Quote: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?
While our sleep does change from night to night, a good titration study does manage to identify a pressure that is sufficient to deal with the OSA when it is at is worst AND that is tolerable to the patient in terms of being able to sleep peacefully with the machine.
Now I will admit, many of us do NOT have good titration studies. (I've had a total of four titration studies and none of them were really good; but hubby's one titration study was a great titration study.) And so the titrated pressure from any titration study really is only a starting point for determining what the pressure needs actually are on a nightly basis.
And for people who do NOT have good titration studies and/or who cannot tolerate their titrated pressure APAP and BiPAP Auto come into play as very useful tools. If you need 9 cm to control your OSA when it's at its worst, but you just can't tolerate 9cm of pressure full time, then an autotitrating machine can allow you to sleep more comfortably and only deal with the need for having the pressure at 9cm when you absolutely need it.
But not everyone prefers APAP over CPAP. And there does seem to be a presumption on this board that APAP will solve problems that it may very well NOT solve.
In particular, patients with low pressure needs may prefer CPAP (See www.journalsleep.org/Articles/300208.pdf for one study that indicates people with pressure needs less than 8 cm may prefer CPAP to APAP.) It could simply be that at low pressures most people simply don't benefit as much from the reduction in overall pressure that is achieved by using APAP in terms of managing aerophagia or other problems. [And I say that as someone who USES low pressures and NEEDS an Auto adjusting machine just to tolerate therapy.]
People who are very light sleepers OR people who are very sensitive to sensory stimuli may find the constantly changing pressures more disturbing to their sleep when using APAP. And if the perceived additional sleep disruptions come with little or no perceived benefits? Then the light sleep or highly sensitive individual may very well do better on straight CPAP rather than APAP. [And I say that as someone who is highly sensitive to sensory stimuli and has frequent arousals when using my machine in Auto mode.]
And finally it's just as easy to get the settings on an APAP wrong as it is to get the settings on a CPAP wrong. There are a lot of people out there who believe that since the APAP is an autotitrating device that it can (even should) be left wide open with a pressure range of 4-20 cm. And then they wonder what the heck is wrong when their AHI is too high or they have significant problems with leaks because they fit the mask at 4-5 cm of pressure and their machine is regularly increasing the pressure up to 14cm or more.