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apap vs cpap [merged with 'CPAP vs Autoset']
#1
Cool 
I was told by my doctor’s office that cpap auto will not work for me because I need to loose weight. They recommended that I use regular cpap I search the I-net but was unable to find any supporting opinion . So I decided to try the cpap auto. Any comments out there.
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#2
I have a Resmed S9 autoset machine on loan right now. It's set on CPAP. Is there any advantage to changing it to autoset? I've been having problems with my AHI being all over the place lately. I get my own machine on Monday and I've been told I probably don't qualify for an autoset so I wondered if trying it is any benefit and might it help my AHI problem. I'm ranging from 1.6 to 7.8 and points in between for the past week or so. I'm in my 4th month on CPAP. My pressure was lowered last month from 9 to 8 due to aerophagia.
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#3
By cpap auto, do you mean specifying a minimum pressure and a maximum pressure? That is what I feel is probably most useful. To begin with, you need a starting point pressure from your sleep lab or the doc. For instance, say it's 7. Then my idea of a good time is to set an automatic machine to a minimum of 7, and perhaps a max 11. Download the Sleepyhead software from this site, and learn to review your data as you go through the process.

This requires a fully data capable automatic machine such as the Resmed S9 Autoset. You can ask your doc to specify that specific machine, or a comparable brand on a prescription for you, which you can then use to acquire the machine. If you don't have any particular vendor you wish to use for this, you can find a list of vendors on this site that we feel are great to work with.

Then there's the mask. You mention the pilero. I don't know that mask but I do know some around here have been pleased with it.

But to begin with, you need to establish your pressure range. Did the doc suggest something?

When I got my machine, they set it to a minimum of 4 (the smallest available) and a max of 20 (the highest available) and figured the machine would work it out from there. That's sort of true, but I'm not convinced that's the best way. Sometimes things get a little goofy in the night and the machine can decide it needs to do something strange, like fill you up like a balloon and see if you pop. So I early on tried to establish my "sweet spot," and continue to monitor it as my weight and other conditions change.
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#4
Terry & Sandra, I merged your two threads because you're both asking very similar questions regarding the effectiveness of Auto-CPAP vs. one-pressure CPAP.

Thanks.
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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#5
Hi terry786,
WELCOME! to the forum.!
Hang in there for more suggestions and best of luck to you as you start your CPAP therapy.
trish6hundred
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#6
(05-09-2014, 03:26 PM)Sandra_ON Wrote: I'm ranging from 1.6 to 7.8 and points in between for the past week or so. I'm in my 4th month on CPAP. My pressure was lowered last month from 9 to 8 due to aerophagia.

It kind of sounds like you may be doing a little dance between having your pressure high enough to keep the AHI low, and low enough to control the aerophagia.

You might be benefited by using the EPR settings on your resmed. I am not an expert on that feature so I would like you to discuss this with others that are. However I did turn it on my machine just so I could see what it is all about. The idea is that it becomes easier to exhale with this feature because the pressure lowers when you are exhaling. What I noticed in my case was that "full" feeling you get in your tummy sometimes... aerophagia, was or seemed to be eliminated.

So, if your pressure to control your ahi is say 9, then by setting the epr to 2 the machine would give you a 7 for exhaling and a 9 for inhaling. At least that's how I understand it. But as I said, I am not really an expert on this feature so I recommend you wait and research it much more thoroughly with those that are.
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#7
From a DME point of view, Auto CPAP is more expensive than CPAP and really only needed by a minority of patients. Is it nicer to have all the bells and whistles....yes. It is really needed to have all the bells and whistles....no.



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#8
(05-09-2014, 03:16 PM)terry786 Wrote: I was told by my doctor’s office that cpap auto will not work for me because I need to loose weight.

Actually, I would think that the reverse is true. If you're in the process of loosing weight, I would think you'd want an Auto-CPAP (APAP) so that your machine could auto-adjust to your changing pressure needs as you loose weight. Not sure I follow the line of reasoning that says APAP won't work for someone who's overweight. If that were the case, APAP wouldn't work for me, because I sure ain't skinny. BigwinkToo-funny

(05-09-2014, 03:26 PM)Sandra_ON Wrote: I have a Resmed S9 autoset machine on loan right now. It's set on CPAP. Is there any advantage to changing it to autoset?

If you have obstructive sleep apnea, all else being equal, you'd probably be able to lower your AHI if you switch to a properly set-up, data-capable APAP machine. Of course, you'd have to monitor your progress and adjust settings appropriately to minimize your AHI, but I personally think an APAP will help you do that much better than a one-pressure CPAP machine.

Of course, that's not medical advice, and I always recommend patients touch base with their sleep doctor before making any pressure changes. That's simply common sense. That said, unfortunately, some doctors are biased against APAP machines and have no good logical reason for that bias. Sometimes they are making a judgement based on decades-old data concerning APAP machine, and don't take into account that data-capable APAP machines have improved dramatically in the past 10 years.

We've had a bit of discussion on CPAP vs. APAP here on Apnea Board in the past. It's always an issue that brings out everyone's opinions, so I'm sure you'll get other opinions here as well.

I personally think most OSA patients will have greater effectiveness of treatment if they use logic, common sense and educate themselves as to how to properly set up an auto-CPAP machine to help lower overall AHI. I even believe this to be true for first-time CPAP patients who decide to take the time to learn about these machines and how they work.

There's also free software for your personal computer to help monitor your treatment as well, assuming you have one of the more common data-capable machines that was manufactured sometime within the past few years. Click HERE to go to our Private Files & Links area, which has instructions on how to obtain the free software for various types of machines.

As for my opinion on APAP vs. CPAP, I'll re-post my reply that I gave in other thread, here:

(05-09-2014, 11:26 AM)SuperSleeper Wrote: Okay, I'm going to jump in here just one time.

While I understand the desire to advise brand-new CPAP patients to live with their prescribed pressure for a time period before considering pressure changes, I have to say that I tend to agree with retired_guy that sleep doctors, RTs or technicians should not be averse to starting off brand new patients on Auto-CPAP (APAP) set to operate within a small range of pressures.

Some of the points retired_guy alluded to I tend to agree with, such as:

1.
Ask for an APAP, because (for most patients) they generally deliver better therapy within a set range of pressures. After all, that's why we all like APAPs over CPAP around here, and APAPs can be operated in CPAP mode if need be. He even states this in his first post: "So it becomes why not have the more capable machine?" I agree with him here.

2. He states "In my case a pressure of 6 would leave me feeling like I was suffocating all night." He didn't say that the OP would automatically feel the same way. In fact in another post, he said, "Straight 6 might be great for some, such as you and the OP perhaps."

3. He then states his opinion that "Setting a machine on 6 and sending you home doesn't sound like a very good idea to me.". I sort of agree with him here. I personally believe that with today's APAP algorithms, it's perfectly safe to set a small range of pressures so that the machine can adjust pressure to lower AHI throughout the night according to the patient's changing needs. Gone are the days when poorly programmed APAPs would have "run-away pressure". That just doesn't happen with modern APAPs now, unless they're defective. So i don't think it's an unreasonable suggestion that if a lab-titration pressure is 6 cmH2O, the technician could safely give the patient an APAP set to 6-10. If the patient doesn't need the higher pressures, the machine will not deliver the higher pressures.

4. He's also right that lab titrations are (at best) an approximation of the most effective single pressure that will prevent most apnea events. I believe that a set pressure via an in-lab titration can be a good starting point, but that one set pressure assumes that everything will be the same in the patient's home-- the same as far as the surroundings and distractions, the same as far as the patient's physical condition from day-to-day, the same as far as what they ate that day, what drugs they took and a number of other factors.

This unproven faith that one single pressure is best for most new patients makes a LOT of assumptions. That's the whole reason behind giving a patient an Auto-CPAP machine - to allow for and adjust to a patient's changing needs during the night and also from day to day as conditions change. So, why do we deny that to a patient, refusing to give them anything but a single-pressure CPAP simply because they are brand new to all this?

retired_guy was not suggesting that the OP change or completely ignore the prescribed pressure. (as in changing the pressure from 6, up to 8 or 10)... Rather, he was suggesting that the technician might have better served the patient by A) prescribing an Auto-CPAP machine, which has a lot more benefits and options, either in CPAP or APAP mode, and/or B) Properly set-up an Auto-CPAP machine which for most patients is likely deliver more effective therapy than single-pressure CPAP (even for brand new OSA patients).

As always, just my opinion, but I personally believe that all obstructive sleep apnea patients should be given an APAP machine unless there is a clear and compelling medical reason not to do so. APAPs offer so much more as far as options of treatment. It just makes sense. And also, no matter what, I think that all prescribed machines should be fully data-capable so patients and doctors can monitor the ongoing effectiveness of treatment and use that data to make small adjustments as needed.

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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#9
(05-09-2014, 03:26 PM)Sandra_ON Wrote: I have a Resmed S9 autoset machine on loan right now. It's set on CPAP.


So you've been using it for 4 months, it was originally set at 9 and a month ago they lowered it to 8 to help with aerophagia? Did it help? Do you have EPR set at its maximum of 3?
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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#10
(05-09-2014, 03:50 PM)jaycee Wrote: From a DME point of view, Auto CPAP is more expensive than CPAP and really only needed by a minority of patients. Is it nicer to have all the bells and whistles....yes. It is really needed to have all the bells and whistles....no.

Really the difference between a standard, one-pressure CPAP and an Auto-CPAP is much more than simply "bells & whistles". There are very substantial differences between the two, and all else being equal, a properly adjusted APAP is going to be more effective than a one-pressure-fits-all-circumstances CPAP machine (for the vast majority of OSA patients).

I'm firmly convinced that those who are newly diagnosed with OSA need to read this post before they accept a low-end CPAP from a equipment supplier.

The reason most Durable Medical Equipment suppliers (DMEs) try to force the patient to accept what we call a "dumb brick" (a CPAP that isn't data-capable) or a standard CPAP over an Auto-CPAP is because the DME makes more money that way. The insurance codes for APAP are the exact same as the insurance codes for CPAP. There's no difference as far as what an insurance company or Medicare will pay out - they reimburse the DME the exact same amount of money for APAPs as they do for CPAPs.

Generally speaking, here in the U.S., insurance or Medicare will reimburse a DME roughly $1500 for a CPAP dispensed to a patient. They reimburse the DME that same $1500 for an APAP as they do for a CPAP - no difference in payout... Same insurance code, same reimbursement amount. But the DME loves to get you to accept a cheap dumb brick (straight non-data capable CPAP, or even a non-Auto machine), because they get to pocket the difference in cost. (more profit for the DME).

Don't let DMEs fool you. As one example: If they offer you a S9 Escape with humidifier, for instance, which cost the DME $650, they make a gross profit of $850 ($1500 - 650). If they let you have an S9 AutoSet with humidifier, for instance, which cost the DME $800, they make a gross profit of only $700 ($1500 - 800).

Most brick-and-mortar DMEs rely heavily upon insurance and Medicare reimbursement in their business model. Unlike online suppliers who tend to get paid directly from patients, brick-and-mortar suppliers have a vested financial interest in trying to convince you that you should only use a cheap CPAP, or they lie and tell you that you're not allowed to have an APAP or that insurance won't cover it. When they start telling you that, STAND YOUR GROUND and insist upon a fully data-capable CPAP at the very least or better yet, a data-capable Auto-CPAP (which can be used in standard one-pressure CPAP mode if necessary or switched to APAP mode in the future should that be what you decide to do).

Take your time before you accept any CPAP machine from a DME... remember: once you sign off on and accept the DME's "dumb brick", generally you're out of luck - and most insurance companies (and Medicare) will replace CPAP machines only once every 5 years. So, if you don't want to be stuck for 5 years with something you'll regret later, stand your ground now while you still have leverage over a deceptive DME.

There is only one reason why a knowledgeable DME would try to get you to accept a lower-end machine: THE LOVE OF MONEY.

Don't let them bamboozle you. Insurance does not care whether the $1500 they dole out to the DME is used to purchase a non-data capable CPAP, a data-capable CPAP or an Auto-CPAP (APAP). There is no difference as far as what the insurance company pays out. The ONLY difference is that the greedy DME gets more money if you allow yourself to be bamboozled by their baloney, or they try to get you to contribute more money in order to get an APAP. If they do that, and don't change their mind when you tell them you know how "the system" works, I'd run away from that DME as fast as I could.

One of our members here (Archangle) has in his signature line, "If it's midnight and a DME tells you it's dark outside, go and check for yourself." I can't stress enough the truth in that statement for most DMEs.

Archangle also has a great article on our Wiki regarding machine choices. You can read it here:

http://www.apneaboard.com/wiki/index.php...ne_Choices

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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