[Equipment] Advantages/Disadvantages of APAP versus CPAP

[Mutineer]

Hi, Newbie here, would like some advice on the Advantages/Disadvantages of APAP machines versus CPAP machines.
Currently really struggling to come to terms with several problems I'm having with my CPAP machine, namely finding it uncomfortable at times when exhaling, the noise the machine makes seemingly in concert with my breathing. Also found the "exhaust" sound the Wisp mask makes can be disconcerting, trialling a F & P Palairo mask currently and it seems to be less of a problem with it. Told my sleep Doc at my last appointment and he had the therapists turn the machine down from 10 to 8 and to the least "resistance" when exhaling I understand...I haven't really noticed the difference. While the therapist hasn't said so in as many words I'm getting the "vibe" she thinks APAP's are far superior to CPAP machines. [/size][/font]

[herbm]

Hi, Newbie here, would like some advice on the Advantages/Disadvantages of APAP machines versus CPAP machines.
Currently really struggling to come to terms with several problems I'm having with my CPAP machine, namely finding it uncomfortable at times when exhaling, the noise the machine makes seemingly in concert with my breathing. Also found the "exhaust" sound the Wisp mask makes can be disconcerting, trialling a F & P Palairo mask currently and it seems to be less of a problem with it. Told my sleep Doc at my last appointment and he had the therapists turn the machine down from 10 to 8 and to the least "resistance" when exhaling I understand...I haven't really noticed the difference. While the therapist hasn't said so in as many words I'm getting the "vibe" she thinks APAP's are far superior to CPAP machines. [/size][/font]

If you are paying yourself, then a CPAP machine probably costs less (list price at least it does).

That's about it for CPAP.

The APAP machines have full data capabilities, the ability to adjust pressures to accommodate the current need, cost the same under for the patient under most insurance plans, and can be used for straight CPAP is required/desired.

It's unlikely that there is an appreciable noise difference between the CPAP and APAP models of the same manufacturer and SERIES when running at the SAME pressure.

An APAP might seem louder when it increases the pressure due to the changes in sound levels rather than the absolute sound level being much greater.

Mask noise is mostly JUST mask noise. Perhaps the quietest mask is the Airfit P10 nasal pillow 'mask'. (It's not a MASK in any real sense except by conventional terminology as it is merely nasal pillows, a strap, a very flexible pigtail hose and a little platform to hold those items together.)

Leak noise however may be attributed to mask noise, but leak noise is that which is due to UNCONTROLLED leaks, i.e., air escaping in ways the mask was not designed to allow.

Masks are actually DESIGNED to leak, but in a controlled, and relatively quiet manner.

Excessive leak or leak outside of the design, is what creates most noise and feelings of being "blown away."

There can be no WIND without an uncontrolled pressure differential.

Masks are designed to control the pressure differential between ambient pressure and mask pressure without allowing for excessive noise or noticeable "wind".

There is NO feeling of wind inside the P10. There is very little noise. There is practically NO wind OUTSIDE the P10 -- there is more an oozing of air through the exhaust filter that is difficult to discern at 3-4 inches distance.

When I measure the sound of the P10 at about 4 inches the noise was almost irrelevant ON THE METER and is almost imperceptible to others.

My wife claims to have NEVER HEARD the P10. No has she every felt any wind from this mask.

She did hear the Innomed Hybrid, but claimed it didn't disturb her.

[trish6hundred]

Hi Mutineer,
WELCOME! to the forum.!
The advantage of an APAP versis a CPAP is that an APAP can adjust to the pressure you need and it can also be use as a straight CPAP if you need that.
Hang in there for more answers to your questions and best of luck to you with your CPAP therapy.

[JWR]

Disadvantages of APAP machines versus CPAP machines.



First off Welcome aboard !
I agree with both Herbm and Trish6hundred . There is no disadvantage to the Auto machine other than price , Your more in control of you own Health when you have a data capable machine that will adjust to you every night . The Biggest thing I see is that being able to see your data every day is a encouragement to use your machine seeing your progress . With a non data machine there is no way of telling if your at the right pressure other than using the (Do you feel good method ) and how many DR appointments and how many more sleep study's that are only a snap shot of how you sleep for a couple of hour . My pressures are never the same two nights in a row , depends on sleep position , what I eat , stress , ect . I'd Go for the Auto , I Love mine as I'm sure you'll find most do on here .

[zonk]

While the therapist hasn't said so in as many words I'm getting the "vibe" she thinks APAP's are far superior to CPAP machines. [/size][/font]

Absolutely, no doubt whatsoever (in my mind)
APAP can be used in straight pressure mode as well as auto mode (two machines in one)
Fine tuned APAP is like having a mini titration at home all night every night
Price wise, in US APAP cost few dollars more while in Australia few hundred dollars more
For that reason, I get my supplies from suppliers #2 and #10, works out cheaper than local rip-off merchants prices, even with exchange rates and shipping cost (both ship internationally)
Suppliers List http://www.apneaboard.com/forums/Thread-...plier-List

Not all Resmed APAP,s are equal
S9 Escape Auto is APAP but without the data capabilities and enhanced features of S9 AutoSet

Edit: btw, the software listed in user profile"CPAP Software: ResScan" does works with your machine "Machine: Phillips Respironics Remstar Pro"

SleepyHead supports PRS1 machines, EncoreBasic too
Software download links page http://www.apneaboard.com/forums/Forum-P...-and-Links

[mjbearit]

Hi, Newbie here, would like some advice on the Advantages/Disadvantages of APAP machines versus CPAP machines.
Currently really struggling to come to terms with several problems I'm having with my CPAP machine, namely finding it uncomfortable at times when exhaling, the noise the machine makes seemingly in concert with my breathing. Also found the "exhaust" sound the Wisp mask makes can be disconcerting, trialling a F & P Palairo mask currently and it seems to be less of a problem with it. Told my sleep Doc at my last appointment and he had the therapists turn the machine down from 10 to 8 and to the least "resistance" when exhaling I understand...I haven't really noticed the difference. While the therapist hasn't said so in as many words I'm getting the "vibe" she thinks APAP's are far superior to CPAP machines. [/size][/font]

Hi Mutineer! Sounds like you have a few issues here. The APAP is designed to adjust the pressure needed to keep your airway from collapsing throughout the night, rather than a standard pressure. Often this means that the pressure is less as you don't need it high all the time but a CPAP they have to set it to the level to address the airway issue all the time as it does not adjust automatically. As a side benefit, this gives you a whole bunch of data because you can see what you really need, not just during the sleep study (did anyone ever manage to sleep during their sleep study?).

As far as exhaling against the pressure, that is something altogether different. You may see things like AFlex and CFlex on Respironics machines. These are certain algorithms Respironics developed (other manufactures have their own as well) that can sense when you exhale and relieve the pressure at the beginning of the exhale and then return to therapeutic pressure before the inhale. I just looked up your machine and it is listed as having the CFlex+ technology so (assuming you are working with a sleep center) you should talk to them about the CFlex+ and get them to set it up and teach you how to use it. This may just fix your exhaling problems.

So yes an APAP is better (in some ways) than a CPAP, but even today's CPAPs have a lot more features than the older models (one feature is a lot more! )

[robysue]

As far as the machines themselves are concerned, the main advantage to having a full data APAP rather than a full data CPAP is that the APAP can run either as an APAP or as a CPAP, whereas the CPAP can only run as a CPAP.

Whether running in AUTO mode or CPAP mode on an APAP is an advantage or disadvantage really depends on the patient. As someone said, to run in straight CPAP mode means the pressure has to be high enough to deal with your worst apnea---typically when you're on your back and in REM.

For many people, running in AUTO mode allows the machine to use lower pressures during much of the night, and this can increase the comfort level and decrease problems like aerophagia in some people.

But for many people, the changing pressures in AUTO mode are disruptive of their sleep and they're really more comfortable running their APAP in straight CPAP mode. And in general, if the straight CPAP mode is genuinely optimized, the overnight AHI's may be lower because the machine is not waiting around for events to occur before raising the pressure to the "high" level needed for the worst of the apnea---in straight CPAP, the pressure is already at that "high" level.

[zonk]

And in general, if the straight CPAP mode is genuinely optimized, the overnight AHI's may be lower because the machine is not waiting around for events to occur before raising the pressure to the "high" level needed for the worst of the apnea---in straight CPAP, the pressure is already at that "high" level.

From my limited experience, AHI is always lower on AutoSet mode and more significantly no central apnea, while higher AHI and few centrals apnea on CPAP mode. In my case, easier to optimize pressure setting on AutoSet mode than CPAP mode, as the S9 AutoSet on Autoset mode can distinguish between apnea events (obstructive and central apnea) and treat them differently. While on CPAP mode, the machine can also distinguish between obstructive and central apnea but cannot treat them differently as the pressure stay constant all night and every night

[JimZZZ]

But for many people, the changing pressures in AUTO mode are disruptive of their sleep and they're really more comfortable running their APAP in straight CPAP mode. And in general, if the straight CPAP mode is genuinely optimized, the overnight AHI's may be lower because the machine is not waiting around for events to occur before raising the pressure to the "high" level needed for the worst of the apnea---in straight CPAP, the pressure is already at that "high" level.

I suppose the same could be said for running in APAP mode with the max and min pressures set very close together. The closer they get, the more it functions like CPAP.

My average is about 10.5 and my range is 8/14 with an AHI of .80 and I'm slowly bringing the max down to see where I get an improvement in aerophagia. What would be a good rule of thumb for the APAP range given an average of 10.25 and a 95% of 12.90? What about 9/13?

[robysue]

From my limited experience, AHI is always lower on AutoSet mode and more significantly no central apnea, while higher AHI and few centrals apnea on CPAP mode.

Like so many things in PAP therapy, there's a big variation from user to user. I based my original comments on what I've seen in both this and other forums in both my data and others.

For me: Fixed pressure will give me excellent AHI results---if the pressure is set high enough. For my BiPAP, that means running with a fixed IPAP = 8 and a fixed EPAP = 6. And my stomach is deeply uncomfortable at those pressures. So in my case, I sleep better and feel better with a tight Auto BiPAP range, even though the AHI numbers are not as good. (There is a point of diminishing returns when it comes to AHI numbers---many of us feel equally good with a long term AHI in the 1.5-2.5 range as we do with a long term AHI in the 0.0-1.0 range.)

In my case, easier to optimize pressure setting on AutoSet mode than CPAP mode, as the S9 AutoSet on Autoset mode can distinguish between apnea events (obstructive and central apnea) and treat them differently. While on CPAP mode, the machine can also distinguish between obstructive and central apnea but cannot treat them differently as the pressure stay constant all night and every night

That is news to me: Back in 2010 when I still had an S9 AutoSet, it distinguished between CAs and OAs regardless of whether I was using the machine in Auto mode or CPAP mode.

Here's a SH shot of some very old data: It was recorded by my S9 AutoSet while running in CPAP mode with EPR = 3:

As you can see, the machine makes a clear distinction between one "apnea" that it called a CA and other it called an OA in the zoomed in part of the wave flow.