It all depends on what you are trying to fix.Snoredog wrote:skjansen wrote:Can someone please explain why I might be better off with an APAP machine versus a straight CPAP? My current CPAP is set a 13 cm and I believe the doc prescribed this back in 2004 when I first got my machine becasue he thought that an auto CPAP would not react quickly enough to my apneas. Does that make sense to any of you?
It seems like to me that an APAP like the Resmed S8 would be great.
Just interested in knowing a little more about machines other than just a CPAP.
All feedback is appreciated!
Let's use your case as the example. You are on straight CPAP at 13 cm pressure for past 4 years.
What is it you are having problems with to wonder why a auto may be better?
Some of the more common reasons where an autopap might be helpful would be:
Suspect pressure needs have changed:
It's been 4 years since last PSG. A person may suspect their pressure needs have changed due to weight loss/gain, or time since last PSG, with a plain jane CPAP offering no therapy feedback how do you know that? You don't, you need a machine that gives therapy details or at least AHI and leak data.
Most autos can find your lab found pressure: Most autopaps on the market can find your 90% pressure found during a PSG within a few hours.
Difficulty tolerating therapy:
The most common problem seen with tolerating CPAP therapy is it keeps the patient awake. They lay there for 1 hr or more trying to fall asleep with an uncomfortable mask, breathing against higher CPAP pressure designed to be where it is at for the worst possible "condition", that is when they are asleep fully relaxed in REM at 4 or 5AM in the morning. It is 10PM they have 7 hours to fight it.
Use the Ramp:
Most doctors and DME's don't set this up for the patient. Most newbies don't know it exists or even how to use it. Then if they DO set it up, it is set up to fail.
If a patient is having difficulty falling asleep at 13 cm pressure they could make their life so much easier simply setting up the Ramp feature found on nearly every machine and using it. In your case, you could set it up to start at say 7 or 8 cm pressure over 30 minutes. Then once set up a simple press of the button enables it when needed. You don't have to use it every night, you don't have to use it at all but having it set up it is there, it is there to help you when you find you are 30 minutes into falling asleep still thinking the pressure blowing in your face is simply annoying. Press the button it is now lower, there is less noise from the machine, there is less noise from the mask, there is less pressure to exhale against. Lay there too long where pressure builds back up, simply hit the button again it starts lower again.
With an auto, the Ramp is automatic, set your low pressure where it is easy to fall asleep, where there is less noise and the auto will start there and return there automatically. Newer machines have Auto-Ramp which offers you even more flexibility and options, but overall they work the same offering you a lower pressure for greater tolerance especially falling asleep.
I spend half my time here "undoing" what many of the experienced here have done. They try to turn a autopap into a CPAP. Well if you are going to buy an autopap and set the Minimum to your CPAP pressure you just wasted a lot of money. It goes back to my very first sentence, depends on WHAT you are trying to fix.
IF a patients is having difficulty with CPAP, don't suggest an Autopap to them then set the Minimum pressure to what their CPAP pressure was, because you have accomplished NOTHING!!
If you do that, then about the only thing you can expect to gain is the ability to generate reports and monitor therapy.
it IS how you use it and what you are trying to fix. If an Auto can keep a patient on therapy where they were going to give up, then the auto has great value.
If you are without insurance, an Autopap is ALWAYS the best way to go. At any price the upfront cost is minimal over 5 years. You can see what your therapy is doing, there is no guessing that your pressure needs have changed, the machine knows that and adjusts on its own. If you change positions the machine will adjust up or down.
What Ozij and Dreamstalker say is true BUT use the Auto how it will benefit you the best not what it does for someone else.
Back to your 13 cm CPAP pressure. What was said about the machine NOT responding directly to Apnea above 10 cm is true, in fact it is true with nearly all the autos on the market. Some offer limited response above 10 such as with the Remstars or the 420e and I suspect some of the newer machines do also such as the Intellipap and Sandman.
But depending on your SDB, that may not matter, if you snore that will drive up pressure above 10 cm, if you have Flow Limitation, that may drive up pressure above 10 cm. Increase pressure where you eliminate all snore and/or all Flow Limitation and the chance of a frank apnea appearing is remote or not enough to worry about.
Use any pressure over 5 cm and you are probably restoring O2 levels back to near normal.
In the olden days they didn't have PSG's, they gave every patient a CPAP machine set to 10 cm and sent them on their way. And it worked fine for a lot of people, the ones that had difficulty handing 10 cm pressure didn't stay with therapy. It didn't matter if there was still residual apnea, pressure kept O2 levels up to acceptable levels. So what they had an AHI=12, machine didn't report that anyway.
Today you have more options for comfort, more options to remain on therapy, more options to make falling asleep easier.
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Snoredog:
I guess the reason I ask this question is I am wondering if my next machine should be and auto CPAP. My Resemd S7 really does not give me much data so I would like to have a machine that I could experiment with a little in hopes of getting even better treatment. Though I am 100% compliant and have been since day one, I always looking for ways to make this experience at least a little more enjoyable and I really want to be able to be better versed on just how well my therapy is working. Quite frankly, my doc and DME gave me such little information about my machine that it wasn't until last year when I came on this forum that I was able to determine what my AHI was just from looking at my machine!
