CPAP versus AutoPAP: are there really advantages to each?

[palerider]

I know that AutoPAP machines cost more, and therefore some doctors and insurance companies might prefer CPAP. But are there any actual medical reasons to prefer CPAP? Or is AutoPAP always better?

APAP is *ALWAYS* better than CPAP, ALWAYS.

If for no other reason than that it gives you more options.

An APAP can act like a CPAP, a CPAP cannot act like an APAP.

The answer is simple. ALWAYS try and get the APAP..

Insurance companies, as you've been told multiple times, don't care, they pay the same for any non-bilevel machine, cpap, apap or brick.

Your circumstance may be different.

[Hose_Head]

My story:

I spent almost 10 years on apap. Two different Philips-Respironics apaps in that period. Apap therapy on these machines worked wonderfully well for me. Ran it at pressures of 7 and 12 for most of this period with 95% pressure of about 8 cm/H2O and ahi's typically under 1. Amazingly consistent results throughout the 10 year period.

This year, I got a new apap, this time a Resmed Airsense 10 auto for her. Found that I cannot tolerate the apap algorithm on this machine. When run in apap mode with pressures of 7.6 and 15 I get 90% pressures of 10.1, ahi's between 1 and 2, and lots of leaks due to the high pressure.

The only explanation for this that I can come up with is that the PR apaps seem to be able to ignore my constant problems with nasal congestion whereas this condition confuses the Resmed, resulting in a constant run-up to high pressure.

I've found that I can only use the Resmed in cpap mode, set at 8.6 cm/H2O with a resulting ahi of under 1.

While I get good therapy for my decidedly plain-Jane apnea by using my Resmed auto in cpap mode, I've lost the other benefits of having an apap. Pressures with the Resmed in cpap mode are slightly higher and overall, I don't feel like I'm sleeping quite as well with it when compared to my older PR machines (even though the ahi results are about the same).

[prodigyplace]

My story:

I spent almost 10 years on apap. Two different Philips-Respironics apaps in that period. Apap therapy on these machines worked wonderfully well for me. Ran it at pressures of 7 and 12 for most of this period with 95% pressure of about 8 cm/H2O and ahi's typically under 1. Amazingly consistent results throughout the 10 year period.

This year, I got a new apap, this time a Resmed Airsense 10 auto for her. Found that I cannot tolerate the apap algorithm on this machine. When run in apap mode with pressures of 7.6 and 15 I get 90% pressures of 13.1, ahi's between 1 and 2, and lots of leaks due to the high pressure.

The only explanation for this that I can come up with is that the PR apaps seem to be able to ignore my constant problems with nasal congestion whereas this condition confuses the Resmed, resulting in a constant run-up to high pressure.

I've found that I can only use the Resmed in cpap mode, set at 8.6 cm/H2O with a resulting ahi of under 1.

While I get good therapy for my decidedly plain-Jane apnea by using my Resmed auto in cpap mode, I've lost the other benefits of having an apap. Pressures with the Resmed in cpap mode are slightly higher and overall, I don't feel like I'm sleeping quite as well with it when compared to my older PR machines (even though the ahi results are about the same).

Pugsy and other here generally recommend that if a brand's algorithm is working for you, try and stay with that brand for a new machine because the algorithms vary among the different vendors.

[jbstarks3]

It is better to know the pressure that is going to "fix" your sleep apnea. The problem with AutoPAP is the change in pressure throughout the night. If you had a CPAP titration study completed, you already know the pressure needed to treat. The change in pressure with autoPAP (if the machines can truly detect a respiratory event) can cause masks to leak. The same reason a RAMP type feature on a machine can cause more problems than it can solve.

The advantage to an autoPAP machine is for those whose insurance company denied an in-lab sleep study and approved a portable home sleep test. The insurance company can save money by only paying for a home sleep study then skip the CPAP titration study and go straight to the home with an autoPAP machine.

[OkyDoky]

Hose_Head, did you try the regular auto mode or just the for her mode? The 2 auto modes respond differently. Are you looking at Sleepyhead to see what is happening and how long your pressures are at 15? Remember the 90% number means at or below and doesn't give information on how long you were at a pressure. Looks like your pressure settings were increased, were you hitting the top when it was set to 12 on your old machine?

[jnk...]

Not to be nitpicky, but usually medical discussions of CPAP vs. APAP are about the two modes, not about the two machines. That can be important to keep in mind when researching the topic. And as has been stated here, both modes are available on some machines (called APAPs) whereas only one mode is available on some others (called CPAPs).

The reason that is important is that although some docs may not like APAP mode for some of their patients, they generally don't mind a bit if their patients own an APAP machine. That's why no one argues against the machine, just the mode.

If someone can travel into the future to know that he will always be perfectly comfortable and perfectly treated at one pressure for the rest of his life, then I think a brick CPAP would be just the thing for that sort of time traveler. Otherwise . . . well, you know.

[chunkyfrog]

. . .
That's why no one argues against the machine, just the mode . . .

No one HERE, of course!
DMEs do what is in their nature.
Money is everything . . .

[jnk...]

. . .
That's why no one argues against the machine, just the mode . . .

No one HERE, of course!
DMEs do what is in their nature.
Money is everything . . .

True. But even DMEs don't argue against the value of it. They just lie that payers are responsible for whatever the DME feels like dumping on someone that day.

[chunkyfrog]

I actually was present when a DME stood up in front of a roomful of cpappers.
and STATED that cpap machines were preferable to apaps.
When I asked if there was any apap which could NOT be set to cpap mode,
the room got VERY quiet. But he admitted that I was right.

[jnk...]

I actually was present when a DME stood up in front of a roomful of cpappers.
and STATED that cpap machines were preferable to apaps.
When I asked if there was any apap which could NOT be set to cpap mode,
the room got VERY quiet. But he admitted that I was right.

OK. Then I modify my statement to "nobody with more sense than an earthworm argues against the value of the machines."

After all, if APAPs were actually inferior, then those would be exactly what the DMEs would be trying to dump on people.

[prodigyplace]

OK. Then I modify my statement to "nobody with more sense than an earthworm argues against the value of the machines."

You just excluded 90% of the DMEs

[prodigyplace]

The advantage to an autoPAP machine is for those whose insurance company denied an in-lab sleep study and approved a portable home sleep test. The insurance company can save money by only paying for a home sleep study then skip the CPAP titration study and go straight to the home with an autoPAP machine.

That is exactly what the insurance company did in my case. In home study and then APAP.

[chunkyfrog]

Not every insurance company has figured this out . . .

[palerider]

It is better to know the pressure that is going to "fix" your sleep apnea. The problem with AutoPAP is the change in pressure throughout the night. If you had a CPAP titration study completed, you already know the pressure needed to treat.

You're quite wrong about your assumptions.

Pressure needs change *during the night* for most people. The "right pressure" for nrem sleep is very often lower than the "right pressure" for rem sleep. The "right pressure" for side or stomach sleeping is usually lower than the "right pressure" for back sleeping.

[chunkyfrog]

My pressure varies throughout the night.
I just LOVE.my APAP.