What Ontario needs to know about APAP, in detail & Verbatim

Jay said:
I really wonder how anyone can get better therapy on a "dumb machine" versus one that actually compensates for how you are breathing, it is possible I suppose but I think it is more possible that that is just an old way of thinking.

Gee Jay, I didn't know that my machine was "dumb"......I have 2 cpap machines and both are set on straight cpap, even though my M series is an auto. I much prefer straight cpap to auto, my numbers are way better too.
I guess I am "dumb" too (according to Jay)........I know I'm an old lady..but I am definitely not dumb.
N

Yes, you are really taking care that your husband is getting optimum therapy! You are using the ridiculous Ontario system to the patient's advantage.

I also got my GP involved. In fact he wrote the prescription for me 4 months before the Sleep Specialist could see me after the titration! My GP called the Sleep Specialist's office while I seeing him and complaining that 4 months was too long to wait for therapy with a serious condition diagnosed as "severe". My GP got the pressure level over the phone and wrote the prescription. I got the machine within the week. When I saw the Specialist, 4 months later, and brought my card (which ony showed compliance in those days) he just said that I was doing fine after I filled out a questionnaire.

By involving my GP, I got a 4 months head start on therapy and have been using that prescription ever since to buy autos and newer machines as well as masks and supplies (much cheaper than from the Ontario Provider) ever since. I've been on cpap for 8+ years.


I don't know why many sleep doctors in Ontario won't prescribe auto for most people. In my case, the Provider did all the paper work for the ADP funding so it doesn't appear to be the extra paper work.

Anyway, glad you are really making the system work and getting your husband going as soon as possible with optimum therapy. We really do have to be involved in our own therapy. No one else seems to care much.

Keep us posted!

Jayjon beach: Yes the system needs some "polishing". If you go back about 20 years we had the best system in N.A. but like every country with socialized medicine ( and without) the costs have spiraled and it is hard for the Gov. to keep up. I have previously been a strong critic of our system but on this forum I restrain myself ( somewhat). Somewhere in this forum awhile back there was a poll on the CPAP coverage in various provinces. Many provide ZERO coverage so maybe the $780 is better than nothing. I as so fed up with the long wait times in my Province that I just went out and bought the equipment in the USA. But what happens if you are on a tight budget or worse yet no budget!! And pleae to all of our American friends do not turn this into a Lib v Conservative thread.

Bob

There are people who do better on straight cpap because they have sleep arousals when an auto moves between pressures duing the night. This makes auto therapy bad for them because they end with their sleep being disturbed many time during the night. They are then, better on straight cpap pressure for their therapy.

Jayjonbeach wrote: I really wonder how anyone can get better therapy on a "dumb machine" versus one that actually compensates for how you are breathing..

Well, consider how APAP works. It starts out low, and reacts to events (not necessarily all are full-on apneas, but events nonetheless). It bumps up the pressure until they stop. THEN, if there have been no further events it starts dropping until they begin again. And the cycle repeats all night.

CPAP at a well-titrated and effective constant pressure eliminates most (if not all) pressure-dependent events. No up and down searching for the sweet-spot.

I used to run APAP with the range at -2 to +1 of my 90% pressure. I get better numbers and sounder sleep on CPAP @ my 90%. Zero AHI night are not uncommon. My 30-day Avg is .2

I USED to go back to APAP for a week every 6 mos or so just as a minl-titration. But with the numbers I'm getting now, why bother? I'll know when something changes.

Remember, APAP also "compensates" when you are breathing just fine.

And I am pretty sure the "dumb" machine remark meant PAPs capable of compliance data only and wasn't intended to include the fully data capable PAPs.

another endless debate
my original study showed an AHI of 100 supine, but ZERO non-supine. 90% pressure 6, 100% setting of 7 - doctor prescribed 8. Obviously non-supine pressure requirement was ZERO. Since I was 4 years old I could have been sleeping on the sofa on my side and I would have never suffered with OSA.

I should have had APAP all along, on straight PAP I constantly woke up during the night with my cheeks glued to my teeth. Why? because I had rolled on my side while asleep and the excess pressure was blowing air out my mouth and had completely dried it out, every now and then I could even taste blood because my gums had been so dried out. Other times the whistling noise of the excess pressure actually woke me up. On APAP this never happens. The transitory problems caused by the pressure changes FOR ME, are overshadowed by the large variation in pressure requirement. And yes, I understand that my variation in pressure is relatively rare.

My point is always, as others have made, that an auto can be set to run fixed and yet it is still a great diagnostic tool to open it up and see where it runs a couple of times a year.

Good luck and Happy New Year to all.

Slinky wrote:And I am pretty sure the "dumb" machine remark meant PAPs capable of compliance data only and wasn't intended to include the fully data capable PAPs.

You forgot the and the

Hawthorne wrote:There are people who do better on straight cpap because they have sleep arousals when an auto moves between pressures duing the night. This makes auto therapy bad for them because they end with their sleep being disturbed many time during the night. They are then, better on straight cpap pressure for their therapy.

LinkC wrote:

Jayjonbeach wrote: I really wonder how anyone can get better therapy on a "dumb machine" versus one that actually compensates for how you are breathing..

Well, consider how APAP works. It starts out low, and reacts to events (not necessarily all are full-on apneas, but events nonetheless). It bumps up the pressure until they stop. THEN, if there have been no further events it starts dropping until they begin again. And the cycle repeats all night.

CPAP at a well-titrated and effective constant pressure eliminates most (if not all) pressure-dependent events. No up and down searching for the sweet-spot.

I used to run APAP with the range at -2 to +1 of my 90% pressure. I get better numbers and sounder sleep on CPAP @ my 90%. Zero AHI night are not uncommon. My 30-day Avg is .2

I USED to go back to APAP for a week every 6 mos or so just as a minl-titration. But with the numbers I'm getting now, why bother? I'll know when something changes.

Remember, APAP also "compensates" when you are breathing just fine.

Some good points, especially APAP causing arousals which I now remember reading people mentioning before. Its hard for me to imagine since I get such a better therapy on APAP but I guess I can see someone else having the complete opposite effect. I suppose one pressure the whole night long actually works for someone, like for you Link, it just seems hard to imagine considering the different stages of sleep, etc.

Too many times on CPAP I'll have a span of 10 minutes where Flow declines and then sure enough I'll stop breathing like 20 times in that span, 20 seconds, 25 seconds, 30 seconds, etc. APAP is designing to cut that sh*t right out. Again I have trouble imagining anyone with more than mild apnea not experiencing the same sort of thing and not being able to benefit from an "intelligent" machine that reacts to this and help stop and prevent it. Again, I guess the "reactions" can apparently do more harm than good for some people, maybe people with more mild apnea are better off on CPAP not sure.

My "dumb" comment refers specifically to a machine that has no intelligence or "AI" at all lets call it, it really is dumb in comparison, a motor that blows air at a constant pressure all night versus something that adjusts to an individual and what is happening at any given time, sorry for those that don't like term or that truth.

If it works thats awesome and obviously all that matters, to me the APAP machine is far superior since it has "some intelligence". I would like to see a study based on the new algorithm in 1000 people, how many do better with APAP versus CPAP, pretty sure I just seen something yesterday about this that Resmed had done and i showed far more people benefitted from APAP which to me at least isn't surprising, maybe I'm wrong though.

Counterpoint...

If your APAP machine scores exactly like the sleep study scores, then you have a point.

However, a recent paper on the S8 indicated that while there was a good correlation between S8 AHI and Sleep Lab AHI, the S8 scored about 4 more than the Sleep Lab. That means that 4 times an hour, on average, your S8 APAP machine is adjusting to a fictional apnea event.

If you stop breathing on CPAP due to an obstruction, your pressure is not properly set.

My S8 scores lower AHI on CPAP than while on APAP, so I use APAP to get close, and adjust my CPAP pressure to fine tune the therapy.

In my case, dumb gives me better therapy that "think I am smarter than I really am" intelligence does.

Maybe smart people can adjust their settings so they get better results with a "dumb machine".

Conversely, do dumb people require smart machines?

Is my APAP running in CPAP mode smart , dumb or of average intelligence? Or perhaps bi-polar?

I had no problem have a split night for my sleep study. My DME dealt with all the paper work for ADP. Sorry to hear that some has had a difficult time. I guess it depends where the study was done, Hope everythings works out for you

LinkC wrote:
Is my APAP running in CPAP mode smart , dumb or of average intelligence? Or perhaps bi-polar?

BI-PAP running CPAP (if that is even possible) might make a good case for bi-polar...

LinkC wrote:Is my APAP running in CPAP mode smart , dumb or of average intelligence? Or perhaps bi-polar?

I think APAP running on CPAP mode is most likely APAP with a learning deficiency. That's exactly what I have for a home trial.

tschultz wrote:

LinkC wrote:Is my APAP running in CPAP mode smart , dumb or of average intelligence? Or perhaps bi-polar?

I think APAP running on CPAP mode is most likely APAP with a learning deficiency. That's exactly what I have for a home trial.

You know YOU can change the setting to put it on Auto right? (its what I did after one night of snoring with the mask on with a pressure of 7 which was a Sleep Doctor guess and WAY to low)