The War on APAP: Why?

[retired_guy]

In the first few days or weeks, it MAY make more sense to make fairly frequent adjustments, and this is what the machines actually do when they are "auto-seeking" for the correct pressure at during the night.

It took me about 1 WEEK to get my settings basically correct -- and that was with 6 changes over the 7 days.

And I must greatly disagree with your method. There are just far too many variables for such advice to fit everyone. Did it fit you or were you just lucky? Who knows. When someone starts using a CPAP for the first time, the body and brain have to make a lot of adjustments. To keep changing the pressure each night over the span of just a week is not a good idea. I do agree, however, that when it is obvious a pressure is not working, that after three nights of the same results, a change is warranted, but not based on one night.

Yes, our sleep docs base our therapies on one lousy night at a sleep clinic. And they almost always get it wrong. We aim to be better than that.

This is what APAPs should be the only machine given. Set a range, determine the best pressure, and either go with a range or go with a set pressure. Best of both worlds. The algorithms that go into making APAPs work have changed a lot in recent years. Any sleep doc or RT who doesn't know this is not keeping up with their field of expertise. It would be like a mechanic still not trusting a fuel injection system and only working with cars that had a carburetor.

So... To summarize......... There are cars that don't have a carburetor?

[jgjones1972]

So... To summarize......... There are cars that don't have a carburetor?

Where do you spray the starter fluid then?






Back to topic...it's just a turf war - crooked docs don't want to give up any of the easy money an elaborate and expensive but somewhat ineffective titration process provides. JMHO

[Gabby]

In Australia if we need financial assistance acquiring a machine through the Goverment, the hospitals issue us with a ResMed S9 Elite.
I assumed it was because of the cheaper cost but when I asked one of the nurses she said they, the Doctors I presume, don't believe the Autoset is any better for you than the fixed pressure.
Personally I think that is just their way of saying we haven't got the budget to cover the Autoset.
I would give anything to be able to afford the Autoset, until then I am happy with my Elite.

[c0reDump]

After two titration studies, the lab was not able to determine a single pressure setting that was "optimal", so my prescription was written for an APAP with range 9-17.

My AutoSet doesn't have a problem figuring it out, but of course it is analyzing every breath and changing pressure constantly (it is a computer after all, performing a titration study every night).

[herbm]

And Paula that is precisely why if you KNOW WHAT YOU ARE DOING, rapid changes can work quite well.

The key is knowing what you are doing so, no, this isn't for everybody but the procedure is straight forward.

Mostly, you make several changes instead of one in order to avoid jumping to the conclusion of the likely final answer.

Sure, you could make the best guestimate all in one go, but that is not likely the most accurate way.

Honing makes more sense, and that means multiple changes.

[Shastzi]

Sad but true. There are some real stupid docs, crooked docs and stupid-crooked docs out there.
Getting in with a good sleep doc & DME is
something like finding a good car mechanic...

[JimZZZ]

Tabbycat, I had the same experience with my sleep doctor. He prescribed a pressure of 4 with my S9 autoset feature disabled. When I asked him to allow my DME to enable the autoset feature he refused. He said I should stay with a straight CPAP set at a pressure of 4 for at least 90 days. So I went around him, enabled the autoset, set the pressure range at 8/16 and am now cruising along with an average pressure of 10.37 and a 95% pressure of 13. You are so right!

With the discussion in the "Aerophagia" thread, you should probably lower your pressures considerably if you think you are having aerophagia-related problems -- perhaps your doc was right, and you need more time to adjust to the higher pressures?

Thanks for the advice c0reDump. I was contemplating doing just that. As you see above, my pressure averages 10.37 and only occasionally reaches 15+. I was thinking of reducing it to 15 and then 14 to see whether it has any effect on my AHI. Is that what you had in mind?

[c0reDump]

Hi Jimzzz, I was thinking the other way around. Lower the max down to 6, and then raise by 1 cmh20 every week until you start experiencing aerophagia again. Much slower process than herbm would recommend, but still much faster than what your doc wants.

Since you have an AutoSet, the unit will automatically seek the optimum pressure in the allowed range. What you need to do is find the maximum pressure that causes your aerophagia, and then back off from that. And, who knows, this process might give your body the time needed to adapt and never experience aerophagia again.

[JimZZZ]

Hi Jimzzz, I was thinking the other way around. Lower the max down to 6, and then raise by 1 cmh20 every week until you start experiencing aerophagia again. Much slower process than herbm would recommend, but still much faster than what your doc wants.

Since you have an AutoSet, the unit will automatically seek the optimum pressure in the allowed range. What you need to do is find the maximum pressure that causes your aerophagia, and then back off from that. And, who knows, this process might give your body the time needed to adapt and never experience aerophagia again.

Thanks c0reDump. Help me understand; my autoset keeps the pressure at an average of 10+ presumably because that's what it takes to stop events. Last night my max pressure was 15.86. So...it seems almost dangerous to lower the max to 6, a pressure well below that called for by the S9 AutoSet feature. Are you thinking I should accept more events in exchange for less aerophagia?

BTW, regarding our conversation on aerophagia in the "war on APAP" thread: I have lowered the EPR to x3 with no effect so am thinking of switching to a nasal mask. If that doesn't help I will consider pressure changes. I want to (must) limit my changes to one at a time to have any chance of determining what works. I have the usual light cramps/bloating this morning and am confident that it is not diet or supplement related. Thanks for your patience and advice.

Sorry, thought I was in the Aerophagia thread...we probably should move this conversation to that thread anyway.

[robysue]

JimZZZ,

Please see the Aerophagia thread for my comments on your last post.