CPAPtalk.com

Nan-- That's exactly what I do. A week on APAP every 6 months or so to ensure my 90% has not changed. Invariably my numbers go up during that week.

I don't have the luxury of two machines, but I have two SmartCards, so changing the settings is as easy as taking out one card and inserting the other.

LinkC wrote:

Jayjonbeach wrote: The doctor was obviously referring to apneas slipping in VERSUS CPAP which IS total rubbish.

Yes, of course he was. Perhaps my argument wasn't explicit enough.

For some people, a properly set CPAP will provide lower apnea numbers than a properly set APAP. It's the "new tech" that is letting them thru.

And for other people their numbers are lower on APAP HENCE CPAP IS LETTING APNEAS SLIP THROUGH (for them).

Again this was pretty obvious and a silly arguement, some people do better on either or, because their sleep patterns ARE different.

LinkC wrote:
My 90% is 17.8cm. The best I could do on APAP was 6 AHI (30 day avg) at a range of 17-20. CPAP @ 18 gives me .2 AHI with one or two ZERO nights per week. I NEVER got a zero night until I switched back to CPAP. My sleep doc explained that APAP "often" lets apneas thru (compared to CPAP) due to the way APAP adjusts...as I explained above. I'm guessing that the OP's RT and my sleep doc have a more experience with different patients than most of us here. I'll trust their knowledge over the opinions of individual patients who deal in absolutes and call any conflicting data "rubbish".

If that's "rubbish", how do YOU explain my results?
What is your clinical evidence that APAP never lets apneas slip thru (compared with CPAP)?

Your results are dead easy to explain, you let your minimum pressure start at 17 YET you say yourself 18 is where you do best. I know this is common for people to set their pressure one or two below their titrated pressure and I really don't see the logic behind that, at all. All you are doing is opening the door for your airway to close.

This is NOT to say that if YOU put the machine on 18 - 20 APAP you will do better than CPAP 18, again, everyone is different, I don't think that even needs to be said in these forums. Possibly for you, the pressure changes arose you and cause apneas, not sure, and really if your AHI is 0.2 there is no reason to try anything else, CPAP clearly works awesome for you, congrats on that, very low numbers.

Looking at a chart with the software, if my titrated pressure is 12, and my APAP is set on 12-15, NOTHING is slipping through because of the how the algorithm adjusts, all it does is simply raise the pressure when it senses problems, it does NOT drop below my titrated pressure at any time and it sure doesn't magically shut off for a few seconds to "let apneas slip through". There is nothing special or secret about how the algorithm works, its a pressure increase at a calculated time so in comparing with CPAP of the same minimum pressure, it is NOT going to let anything more slip through, no clinical evidence necessary, just a little logic and understanding of APAP.

Please feel free to continue to believe your doctor though, I certaintly don't just trust people on just their word (doctors or not) and would much rather look at facts. Next time you see your doc, ask him on what basis he is using such a blanket statement and see if he really has an explaination or is he, like many others, just lacking understanding....

Jayjonbeach wrote: And for other people their numbers are lower on APAP HENCE CPAP IS LETTING APNEAS SLIP THROUGH.

Yes, that's true in many instances. Thus, NEITHER statement is "rubbish". Both are situational.

Jayjonbeach wrote:This is not to say that if YOU put the machine on 18 - 20 APAP you will do better than CPAP 18

You are correct, I do WORSE at 18-20 than 17-20. And best at 18 CPAP.

Jayjonbeach wrote:There is nothing special or secret about how the algorithm works, its a pressure increase at a calculated time so in comparing with CPAP of the same minimum pressure, it is NOT going to let anything more slip through, no clinical evidence necessary, just a little logic and uunderstanding of APAP.

And yet doctors and RTs working with REAL cases and REAL patients in REAL situations find that APAP sometimes fails to catch apneas as well as CPAP. While you, with your vastly superior "uunderstanding of APAP". call their actual findings "rubbish".

So be it. Obviously facts won't sway your misconceptions, so there's no point in further effort. Your personal knowledge and experience trumps that of doctors actually treating patients. We've been around this block a couple of times here already.

Have a nice day.

LinkC wrote:

Jayjonbeach wrote: And for other people their numbers are lower on APAP HENCE CPAP IS LETTING APNEAS SLIP THROUGH.

Yes, that's true in many instances. Thus, NEITHER statement is "rubbish". Both are situational.

Jayjonbeach wrote:This is not to say that if YOU put the machine on 18 - 20 APAP you will do better than CPAP 18

You are correct, I do WORSE at 18-20 than 17-20. And best at 18 CPAP.

Jayjonbeach wrote:There is nothing special or secret about how the algorithm works, its a pressure increase at a calculated time so in comparing with CPAP of the same minimum pressure, it is NOT going to let anything more slip through, no clinical evidence necessary, just a little logic and uunderstanding of APAP.

And yet doctors and RTs working with REAL cases and REAL patients in REAL situations find that APAP sometimes fails to catch apneas as well as CPAP. While you, with your vastly superior "uunderstanding of APAP". call their actual findings "rubbish".

So be it. Obviously facts won't sway your misconceptions, so there's no point in further effort. Your personal knowledge and experience trumps that of doctors actually treating patients. We've been around this block a couple of times here already.

Have a nice day.

Sorry but the original statement is still rubbish as was pointed out very clearly, their findings are not rubbish at all, just the blanket statement.

You are confusing two different facts here; that different therapys work differently for different people AND APAP does NOT let apneas slip through IF set properly (which I already clearly pointed out, there is no magic or mystery unless you think all the info on charts lie, I'll believe the charts thanks)

You are trying to say just because someones numbers are higher using APAP over CPAP, it is letting apneas slip through, sorry but that is impossible in the scenario I proposed (both set with a minimun pressure of 12 means APAP will no more let apneas slip through than plain old CPAP, again there is no mystery here) in my other post. What is possible is the pressure changes in APAP cause people to have arousals which then causes apneas that do NOT happen with CPAP, this is well documented as you should very well know.

IF however people put their pressure LOWER than their titrated pressure which many do, then of course apneas can slip in hello, IT DEPENDS ON THE SETTINGS in a given situation.

Once again, feel free to believe a doctor, I'll believe my own research and facts and not someone on their word. I agree if you don't see the logic here, the debate is more than dead. Maybe instead of coming to a debate citing what some doctor said you actually understand what is being debated, it could then be re-opened for discussion but until then it is clearly dead.

You have a nice day too

Ah! It's all clear now!

The whole point of APAP is that it allows you to use a lower pressure than CPAP most of the time, rising ONLY when necessary to prevent apneas. If you are going to set the lower limit at your 90%, you might as well use CPAP. That's the logic you admit you've never understood.

Obviously, if you set it high enough, it will not let apneas thru any more than CPAP will at the same setting. Set properly, it can--and does, according to professionals in the field,

So yes, if you set your lower limit high enough, APAP won't miss any more apneas than CPAP.

LinkC wrote:Ah! It's all clear now!

The whole point of APAP is that it allows you to use a lower pressure than CPAP most of the time, rising ONLY when necessary to prevent apneas. If you are going to set the lower limit at your 90%, you might as well use CPAP. That's the logic you admit you've never understood.

Obviously, if you set it high enough, it will not let apneas thru any more than CPAP will at the same setting. Set properly, it can--and does, according to professionals in the field,

So yes, if you set your lower limit high enough, APAP won't miss any more apneas than CPAP.

Glad you finally got it, it sure was obvious.

Again you missed the most important part of APAP though, the algorithm which prevents apneas. This happens no matter what you set your lower pressure at and to ME, I don't see the logic of setting it lower than the titrated pressure which I clearly pointed out why and admitted many people are doing this. If someone has a high enough pressure like yourself, then it would seem a more a viable option (but alas opening the door for "slip through apneas").

You also say "you might as well use CPAP" if you have the minimums set the same. Nope. CPAP has no tech at all, ZERO, the greatest benefit of APAP is the algorithm, not a lousy 1cm pressure difference. As a CPAP user, I guess you really don't get it and, you don't need to since your AHI is so low on CPAP.

See to those who don't do so well on CPAP, they can, if they choose, set their APAP machine to the same minimum pressure AND ALSO have the benefit of a pressure increase IF an issue arises (which is proven to help prevent an airway from closing), which for many, will give them a lower overall AHI since also for them the pressure changes don't bother them but rather help them. I really can't spell it out any clearer, its only been about 6 posts already....

I rented a machine through my sleep doctor and a representative of a company the sleep company worked with. That is probably what you are talking about. I rented for about 1 year. In this year I was able to switch between a c-pap and a-pap without buying a new machine or changing my rental time. I was also able to get whichever mask I needed. You just have to be firm with them and let them know what YOU want in a machine and mask. After a sleep study, which my insurance paid for, I was put on an a-pap machine to see where my numbers fit in for me. Then they switched me to a c-pap. I didn't like that at all and sort of demanded to go back on the a-pap. I really like that. I didn't know you can switch them to a c-pap - good to know for the future. After the rental contract was done I switched my prescription to a medical supply store. They have all the masks on display and are very good to work directly through my insurance company. I am very glad I stayed with the clinic for that first year of adjustment. They doctor and rep were both in on my appointments and worked hand-in-hand. Now I am very glad to be with this medical supply company. I go to a local company instead of on the internet because I can return things without postage and get a knowledgable person to fit my masks. Also all the supplies on hand.

Jayjonbeach wrote: I don't see the logic of setting it lower than the titrated pressure

Search on "APAP settings". It's been thoroughly discussed on several threads. Maybe you'll "see the logic" of lowering the pressure (frankly, I kind of doubt you will be accepting of anything that challenges your mindset, tho).

LinkC wrote:

Jayjonbeach wrote: I don't see the logic of setting it lower than the titrated pressure

Search on "APAP settings". It's been thoroughly discussed on several threads. Maybe you'll "see the logic" of lowering the pressure (frankly, I kind of doubt you will be accepting of anything that challenges your mindset, tho).

Link: be kind; Jay's is a new member and probably hasn't tried out the search functions

Jay: as Link pointed out, this question has been discussed in numerous threads. There's quite a bit of wisdom and food for thought - take a peek. I think you'll find it interesting reading. I know it helped me when I made the switch from cpap to apap.

Good luck!

LinkC wrote:

Jayjonbeach wrote: I don't see the logic of setting it lower than the titrated pressure

Search on "APAP settings". It's been thoroughly discussed on several threads. Maybe you'll "see the logic" of lowering the pressure (frankly, I kind of doubt you will be accepting of anything that challenges your mindset, tho).

LOL - the only thick skull here is apparently yours, it took you 6 posts to see a very simple concept I clearly explained each time......

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Did the searches ages ago and near the start of my very long research project to educate myself since my doctors were near useless on the subject. Some "people" recommended 1 or 2 below ideal pressure yet NO ONE ever said why, and I really don't see any logical reason for it as I stated, other than if you want a few apneas to slip through or if your ideal pressure somewhat bothers you because you can't handle it so well (which someone with a HIGH pressure could experience, this is not the majority however which falls more into the 10 - 12 range).

I'm really done talking to a brick wall here and you have offered up NOTHING to support the "theory" you blindy believe in, just some empty babble unlike what I have done, but here is just one more point to ponder for you, not that you'll really pay it any heed, your mind is clearly made up based on what a doctor told you:

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If someone's ideal pressure, the one that gets them the lowest AHI and keeps their airway open most of the time is 12, then "conventional wisdom" says you should set an APAP machine lower setting on 11 or 10. Why? Again just to be "more comfortable"?? The whole benefit of 1 lousy cm of pressure lower? paaalllease

Now note, that a good number of educated experienced people said put the lower setting on the ideal pressure, which, if you think about what APAP is designed to do, DOES make perfect sense. Most of the time you will be at the pressure that works for you and have minimal apneas, duhhh. If during REM sleep your airway becomes so relaxed it closes on you even with your ideal pressure (which happens and only one of the big reasons people need APAP), APAP will then ramp up the pressure to open the airway back up and stop further events from happening. Same goes for if you start snoring, etc, etc. Of course by lowering your pressure BELOW your ideal pressure, you are only inviting more bad things to happen, anyone that doesn't see that logic, well, I dont think I even have to say it. I'm open-minded however, unlike some people around here... , I would love to see someone refute that with any kind of intelligent statement, and not just "ahhh, some doctors say differently...".

viewtopic.php?f=1&t=35160&p=301451&hili ... gs#p301451 just a very fast search just to prove the point, some people took the time to actually think about it, everyone in this one thread I quickly found agrees on the same point. Maybe you should try searching and then, just maybe, try to develop an understanding behind the WHY like I have, then maybe you wouldn't be just blindy advising people on things just because some other people said it, and clearly losing a debate you never understood, maybe then you'd know WHY.....

Of course this is not to say everyone should go and set their minimum pressure on APAP on their ideal pressure, I'm sure there are some people that can somehow benefit from a slightly lower pressure than their ideal pressure, likely people at a high pressure though, or breathing issues, etc.

Also of course, and heres the kicker and probably where this whole theory came from, IF you just had a titiration one night in a hospital and they titrated you at 12, THEN GOING HOME AND PUTTNG THE MACHNE ON 10 - 14 MAKES PERFECT SENSE, FOR A WEEK OR SO. WHY? Just to make sure your titration was accurate, NO OTHER REASON. Hey check out that concept, backing up statements with a reason and a WHY....

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Sorry if it looks like I've been hard on you there Link, its just that when people want to start a debate and then stick to it, they should at least have some knowlege on the subject and back up their claims with something other than " well that is what so-and-so told me". You started it on page 1 saying you didn't want to, and clearly you shouldn't have as you seem to have next to no knowledge on the subject, unlike others that HAVE clearly done their homework.....

Maybe in your next debate, in another thread, far, far, away, your empty theories could pass....

Jay,

I really don't see anything in that link you listed that contradicts with what LinkC has been trying to say all along in this thread.

I'm also one whose sleep is disturbed by the pressure changes of APAP mode during the night, so I prefer CPAP mode. I've never actually tried to find a pressure that eliminates ALL of my events......just one that I can sleep comfortably with and have an AHI of less then 1.0 (which are mostly hypopneas). My monthly AHI is typically around 0.4 - 0.8. That's close enough for me.

Up in the pressure range where LinkC is running, he doesn't have much room above that for the machine to pursue events in APAP mode anyway. I was actually prescribed a pressure of 18 cm., which turned out to be incorrect......but I did try it for about an hour and discovered it was too much for me to start with.......so, at least I know what it feels like.

I've tried APAP mode a number of times and always had higher AHI numbers than I have with CPAP mode. I seem to be one who has "frank" apneas (when I have one). They're ones which occur our of nowhere without preceding events. And, once an apnea is in progress, an APAP won't pursue them......and besides, they only last for about 10 - 12 seconds anyway.....so, by the time an algorithm figured out what was going on, they'd be over with anyway.

I think it's too simplistic to say that there should be one particular way of doing things. Some people have severe aerophagia and need to set their APAP at lower pressures. Some people like a wider range and some like a tight range. It all depends on the individual and the type of sleep and events they have. Snoring, flow limitations and leaking can drive an APAP crazy.......and, for new users, I cringe to see them using an APAP without software. Most of them get so frustrated in a short amount of time and are on the verge of giving up. That's why I recommend that new users start out with CPAP mode (AND software)......it cuts down on the number of variables (problems) to diagnose.

Anyway, that's my take on CPAP vs. AutoPAP.


Den

Sleep Disorders Guide wrote: Different pressures are needed for different levels of sleep and positions. The purpose of APAP is to have the lowest possible pressure for each position or sleep level.

At a given pressure, the machine adjusts the pressure higher until the occurrences are controlled, if a person starts to have an apnea or hypopnea. The pressure is decreased, if a person is in a sleep level or position that doesn’t need a higher pressure.

The advantage is when a lower pressure is all that is required; the machine is not stuck at the highest pressure needed. The down side is, a person can be stuck at a lower pressure having apnea episodes, if the machine does not adjust quickly enough to stop them.

With auto adjusting positive airway pressure (APAP), the mean pressure throughout the night is lower, and 2/3 of the night is spent below the set CPAP pressure. The machine can also adjust for the changes in pressure that are needed to overcome the effects of weight gain and alcohol or narcotic use.

http://www.ncbi.nlm.nih.gov/pubmed/15683142 wrote:
CONCLUSIONS: Compliance, subjective sleepiness, and quality of life are similar between patients who used CPAP and APAP. APAP delivers lower pressures and results in lower-pressure leaks and fewer reported side effects. Compliance is higher with APAP in subjects reporting any side effect. APAP may be indicated in patients reporting side effects with conventional CPAP.

http://www.sleepnet.com/apnea131/messages/655.html wrote: Many feel that a setting of 3 below and 3 above the 90 pct pressure is optimal.

If the lower is set below the minimal pressure that effectively controls the apnea, then there is a chasing the pressure situation. This is where an apneic event is triggered when the presure gets too low and is repeated every time the pressure goes below this point.

If the lower setting is above it, there will be fewer triggers.
My titrated(CPAP) pressure is probably 13 from an inital study of 12.
My APAP settings are 10/16.
About 60- pct of the night, my pressure is at 10 and my ahi index is less than 1.0.
Some feel the aerophagia problem is greatly reduced with the lower pressure as well as the potential of central events due to higher than needed set pressures.
Others report less problems with mask leaks.

http://www.umm.edu/patiented/articles/continuous_positive_airflow_pressure_cpap_devices_used_sleep_apnea_000065_8.htm wrote: APAP devices usually use one of three methods:

Overall pressure is kept low until a specific problem is detected. At that time the pressure is automatically increased rapidly.
Pressure is low when there are no problems but is raised gradually when they are detected.
Pressure is gradually raised and lowered in response to problems or their absence. In addition, the device can change depending on problems within single breaths.