Do you like CPAP or APAP

[B1Sailor]

I would like opinions about the possible benefits of using CPAP versus APAP. A Sleep Therapist “TheLankyLeft” has posted videos that his opinion of the algorithms for APAP from all the manufacturers are bad.
 
Another YouTube CPAP therapist in Australia has a channel “CPAP Reviews”. He has a very good review of many machines and their proprietary APAP algorithms. Our most popular machines were not the winner in his comparison. If you call it a winner. 

As I use OSCAR to tune my therapy, I feel I am slowly going back to CPAP. I have been on CPAP for many years. A change of Doctor and I now have APAP with a wide range prescribed. It was partly due to the wide range that made me want to tune my therapy.

I believe comparing my therapies that my fixed CPAP did not cause as many leak problems. I am probably different than most since I was used to CPAP so the comfort benefits of APAP don’t outweigh the leak problems.

I would like to hear opinions and experiences of those on APAP and not the more complex therapies. A more simple comparison of just CPAP to APAP and opinions if you like APAP better.

I get a lot of nights with Time at pressure like my attachment. Thinking of changing my settings to CPAP fixed at 10.
   

[Bluesv6]

Personally I'd look at your median pressure and set close to that.  I've watched cpap reviews and one video he had instructed to set to 95 percent pressure. You'd induce some apneas but the pressure would be more consistent.

I did that and my pressures went to the max pressure and I felt like crap .

I feel apap is good once you have your machine set up.  If you have a wide range of pressures and EPR not properly set it sucks.

I feel I would proably have less sleep disturbances . But would induce some apneas , loss off epr and loss of some therapy .

So apap is my choice and feel cpap constant pressure is old school of thought.  I do feel comsat pressure might be a good fit for some users.

If you're interested in doing it, I would first dial in your apap machine .

Then take some screenshots do some runs. Then try cpap out and take some screenshots and compare

[Phaleronic]

I've used this board to self-titrate initially on a DS1 APAP, then a DS1 auto-Bipap, then a Resmed S10 APAP, and finally I tried CPAP mode (on the auto bipap) with C-Flex + at 2, and 14.5cm, it's been the most efficacious AND comfortable treatment mode I've found in the last 5 years, I won't be moving off of it anytime soon.

[OpalRose]

There is no right or wrong answer, as it depends on the person and what they are experiencing.

Cpap mode can be advantageous for someone who is bothered by pressure swings when using Apap mode. Or the person who suffers from Aerophagia (the swallowing of air).

To determine what pressure to use in Cpap mode, look at the Median pressure when using Auto mode. Set it at that pressure to start.

[Dog Slobber]

Almost always, when I see APAP algorithms criticized, they are criticizing a misconfigured device.

If I was comparing my properly configured APAP (8-12), against a misconfigured fixed pressure CPAP of 4cm, would that properly represent CPAP treatment?

No, it wouldn't.

So why can do we accept conclusions of poor APAP algorithms, when they are misconfigured at 4-20?

[OpalRose]

So why can do we accept conclusions of poor APAP algorithms, when they are misconfigured at 4-20?

I don't personally accept conclusions of poor Apap algorithms, but there are times when switching to Cpap mode is beneficial to the user, as I stated in above post.

Of course... when I see a 4-20 setup, the first thing I do is advise on pressure adjustments according to what I see on their chart. I believe Apap mode works for most of us, but not in all cases.

[B1Sailor]

I was looking for a conversation about what people thought of the CPAP versus APAP and that some experts complaining about APAP algorithms more than suggestions for my therapy. But that is a nice addition.

My old CPAP had C-Flex at 2. So I guess APAP with some target plus and minus 2 for the range like low setting 8 – target of 10 – high 12 would be equivalent to my old settings.

OpalRose has made the best comment so far for my intention that some people with aerophagia would be better with a wider but not too wide range of APAP.  Other than serious problems like that or people with mostly CAs (which is me with therapy), I though of APAP as more of a pursuit of comfort technology to boost compliance problems As OpalRose pointed out, it is much more than comfort for some.

The two Respiratory Therapist I mentioned on YouTube, I don’t believe were comparing poorly set APAP. I believe their points were even fine tuned APAP that the algorithms responded to some events with incorrect changes. But it is the 80/20 type that they do respond correctly to most. But some respond in too big of chunks. Leading them to also compare the Soft Response mode to the Regular Response modes.

[B1Sailor]

I guess most are not interested in the APAP discussion. I find it very interesting when I hear someone even somewhat educated in the CPAP industry questioning the APAP algorithms. When I hear pretty good experts demonstrate the problems, I can’t believe it is not getting attention from manufacturers and users of PAP devices.

I believe the insulation disaster has set the industry back in motivation for improvement. With such a spike in demand for replacements, why put your company’s position at risk.

[Bluesv6]

I think people have putten enough input and don't feel the need to create a debate

[Lucid]

Like most, I started out with APAP and a wide range.  After a couple of months, my doctor raised the minimum pressure somewhat and lowered the max a little.  I didn't feel he was looking that closely at the data, though -- just going by whatever ResMed recommends to clinicians.  He's a pulmonologist, so he does treat patients with sleep apnea, but it's not his core specialty.  

A few months later, I wasn't sure I was feeling as crisp mentally as maybe I could be, so I did a consultation with the Lanky Lefty / Jason and tried CPAP.  He initially suggested a pressure a bit higher than my current level (13 to 15??) and doing without EPR, but that made my numbers much worse.  Then he recommended that I drop back to about 9 or 10 with EPR.  Within a week, I worked my way up to 11, watching the results from OSCAR.

I also tried mouth taping for a while but was having too many problems with skin irritation and stopped.  It doesn't seem to make much difference for me, fortunately.

It's weird to think back to when I first started using PAP therapy:  I was uncomfortable when the pressure even went up to 6, after the ramp period.   Now that I'm used to the mask and machine, I'm uncomfortable without 11 cm.  I don't really need more than that.  So CPAP works very well for me.


Thinking back on my initial adjustment period, I often wonder if the adjustment was physical -- that is, did my throat and tongue muscles somehow adjust to having forced air?  Or was my initial discomfort mainly due to mental anxiety?  The mind does give feedback to the nerves and can heighten the perception of pain and discomfort.  Maybe I just "got used to it," that is, accepted the once novel sensations and sounds.  I do know that as soon as I was able to sleep through the night (which was with APAP at that point), I felt significantly better and even subconsciously never wanted to do without PAP therapy again.

Perhaps the utility of APAP differs from person to person, depending on the type of sleep apnea?  For me, at least, I think Jason is correct that the right CPAP setting is better than APAP.  The Australian guy (CPAP Reviews) seems to suggest using APAP to find a narrow range that works well.  I did try 11-13 last year after a weight gain (yikes!), to see if I was still at the right pressure, but my numbers worsened with the range.  I haven't tested out lowering it to say 9-11, but my nose tends to feel a bit stuffy when I lie down, and I'm not bothered by aerophagia, so I really just prefer 11.

Based on what little I know about health care financing (insert large grain of salt here) I think that ResMed, doctors, and insurance companies are just trying for "good enough."  As long as patients can drive or pilot safely again, that's good enough.  Compliance is a sine qua non, so initial comfort is perhaps disproportionately important.  Also, don't underestimate how difficult and expensive it would be to train and to retain very many techs and doctors up to the level of a sleep tech like Jason or the best advisors here on Apnea Board, and to make that level of skill available to everyone.  Of course, as AI develops further and the price of it comes down, the algorithms may improve.