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CPAP versus APAP
#41
(12-02-2012, 12:43 AM)IDRIck Wrote: Okay, you obviously believe that APAP are better. Please provide links/references to the well designed studies that clearly demonstrate significant biological improvements in OSA patients with a proper adjusted APAP over a properly adjusted CPAP.

Who put you in charge? Why are your beliefs to be accepted at face value and those who disagree are required to provide proof?

Please provide links/references to the well designed studies that clearly demonstrate the lack of significant biological improvements in OSA patients with a properly adjusted APAP over a properly adjusted CPAP. The definition of "properly adjusted" needs to include setting a limited pressure range customized to the results of a PSG study, along with followup analysis of the data recorded by a fully data capable APAP machine with airflow waveforms and adjustment of the machine settings.

Also provide links/references to the well designed studies that clearly demonstrate the lack of significant biological improvements in OSA patients with a properly adjusted APAP over a properly adjusted CPAP. In this case, don't have the therapy managed by researchers, but by a sample of commercially practicing physicians in their daily practice with a small amount of training in proper use of an APAP using the definition of "properly adjusted" above.
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#42
It seems to me you want to argue the point, IDRickm no matter what anyone says. And that is fine. But you also have to realize that users are by far the best scale to use.

Studies have shown that increased pressure does not cause an increase in Central Apnea events. Yet, there are a lot of us who have had that situation. There are a lot of sleep doctors who believe this does indeed happen. But studies can't prove it.

In a field that thrives on secrecy and "compliance" versus accountability and education, the studies are going to be outdated, rare, and inconclusive. When autoPAPs first came out, there were a lot of studies that debunked them. They have vastly improved, as have all CPAP machines, yet studies have not kept up with them.

Meanwhile, Google is your friend. Go on a search for what you are looking for if what we say based on experience is not enough. I just did that. And the first two pages were almost entirely CPAP forums of members arguing this same thing and no one reaching any firm conclusions.

Putting on moderator hat: As long as this discussion stays civil, it will remain open. But if it starts to get beyond that line, it will be closed. So be nice, be polite, and be considerate.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#43
Sorry--my goof. Please disregard this post, thanks.
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#44
(12-01-2012, 09:58 PM)SuperSleeper Wrote: Dawei, I'm having trouble deciphering which part of your posts are quoting someone else and which is your own post... and I've been trying to keep up with this thread. Cool

Here's a how-to on how to quote properly:

http://www.apneaboard.com/forums/Thread-...85#pid3285

I think part of the problem is that you starting typing in the middle of a quote perhaps and then try to fix the quote tag and it gets goofed up maybe? - I'm not sure what's happening with your posts.

No big deal, it's just that it's difficult to know what is your own post and what is quoted text. You should be able to go back and edit those posts and fix it - I sure would appreciate if you did that. Coffee

Super--My apologies. Your guesses were correct. I've now been reading Paula's How To. I hadn't found it earlier. Thanks for the link. I've edited my post #30 to show it as a quote from JJJ, not mine. If you would like to delete my post #30, please do so, since I cannot.
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#45
For the first six weeks I spent using my S9 autoset, I had a set pressure of 10cm which was my prescribed pressure after my sleep study and my AHI were constantly under 2 and mostly under 1.

After attending my follow up visit with my sleep specialist I changed my machine to auto with a pressure range of 8 to 15 and found my average pressure was 12.6 and my AHI was still under 2 except for one night which was 2.5.

I didn't like the setting at 8 as I had become accustomed to the pressure at 10, so changed the lower setting to 10 and left the high setting at 15 and my AHI is back to under 1 again. I haven't downloaded the information from my SD card as yet so don't know how high the pressure has gotten too but I'm sleeping very well
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#46
Quote:But why can't you buy the idea that a machine running at 16 cm. (in my original scenario) would eliminate an apnea event that a machine in auto mode at 10-16 might not react in time to avert?

JJJ--Let's say the high pressure CPAP would prevent that initial event while the Auto would miss it. But what goes on over time during a series of events? There's more to effective therapy than a steady high pressure acting on one event. This point is mentioned in the interesting info that zonk brought to our attention. In addition, zonk reminds us that the articles he linked were from 2009, before the latest scientific developments in auto machines. Anticipating events is an area where improvements have recently been made in auto machines. So, following your example leads to an incorrect conclusion--that CPAP is better therapy than APAP.
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#47
(12-02-2012, 04:40 AM)PaulaO2 Wrote: It seems to me you want to argue the point, IDRickm no matter what anyone says. And that is fine. But you also have to realize that users are by far the best scale to use.

My apologies, as I scientist I like to see the data behind various viewpoints. I'm not trained in a medical field but I do have an understanding of clinical trials and frequently do searches on topics relative to my particular health issues. In the medical discussions that I've found, initial recommended therapy is a CPAP with APAPs reserved for a subset of sleep apnea patients. Perhaps we're merely in the transition period and soon all will be started on an APAP. Prevailing opinion by many on this board would support this change but I don't know what would need to change for the medical community to indeed transistion to an all APAP approach. Again my apologies for asking for data. I will cease and desist.
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#48
(12-02-2012, 12:56 AM)IDRIck Wrote: Based on the opinions expressed here, my doctors are way out touch and out of date.

I don't see that conclusion being drawn from those opinions. Most of us have been careful to note that a APAP can be put in CPAP mode for those cases where that mode works better.

The fact is, and I don't think this opinion has yet been stated in this thread, the APAP algorithms don't work for everyone. Some patients have reported that a APAP "runs away" for them and always sets itself at the higher end of the pressure range.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#49
(12-02-2012, 11:14 AM)IDRIck Wrote: My apologies, as I scientist I like to see the data behind various viewpoints.

So do I, which is why I didn't take the meta analysis conclusions at face value, but rather began to look at the underlying studies that made up the entire picture, plus the methods and data that were used in those individual studies. So, if you did as you said you like to do ("see the data"), you should have come to a similar conclusion: that the studies were biased because they used very old APAP machines and because they used the APAPs in a wide pressure range mode, which is NOT the way APAPs should be used.

Quote:I'm not trained in a medical field but I do have an understanding of clinical trials and frequently do searches on topics relative to my particular health issues.

That's good. Part of the problem here is two-fold, I think:

1. APAP technology has improved dramatically in the past 2-3 years. The scientific community just hasn't caught up yet, therefore there is a lack of quality studies to show that APAP is a better solution for many patients.

2. We also must open our eyes to the fact that the sleep apnea industry is a lucrative one for many stakeholders. The truth is that DMEs have a vested interest in providing you with a low-end CPAP machine over a higher-end APAP, because they make more profit with a low-cost machine (they are usually reimbursed around $1400-1500 for distributing a CPAP to a patient, no matter what make or model, and therefore make more profit by giving you a low-end machine). In addition, doctors have a vested interest in wanting you to "come back for more" so-to-speak, so they can charge you continuing fees for office visits, more sleep tests, etc. You're likely to need more "adjustments" and "changes" to your therapy if the doctor puts you on straight CPAP than if he were to properly instruct you on how to use an APAP.

Here's the bottom line: Data-capable APAP machines hand the "keys to treatment" over to the patient. If you can take control of your own therapy, you'll need less professional health care services, not more. Not all patients are able to use those "keys", but many increasingly are. Biased meta studies like this only serve to give ammunition to those health care professionals who want to keep patients "in the dark" with regard to how to best treat their condition, so that they can guarantee a steady cash-flow stream, as uninformed patients are forced to pay for "expert advice". We've had health care professionals on Apnea Board in the past who have haughty attitudes saying things like "I'm the professional here and I know better than you; so quit trying to 'play doctor' with your CPAP treatment - that's my job". The Sleep Apnea Patient Empowerment Movement is threatening their profit margins, quite simply. But, it's a snowballing movement that is starting to move exponentially - these doctors need to change their mindset and realize that increasingly, patients want more control over their own healthcare decisions, not less.

Quote:In the medical discussions that I've found, initial recommended therapy is a CPAP with APAPs reserved for a subset of sleep apnea patients. Perhaps we're merely in the transition period and soon all will be started on an APAP.

Yes, I think you're correct here. It's important for doctors to remember that an APAP can be set in straight CPAP mode if need be, and that it's really the gold-standard for treatment, since it offers the most options for future treatment, at little cost. If straight CPAP is prescribed and there is a future need to change fixed pressures, the only way to do that properly is with an expensive sleep study in a lab; with a data-capable APAP, that expensive necessity many times can be avoided.

It's probably going to take a year or two more yet before the medical community catches up with the reality of what's going on in the Sleep Apnea Patient Empowerment Movement. As I do communicate with many doctors, RTs, sleep center owners, etc, I see a few of them have already started to make this transitional mindset. It's slow progress, but it is occurring out there. This move essentially changes the primary focus of a sleep lab's goals - in the past, it was used to diagnose OSA and titrate a proper fixed pressure.

Now, with the advent of improved data-capable APAPs, along with PC software, many patients see no need for regular overnight sleep studies at all (other than their initial diagnostic study).... the old standard of "get a sleep study every 5 years" (for mainly titration purposes) is being taken over by patients armed with an APAP and PC software who can manage their own titration with these useful tools. I'm sure you can see how that is a financial threat to some sleep labs who will lose revenue as follow-up sleep studies become unnecessary. This is primarily where resistance to our movement is coming from, I think.

Quote:Prevailing opinion by many on this board would support this change but I don't know what would need to change for the medical community to indeed transistion to an all APAP approach.

No one is demanding a transition to an "all APAP approach". Instead, we simply want health care professionals to quit blindly attacking those who prefer APAPs over CPAP, or using biased studies like this as "proof" that APAPs are no better (or worse) than CPAPs. We do think it's wise to consider prescribing APAP over CPAP, if only for the additional treatment options that such a decision allows.

Quote:Again my apologies for asking for data. I will cease and desist.

There's nothing wrong with asking for data. But, when you present a biased meta study to support your opinions, you can't expect that folks around here will just "let that stand" without challenges.

This is the the beauty of Apnea Board and the Sleep Apnea Patient Empowerment Movement: we realize that the training, education and experience health care professionals have is very useful to us and many times is worth paying for. We also realize that training, education and experience can be obtained by anyone - including us lowly patients, and that at times, we can save money and obtain better treatment if we take a more active role in our own therapy.

Coffee
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.



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#50
There do seem to be signs that we're in a multi-faceted transition period in the apnea treatment field. Along with what Super just posted, there is also a move on now for sleep labs to work toward either beginning to conduct or increasing the number of pts. for whom home sleep studies are conducted in place of in-lab studies. From what I've heard from the director of my local, hospital-based sleep lab, this appears to be motivated by the increasing number of folks for whom apnea is strongly suspected and a sleep study is ordered. It sounds like they have more pts. than they can handle with limited beds in the lab.
About the money part, I have not personally experienced an "I'd-like-to-increase-my-profit" attitude from sleep docs or from the DME. When my doc wrote a script for a change from an S9 Elite to the Autoset, the DME immediately complied, no questions asked, since they had received the Rx.
As for my being called back for office visits to the sleep doc, this has occurred for reasonable purposes, such as when modifications in pressure were being tried with a CPAP. I never felt the doc was scheduling a future visit without a real purpose. When I finally got on the right track with my S9Autoset, the doc suggested that I return in something like 12-18 months just to "keep me active." I believe that reference has to do with Medicare. Five years had gone by previously during which I did not see a sleep doc, nor was it suggested that I do so. When I wanted to try a different mask, the DME said I first needed to see a doc, since it had been more than a year since I had done so.
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