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
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.
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.