APAP disadvantages?

Some experience positional apneas. In other words, they may require more pressure to stent the throat when sleeping on their back than when sleeping on their side. If you have trained yourself to sleep on side (as I have), then sure, CPAP mode will prolly work just fine. If you sleep on both your back and sides during the night and you OSA is worse on your back (as it is for some, your sleep study should have noted that too), then an APAP may be a good approach. There are other positives where using APAP may benefit like aerphagia. But the most important reason for having an APAP is that it can be set to CPAP mode should that be the better choice. But you won't know if it is a better choice unless you try the APAP first cuz everyone is different.

The algorithm, or a set of rules for adjusting pressure, varies from one manufacturer to another.This means that each brand gives different results for a given patient,so machines are not as standardized and predictable for the doctor to prescribe as straight CPAP.For the user, one brand may work better than another, so some experimentation with another brand may be necessary if the first machine tried isn’t comfortable.This is a good reason to rent before buying. With user research online, from professionals at a trusted hospital sleep lab,and from an experienced sleep doctor who is informed about APAP technology, a carefully selected first machine may work without further machine trials.Sometimes the machine may react too slowly to the body’s changing pressure needs. This can be overcome by using the APAP machine and software to find your sweet spot, single optimal pressure and using the straight CPAP mode,or optimal narrow range of pressure.

The cost difference should be marginal between PR1 CPAP and APAP units. If not, you should be shopping online instead.

The APAP can accommodate your current prescription as:

1. A brain dead CPAP with no data (don't download the SD card or look at the printouts)
2. CPAP with data (download the SD Card)
3. APAP w/o data
4. APAP w/data in CFLEX/AFLEX (or "No-flex"),
a. narrow range: min=10cm, max=10cm (same as CPAP)
b. wide-open (for DME's or Doctors who don't know any better) min=4cm, max=20cm

This last option (4b) is what doctors think of when they consider APAP, is highly INEFFECTIVE, and is how many DMEs program the machine. WRONG!

So let's review...with an APAP, you have the OPTION...but not the OBLIGATION...to run the machine in straight CPAP mode (or Warp Factor 12) for about the same price.

Also consider that your pressure needs can change from day-to-day due to weight, stress, sleep position, temperature/humidity, illness. With CPAP, the settings start with the sleep lab guesstimate, changes (or not) made by the Sleep Doc, DME mistakes, and then you get to try it out for about five years as your health goes up and down.

The best thing I can say about CPAP is that it COULD be right some of the time. Will it get you under below an AHI of 5.0? It's possible. Will it get you optimal therapy and make you feel your best? Probably not. It's your call.

My story (briefly):
I've always been under the care of a sleep doctor. Moderate Sleep Apnea (untreated AHI=27). Home Titration: 10cm 90% pressure (set at 4-20cm).

I used the AUTO M with AFLEX for about 9 months.
* DME initially set it wide open at 4-20cm. Machine never went above 10cm . AHI = 15. (Epworth = 17)
* Got AHI down below 5.0 with settings of 12-15cm (Epworth was still 17)
* Got it down to 2.0 at 15-17cm (Epworth still 17--felt great in the morning...by noon...back to zombie mode)

* My first real sleep study. Titrated at 19cm. Jeez!
* Finally got pressure up to 17cm-20cm. (still tired...fragmented sleep, etc). Pressure (especially exhale pressure) was hard to take.

* Switched to new sleep doctor. Got a BI-Level titration. Results were IPAP 15/ EPAP 10. (Inhale/Exhale pressures).
* Begged for an AUTO Bi-pap (versus fixed) and got it. PR System One Auto BiPAP with BiFlex. (Apria prices for Fixed and Auto are the same: $ 2107).
* Machine was set fixed at 15/10...couldn't sleep the first night. Switched to AUTO, now at MAX IPAP = 17 / MIN EPAP = 12 / Pressure Support = 4.

After just two weeks with the Auto Bi-Pap...Results: OA + HY < 1.5 I feel like I'm actually sleeping at night...my energy level has increased three-fold. I feel great!
Even with the Kaiser/Apria bureaucracy, I got these results in just 10 months. If I wasn't using AUTO titrating units, this process would have taken years!

Looking back. I guess it would be possible to finally narrow the pressure range down until you arrive at a single number. Unfortunately, you will still suffer from fatigue and other health issues until you get there (if you get there). But why bother?

---
As far as medical statistics are concerned: You're either 100% dead or 100% alive...there are no 50/50 chances with a population sample size of 1.
YOU ARE A STATISTIC OF ONE!

Since each of us is a stastistic of one( as OCSleeper said), we owe ourselves a trial of all options.

Medical studies -- which your doc seems to have read -- get published when they have a 1 in 20 of being wrong. 1 in 20 is not a bet I want to take on my health or comfort.
Which is why I bought an APAP, and 5 years later, another one.

For most of the studies, the APAP was set at a 4 or 5 to 15 or so range (just like roster aka Rooster said) - few of us have found that minimum a good setting for effective therapy -- most machines are not as good at pre-empting events as their inventors would have you think.

LinkC wrote:APAP has a built-in disadvantage in that it adjusts the pressure in response to events. It starts out at the minimum setting. When (not if!) an apnea event is imminent, it steps up. That step may or may not be enough to quash the apnea. It may take 2, 3 or more events before the APAP reaches an effective level. Then guess what? After a period of no events, it starts dropping back down until events begin again.

Exactly. That said, an auto with the minimum set close to where the majority of your events are avoided and with headroom left for when you need more pressure can be an excellent solution for some people (DreamStalker gave an example)

Personally, I find a narrow range does make a difference -- I need the upper range for those times when the minimal pressure is not enough -- and for me, the top has to be limited as well, because auto's tend to go to a height I can't tolerate - so while I agree with Wulfman's statement that pressure changes can wake people up, I don't agree that a narrow range is "silly". Whether or not its silly for you is something you will have to try out for yourself.

For all you know, the doc's approach may simply be another example of "defensive medicine": he's read the papers saying that CPAP may be better than APAP, and he's not going to let himself be sued for not acting according to that info....
I don't think your doc is ignorant -- he sounds like he's read this http://chestjournal.chestpubs.org/conte ... 3.abstract at the very least. And possibly this one as well http://chestjournal.chestpubs.org/conte ... /1051.full

O.

blakepro wrote:What are your thoughts on runing Apap min pressure at your 90-95% and setting your max a few notches above it to account for various changes. Seems like that might give the best of both worlds with what LinkC is saying.

Indeed! That is the ONLY reasonable way to use APAP (unless you enjoy re-titrating every night!) Doctors who order APAPs set wide open aren't worthy of their title. (Why bother with a titration study if you ignore it?)

My 90% is 17cm. Initial PSG showed 96 AHI. When I was running 16-19cm, I was averaging .43 AHI (low .1, high 1.4). Now CPAP at 17 (no ramp) currently gives me an average .25 AHI, (with 0.0 AI about twice a week) and the occasional 0 AHI! I haven't had a night above 1.0 AHI in months.

But everyone is different. If one finds APAP works better, make sure to have the range at the optimal tightness, especially the low end.

EDIT: There are some folks who run APAP with both* the Min and Max at their 90%. Essentially CPAP, but some machines give additional data in APAP mode. *I think most machines require a .1 or .5cm difference in Min/Max, so you can't run EXACTLY the same.