And finally I want to respond to this:
Quote: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.
In the 3.75 years I have been PAPing I have used straight CPAP, APAP wide open, APAP in a tight range, fixed BiPAP, BiPAP essentially wide open, and BiPAP in a (ridiculously) tight range. I've used each of these modes for at least 2 weeks, and except for the "wide open modes), I've used them all for at least a month or more.
In terms of treating my OSA, my best objective
results in terms of AHI, snoring, and flow limitation data recorded by my PAP machine night after night in my own bed has been when I used straight CPAP and straight BiPAP at pressures identified on my in lab titration studies. On straight pressure settings, my AHI was almost always below 1.5 and usually below 1.0 with little or no snoring and little or no flow limitations. Whereas on APAP and BiPAP Auto, my AHI bounces around much more frequently and it usually runs between 1.0 and 2.5. And there's more snoring and more flow limitations.
The reason my AHI data and my snoring data is marginally worse in APAP and BiPAP Auto is this: When running in Auto, the machine must wait
for events to occur before bumping up the pressure just a bit to resolve my SDB once my airway starts to collapse. When running in fixed pressure mode, the pressure is always
high enough to do a great job of controlling the SDB and so I have fewer events overall.
And if I could manage to fall asleep, stay asleep, and NOT get aerophagia when using my titrated BiPAP settings of 8/6
, I'd switch back to straight BiPAP at 8/6.
But an extremely important part of making any kind of PAP therapy work is figuring out a way of falling asleep comfortably with the mask and being able to sleep all night with a minimum number of wakes/arousals. And (unfortunately) for me, I can't do that when using fixed pressures of 8/6, which is enough to control my OSA: When I use my titrated pressures all night long, I have severe aerophagia (as in I wake up with my stomach rock hard and in so much pain that it is difficult to move) and I have a great deal of difficulty falling asleep because when I'm awake and the pressure is at 8/6 I can feel the air being blown down my airway and it is uncomfortable enough to cause problems with getting to sleep.
And so, in order to be able to get to sleep and NOT experience severe aerophagia night after night, I use Auto mode in consultation with my sleep doctor. And the kicker is, I still wake up more than I should on Auto, and a lot of the time it's because the machine has increased the pressure and the pressure is starting to trigger some aerophagia. But overall, I'm getting better quality sleep on BiPAP Auto than I did on BiPAP, but it's still not great sleep on most nights.
Hubby on the other hand is about 1 1/2 months into CPAP therapy. He's using a PR System One Auto running in CPAP mode with a pressure of 8cm. He has no comfort problems at night AND he's sleeping well AND he's waking up feeling refreshed and rested AND he's already feeling much better on PAP than he's felt in several years AND his leak line is great AND his AHI is typically lower than mine---it's usually below 1.5 and often below 1.0.
So why is there any need for for hubby to switch to APAP mode just because his machine has it? As I see it, the APAP mode is there if he ever runs into problems. But for now? Why run the risk of messing up his high quality sleep by introducing changing pressures?
To conclude: I'm not saying all people with ordinary OSA would do better on CPAP than on APAP. And I'm not even saying most people will do better on CPAP. I am saying that some people will do better on CPAP and that if a person starts out on straight CPAP and does fine with it, there's no real point in switching to APAP. But at the same time, I also think that if a person doesn't do well on straight CPAP, then it's well worth exploring whether s/he will do better on APAP than s/he's done on CPAP.