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

[SnuffySleeper]

I just want to point out that apap is not for everyone. I just recently learned that any pressure above 10 after two sleep studies induces central apneas for me.

I know I am in the minority, but what I have read is that it is much more common than people think.

Seeing as a pressure of 6 or 7 makes me feel like I am not getting enough air, an apap would not do me much good as the only pressure I can do without it causing central apneas is 8 or 9.

I sometimes wonder if people here that feel that apap is not working have undiagnosed complex apnea, and when the auto pressure goes up it starts inducing more central apneas. Of course this would show up in sleepyhead.

[SuperSleeper]

Howdy Snuffy,

Obviously an APAP machine would even work for you if you used it in CPAP mode with a single prescribed pressure of 9. It would probably even work for you in Auto mode with a pressure range of 8-9 or even 8-10. At least set in that small of a range, it's likely to provide more proactive and responsive therapy than a single pressure all the time, and would still be low enough to prevent pressure-induced centrals.

There's really no compelling medical reason to manufacture machines that only offer one pressure all the time with no option to act in Auto mode... many believe the only major differences between most CPAPs and APAPs is in the digital firmware on the motherboard and perhaps a a slightly different set of pressure controls that amount to a few dollars extra cost to the manufacturer.... hardly enough to justify making a completely different set of machines with retail price points varying as much as $100+. Why not make them all APAPs? An APAP can do everything a CPAP can do, plus give patients the possibility for APAP mode if the need arises.

If patients start refusing to accept dumb bricks, or if they stop accepting CPAPs in deference to APAPs, the manufacturers will start making more APAPs in response to the market. Under the current Medicare and insurance reimbursement scheme, patients can be issued any type of CPAP (Auto or fixed pressure) under the same billing code. But the more we have patients willing to "go with the flow" and blindly accept whatever is given to them by a less-than-completely-honest DME, the less control over our own treatment we have, and the more money we end up spending in the long run, as eventually many informed CPAP owners end up spending their own money to get an APAP, which in the majority of OSA cases offers more effective treatment.

CPAP machines and their associated hardware, firmware and PC software programs have no way of judging true central events. They may "mark them" as centrals (or more appropriately "clear airway events") but since a true apnea event is a brain-triggered event, no consumer-level CPAP machine on the planet can honestly come to the conclusion that events that don't fit neatly into the obstructive category are by default, true central events.

And even if they are "pressure-induced centrals", we had that discussion before here and no one and no study has been able to provide unbiased and sound scientific evidence that pressure-induced centrals are significantly harmful in the overall scheme of things.

As always, just my opinion.

[Sleepster]

I just recently learned that any pressure above 10 after two sleep studies induces central apneas for me.

Hopefully that will subside with time so that if you need a pressure of 10 or higher to eliminate obstructive apneas and hypopneas you'll be able to do that.

I sometimes wonder if people here that feel that apap is not working have undiagnosed complex apnea, and when the auto pressure goes up it starts inducing more central apneas. Of course this would show up in sleepyhead.

This is one of the reasons it's so important to look beyond the AHI and see the components. Like you say, SleepyHead can do that. So can ResScan and Encore.

Many times it's not possible to answer the question as to whether fixed pressure or auto-pressure would be better without knowing those details.

[SnuffySleeper]

Well, insurance companies in America might treat cpap and apap the same, but not in Canada. Doctors are hesitant to prescribe them here, and have to follow strict guidelines when prescribing an apap In Ontario (which we went over in another thread).

I agree we should all get apaps but there is a price difference in Canada here it's almost 400 more.

Well in my book an apnea is an apnea, wether it's induced by muscle contraction or airway blockage or from o2 saturation from high cpap pressure telling your brain the body has too much oxygen, they are basically all dangerous. I think in my case I stopped breathing for a long time (I am waiting for my polysomnogram wavforms, but my report showed my ahi was 45.2 at a pressure of 14, which without cpap it was 48.9....not good. So the higher the pressure the higher my ahi.

Anyways, yes apaps would be nice for everyone, but there are doctors out there that still say cpap is better as by the time apap responds to events, they have already happened. Which does have a certain simple logic to it. But yeah, if resmed/Philips only made apap's that would make things easier, but I don't see that happening.

[zonk]

I just want to point out that apap is not for everyone. I just recently learned that any pressure above 10 after two sleep studies induces central apneas for me.

IMO ... No reason why APAP [to be precise, S9 AutoSet (not just any APAP)] is not for everyone

To assume the S9 AutoSet increase pressure at a whim is a fancy idea, the machine can distinguish between types of apneas and prevent apnea by monitoring snoring and flow limitation which typically precede obstructive apnea (not central apnea) and reduces arousals

Unlike early APAP machines, the S9 AutoSet treat obstructive apnea above 10 without inducing central apnea

Read more: http://www.s9morecomfort.com/s9morecomfo...toset.html
Central Sleep Apnea Detection and the Enhanced AutoSet Algorithm
http://www.resmed.com/au/assets/document...-paper.pdf

[retired_guy]

Snuffy, I wonder what would happen if you were to use a system where your exhale pressure was around 9, and your inhale around 12 max? What is being reported as "centrals" might be helped with the lower exhale while your obstructive might be helped with the higher inhale? I don't know for sure actually, but maybe it's something that could be explored with you doc.

[PaytonA]

I just want to point out that apap is not for everyone. I just recently learned that any pressure above 10 after two sleep studies induces central apneas for me.

I know I am in the minority, but what I have read is that it is much more common than people think.

Seeing as a pressure of 6 or 7 makes me feel like I am not getting enough air, an apap would not do me much good as the only pressure I can do without it causing central apneas is 8 or 9.

I sometimes wonder if people here that feel that apap is not working have undiagnosed complex apnea, and when the auto pressure goes up it starts inducing more central apneas. Of course this would show up in sleepyhead.

Snuffy,

I wonder if someone is misquoting Dr. Berthon-Jones of Resmed who has stated, "...the vast majority of obstructive apneas are already well controlled by 10 cm/H2O...".

The other thing that I will tell you is that I reduced , by using APAP, my pressure to 16-17 cm/H2O and my apneas (I presume them to be central since my machine's data does not differentiate) went up substantially. When I went back to my 20 cm/H2O Bipap setting the apneas almost disappeared. Again it is my opinion that these were central apneas because of what Dr. Berthon-Jones said and also because in auto mode my machine did not respond to the apneas at all. This is part of the programming in the case of centrals.

Best Regards,

PaytonA

[SnuffySleeper]

@zonk
Well having a cs degree myself I understand how the algorithm would theoretically work, but the weakness would be it uses a forced oscillation technique, (air resistance) so it can never know if you're awake, having real centrals or just clear airways events and so on as it only works off a limited variable. Even so, the event has to happen already for the machine to react, so it's never going to react as fast as constant pressure would to keep the airway open.

I would be more worried that insurance companies in America will start distinguishing between the two machines, seems to me that is an oversight that they might change if they notice they can save a buck or two. Then again they probably are the same machine with different firmware, so maybe insurance companies really do pay the same wholesale price so they just let it slide.

@retiredguy

I asked him about bi pap, he didn't really want to do it. But I should say, my ahi in sleepyhead is .8 to 1.8 a night so I think he feels as do I that 9 is treating my apnea as is, so no need to go that route, just yet. But it's a good suggestion!

@paytona

I hear ya. Everyone is different. From what I read, is that complex apneas are because the body is already getting toO much o2 and telling the brain to stop breathing. My theory is the better your body converts o2 to red blood cells the more susceptible you are to complex apnea, but that's just my opinion.

[retired_guy]

I would be more worried that insurance companies in America will start distinguishing between the two machines.......

That might happen. But basically Medicare is driving the bus down here, and they will pay the same fixed amount whether the doc prescribes a S9 auto, or bicycle pump with built in hamster.

[SnuffySleeper]

I would be more worried that insurance companies in America will start distinguishing between the two machines.......

That might happen. But basically Medicare is driving the bus down here, and they will pay the same fixed amount whether the doc prescribes a S9 auto, or bicycle pump with built in hamster.

Just curious, do you know how much Medicare pays (or gives the DME) for an autoset?