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Do sleep studies ever suggest AutoPAP right away?
#21
(11-18-2015, 06:26 AM)StoopidMonkey81 Wrote: Thanks for the info! Let me rephrase the question as a follow-up? Let's say I start my therapy at the static pressure prescribed by me ENT. Are there any indications I should watch out for that would suggest that APAP would work better for me, such as particular events in SleepyHead or physical indications?

Static pressure can be an effective treatment for OSA, if the pressure is at a therapeutically effective level. The only disadvantage, is that the pressure needs to be generally higher than an APAP to cover all stages of sleep, sleep position and other factors. Indications that pressure may not be optimal are increases or high residual snores, hypopnea, and OA events. CA events can generally be ignored. If the machine measures flow limitation and RERA that can also be considered in optimization, but most CPAPs do not measure those. Snoring is an early sign of airway collapse and is generally used in APAP as a signal to increase pressure.

CPAP pressure can be reduced to the point where any snores or AHI begin to increase, then should be reset back to levels where those events are acceptable. It's a little more work than APAP, but both machines essentially function the same, and both are CPAP variants.
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#22
My pulmonologist ordered a split sleep study. The 2nd portion used a FFM and set pressure in steps from 8-15. The machine could not go above 15 as leaks were too high. I still had a few events at 15. Curiously, there were fewer events at 10-12, substantially more at 13-15. AHI=86 w/o CPAP, AHI=29 w/ CPAP with above pressure ranges.

My doc ordered APAP with 15-20 pressure. My AHI now range from 0.83 to 5.9 with a 22 day average of 2.8 - only about 15 total OA over 22 days, most events are H and CA. So my doc did order APAP without a recommendation from the Sleep Lab Doc that reviewed. I have all the sleep lab reports and some raw data but do not know much about how to accurately interpret the information. My pressure is ~ 15.5cm at 95% with max of 17.5cm. Leak rate is ~11 L/min 95%. Seems to be effective, but I have to use the auto pressure relief or I experience difficulty in exhaling and tends to slow my resp rate. Varing pressure may contribute to my high CA I am told by other members of the board.

So some Docs do prescribe APAP from the getgo.
It does not matter how slowly you go as long as you do not stop. --Confucius
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#23
Prescribing APAP is common, and my original prescription did that in 2008. Unfortunately some doctors prefer to have tight control over the patient therapy and know higher-end machines produce data, and DMEs that want to maximize profit margin will offer the cheapest possible machine. More often today, we see auto CPAP being the standard equipment being provided, but there are unfortunate exceptions. Policies vary by country as well. It's very hard to get auto CPAP in some parts of Canada, Europe and Australia.
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#24
The sleep center I went to (Kaiser) does 100+ sleep studies a week. As a result, the ONLY thing they do is prescribe APAP following an overnight at-home test with a "Watch-PAT" and a one-week in-home trial with a ResMed S9 Auto. Only if that plan doesn't work out do they even consider doing a traditional sleep study, or repeating the one-week at-home trial with a BiPAP machine.
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#25
FIL went in for his first study and walked out with an Aircurve VAUTO for his first machine. go figure
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#26
(11-18-2015, 06:26 AM)StoopidMonkey81 Wrote: Thanks for the info! Let me rephrase the question as a follow-up? Let's say I start my therapy at the static pressure prescribed by me ENT. Are there any indications I should watch out for that would suggest that APAP would work better for me, such as particular events in SleepyHead or physical indications?

The most glaring indicator would be having aloy of residual apneas. Meaning your static pressure isnt high enough.
I see no earthly reason straight pressure cpap machines are made anymore. Other than profit for docs and DME.
If you want static pressure the apap can do that . And do it better since one can set their titrated pressure as min set max 1 or 2 above that to handle any bad nights or residuals.
Nobody is going to notice a 2 cm rise in their sleep.
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#27
Sleeprider described areas in your sleep data that point to the need of AutoPAP. When I had a brick, there was no data available. Meanwhile, my wife was reporting my inside-the-mask snoring and struggling with that original CPAP pressure. The sleep doc increased my pressure, and I kept returning to report the problem was not yet solved, and he increased it again. Finally, he didn't know what else to do other than another sleep study. Instead, I got him to write for an APAP loaner, and he agreed as long as he set the pressure range. When the APAP worked, he wrote another script to make the APAP permanent. It's my understanding that he wanted to set the pressure for fear of my getting it too high and causing CAs (liability issue?).

David
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