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Re: I switched from APAP to CPAP
Posted: Mon Dec 07, 2009 5:48 pm
by Autopapdude
Clinical review
The value of auto-adjustable CPAP devices in pressure titration and treatment of patients with obstructive sleep apnea syndrome
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References and further reading may be available for this article. To view references and further reading you must purchase this article.
Katrien HertegonneCorresponding Author Contact Information, a, E-mail The Corresponding Author and Fré Bautersa
aSleep Medicine Centre, Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium
Available online 28 August 2009.
SUMMARY
In moderate to severe obstructive sleep apnea syndrome (OSAS), the use of Continuous Positive Airway Pressure (CPAP) is the gold standard therapy. In the last decade, new technologies such as auto-adjustable CPAP (APAP) have been promoted as having an added advantage over CPAP, because of their ability to adapt the pressure level to the patient's need at all times. This could logically result in the deliverance of lower pressures, which was hypothesized to improve patient acceptance and compliance for therapy.
Several clinical trials have been performed with APAP in different modalities, as a titration tool in attended or unattended conditions, or as a treatment device for chronic use. Comparison of these trials is challenging, since APAP technology is evolving promptly and devices differ not only in how sleep-disordered breathing is detected, but also in how the operational algorithm responds accordingly. Although the question remains whether proof has yet been delivered of the superiority of this technology over CPAP, there is a tendency to accept it as common standard practice in OSAS titration and treatment. This review will bring available evidence on this subject into perspective.
Read the entire article. Summary indicates that it is becoming the preferred treatment.
Re: I switched from APAP to CPAP
Posted: Tue Dec 08, 2009 12:19 am
by rested gal
Not to quibble, but .... in the summary:
"the question remains whether proof has yet been delivered of the superiority of this technology over CPAP"
A "tendency to accept it [autopap] as common standard practice in OSAS titration and treatment", to me, simply means that autopaps have a place, along with other common standard practice treatment machines such as CPAP and Bilevel machines. Choice of type of machine can depend on what you're trying to treat, what other underlying conditions the person may have, etc.
I have no quarrel at all with autopaps being very good at titrating for many people. They can also be good treatment machines for many people.
CPAP can't "titrate" (although a study demonstrated that people using simple CPAP have shown themselves to be capable of titrating themselves) but CPAP certainly can treat many people effectively. And has been proven to do so.
I think there's a place for both types of machines. But to tout autopap (in auto mode) as being "far superior for MOST people" (as you put it) .... nothing in the summary of that article you quoted supports such a big generalization, imho.
Re: Should I switch from APAP to CPAP?
Posted: Tue Dec 08, 2009 6:28 am
by LinkC
Autopapdude wrote: that first "rogue" apnea would signal the machine to increase pressure. It isn't the first apnea that would be stopped--it is subsequent ones within a short interval
Right! The triggering apnea is NOT stopped. And the APAP constantly roams up and down throughout the night, chasing the optimal pressure at that time. You will continue to have apneas that drive the pressure up and periods of no activity which allow pressure to fall. Each uptick is triggered by an event.
CPAP at the optimal pressure eliminates that searching and the triggering events. On average, my AHI is lower using CPAP. That's a fact, not an opinion. Unless you are prone to centrals, I'd bet yours would be lower also.
Re: Should I switch from APAP to CPAP?
Posted: Tue Dec 08, 2009 6:35 am
by GaryG
LinkC wrote: On average, my AHI is lower using CPAP.
And Autopapdude's AHI is lower using APAP. That's what makes this forum so great. Seriously, folks.
Re: Should I switch from APAP to CPAP?
Posted: Tue Dec 08, 2009 7:23 am
by LinkC
GaryG wrote:And Autopapdude's AHI is lower using APAP.
How could you possibly know that? I've read nothing that would indicate he's compared the two on himself. Just blanket claims that "APAP is better for most people".
Re: I switched from APAP to CPAP
Posted: Tue Dec 08, 2009 7:34 am
by KatieW
Good morning everyone. I'm enjoying the lively debate here.
Night 2 on cpap pressure of 10 cmH2O, just under 8 hours of sleep:
AHI 3.7
AI .3
HI 3.4
1 month average on apap:
AHI 5.0
AI .5
HI 4.6
Looking good....numbers are a little, though not significantly better than my 1 month average. But I feel much more alert, and less aerophagia than on apap 8.6-10. I'm liking this, but will know more in a week.
I changed the setting for EPR INHALE. Found the "fast" setting was starting the next inhale before I finished exhaling. The "medium" setting suits my breathing pattern better.
Re: I switched from APAP to CPAP
Posted: Tue Dec 08, 2009 7:47 am
by nobody
@ autopapdude
Why are you so bent on getting everyone on APAP? If it works for you, that's great, but others might need something different. Like you yourself said, it's not all about numbers. It's also about comfort and how the person sleeps and feels during the day. Not everyone needs to be on APAP range to get the best results from this therapy.
Re: I switched from APAP to CPAP
Posted: Tue Dec 08, 2009 8:16 am
by LinkC
Congrats, Katie! That's two nights in a row below your average.
But the important factor is that you also feel better. Keep it up.
Re: I switched from APAP to CPAP
Posted: Tue Dec 08, 2009 1:53 pm
by Autopapdude
Right! The triggering apnea is NOT stopped. And the APAP constantly roams up and down throughout the night, chasing the optimal pressure at that time. You will continue to have apneas that drive the pressure up and periods of no activity which allow pressure to fall. Each uptick is triggered by an event.
CPAP at the optimal pressure eliminates that searching and the triggering events. On average, my AHI is lower using CPAP. That's a fact, not an opinion. Unless you are prone to centrals, I'd bet yours would be lower also.
Sorry, but in my case you are wrong. Last night, just to try and prove that an autopap does pick up the apneas to a greater degree, I did switch to straight Cpap at my prescribed titration. My AHI was 3, and I had 1 NRI per hour. Normally, my AHI hovers around .7 to 1. In addition, I was awakened several times. So much for straight Cpap being superior. If I kept the trial up, the same thing would happen, as I have done it before. Autopaps are designed to pick up events--and they normally do it quite well. They are the preferred method of treatment by most physicians according to various studies, as they adapt to change. A cpap can't change with differing demands. Tonight I go back to autopap and will compare again.
Why are you so bent on getting everyone on APAP? If it works for you, that's great, but others might need something different. Like you yourself said, it's not all about numbers. It's also about comfort and how the person sleeps and feels during the day. Not everyone needs to be on APAP range to get the best results from this therapy.
_________________
Machi
I don't care which one you use. As long as you are treated, that is great. However, I honestly believe that autopaps are better for most people. Pressure is not a constant thing all night long, nor is it from night to night. There are considerable variations based on sleep habits, stress, and position of sleep. An autopap can pick up these changes, whereas a cpap is passive.
Re: I switched from APAP to CPAP
Posted: Tue Dec 08, 2009 2:38 pm
by nobody
@ Autopapdude
The results of your little experiment only apply to you. It doesn't mean you get to generalize the results to everyone. In addition, your prescribed pressure might not be high enough. I still don't understand why you are so adamant about this on this thread. It does not hurt the OP if she tries the straight CPAP for a while.
Re: I switched from APAP to CPAP
Posted: Tue Dec 08, 2009 3:01 pm
by LinkC
nobody wrote:@ Autopapdude
The results of your little experiment only apply to you. It doesn't mean you get to generalize the results to everyone. In addition, your prescribed pressure might not be high enough. I still don't understand why you are so adamant about this on this thread. It does not hurt the OP if she tries the straight CPAP for a while.
Apparently, his ONE NIGHT trial negates the results of those of us who consistently do better on CPAP... including the OP who is well on her way to better numbers with CPAP.
I wonder why so many people have trouble getting a prescription for APAP if it's the "preferred method of treatment by most physicians"?
Re: I switched from APAP to CPAP
Posted: Tue Dec 08, 2009 3:19 pm
by KatieW
Hey! this is the OP speaking....what does OP stand for....in case I should object.
Re: I switched from APAP to CPAP
Posted: Tue Dec 08, 2009 3:25 pm
by LinkC
Original Poster
(or Outstanding Person)
Re: I switched from APAP to CPAP
Posted: Tue Dec 08, 2009 3:38 pm
by Autopapdude
Apparently, his ONE NIGHT trial negates the results of those of us who consistently do better on CPAP... including the OP who is well on her way to better numbers with CPAP.
I wonder why so many people have trouble getting a prescription for APAP if it's the "preferred method of treatment by most physicians"?
If you would or could read, it says that I have tried that before. That was a one night experiment that I have tried before. As regards the original poster having better numbers, I don't think hers were significantly different if I recall.
Trouble getting a prescription for autopap? What are you talking about? Have you been driving your Escalade into too many trees? Most doctors write exclusively for autopap. Or maybe your barbershop won't?
Re: I switched from APAP to CPAP
Posted: Tue Dec 08, 2009 3:41 pm
by Autopapdude
The results of your little experiment only apply to you. It doesn't mean you get to generalize the results to everyone. In addition, your prescribed pressure might not be high enough. I still don't understand why you are so adamant about this on this thread. It does not hurt the OP if she tries the straight CPAP for a while.
Why are YOU so adamant that she use a straight cpap? Because you're operating on self-justification?