This is my big chance. Which machine?

PolyMar did your testing include the REMstar Auto with C-Flex would like to know if this would make a difference to an auto or not? Also the same with A-Flex?

Thanks.

PolyMar wrote:

In my personal experience the APAP sounds great but rarely delivers the optimal pressure that was found during a pt's titration.

You're "experience" is inconsistent with the plethora of scholarly literature regarding APAP, certainly inconsistent with my (and many others!) experience with sleep study versus APAP titration. Where did you go to school?!

PolyMar wrote:.........the optimal pressure that was found during a pt's titration. ........

One night in the strange environment of a sleep lab; a room/a bed/some people - unlike any at your home; wires all over you; anxiety.

In your sleep lab the PT is just guessing at what pressure might be optimal for you for nights in your own bed.

Hello & Welcome, mybrid! Glad you found this forum—SO much useful info and everyone here is so willing to help!
Unfortunately, we do have an occasional “wanabe expert” who shows up here from time to time, but if you really want to learn, I suggest following GumbyCT’s advice below. Good luck!

"You are getting sleepy . . ."

—

GumbyCT wrote:Knowledge is power, so get busy

Watching this will help -
http://www.resmed.com/en-au/clinicians/ ... 40x380.swf

Start at the Yellow Lite bulb - Our Collective Wisdom found at the top of the page at http://www.cpaptalk.com
our-collective-cpap-wisdom.php
new-cpap-user.php

If you've been reading - do you have your PSG? Use the software?

Watching this will help -
http://www.resmed.com/en-au/clinicians/ ... 40x380.swf
http://www.resmed.com/en-us/patients/un ... 40x380.swf
http://www.nbc.com/Saturday_Night_Live/ ... -2/742141/

take a breath, put on your reading glasses and get comfy
there is NO wisdom pill
and one size does NOT fit ALL
Faces are like fingerprints

Reading this will help -
For Acronyms & Definitions
http://www.sleepnet.com/definition.html

Where A CPAP Newbie Should Start
viewtopic/t35702/Where-A-CPAP-Newbie-Should-Start.html

READ cpaptalk.com FAQ
faq.php


Learn to search
use Google & the syntax "search words" site:http://www.cpaptalk.com
or the Advanced Search at the top of each page.
or here - viewtopic/t35702/search.php

This is the Yellow Lite bulb you'll hear people mention aka "Our Collective Wisdom" -
our-collective-cpap-wisdom.php


Read some more.
Good Luck,
GumbyCT

PolyMar wrote:I am an experienced sleep professional (RPSGT) who is on PAP. In my personal experience the APAP sounds great but rarely delivers the optimal pressure that was found during a pt's titration. When I myself went from CPAP to APAP I begin noticing I did not feel as rested, this result prompted me to "download" my device. The information I found when my download was complete is the average pressure my machine was dispensing was 6cwp and my optimal titration pressure is 8cwp.

<snip>

You did not mention how you setup each of these APAP machines you tested.

Was it setup "wide-open" as many APAPs are? ...or was the range narrowed down around your titration?

My sleep lab titrated me at 7. Using the Resmed Autoset, I am currently seeing my pressure running at 9-10 most of the time. I saw my sleep doctor today, and she happily told me that I could raise my minimum pressure if need to keep the AHI down as low as I could get it, and still be comfortable. So, at least 2 points over what I was titrated, and still rising.

However, if I had kept my minimum pressure at 4, as originally suggested by the lab, I would not be doing this well. It is currently set at 8.4-15, and keeping my AHI under 5. For me, a straight CPAP set at 7, with no data, would have been a disaster.

That note from the "pro" bothers me a bit, because while it gives her personal experience, it implies that she must know something we don't. The fact is that while there are people who do well on straight Cpap, there are also a whole lot of us who prefer and do very well on Apap, and have not had the somewhat odd experiences the poster has had. I'm only saying this because I wouldn't want you (5old dogs) to be put off by her note as it may be misleading to someone so new. Anyhow... that's all for now . Hope you get organized.

When I was making my decision about the machine I wanted...I went to cpap.com and the sleep apnea forum and read the specs on all the machines. I thought about which of the features I thought would most likely result in a good experience for me. I liked the idea of a APAP to have flexible response to apnea, I wanted a quiet machine, I wanted humidifiaction, I wanted light weight.I wanted date capability, etc.....then I asked a few people for their opinions on the machines I narrowed my options to. Then I called the local DME's asked what they machines they carried and if they were in network with my insurance...I found a DME that carried my preferred machine which is not the popular brand in my area......I then went to my post cpap titration MD appointment, dressed professionally, with a written request and list of specifications I thought would result in my success and pretty much presented my case like a well dressed lawyer!!!! The jury found me guilty and sentenced me to the machine of my choice!!!!!

Duh! If you use Ramp, C-Flex, A-Flex or EPR you are NOT going to get your set pressure the entire sleep time. (You do exhale half the night, don't you?) And the reported pressure is either the 90th or 95th percentile of pressure at or below which you spent your total sleep time.

Some people flat out do not do well w/constant pressure changes thru out the night due to EPR, C-Flex or A-Flex. Some people don't do well w/the pressure changes of an APAP, you may be one. BUT many of us do as well or better w/Ramp, or EPR, C-Flex, A-Flex or an APAP properly set. Wide open 4 cms to 20 cms is NOT a properly set APAP, it is a STUPIDLY set APAP by someone (doctor or other) who doesn't know diddley-squat about how to properly utilize an APAP. The best set APAP is done based on the in-lab titrated pressure with a pressure range set 1-2 cms below and 1-2 cms above the titrated pressure.

A CPAP RX is valid for an APAP machine, without any modification by the Dr. My Rx was written specifically for the CPAP as the Dr does not believe in the APAP. I wanted an APAP and when I started shopping DME's, I found that the DME could give either one with the Rx as written, but some were greedy and would not give me the more expensive machine. I shopped DME's until I Found one I was comfortable with and was more than willing to give me my current machine. Do not take NO for an answer, just find another DME.

Autos are not loved by everyone, but to say that because of your experience with all of the brands of autos, they didn't work for you, so they don't work well for any one is a bit of a stretch. My experience is different from yours. I was using straight CPAP and after nine months, I felt worse than when I started CPAP. So maybe the person who "went to great lengths to find a pressure that helps you consolidate and maintain all stages of sleep, not just REM." was having a bad night and missed my number. Maybe I changed. Maybe having a machine that is able to change pressure as I need it, is the right machine for me. Or I could have my insurance company pay for another $2000 for another study and hope they get the right number this time. If I want to switch to CPAP all I have to do is change the numbers and I have a CPAP machine. For now, I'll just use what my Doctor thinks is right for me and my therapy.

PolyMar wrote:I am an experienced sleep professional (RPSGT) who is on PAP. In my personal experience the APAP sounds great but rarely delivers the optimal pressure that was found during a pt's titration. When I myself went from CPAP to APAP I begin noticing I did not feel as rested, this result prompted me to "download" my device. The information I found when my download was complete is the average pressure my machine was dispensing was 6cwp and my optimal titration pressure is 8cwp. When you are in the sleep lab the professional working with goes to great lengths to find a pressure that helps you consolidate and maintain all stages of sleep, not just REM. When your machine is not dispensing optimal pressure at all times you are losing some of the benefit.

While the idea of APAP is great I myself do not believe it is worth the risk of not getting to sleep at your "perfect pressure". Once I realized my APAP was not working like I thought I decided to test all major APAP devices available on the market, since I am a DME Coordinator I have the benefit of being able to call my manufacurers reps and request to demo there APAP devices at no charge. I received the same result with all APAP devices, none blew at my optimal pressure for my TST (Total Sleep Time).

APAP devices rely on algorithms to determine optimal pressure which eliminates human deductive reasoning and experience. If you are interested in a device that adds additional comfort I recommend you try ResMed's S8 CPAP model which offers EPR(Expiratory Pressure Relief) or Respironics CPAP with C-Flex. What C-Flex and ERP do is minutely drop pressure during exhalation to make breathing more comfortable.

You are prescribed a pressure for a reason, and hopefully you were able to work with an RPSGT, not just a sleep tech, which better assures you proper treatment, this is because RPSGT's have sat for their sleep medicine boards/registry and passed. PAP therapy is a process in the beginning, it takes time to acclimate however it is worth it in the end. Keep in mind that just like any other industry PAP manufacturers have a tendency to push the most expensive product and while this product might look attractive many times you end up losing some theraputic benefit thus doing yourself an injustice.

JimW203 wrote:If my interpretation of their guidelines is correct, your CPAP script will suffice for an APAP machine from them. I think this assumes you have no specific pressure noted on the script. This from https://www.cpap.com/cpap-faq/Prescriptions.html#133 regarding APAP script format:

Contains one of the following words or phrases "APAP", "AutoPAP", "AutoSet", "Auto CPAP", "Auto Adjusting CPAP", "Self Adjusting CPAP", "CPAP" or "Continuous Positive Airway Pressure" or similar term.
Contains your physicians contact information
Contains your physicians signature
Contains your pressure range (Optional, Not Required)

Example: 4-20 CM/H20
Example: 4-20
Example: 6-18 CM/H2O
Example: 6-18

CPAP prescriptions are accepted for Auto Adjusting (APAP) Machines.

cpap.com supplied me with an APAP when my prescription said CPAP and 13cm H2O.

Also, I later talked my DME provider into giving me a Resmed Autoset II even though the script from my doctor only said CPAP. I had discussed it with him, and he said that if I thought that I could use APAP intelligently he would support me getting an APAP, and if the DME provider balked, they should call him. They didn't balk. This was Apria, and my heath coverage is an Aetna PPO plan.

BTW, I love the Autoset. I previously used am M-Series Auto, but this is MUCH better.

Reasons it is better for me:

1. Much, much quieter.
2. I prefer the feel of EPR to A-Flex.
3. Visually more attractive.
4. No blue searchlights on top of the machine.
5. Humidifier can preheat water: no more frost on the nose (I sleep with my window open year round.

Well I definitely didn't mean to upset anyone nor imply I am trying to undermine a doctors recommendations. I think it is important to remember that most research is funded by the company making the product and so of course published research on PAP manufacturers sights will favor the product they are pushing.

In regards to my research I experimented with each device set at many different types of parameters. As someone previously mentioned my best resuls came from setting a range close to my optimal pressure. I realize it is a "Duh" moment regarding not getting optimal pressure all night with ramp, C-Flex, Auto, etc. however I believe the ramp should only be used in the beginning acclimation process and that all users should eventually get to the point of not needing ramp. C-Flex is a pressure swing, and so to be honest I am not a big advocate of it either. However in the end I will supply my patient whatever type of the device it takes to increase compliance.

Yes you need air during inhalation to open the air passage, but you also need the pressure when exhaling as this activates the muscles around your airway allowing you to exhale. When you exert effort to breath out against PAP you are opening the airway allowing you to expire your CO2 and take in fresh O2. Apnea occurs at the end of inhalation and the beginning of exhalation so you need the air to assist with opening the air way to breath in and to open the airway when breathing out.

To the person who questioned my schooling, I went to a four year college and graduated, then went on to a local specialty school for Sleep, then on to The Atlanta School of Sleep, passed my RPSGT exam and have continued on with my education to maintain my credentials. While I realize not all "pros" are created equal I try my best to do well with everything my name is associated with, be as knowledgable as possible and hopefully offer informed information... of course it is every persons right to take information as true or discard it as false.

When all is said and done I want everyone to have as much information as possible regarding any type of therapy. To the folks who found they were not titrated properly in the lab that is unfortunate. For future testing I recommend you do some research regarding the sleep lab you will be attending. I think it is important to make sure an RPSGT is running your study or at least directly supervised by an RPSGT, your technologist/technician needs to always go at least 2 pressures above what they thinks is optimal for comparative purposes. I also believe your study should be interpreted by a doc boarded in sleep, if your referring physician is not they can always outsource the interp to a sleep doc and then sign your script if the lab is not AASM accredited. Sleep Apnea is a disease, just like cancer, diabetes or any other illness you want the most qualified individual providing you care and therefor you should be diligent in making sure you are working with true professionals by looking into the staff's qualifications.

Peace and love to all, strive to use your PAP, ask for assistance from your DME (oh by the way you should make sure your DME company is truely qualified as well) company if you are struggeling and most importantly never give up, there is a perfect therapy scenario for anyone willing to be patient and who is working with the right team of people!

By the way if you haven't already guessed the previous post was by me...PolyMar

PolyMar wrote:By the way if you haven't already guessed the previous post was by me...PolyMar

PolyMar
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