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apap vs cpap [merged with 'CPAP vs Autoset']
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SnuffySleeper Offline

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Post: #31
RE: apap vs cpap [merged with 'CPAP vs Autoset']
Saying because the studies are 4 years old they are not valid is stretching. Here is one from February 2014 talking about the problem.

http://www.hindawi.com/journals/sd/2014/798487/

Sleep Labs and doctors know of this it's a common occurrence that is why you have titration studies.

It's why doctors don't just prescribe Apap to everyone and set the min/max settings to whatever. Thinking that Apap is a cure for this is really dangerous. That algorithm you think is the miracle cure for every apnea event is not, it's only as good as the variables it processes.

Putting people on Apap with pressure induced CA's is dangerous.

I think you guys should stick to giving your experiences and helping people new to Cpap therapy that are adjusting and not try to be doctors. You may mean well but you could hurt people and not even know as they wouldn't post here again or you would never know if your advice was bad because rarely do people follow up on online forums.

Anyways, ok enough from me. As someone who was just diagnosed and suffers from pressure induced CA's I don't like it when people say "it goes away over time" or an Apap would cure it because it has a algorithm, it's frustrating to read that.
(This post was last modified: 05-10-2014 11:14 AM by SnuffySleeper.)
05-10-2014 11:11 AM
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Post: #32
RE: apap vs cpap [merged with 'CPAP vs Autoset']
It's ok Snuffy. Everyone just wants you to have the very best outcome for all your issues. It just seems like there has to be a sweet spot for you where your oa's and your ca's are nicely contained. Like all things in life there is always more than one way to skin the cat. In your case working with a limited/fixed pressure machine might be just the right thing to do. I would only hope, and I believe you agree, that to be effective you will want to be watched closely by your medical team.

Stay open to ideas, and don't be afraid to discuss any option with your doc that might make things better. Mostly, stay cool Snuffy. We love ya'.
05-10-2014 11:24 AM
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robysue Online
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Post: #33
RE: apap vs cpap [merged with 'CPAP vs Autoset']
(05-10-2014 11:11 AM)SnuffySleeper Wrote:  Saying because the studies are 4 years old they are not valid is stretching. Here is one from February 2014 talking about the problem.

http://www.hindawi.com/journals/sd/2014/798487/

Sleep Labs and doctors know of this it's a common occurrence that is why you have titration studies.
I agree with you Snuffy. Pressure induced centrals (that may or may not go away with time) are a problem in at least 10-15% of the PAPing population. And while it's reasonable to hope that centrals that are being scored by a PAP machine during the first few weeks of use might just be sleep/wake/junk breathing patterns that are misscored as centrals that will disappear as the new PAPer learns how to sleep soundly with the machine, there's always a chance that they're the real thing. And we need to keep that in mind when helping newbies who are seeing significant numbers of centrals being scored by their S9 or System one.

And certainly someone who is still seeing lots of centrals after a few weeks on PAP should contact their sleep doctor and report the problem.

Quote:It's why doctors don't just prescribe Apap to everyone and set the min/max settings to whatever. Thinking that Apap is a cure for this is really dangerous. That algorithm you think is the miracle cure for every apnea event is not, it's only as good as the variables it processes.
Personally I think there are a lot of reasons why docs don't prescribe APAPs. One is a general distrust of the equipment, and in some cases the data from all machines that record efficacy data. Another is the very real fact that allowing the APAP to increase pressure as high as it thinks the pressure needs to go can create a whole range of issues. Most of the issues are of less medical importance than the possibility of causing the patient to develop CompSA, but they remain serious issues for establishing full compliance to therapy during the critical first three months or so of therapy.

With higher pressures come the risks of severe aerophagia; serious leak problems and more of a tendency to mouth breath; more problems with air being blown into the eyes through the tear ducts; more problems with keeping the nasal passages and oral cavity sufficiently moist; and, of course, more of a chance that a person who is susceptible to developing CompSA will have problems with pressure-induced centrals that do not go away with time.

Add to that the fact that some people are sensitive to the pressure changes that an APAP makes: They'll wake up simply because the machine has been increasing the pressure due to minor flow limitations simply because the pressure gradient wakes them up.

To put it simply: Starting out with a fixed pressure setting takes one variable out of the process for getting used to this crazy therapy. And if you're lucky enough to have a quality titration study (and some people ARE that lucky) AND you have no trouble tolerating the titrated pressure, there really is no particularly good reason to prefer APAP to CPAP.

Where APAP comes into play is in dealing with less than good titrations or when the patient has trouble tolerating the titrated pressure. It allows the patient and the doc to get additional data on what the real pressure needs are AND it allows a way of letting some people run at lower than titrated pressures which are somehow more "tolerable" for a good bit of the night without compromising overall therapy.

I'm a good example of that last situation: My titrated pressure needs are roughly straight CPAP = 8 (or even 9) or BiPAP at 8/6. I know those are ridiculously low pressures for many of you, but sleeping at 8/6 all night long induces painful aerophagia in me. Using a BiPAP in a tight auto range, my stomach is not subjected to the aerophagia pressure which increases my overall comfort (and daytime functioning) and yet, when I need 8/6 for the OSA, the machine adjusts the pressure upward fast enough to keep the OSA in control.

Hubby on the other hand is running in straight CPAP mode at 8 cm with C-Flex+ set to 2. He has no trouble sleeping through the night and has no problems with aerophagia at his titrated pressure. And I wish my AHI were as good as his is. Right now I see no reason at all to suggest to hubby that he switch his APAP from CPAP mode to APAP mode: If it's not broke, don't fix it.

I think you guys should stick to giving your experiences and helping people new to Cpap therapy that are adjusting and not try to be doctors. You may mean well but you could hurt people and not even know as they wouldn't post here again or you would never know if your advice was bad because rarely do people follow up on online forums.

Quote:Putting people on Apap with pressure induced CA's is dangerous.

Anyways, ok enough from me. As someone who was just diagnosed and suffers from pressure induced CA's I don't like it when people say "it goes away over time" or an Apap would cure it because it has a algorithm, it's frustrating to read that.
I agree 100% with what you're saying: Suggesting to someone who's having documented problems with pressure induced centrals or CompSA that all they need to do is switch to APAP is naive at best and potentially harmful at worse.

When it's clear that pressure induced centrals may be a problem, the best advice is to tell the person they need to see their doc for a potentially long chat about whether the centrals are actually real or not and if they're real, what the best way of tackling them is.

And if an APAP is actually suggested by the doc, then my guess is that the doc will have the good sense to list a max pressure setting that is low enough to try to minimize the number of pressure induced centrals.
05-10-2014 01:40 PM
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Sleepster Offline
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Post: #34
RE: apap vs cpap [merged with 'CPAP vs Autoset']
(05-10-2014 10:04 AM)SnuffySleeper Wrote:  It's dangerous to think that, as you are telling people to keep doing something that is hurting them because they will "get use to it". With complex apnea it doesn't work like that.

I agree that complex apnea doesn't work that way.

I was talking about CPAP-induced central apnea. In these patients there may be no sign of central apnea or complex (also called mixed) apnea when there's no CPAP machine in use.

In other words, the diagnosis could be pure obstructive sleep apnea.

Then, when a CPAP machine is used the central apnea index rises. But as time goes by it tends to return back to what it was before CPAP therapy was started.

I do not recommend that nothing be done about it. It should be discussed with your doctor, and the treatment is usually to lower the pressure. On the other hand, often the treatment of central or mixed apnea is to use a more advanced type of CPAP machine called a ASV. As with all CPAP machines, significant advances have been made in recent years.

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05-10-2014 04:52 PM
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zonk Offline

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Post: #35
RE: apap vs cpap [merged with 'CPAP vs Autoset']
(05-09-2014 07:19 PM)SnuffySleeper Wrote:  I just recently learned that any pressure above 10 after two sleep studies induces central apneas for me.
What was the doc recommendation?
If obstructive apnea is well managed than you don,t need above 10 or going to a different kind of machine
In US, CPAP have to be tried and failed before BIPAP or ASV prescribed
05-10-2014 04:57 PM
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SuperSleeper Offline

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Post: #36
RE: apap vs cpap [merged with 'CPAP vs Autoset']
Again, this thread is about obstructive sleep apnea and whether or not APAP is preferred over CPAP with for most patients with OSA. The thread isn't about central or complex sleep apnea. Not sure what you all don't get about that, nor do I understand why you keep using arguments and studies that focus around patients who have complex or central sleep apnea events, when that's not what the thread is about. Patients diagnosed with complex or central sleep apnea or who clearly have centrals when pressures are increased to a certain level, should not be using APAP or at least APAP that initially is set above the point at which an unacceptable level of centrals are induced... I AGREE WITH THAT. But we're talking about the majority of OSA patients in this thread who do not have CSA or complex SA, not the smaller number of people with CSA or complex sleep apnea.

Quote:And if you're lucky enough to have a quality titration study (and some people ARE that lucky) AND you have no trouble tolerating the titrated pressure, there really is no particularly good reason to prefer APAP to CPAP.

Really? "No good reason for someone to prefer APAP to CPAP"? Seriously? That seems like a pretty radical conclusion to put out there. APAP is not simply used because someone has "trouble tolerating the titrated pressure".

APAP responds on an ongoing basis and adjusts accordingly to nightly events and also responds to changes with the patient, such as weight loss, physical condition, drug use, foods ate and a host of other changing variables that a one-pressure-all-the-time CPAP cannot ever do.

It's like there's this unbelievable trust and faith in a titration study - I just don't understand that. Unless you're having a titration study every week, how to you expect the titrated pressure to adapt to the patient's needs every day or even during the night? It can't, because it's a one-time study to determine a single pressure that helps to eliminate most of the events that occurred in that one single overnight stay. Lab-titrated patients are in an unfamiliar, uncomfortable setting - they're already nervous and have tons of wires attached to them, all the while knowing that someone is watching them sleep the entire night and that they're likely being videotaped. But those type of sleeping conditions are your "gold standard" for making a statement that there "is no particularly good reason to prefer APAP to CPAP?"

I think you have too much faith in lab technicians and their titration studies, IMHO.

And before you all respond yet again with examples of people with Central Sleep Apnea or Complex Sleep Apnea, let me remind you again that we're talking about whether APAP is better than CPAP for most folks who have obstructive sleep apnea. So far, no one has given solid evidence that most OSA patients are better off with single-pressure CPAP. The evidence weighs on the side of APAP over CPAP for the majority of OSA patients, hands-down.

Quote:I think you guys should stick to giving your experiences and helping people new to Cpap therapy that are adjusting and not try to be doctors. You may mean well but you could hurt people and not even know as they wouldn't post here again or you would never know if your advice was bad because rarely do people follow up on online forums.

With all due respect, you're doing the exact same thing by recommending to new OSA patients that they go with single-pressure CPAP over APAP. You mean well too, but you could hurt people and not even know as they wouldn't post here again or you would never know if your advice was bad because rarely do people follow up on online forums.

We always state here that this is all personal opinion and not medical advice. The thing you have to realize is that many doctors are uninformed, biased and simply don't know what the benefits of APAP are over CPAP for most OSA patients. That's just the facts. Where in life is it ever wise to simply tell people to "trust the authorities, they know what they're doing"? NEVER.. you can take their advice into consideration, knowing that they probably know a heck of a lot more about OSA treatment that you do. But they don't know everything about OSA treatment - especially if they're the types that have hugely inflated egos, as we have heard of here on Apnea Board often. And most sleep doctors have very little follow-up with newly diagnosed patients.. it's just "here's the CPAP, now wear it every night". The vast majority of sleep doctors NEVER adequately communicate on an ongoing basis with their newly-diagnosed patients, or look at the patient's data, unless it's to satisfy an insurance requirement on compliance, or the patient complains of a problem. They just hand them over to the DME, who has even less sincere desire to help the patient unless it can generate income somehow.

We've never told patients to have blind obedience to a medical professional and simply ignore common sense and logic. We're about patient empowerment, and that concept has empowered many of the members here to take a more active role in their own treatment and not blindly accept what a doctor, sleep technician or DME tells them. Doctors are quite often wrong. DMEs are quite often wrong. I'm also often wrong. But because people have faults is no reason for a patient to blindly follow someone with a degree up on the wall and discount their own logic and common sense. Nor is it a a good reason for folks to discount their own ability to seek out knowledge and educate themselves.

As always, just my opinion. Do not consider my post in any way to be medical advice.

Coffee

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05-10-2014 06:51 PM
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retired_guy Offline

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Post: #37
RE: CPAP vs Autoset
(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. 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.

(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? 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.

I thought I'd just refresh all of our memories as to what the original OP's were concerned about.

In Terry786's case the question was should he use cpap instead of apap? His doc said he should not use apap because he needs to lose weight. That just seems counter intuitive to me (wow! I've wanted to say counter intuitive for ever!). My opinion is it is precisely because Terry's environmental and physical conditions will be changing with time is a very good reason why he should by using a narrowly banded apap range, and monitoring it frequently.

In Sandra's case she's using a loaner S9 Auto, and is expecting her machine to not be an Auto. She needs the information to ask for an auto based on the fact that when her pressure gets high enough to stop the apnea's, she gets into aerophagia issues. With the auto, she can take advantage of the EPR settings that might allow for better patient treatment.

Why would you not allow auto's in each of these cases?
05-10-2014 08:19 PM
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Post: #38
RE: apap vs cpap [merged with 'CPAP vs Autoset']
(05-10-2014 06:51 PM)SuperSleeper Wrote:  
robysue Wrote:And if you're lucky enough to have a quality titration study (and some people ARE that lucky) AND you have no trouble tolerating the titrated pressure, there really is no particularly good reason to prefer APAP to CPAP.

Really? "No good reason for someone to prefer APAP to CPAP"? Seriously? That seems like a pretty radical conclusion to put out there. APAP is not simply used because someone has "trouble tolerating the titrated pressure".

APAP responds on an ongoing basis and adjusts accordingly to nightly events and also responds to changes with the patient, such as weight loss, physical condition, drug use, foods ate and a host of other changing variables that a one-pressure-all-the-time CPAP cannot ever do.
SuperSleeper,

I think I may have used language that didn't quite say what I meant it to say clearly enough.

First, while many people do NOT have a good titration study, some do. And that was one of my assumptions: That the user is lucky enough to have a good titration study.

Second, a good titration study (by definition) does identify a pressure that is high enough to eliminate the OSA during REM supine sleep. And the patient can tolerate the titrated pressure. Fact is many of us don't have a good titration study, but some people do.

Third (and this where I think my writing was not precise enough), what I really meant to say is this:

If your straight CPAP pressure controls your OSA extremely well AND you are comfortable when using CPAP AND you are sleeping well on straight CPAP AND you are feeling well during the daytime, then there is no real good reason to switch to APAP just because someone else prefers APAP.

Sure, under these circumstances you can try APAP if you want to. But if straight CPAP is working well for you, you might just find that running in APAP doesn't actually make a good situation any better AND you may find that running in APAP makes things worse.

In other words, all I'm saying is that if straight CPAP works well---in terms of controlling the OSA AND in fully resolving your daytime symptoms---there's no need to "fix" CPAP by switching to APAP.
05-10-2014 08:56 PM
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Sleepster Offline
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Post: #39
RE: apap vs cpap [merged with 'CPAP vs Autoset']
The only caveat I have is that it's best that the user have their data monitored so that changes to the pressure settings can be made when necessary. This takes some knowledge and expertise.

This can be done using a good data-capable CPAP, or a BiPAP or APAP. People here can help with that process.

If your doctor doesn't seem to be on board with this, find another doctor, preferably a doctor certified in sleep medicine.

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05-10-2014 09:03 PM
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Post: #40
RE: apap vs cpap [merged with 'CPAP vs Autoset']
I'm starting to feel like I'm beating a dead horse, here. Bigwink Too-funny

(05-10-2014 08:56 PM)robysue Wrote:  Fact is many of us don't have a good titration study, but some people do.

I obviously agree. But one thing I think you'd probably agree to and that is that no matter how good a titration is, single-pressure CPAP cannot possibly respond by changing pressures to adapt effectively throughout the night to the needs of the patient - only an auto-CPAP can do that. One-pressure CPAP assumes that most variables will remain roughly the same as they were during the titration. That to me, is a huge assumption.

Quote:Third (and this where I think my writing was not precise enough), what I really meant to say is this:

If your straight CPAP pressure controls your OSA extremely well AND you are comfortable when using CPAP AND you are sleeping well on straight CPAP AND you are feeling well during the daytime, then there is no real good reason to switch to APAP just because someone else prefers APAP.

Obviously with all those conditions you listed in there, I would have to agree.

That said, this thread was started by two patients who have not yet accepted their final CPAP machine, and they were asking advice on whether to ask for APAP over CPAP. Obviously, as others have said throughout this thread, APAP should always be preferred over CPAP by brand new OSA patients (all else being equal), as APAPs have much more versatility, being able to operate in CPAP or APAP mode should the need arise. If the patient is on Medicare or has insurance here in the U.S. why in the world would they want to accept a lower-end CPAP machine when without additional cost, they could receive an APAP?

Quote:Sure, under these circumstances you can try APAP if you want to. But if straight CPAP is working well for you, you might just find that running in APAP doesn't actually make a good situation any better AND you may find that running in APAP makes things worse.

The two original posts in this thread were written by 1) a patient who had not even accepted any machine at all and therefore knows not whether "straight CPAP is working well" or not, and 2) another patient who has a loaner APAP that was set to CPAP mode, but found that running in CPAP mode was giving her erratic AHI numbers (from 1.6 to 7.8).

Neither patient has had complete success with one-pressure CPAP at all, and might indeed benefit from APAP - we just don't know at this point... Why should we try to place the thought into a brand new OSA patient's mind that one-pressure CPAPs are "just fine" and that by accepting an APAP, it might "make things worse" for them? In these two cases, why not issue both of them APAPs so that their options are greater in the future?

Quote:In other words, all I'm saying is that if straight CPAP works well---in terms of controlling the OSA AND in fully resolving your daytime symptoms---there's no need to "fix" CPAP by switching to APAP.

Agreed. But this advice doesn't even apply to the two OPs in this thread, since one hadn't gotten a machine yet and the other was having erratic AHI numbers while in CPAP mode.


(05-10-2014 09:03 PM)Sleepster Wrote:  The only caveat I have is that it's best that the user have their data monitored so that changes to the pressure settings can be made when necessary. This takes some knowledge and expertise.

Agreed 100%, no matter what kind of machine you have - it ought to be fully data-capable at a bare minimum.

Okay, I've blathered on in this thread long enough. Don't mind me, I get this way sometimes. Bigwink Too-funny

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05-10-2014 09:51 PM
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