, it will automatically adjust. Does seem low to me!

m

Hi Mindy,

Can you please show me the comparisions of the 7 machines.
Thank you.

Mckooi

I'd like to add a comment on the APAP vs CPAP studies using a pressure range of 4-15.

First, it may help to understand a little bit about how medical research occurs. In order to do research, they need $$$$. In order to get those dollars or euros or whatever, they have to prepare very carefully designed proposals to those who provide those $$$$. There are usually expert panels who review research proposals and decide which get funded. They evaluate the goals, the design, etc. There are always far more proposals than funding so poorly designed studies don't easily get funded by public funding organizations. That is not to say it doesn't happen.

In the case of xPAP equipment, IMHO, the proposal would likely need to specify things like the APAP range to be used. If there were any known risk that what was specified could harm a patient (and too little treatment could do that), then the proposal would not likely be approved by the funding organization or the institution's internal review board.

Note that nothing in life is ever 100% guaranteed!

In addition, APAP machines *apparently* use very sophisticated algorithms to attempt to figure out *in advance* (by looking at flow and sometimes other things) when pressure needs to be raised -- thus theoretically limiting the time to raise pressure so it mostly occurs before an *event* rather than after.

Thus I think it would be a not unreasonable assumption that, as Snoredog noted, a pressure range of 4-15 or 4-20 might not be optimal, it also wouldn't be awful. The problem of feeling like we are suffocating at a pressure less than 6 may be very short-lived for the people who participate in these trials because typically they seem to recruit patients with moderate or, more likely, severe OSA in which case the bottom pressure would likely go up rather quickly. In addition, since there are multiple studies using these pressure ranges for APAPs, that makes it less likely that it's a poorly designed trial.

I hasten to add that I am making some assumptions here and I am most definitely *not* an expert. So these are only my personal thoughts and should be taken as such!

Mindy

My opinion:

I listen very little to what sleep doctors and techs have to say on these boards, for the most part they tell you a whole lotta NOTHING, just like a horoscope, the information is pretty much worthless in helping you resolve anything.

Usually they only stop by here to grab attention and peddle their books. There are always going to be the gullible to take the information they provide hook, line & sinker.

But when was the last time you seen:

a sleep doctor at your PSG?
a sleep doctor go over your PSG the next morning after your study?
a sleep tech going over your study data explaining what was seen?

or that you can

tell your sleep doc and the sleep lab you think you need to be titrated for UARS?
Most likely never!

Their message is usually the same, autopaps are bad and you should only titrate yourself in a sleep lab wasting thousandths on those worthless studies. I like the one where I'm not confident in the algorithm and its effectiveness. I bet that doctor couldn't identify an algorithm if it was put in CPAP mode.

They are not going to shoot themselves in the wallet you can count on that.