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In what case CPAP is better then APAP?
#1
In what case CPAP is better then APAP?
I tried to find some data on this topic but without success. 

I wonder if ones could profit from choosing CPAP over APAP?
If there are people for whom changes in pressure over night make AHI worse etc.
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#2
RE: In what case CPAP is better then APAP?
Pretty much all APAP machines can be set to CPAP mode or to a limited pressure range, so there's basically no reason to buy a CPAP machine vs. APAP other than cost.

If you're asking about why everyone doesn't just get an Auto CPAP and let it find your pressure, there are many reasons.  You can usually fix these problems by limiting the range of the APAP. 

Some people get central apneas if the pressure is too high, and you need to limit the max pressure.

If the pressure starts too low, many people will feel they are suffocating, even if they are not having apneas.  You may need to choose a higher minimum pressure.

Some people only have apnea for part of the night.  When they start having apneas, they may be uncomfortable until the machine adjusts upwards. 

You may "need" a higher pressure, but it's too uncomfortable for you.  Sometimes you have to compromise treatment vs. comfort to get the patient to use the machine. 

Higher pressures may cause problems like mask leaks, mouth leaks, ear problems, gas in the stomach, etc.   Once again, you may need to find a compromise setting.

If you adjust your mask at a low pressure, it may leak at a higher pressure and need to be readjusted while you're asleep.

Some people are bothered by pressure changes.

Some auto machines have a tendency to "run away" to higher pressures and never fix your apneas. 

Sometimes, the APAP machine simply doesn't find "THE" right pressure and fixed pressure CPAP works better.  It's not simply a matter of "crank the pressure up till the apnea stops."
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#3
RE: In what case CPAP is better then APAP?
(07-13-2021, 02:45 AM)archangel Wrote: Some people are bothered by pressure changes.

Some auto machines have a tendency to "run away" to higher pressures and never fix your apneas. 

Sometimes, the APAP machine simply doesn't find "THE" right pressure and fixed pressure CPAP works better.  It's not simply a matter of "crank the pressure up till the apnea stops."

Basically I was thinking about those 3 situations. But first is the most important one   .

People are bothered by pressure changes - ok, but how? How it influence breathing? Where it may lead to?
If you have any links to articles I would appreciate it
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#4
RE: In what case CPAP is better then APAP?
(07-13-2021, 05:36 AM)koala1 Wrote: People are bothered by pressure changes - ok, but how?

Probably mostly that their mind or body gets used to one pressure and notice it when it changes.  For instance, you might find a pressure of 12 uncomfortable, but get used to it after a few minutes and fall asleep.   If the pressure drops to 6, then goes back up to 12, you might find 12 feels uncomfortable again and wakes you up.
Get the free OSCAR CPAP software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#5
RE: In what case CPAP is better then APAP?
CPAP may also reduce TECSAS.
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#6
RE: In what case CPAP is better then APAP?
Is this what you want?

Quote:Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis

Study objective: To compare the effectiveness of auto-titrating continuous positive airway pressure (APAP) versus conventional continuous positive airway pressure (CPAP) in reducing the apnea-hypopnea index (AHI), reducing the mean airway pressure, improving subjective sleepiness, and improving treatment adherence in patients with obstructive sleep apnea (OSA).

Design: Meta-analysis and metaregression of published randomized trials comparing APAP to CPAP.

Results: We identified 9 randomized trials studying a total of 282 patients. Compared to CPAP, there was no significant advantage of APAP in reducing AHI or sleepiness (pooled APAP-CPAP posttreatment AHI and Epworth Sleepiness Scale score = -0.20 events per hour, 95% confidence interval:[-0.74,0.35], and -0.56 [-1.4,0.3] respectively). The use of APAP reduced the mean applied pressure across the night by 2.2 cm water [1.9,2.5] compared to CPAP. Adherence with therapy was not substantially improved with APAP; pooled estimate of improvement was 0.20 hours per night ([-0.16,0.57], P = .28) using a random-effects model.

Automatic pressure titration with APAP is as effective as manual titration with CPAP in patients with obstructive sleep apnea

Background: The optimal approach to initiate positive-pressure therapy in patients with obstructive sleep apnea is still debated. Current options are autotitrating positive airway pressure (APAP) or manual titration with continuous positive airway pressure (CPAP). Procedures differ by parameters and by algorithms used for adapting pressure.

Objectives: To evaluate the efficacy of attended automatic titration in a randomized crossover study compared with manual titration over 2 nights where the sequence of the titration mode was changed. Therapy outcome was controlled after 6 weeks.

Methods: 21 sleep apnea patients were treated using manual CPAP versus automatic APAP titration. The mode used during the 2nd night was continued for 6 weeks. Cardiorespiratory polysomnography, Epworth Sleepiness Scale (ESS), SF-36 score and compliance were assessed.

Results: Apnea-hypopnea index reduction was equally effective at similar effective pressure independent of the titration mode. If APAP was applied during the 1st night, total sleep time was longer (384 vs. 331 min, p < 0.01) and sleep efficacy was higher (91 vs. 81%, p < 0.01) than after starting with manual titration with CPAP. Compliance was comparable in both groups (4.6 +/- 1.9 h). The ESS improved in both groups (from 12.9 to 6.5). SF-36 scores and therapeutic pressure did not much change.

Conclusions: Taking the sequence of titration into account, we found equal effectiveness of CPAP and APAP. Sleep quality was better with initial application of APAP - which favors attended automatic titration if only 1 titration night is possible. Both modes are comparable after 6 weeks regarding therapeutic pressure, efficacy, compliance and quality of life.

My personal opinion (started with S8 CPAP in 2008 and switched to S10 AutoSet in 2016.) I like the flexibility of being able to use CPAP or APAP and the APAP's continuing changes when I gain or lose weight. While I can use CPAP at the 95% pressure level, I find I am more comfortable with APAP. Both machines were data-capable -- but I find less variance in my APAP day-to-day trendline.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#7
RE: In what case CPAP is better then APAP?
(07-14-2021, 02:22 AM)multicast Wrote: CPAP may also reduce TECSAS.

I had to look that up.  Back in 2010 when I had my sleep study it was called “Complex” sleep apnea.  The tech thought I might need to come back because I had lots of central apneas.  CPAP can cause TECSAs initially (just read this in a 2020 study), but research shows that such TECSAs can resolve itself over time.  

Insurance said first I had to fail CPAP before being evaluated for “complex” sleep apnea (TECSA), but over a few months I was doing pretty well with CPAP (thanks to finding online forums).  TECSAs did resolve with me over time (after 5 months no nights with high proportion of central apneas, and very few such nights after the first weeks), but I might have been put on BiPAP S/T if it hadn’t.

I’m one of those folks well treated by straight CPAP (<1 AHI if I’m paying attention and taping my mouth), not even pressure relief, and changes of pressure can be disturbing to me.  I’d wake up when the machine did pressure pulses during apneas at first.  Also, my machines have a temporary “AutoIQ” test mode and I’ve noticed PRS1 does spikes of pressure to test the airway when in Auto mode.  I did not like that at all.  So CPAP is better for my sleep quality (at least on Respironics machines).

I’ve considered that ResMed’s “soft” auto mode, or “for her” might not bother me, so I may explore that in the future (when the whole foam issue stops causing shortages and the 11 comes out).

-SleepyCPAP
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#8
RE: In what case CPAP is better then APAP?
Thank you all!
This is something I was looking for.

I’m on Apap for only 90 days now.
And finally I may have found good min pressure for myself. With 8.5 for last few days my Hypopnea is gone.
Obstructive is consistent and I try to find good position to get rid of it.

What bothers me though is CA which is getting higher and shows more frequently than on lower pressures.

So I was thinking if EPR/Flex function or APAP itself may induce CA events.
With CA gone, my AHI would be close to 0 (down from 38 during test!) which would be awesome. But in the same time I think I could have sleep of overall better quality. Somehow I suspect that pressure changes are not so good for me, and I try to find some research based explanation before I try to experiment with setting myself.
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#9
RE: In what case CPAP is better then APAP?
(07-14-2021, 08:16 AM)koala1 Wrote: So I was thinking if EPR/Flex function or APAP itself may induce CA events.
With CA gone, my AHI would be close to 0 (down from 38 during test!) which would be awesome. But in the same time I think I could have sleep of overall better quality. Somehow I suspect that pressure changes are not so good for me, and I try to find some research based explanation before I try to experiment with setting myself.

Here is a study, though just about Central’s emerging from CPAP (no differentiation to APAP)
Treatment-emergent central sleep apnea: a unique sleep-disordered breathing”
https://pubmed.ncbi.nlm.nih.gov/33009018/

There is a full-text version (with PDF available) and links to similar articles, good luck with your research!

Edited to add: You may be far along enough in your treatment to warrant a follow-up with the Sleep Doctor and referral to another sleep study to see if Bi-level or ASV would be advised for you.
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#10
RE: In what case CPAP is better then APAP?
koala1 - I, for one, seem to do better with a static pressure.  I seem to be overly sensitive to a change in pressure.  Any slight change in pressure causes self-aware arousals.  I have tried several times using a variable pressure range, only to have very disrupted sleep.  These attempts were not just a few days in length, but were attempted several months at a time, hoping my body would "give in" to variable pressure usage.  Reading here all the great things about APAP and how everybody else seems to flourish using this mode was very disappointing, to say the least.  During these trials, my AHI was low, but I would wake up feeling like 9 miles (14.5 km) of bad road and could recall most of the events that I was awoken.  For the last 352 days, I've been on a static pressure with an AHI of .36 for the period and not feeling tired.   Of course, I still have some bad days, but they only come every few weeks or months.

- Red
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
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