Auto PAPs are the norm* over here - Not much controversy about it.
"What would you say to a beer, Normie?"
"Daddy wuvs you."
Sorry, couldn't resist.
My doc prescribed an auto, no issues. He probably would have done so anyway but I'm not sure. I made sure to ask for it before the Rx was written.
It might depend on how you ask. If the doc senses that you want an auto just because you read somewhere that they're the "best" (and not even sure why) you're likely to get some eyerolls.
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The first machine I got was a straight CPAP machine and I am sure glad that I was able to move into an S9autoSet.
The medical mafia types don't like auto CPAP because reduces their profit opportunities for repeat visits, adjustments, sleep tests, etc.
The dumb or lazy types don't want to go to the trouble to do APAP right, and CPAP is simpler, especially if you don't really care about finding the right pressure for the patient.
Some DMEs (CPAP salesmen) don't like APAP because it costs a little more and they are usually paid a fixed fee for any CPAP.
Some honest doctors don't know much about CPAP and may have even been steered wrong by the dishonest crowd. They think that APAP machines are simply set to "wide open" settings and run the full pressure range of 4-20 cmH2O. An auto CPAP should be set to a narrower pressure range for most patients, so it starts at something close to the right pressure for the patient.
If you set the minimum pressure too low, the patient may feel they're suffocating until the APAP adjusts upward. This can be avoided by raising the minimum pressure.
On a limited number of patients, the pressure will "run away" and get too high. Sometimes the patient actually needs the higher pressure, sometimes the machine is just "wrong." Either problem can be fixed by reducing the maximum pressure setting. Runaway pressure can make your apnea worse by causing central apnea. This scenario is fairly rare.
Some patients are bothered by the changes in pressure.
It may be more difficult to prevent mask leaks if the pressure changes much. You fit the mask when you put it on, but when you go to sleep, it may leak if the pressure increases.
There may be a small price increase for some patients, but I believe all patients should be given auto CPAP machines. All auto CPAP machines can be set to a narrow pressure range, or even manual CPAP if the medical professionals can't "tame" the auto CPAP.
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