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I also agree with Bill. I started out with a straight-pressure (data-capable) CPAP......then at about a year into my therapy, I acquired my first Auto. I tried a range of pressures (10 - 15) for about a week before I had to go back to straight pressure to get some restful sleep. The pressure changes disturbed my sleep and I had higher AHI numbers during that time.
Since then, I only use one in a range of pressures during naps......if I'm in an adventurous mood (which isn't often).


Den

Just to be clear. APAP and BiPAP are NOT THE SAME. Just because a machine can do EPR and vary it's pressure does not make it a BiPAP.

I started under this false premise and I got burned. APAP is a variable CPAP. BiPAP is something completely different. Get what you are prescribed.

I think there are many here that do well on APAP and many that do well on CPAP. And its really a personal choice, and I personally don't think one is better than the other. We're all different, and there is no right or wrong. I think everyone should try both methods of therapy to see what works best for them. Cos the real thing is to be comfortable as you can, with a hose connected to a mask to your face.

I started on APAP, after a trial on CPAP, I stayed on CPAP. That's what works for me. But as LinkC mentioned, I do plan periodically to try APAP with a small range around my CPAP pressure, to see how it works from time to time. There is nothing magic about this. Our bodies change over time. And what works optimally now may not down the road. Plus based on how we feel, external factors, what we eat etc , over time, if these change, these can impact what our settings should be.

JohnBFisher wrote:

dave21 wrote:... A lot of doctors and sleep staff I've spoken with over the years tend to think that Auto machines won't respond to apnoeas quickly enough, although do admit that it reduces the length of them and prefer to go with fixed pressure machines. I wondered whether there's any truth in that? ...

Sure. Unless you have an ASV machine the APAP machines won't quickly respond to an obstruction.

But they will address:

• when you had more alcohol than normal and have more airway collapse than normal
• when you take some pain medication that also causes more airway collapse than normal
• when you had a very stressful day, which at least for me seems to cause more airway collapse
• when you just have a "bad night" and have more airway collapse than normal
• when you have some nasal congestion so need slightly higher pressure

And the list goes on ...

Your doctors are right that the machine does not respond immediately to changes in needs. But they miss the bigger picture. You don't just sleep for one night! You and your body change over time based on the world in which you live. An APAP machine helps adjust you adjust to those changing conditions.

Just my opinion, based on my own personal experience. But it seems pretty valid for me based on that experience.

I am in the same school of thought. I have been using an M-Series Pro for over three years at 8cm. I am getting AHI results under 2.0 and typically under 1.0. I notice the difference with and without the CPAP big time so I am not complaining about where I am at. I am getting an S9 AutoSet this week because my M-Series is pretty noisy and I tested out an S8 which was whisper quiet. I am hoping that the S9 is equally quiet based on the reviews I found on this forum. Plus the ResScan 3.10 software seems so much better than Encore Viewer 1.0 which will be nice in terms of monitoring my sleep performance.

The equipment provider is leaving the S9 range in APAP mode at 4-20 cm and setting the CPAP mode at 8cm …but I was thinking that I do not have any problem sleeping at 8cm of pressure so why go lower? My interest in the APAP mode is to address the days when I am not “normal” and need a higher pressure (e.g. 8cm is definitely not enough for me after a night with a couple drinks!). Is there ever a time when I would need a lower pressure than 8cm if I am fine sleeping at that pressure?

So, what do the resident experts (I realize no one here is giving medical guidance, but personal informed experience is relevant, IMO!) think about initially setting my APAP mode at 8-20 and see how the pressure runs for a couple weeks and then tune the high side down to capture that upper boundary based on how the unit operated during my less than “normal” days to keep the pressure from bouncing around too much?

I will experiment with APAP mode compared to CPAP more for a couple months and figure out what makes the most sense. I know that I was all jazzed up on the C-Flex technology when I got my M-Series Pro, but I found it to be a bit of a bother and stopped using it pretty quickly. I imagine that I might have found it more useful if I was at a higher breathing pressure, but at 8cm I was not a big fan of how the C-Flex modulated the air flow…but it was probably something I could have gotten use to if I gave it a chance.

All that remains is getting the S9 and taking it through its paces. I will report back on my findings on APAP vs. CPAP.

8-20 BAD BAD BAD IDEA!!! APAP 8 to 10 / 12.. better .. 20 is plenty of pressure. Don't go there ! Your mask will blow off your face in seconds and you will be wondering WTF just happened. Reset.. 20 minutes later... same deal.. you better have a REALLY REALLY good mask to deal with all of this .. and you aren't going to get any sleep. Waste of time.

ifrimmel wrote:8-20 BAD BAD BAD IDEA!!! APAP 8 to 10 / 12.. better .. 20 is plenty of pressure. Don't go there ! Your mask will blow off your face in seconds and you will be wondering WTF just happened. Reset.. 20 minutes later... same deal.. you better have a REALLY REALLY good mask to deal with all of this .. and you aren't going to get any sleep. Waste of time.

I agree that 20cm is too high on the high side, but if my S9 is in APAP mode will it run straight to 20cm of pressure right away even if I am not having any events at 8cm? I am fine lowering the max pressure to something more reasonable, but I figured I could figure that out letting it run between 8cm and 20cm for a couple nights.

I am not saying you are wrong...I am a noob on APAP operation...but I figured it was not a big deal since the equipment provider set the APAP mode to 4-20cm initially.

Bill,

I won't get into it but can say I went from the CPAP to APAP and sleep like a baby, however, I'm not all users.

billbolton wrote:

dave21 wrote:All of us that are on APAP machines know that the technology does work...

In fact, that is not the case.

There are plenty of user reports here on CPAPtalk, going back over several years, from users who find that APAP is not a sustainable technology for their OSA treatment, while CPAP is.

Cheers,

Bill

Prowest wrote:

ifrimmel wrote:8-20 BAD BAD BAD IDEA!!! APAP 8 to 10 / 12.. better .. 20 is plenty of pressure. Don't go there ! Your mask will blow off your face in seconds and you will be wondering WTF just happened. Reset.. 20 minutes later... same deal.. you better have a REALLY REALLY good mask to deal with all of this .. and you aren't going to get any sleep. Waste of time.

I agree that 20cm is too high on the high side, but if my S9 is in APAP mode will it run straight to 20cm of pressure right away even if I am not having any events at 8cm? I am fine lowering the max pressure to something more reasonable, but I figured I could figure that out letting it run between 8cm and 20cm for a couple nights.

I am not saying you are wrong...I am a noob on APAP operation...but I figured it was not a big deal since the equipment provider set the APAP mode to 4-20cm initially.

I am not one of experts, but if you have a mask leak the auto will run away with the pressure. I keep my pressure 8-14. That is a pretty big range for some people, but mostly my APAP behaves and I have some nights at 9 or less, some at 10 or so and every now and then one at 13. My AHI is 2.5-3.5 most nights and I can live with that. I do not have a problem with the pressure changes and I like my EPR which is set at 2.

Here's the way I look at it. APAPs RESPOND to events. If you have an event, you've probably had your sleep disturbed. The trick is to run the machine at a pressure where you don't have the events in the first place! I have an APAP for the data, but I generally run it at a straight 12cm, which doesn't bother me at all. Sometimes I'll set it at a range of 12-14 to give myself a little bit of extra headroom in case I think I'm going to have a rough night, but 12 is usually great. APAPs can provide more comfort to users by lowering the average pressure, which can improve compliance (a good thing), but they aren't going to provide better treatment in most cases. Of course, everybody has to experiment to see what works for them.

APAP vs CPAP is about sleep quality, not about AHI numbers.

The basic assumption of APAP (i.e. self adjusting) therapy is that the machine's capacity to raise pressure when the need rises, lets you spend more of the night sleeping comfortable at lower pressures.

That's an assumption - and has to be tested empirically for each person.

APAP algorithms have different ways of analysing breathing in a attempt to raise pressure before airway collapses begin -- and they all need and use "obstruction indicators" to respond to in order to raise pressure in a timely manner. Different algorithms go about this differently -- but that's the theory behind all self adjusting machines: Use lower pressure, raise it only when obstruction, or their warning signs appear.

Assuming the algorithm is capable of correctly analysing your breathing (assumption again) the next empirical question is how pressure changes affect an individual's sleep.

Some people are bothered by pressure changes -- and therefore sleep better at the higher pressure needed to eliminate all (or practically all) of their obstructive events.

Other people are bothered be having the pressure too high for their need during parts of the night, and therefore sleep better when they have an APAP supplying higher pressure only when it becomes necessary, and the dropping the pressure when possible.

All population studies only give you a probability on what may happen in a single randomly selected case, but once its you and the machine at your bedside, you owe it to yourself to test all options - because the less probable cases exist in reality, and you may just be one of those.
O.

ozij wrote:APAP vs CPAP is about sleep quality, not about AHI numbers.

I think you are half right. It's about sleep quality AND AHI numbers.

If you have a significant number of apneas, you won't have sleep quality. Since "sleep quality" is subjective (thus nearly impossible to quantify) you must look to the recorded data. If your numbers are good, but sleep quality poor, you must look for other causes. On the other hand, if your numbers are high, but sleep quality good; you STILL have to work on it. Apneas have medical consequences.

xPAP is meant to treat BOTH. They go hand in hand. You shouldn't ignore a high AHI just because you think you are sleeping well.

LinkC wrote:... Since "sleep quality" is subjective (thus nearly impossible to quantify) you must look to the recorded data. ...

One minor suggestion on this, using the Epworth Sleepiness Scale (ESS) can capture the intangible subjective experience. But it takes something tried, true and proven - such as the ESS to be consistent. And Dr Murray Johns, who developed the scale, recognizes that both the subjective and objective must be addressed. As you note:

LinkC wrote:... If your numbers are good, but sleep quality poor, you must look for other causes. On the other hand, if your numbers are high, but sleep quality good; you STILL have to work on it. Apneas have medical consequences. ...

Well said. Not a complaint about ozij, who noted:

ozij wrote:... The basic assumption of APAP (i.e. self adjusting) therapy is that the machine's capacity to raise pressure when the need rises, lets you spend more of the night sleeping comfortable at lower pressures.

That's an assumption - and has to be tested empirically for each person. ...

In that context, the makers of APAP devices hope their units will help APAP users sleep with lower pressure, attain acceptable (or even better) AHI numbers AND see good ESS scores. As ozij notes, it is not true for everyone. But many people do see better results with APAP than CPAP. They see fewer problems with aerophagia. They see fewer issues with mask leaks. They are better able to sleep most of the time with a lower pressure.

But not always. Some people do better with a continuous pressure, rather than a pressure that adjusts to fit the physiological needs.

Would anyone like to go out on a limb and say that the "majority of people sleep better with.......(Cpap vs Apap)? I ask this because I experiment with both in my husband's therapy and he "says" he feels no difference between Cpap=11or12 and Apap=11-13 and I don't observe any. Since I don't get much input from him I'm always wondering if I'm missing something. His titration was 13 but he never slept well at that pressure so it's usually been 12 and on apap he sleeps most of the night at 11 so I'm even thinking of trying 10 or is that pushing my luck? His AHIs are always 0.7-1.9,rarely above 2.0 in either mode. I'm still determined to find the lowest pressure that will give him the best therapy.

DoriC wrote:... Would anyone like to go out on a limb and say that the "majority of people sleep better with.......(Cpap vs Apap)? ...

As a matter of fact, it has been studied:

A Long-term Randomized, Cross-over Comparison of Auto-titrating and Standard Nasal Continuous Airway Pressure
http://sleepds.com/PDF/A%20Long-term%20 ... essure.pdf

The study summarizes the findings with the following:

This study demonstrated that the average pressure recorded overnight was lower with APAP than with CPAP, and that APAP was used for a longer period of time per night than CPAP in both OSA and UARS patients. The same degree of improvement in daytime sleepiness symptoms was documented with each mode of pressure support for OSA and UARS. ... Subjects who began treatment with CPAP were more likely to drop out than if they began treatment with APAP. ... These results illustrate that OSA and UARS patients given APAP may be more likely to stay on treatment and that APAP may be better tolerated than CPAP by both patients with OSA and UARS.

So, if your husband will tolerate it, I recommend using APAP. You might want to lower the beginning pressure a tad. [That's about 1cm H2O, if you want to pin me down on the scientific meaning of a "tad" ]. That will allow him to sleep at lower pressure. However the machine will adjust as needed to address obstructions. And of course, I always recommend discussing something like this with his doctors.

Hope that helps.

John, thanks for that link, I read every word of it. I will consider trying apap at a lower pressure (10-13). The reason I hesitate is that at the beginning Mike was very sensitive to pressure changes,even at narrow ranges, and did better on cpap but now the auto doesn't seem to bother him so we'll see what widening the range does. I seem to go along fine with his settings for awhile and then the "obsession" for a lower pressure overtakes me and the devil makes me try these experiments. I know if my good buddy Den is reading this he's probably getting a 2x4 ready for me! Even though I've been at this for 18months and have learned a lot, I've never actually been able to try the mask myself and have a hard time imagining breathing with a mask covering my face and all that perceived air rushing at me. I have asthma, COPD and sinus allergies(and a vivid imagination) so breathing comfortably is sometimes a problem for me. Thanks again.