Auto-CPAP without titrating first?

[EddyDee]

Can an Auto-CPAP titrate itself? If so, why does this forum even exist? Just let the machine get on with its job and don't interfere...

The reason I ask is that I'm mystified my recommended treatment strategy.
I had a home sleep study which showed OSA, and CPAP therapy was recommended.
I assumed the next step would be a tritration study in the sleep lab.

Instead, I am being referred to a DME who is going to loan me an Auto-CPAP machine for a week. Since the sleep study itself gives nothing for them to go on, I guessed they are going to set it at 4-20 and just let it run. This was basically confirmed to me by the DEM rep.

Is this reasonable?

1. As I said, can an Auto-CPAP titrate itself?
   
2. Is a DME rep the right person to run a titration study? Seems like their expertise and interests are elsewhere
   

[Psychotech]

1)yes auto cpap will titrate itself but setting should be within the parameter as per your comfort
2)the reason this forum exist as you said your dme will provide a auto cpap with 4-20 factory setting and if that setting is uncomfortable for you or your having any other problem relating to your cpap/bpap we are here to give you solution to those problem if we can
3) tritration study is usually not needed for osa if your treating it with auto cpap but tritration study is needed for bpap to treat osa and copd

[Sleeprider]

Auto CPAP has varying success in auto-titration, but with knowledgeable intervention, the data produced by an auto CPAP can allow for significantly more optimized therapy than the default 4-20 pressure can produce. Auto CPAP machine vary significantly in how their algorithm responds to events. Philips auto CPAP is chronically slow to respond to indicators of an event and result in significantly higher AHI than a Resmed machine. There are some comparison studies that show how different auto CPAP models respond to events and compare the effectiveness. In addition, some machines offer exhale pressure relief (EPR) which can have direct therapeutic effect on flow limitation, helping to minimize respiratory effort related arousals (RERA) and hypopnea. The optimization of auto CPAP requires experienced, knowledgeable coaching, which is part of the reason this forum exists. The help individuals receive from doctors, respiratory therapists and equipment providers varies widely, and a very high quit-rate among CPAP users is part of the consequence of that. Many members of this forum have experience and acquired knowledge that can help identify why problems are present in therapy and to improve the efficacy and comfort of the therapy. Your question is entirely centered on an auto CPAP machine, but we also assist members with bilevel and sophisticated ventilation devices, and you should be aware that the mask interface is one of the most important variables whether therapy will succeed or fail.

In response to your questions: An auto CPAP can generally achieve an effective range of pressures to lower AHI to an acceptable level. That is not the sole indicator of effective therapy.

DME providers are either unqualified or not permitted to actually make machine settings that are not prescribed by a doctor. They often report their finding to a doctor that does the actual prescribing. These assessments are overly simplified and mostly based on AHI, and not many other respiratory, arousal and comfort variables that would indicate what we consider "successful" titration on the forum.

[Gideon]

Sleeprider, think about converting your above post to a Wiki article

[EddyDee]

I agree, I think it makes it very clear what can and cannot be automated. Thanks a lot!

[Sleeprider]

I'll try to get this into a wiki. The real take-away is that an auto CPAP does not learn and often returns pressure to a pressure below the threshold where obstruction will be likely, or fails to fully clear obstruction. Philips bases its algorithm on mainly snores and events, while Resmed interprets flow limitation as a precursor of obstruction. Both have different problems. Some people do not present adequate snores or flow limitation ahead of an event, and some people have chronic flow limitation which results in an Autoset reaching pressures far above anything therapeutically beneficial. The algorithms have improved with Opti-Start for Philips to start pressure at the 90th percentile of the previous session, and "For Her" on Resmed which modifies pressure increases from flow limitation.

[clownbell]

Great posts, sleeprider. I too encourage a wiki. Gonna go back and read that again.

[dwd1249]

BCM Resmart acpap machine
10-02-14, 10:36
Sleep study shows my acap providing low pressure
I have to have a review every year with my sleep medicine physician to maintain my buss driver authority. He was bothered by the fact that my machine was only applying 7 - 8 cm of water. He expects some one my size to be 10 - 15 cm of water. So off to the sleep lab for an over night study.
I had my study with the outcome being my pressure should be 14cm of water. The Dr suspects that the low pressure provided by my acap could be due to the algorithm or my relatively narrow nasal airways.

I made some changes to my acap and got it providing 14cm of water and more at times during the night . Then 3 days ago I changed the machine to be a cpap at 14cm H2o and I feel better, not that I was bad before.

So I guess a Auto machine is not always the best. And that you have to keep aware of what is happening.