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

[Sleepster]

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.

The waveform (graph of volume flow rate versus time) takes on a different shape during the flow rate limitation that precedes obstructive apneas and hypopneas. The APAP can respond to these changes in shape and raise the pressure before the airway starts to collapse.

Of course, if you're already at a high enough pressure none of that is necessary.

But if that high of a pressure causes discomfort, then it can be a benefit to have an APAP.

[zonk]

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.

True if the minimum pressure set far too low and this is a recipe for failure.

For constant pressure to work effectively, set pressure ought be able to deal with apneas, hyponeas, snoring and flow limitation without inducing central apnea ... big ask for constant pressure machine, only the AutoSet can deal with all that stuff without inducing central sleep apnea

So in a nutshell, if one worry about central apnea, the AutoSet is better option but as always any machine can be set to succeed or fail

[Sleepster]

CPAP-induced central apnea is transient. Like so many other things, it subsides as we adapt to CPAP therapy.

[robysue]

Throwing in my two cents:

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.

It's not that there is an increasing number of patients who are "willing to 'go with the flow'". The problem is that folks like us represent a small minority of OSA patients. Most newly diagnosed patients are totally uninformed about the fact that different kinds of PAP machines exist---they literally have NO idea that some machines record full efficacy data and some only record usage. And they have no idea that an APAP exists and that it has the same billing code as a CPAP.

And in most cases, no one bothers to educate the newly diagnosed OSA patient. Not the doctor, not the sleep tech, not the insurance company and certainly not the DME. Yes, a small percentage of newly diagnosed patients take the initiative and go on line and find a forum like this before they meet with the DME and get stuck with a brick (that they don't even know is a brick). But most don't.

And as long as the docs and insurance companies do not demand efficacy data in addition to usage data, the DMEs will continue to set up as many patients with bricks as they can since it's good for their short-term bottom line. And the manufacturers regard the DMEs as their customers instead of us. So as long as the DMEs want to sell us bricks and keep ordering them from the manufacturers in great numbers, that's what the manufacturers will make.

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

Ok: First, I agree that all newbies ought to be set up with an APAP rather than a CPAP; APAPs are much more versatile and can be set to straight CPAP for people who do better on straight CPAP.

But: The Resmed S9 AutoSet is just not any better than the PR System One Auto CPAP. Most newbies won't be able to feel much of a difference between the way the two machines feel in use. Both machines have well tested and effective auto algorithms, provided the machine is not left running wide open. Both machines distinguish between OAs and CAs and record full efficacy data.

And there are SOME people who find the System One's Auto algorithm and a choice of A-Flex to be more comfortable than the S9's Auto algorithm with EPR. But yes, there are also SOME people who prefer the way the S9's auto algorithm and EPR feels.

Also add in the fact that the System One runs off of 12volt power, so you don't need an inverter if you're using a battery (flexibility while camping is important to some of us.) And the fact that the System One doesn't overwrite the detailed data on the SD card every seven days, so you don't have to download it at least once a week if you're inclined not too. And the price of the System One Auto is often $100-200 cheaper than the S9 AutoSet if you are forced to buy completely OOP. So for some people, the System One makes a lot of sense.

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

The problem is: Flow limitations can lead to unnecessary pressure increases. And wake breathing can be misinterpreted as flow limitations, hypopneas, and OAs as well as CAs. And so if you're having a restless night with a lot of tossing and turning (caused by some non-OSA reason), that "sleep/wake/junk" breathing can cause the machine to increase the pressure more than it needs to. (And this is a problem with ALL Auto PAPS, not just the S9 AutoSet.)

For some of us, there's a balancing act that has to be done: Too much pressure triggers other problems---perhaps they're as "simple" as aerophagia or perhaps they're more involved such as triggering centrals. And if you're one of the unlucky people who has a natural "max pressure tolerance" before the PAP starts causing problems, then you really don't want the machine continuing to increase the pressure unnecessarily. Of course, the intelligent thing to do when faced with this need to make some tradeoffs on pressure is to set the max pressure low enough to not cause (too many) problems and high enough to effectively treat the obstructive events.

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.

and

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.

Unless Snuffy is having problems keeping the obstructive events under control running at a fixed pressure of 8 or 9, there's nothing to be gained by allowing his inhalation pressure to go all the way up to 12 cm and there's the potential for a whole lot of problems.

That said, I've not gone back and checked all the posts. It could be that at a straight CPAP pressure of 8 or 9 cm, Snuffy's obstructive events are not yet well controlled. And in that case, Snuffy and his doc need to do some real exploring about what might be an appropriate way to handle the situation.

[SnuffySleeper]

CPAP-induced central apnea is transient. Like so many other things, it subsides as we adapt to CPAP therapy.

No, that's not true. For me, I started in January and have adjusted to Cpap. Like I said in previous posts, Complex Apnea doesn't go away. It's a different form of Apnea.

http://www.sciencedaily.com/releases/200...161349.htm

My doctor told me that it does not go away. Even studies show that it happens in 15 percent of people, but if it's you, it's 100 percent.

[SnuffySleeper]

Also Apap is not a magic cure for Complex Apnea, that's very dangerous to think. If it was, Complex Apnea would not be around. This is a good article I found as well on Complex Apnea:

Complex Sleep Apnea: It Really Is a Disease
Peter C. Gay, M.D

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576323/

[zonk]

Now the discussion taking a different direction and on this note, I,m going to bed, bid you all good night ... bon nuit my friends

[Sleepster]

Like I said in previous posts, Complex Apnea doesn't go away. It's a different form of Apnea.

In patients with complex sleep apnea, central events occur in the absence of CPAP therapy.

In patients with CPAP-induced central sleep apnea, central events occur in the presence of CPAP therapy.

The latter tends to subside as the patient adapts to the therapy.

As you say, the former doesn't. The article you cited is pretty old, ASV machines are more effective now at treating complex sleep apnea.

[SnuffySleeper]

In patients with CPAP-induced central sleep apnea, central events occur in the presence of CPAP therapy.

The latter tends to subside as the patient adapts to the therapy.

The term is complex sleep apnea. The studies are 5 years old because there is no need to repeat them. No, it does not go away over time, where did you get this mindset? That's like saying OSA goes away when you lose weight and only affects fat people.


It's dangerous to think that, as you are telling people to keep doing something that is hurting them because they will "get use to it". With complex apnea it doesn't work like that.

Yes, I agree that it takes awhile to get use to Cpap and people should give it a month or so, but after that if CA's keep happening they need to see their doctor as they don't just "go away".

Yes, ASV will treat it, but if Cpap can treat the OSA without inducing CA's then that will work as well.

[SuperSleeper]

I think the thread is diverging from the original posts significantly. This thread was primarily about how whether to use CPAP or APAP to treat basic obstructive sleep apnea, not central sleep apnea and not complex sleep apnea.

Snuffy, you may have mis-read Sleepster's post. He was saying that pressure-induced centrals often go away as one's body adjusts to the pressures.

Also, going back to a nearly 6-year old study that used machines even older than that is probably not taking into account the great advances in CPAP technology and fine tuning of algorithms that have been accomplished during the past 5-7 years.