C-Flex Vs. Bi-PAP

Update:

My wife called my insurance company and determined that I have no limit on DME equipment. And they accept out of network billing. Now, I'm not exactly sure how this works but if this is true, and it's not a "reimbursement" for out of pocket expenses, then I want to possibly go another route. I'm going to give my DME the option of upgrading me to the Remstar Plus Auto with Cflex. If they will do that, then I will get it through them. If not, then I won't. It's just that simple.

Here's how I feel: CPAP's are fine if you only have this problem short term. If you're going to have it 5 years or longer, then it's not going to account for weight changes. I don't want to have to do another sleep study everytime I lose 30 lbs. It's cheaper for the insurance company to give me the "deluxe" option and let me and the software do the work.

Sure, I'll need a script for an APAP possible IF I go to another vendor. But this is MY life we're talking about and while I'm grateful for the sleep study, through all my research I've determined that an APAP would be better. Why use 13 as a catch-all, when 6 to 11 might do just fine in a few weeks. I'm looking for the minimum pressure for MAXIMUM comfort. At these prices we're not talking about Porsches and Lamborgini's. We're talking about a Honda Civic or a Honda Accord here. That's how I feel. Sure a Civic will work but a Accord will work better. And sure, I could be wrong in my assessment but I'm also assuming some of you (maybe just one but maybe more) actually work for these type of companies and when you STEER us away from APAP for no real apparent reason, it makes me wonder about you

I could buy an automatic vehicle or I can buy a stick shift. Stick shifts give better gas mileage and are overall better cars. Automatic works fine for some people. And that's great. I just don't want to sell myself short when an APAP does both CPAP and APAP and logs everything for me.

What do you think?

See my post under your "What gets prescribed most: CPAP or Auto" thread.

APAP may be right for you. Just make sure that you're not getting swept up in CPAPtalk groupthink about APAP. Its not proven to be better than CPAP, and CPAP pressures can and should be adjusted periodically by your sleep doc, as your needs change. There are some conditions like heart failure for which many doctors feel that APAP is risky, and centrals may be adversely affected by APAPs that are experiencing high or runaway pressures.

On a clinical note, I switched from CPAP to APAP in part because of CPAPtalk groupthink (I believe) and in part because of intolerance of the heated air produced by the heated hose of my Fisher&Paykel HC608 CPAP that I had first been issued. Though I am having a good response with the treatment I am receiving from my S8 AutoSet Vantage, it is worrisome lying there wondering what pressure my ResMed is blowing at at any given moment, noticing wakeful titrations of my pressure by the ResMed, and wondering what the hell the algorithm is doing, since I had ABSOLUTELY no control of the algorithm, other than setting min. and max. values.

With my CPAP, I'd turn it on, and that was that. I tolerated the 10.0 cmH2O that I was titrated at with no problem, and adjusted so quickly that there were times that I had to pass my hand in front of the Swift's exhaust ports to assure myself that it was still on. The ONLY complaint that I had was that the heated hose would make the air stuffy sometimes, and I was having lengthy early AM awakenings . My sleep doc readily agreed to an APAP trial to see if my awakenings were related to a breathing event. Turns out that I'm still having occasional awakenings, and it turns out that my 95% pressure on the S8 is, you guessed it, 10.0 cmH2O.

So, I often think of switching back to CPAP mode so that once again, I can turn it on, go to sleep and forget it, rather than wondering about what the hell the algorithm is deciding is best for me.

Anyhow RM, like I said, just be careful and RELAX. Don't get swept up in the reverence for APAP (particularly Respironics APAP) that pervades around here. It AIN'T THE HOLY GRAIL, fer chrissakes! Its a good and powerful and adaptable technology that ain't been shown to be ANY better than good ole' CPAP, and may be worse for some. If what you want is data, the Respironics Pro2, or the M series Pro2 , or the ResMed S8 Elite will give you that.

Do you really wanna be lying there at night feeling your exhaust to see what pressure you're being blown at, if you're over-ideational anyway???

Chuck

BTW, You needn't worry about which C-Flex setting you use with regard to its impact on your treatment. First, the pressure relief from C-Flex is VERY brief, unlike ResMed's EPR which lasts for the duration of the exhalation. Second, obstructive sleep apnea is cause by a collapse of your upper airways when you try to INHALE. Your own exhalation will reinflate your upper airway.

Chuck

GoofyUT wrote:Anyhow RM, like I said, just be careful and RELAX. Don't get swept up in the reverence for APAP (particularly Respironics APAP) that pervades around here. It AIN'T THE HOLY GRAIL, fer chrissakes! Its a good and powerful and adaptable technology that ain't been shown to be ANY better than good ole' CPAP, and may be worse for some. If what you want is data, the Respironics Pro2, or the M series Pro2 , or the ResMed S8 Elite will give you that.

Maybe a comparison between APAP and CPAP would help. Be sure to let me know if I leave anything out.

APAP advantages:
- auto-titration (like a sleep study every night)
- better for folks with aerophagia
- better for folks with REM only apnea
- better for folks with wildly varying pressure needs
- proven as good as CPAP
- CPAP only mode as well

CPAP advantages:
- CPAP capable

Cost Difference:
$500 vs $650

OK, any questions?

Regards,
Bill

Bill-
Very nicely done, and I by and large agree.

However, do you know of studies that support any of the "Better for...." conclusions that you've drawn? Could you provide the references so that I can read them, too?

Many thanks!!

Chuck

Hmmm. I called someone at my sleep clinic and told them about some concerns I have. Namely air escaping my mouth even with the chin strap, pain on my ears from the chin strap, waking up twice last night with the mask OFF, and ofcourse just general neck pain from not moving all night like I usually do. During the sleep study I had all those diods and wires and what not on me. I could turn sideways very well, and definitely couldn't turn sidewise towards the wires on the other side. I'm sure it was a good study as far as diagnosing that I have OSA. Cool I say!

But I'm about to lose 75 to 100 lbs. And while my rep says we can make changes to my settings (now at 13) as needed, someone else here said that beyond 3 setting changes requires a new sleep study. I want to avoid that. I like the idea of a machine that can cover me for all sleeping positions. Obviously, I sleep on my back 50% of the time. But I also sleep on the other two sides as well.

Pulling the mask off is totally subconscious. I wouldn't do that if I was awake. I know better. I want the benefits of xPAP. But I'm concerned that the pressure is too high during the night sometimes. I'll wake up and notice it. The rep at the sleep clinic says I'll not notice that in a month. Time will tell right? There really isn't that much price difference between CPAP and APAP. And the APAP works as both. Why not find the exact minimal setting during each phase of the night rather than one catch-all?

I'll go do another sleep study if things change enough but I'd like the machine to make minimal adjustments over time as my weight decreases. My weight will have dropped 10 to 15 lbs by the time I go back in for my 1 month assessment. By the a setting of 13 will probably be too much.

My wife did the footwork and found out I have no limit on DME equipment. I also probably need a mask change since I'm a mouth breather who's not having much luck with the chin straps. At this point I can't quite figure out why people jump through so many hoops just to swear a nasal pillow type setup? Do they leak less equalling better therapy? Which is worse? Air escaping my mouth all night long or through a leak? What If I could get a mask that does leak much and also doesn't need the dreaded HARD TO PUT ON chin strap? What if?

I've learned so much in a week and by the time I go in for my appt. on June 21st I'll be armed with knowledge about both the masks and the unit. I don't want the most bells and whistles. I want the most effective therapy

Rastaman wrote:I've learned so much in a week and by the time I go in for my appt. on June 21st I'll be armed with knowledge about both the masks and the unit. I don't want the most bells and whistles. I want the most effective therapy

Rastaman, if you get an APAP now you probably won't go back in for another sleep study in a few years, because you'll realize that the sleep lab won't be able to titrate you any better than you've already done yourself.

On the other hand, if you don't get an APAP you'll continue to pay for adjustments, studies, consultations, etc. Is it any wonder that some "professionals" don't like APAP's? Or you might decide that the experiences of those of us on this forum are nothing compared to what the "professionals" know. But if you lean that way, I'd recommend that you ask your "professionals" all the same questions you've been asking here and make sure that you are satisfied with the answers you get, if you can even get answers to most of them.

Just my $0.02, of course.


Regards,
Bill

GoofyUT wrote:Bill-
Very nicely done, and I by and large agree.

However, do you know of studies that support any of the "Better for...." conclusions that you've drawn? Could you provide the references so that I can read them, too?

Well Chuck,

I've been conducting my own aerophagia study over the past five months now, and have discovered that I can't tolerate CPAP over about 5 cm pressure for an entire night without suffering painfully debilitating aerophagia. On APAP though, I easily tolerate pressures up to 13 cm (maximum my machine has ever gone) for short periods of time. I suspect the NEJM wouldn't publish my results though, even if I wrote it up.

On the other matters, I'll again relate my own experience. My apnea is clustered during REM sleep only. With an APAP, my pressure stays near the minimum for most of the night, and only increases during REM periods. Again, just my experience, but other folks have posted charts showing a similar pattern, so it is not an uncommon condition.

As to the wildly varying pressure needs - I have TMJ issues and as my jaw moves in or out a little it affects my pressure requirements, a lot. I've had nights when my pressure stayed at the minimum of 5 cm all night, and I've had nights when the pressure stayed at or above 10 cm a good part of the night.

Am I typical? Probably not. But the strong impression I get from reading posts on this forum is that most folks here are not typical either. I extrapolate from that to think that there isn't a "typical" apnea patient. All of us are fighting our individual battles. Given that, does it really make sense to handicap your therapy unnecessarily with a one-trick pony from the start, when for little or no increase in price you can have a machine which works well under a variety of conditions?

The success rate with the "professionals" is only around 50%. The success rate of folks here appears to be considerably higher than that. I ran a poll a few months ago asking folks if they were still at their original titration and I was even surprised at the results. Very few people remained at their original titrated value.

Just my $0.02 of course. At least with open discussion and lots of information flow, folks here can form their own conclusions and decide what they think will work best for them.

Regards,
Bill

GoofyUT,

I have just ONE question for you at the moment. Do you stay in the same position all night long? You said 95% was at 10 on your APAP. Because of that I'm thinking that you don't move normally when you're sleeping except a small percentage of the time. The wife says I move when she moves. If she rolls over, I too roll over. It's funny to her but true to me.

Should I have one setting for my left side? one for my right? one for my back?

At this point I'm still renting the unit. I haven't gone in yet for my 1 month check-up and at that time we decide to rent or buy. I'm making a list and checking it twice on MY issues.

You said your setting SHOULD be set by professionals. But you also said you have an APAP. I'm guessing your machine makes adjustments for you but in reality you're 95% a CPAP man, with 5% being........under 10? Would having the setting on 10 ALL NIGHT bother you? I guess the good part is that you got the APAP which functions as both, so should your needs change over time, you're already ahead of the game.

All very good questions, RM.

Here's what I think:

1) My "95%" pressure is a term that corresponds to the pressure reading on my S8. It means that my S8 operates at 10.0 cmH2O or BELOW 95% of the night. Only 5% of the time does it exceed 10.0 cmH20.

2) Yes, I do turn in my sleep, but not much. My S8 probably adjusts for these postural changes, but again, 95% of the time it stays at or below the same 10.0 that my CPAP delivered.

3) I said that professionals SHOULD adjust your settings as your needs change. What I meant was that a good professional doing their job should take it upon themselves to make sure to review your therapy regularly and make whatever adjustments are indicated. So, i was refering to what professionals should do, not what you shoulod do. Your only obligation is to be an honest and compliant patient. I will agree though, that the literature suggests that APAP does at least as good a job of titrating pressures as a good professional does.

4) I Started this journey on CPAP titrated to 10.0 and I adjusted to it fine. I found NO discomfort either from exhaling or inhaling, and I'm blessed in that I very quickly was able to adjust to nasal CPAP without mouth-breathing, and without having to resort to taping, chin-straps, dental appliances or anything else. Me and my Swift have formed a DEEP friendship. I find that I'm spending more time thinking about what the damn algorithm is choosing for me, than I EVER thought about with CPAP.

5) I have NEVER had aerophagia, either with CPAP or APAP.

So RM, again, all I'm saying is that APAP AIN'T THE MAGIC CURE!!! It might be right for you. It might not.All that you can do is be as informed as you can be and then make the best decision that you can about your own treatment. Take anedcdotalk evidence that you'll find here in abundance with a grain of salt. Take the time to read the literature yourself. And get a good doctor that you trust, and then follow his/her advice.

Bill, though i appreciate reading about your experiences, and have been grateful for your excellent observations and excellent reports and posts, they remain ANECDOTAL and therefore, have NO usefulness beyond you, and the entertainment value they present.

Chuck

GoofyUT wrote:Bill, though i appreciate reading about your experiences, and have been grateful for your excellent observations and excellent reports and posts, they remain ANECDOTAL and therefore, have NO usefulness beyond you, and the entertainment value they present.

If I were an isolated case, Chuck, I'd agree with you. If I were in a physician's office and he told me the same thing you just said, I'd be hard pressed to argue with him. However, it appears that there are a lot of us isolated anecdotal cases running around. Interesting isn't it that so many of us seem to have found our way here. There's nothing about my apnea condition that others here haven't posted about as well. Hmm . . ., me thinks, perhaps, we're not such isolated cases after all.

Regards,
Bill (just connecting dots)

Rastaman wrote:]There really isn't that much price difference between CPAP and APAP. And the APAP works as both. Why not find the exact minimal setting during each phase of the night rather than one catch-all?

(bold emphasis added by me)

Those are two very good reasons to get the more versatile machine -- APAP instead of a CPAP.

I just want to say you guys have turned me into a cpaptalk.com junkie. What gives?!?! I used to get on a local rock radio station website. Well, I still do. It's a community just like this one. And people who listen to all different kinds of music get on there mainly because we all listen to the same morning show. But now, I find myself here every day and no real interest over there. Afterall, I know what they have to say about all the topics we generally discuss.

And I noticed that many of you stick around well after your initial help phase and continue to help "newbie'" hoseheads like myself, which I find very cool. It's much appreciated.