What about APAP?

erik67 · Post by **erik67** » Sat Feb 17, 2007 9:27 am

I am recovering from a septoplasty and trying to lose weight - I assume that both of those things will likely change the pressure setting that I need to control my apnea (CPAP currently at 12 cm). The question that I have is:

should I request an APAP from the DME so that the pressure will auto-adjust to my needs? If the APAP actually can tell how much pressure you need to keep your airway open, then why do the DMEs give everyone CPAP? I started at 6 cm 2 years ago, and recently had to go in for a second sleep study my pressure was not high enough.

If I had an APAP, would I necessarily have needed the second sleep study? Or would the APAP just have compensated and increased the prssure? Do I have a correct understanding about how APAP works?

Ant advice would be appreciated.

Erik

JimW · Post by **JimW** » Sat Feb 17, 2007 9:44 am

With today's APAPs, data read-out would be able to tell you if you were "maxing out' your set range. For example, given your initial titration pressure of 6 cm, assume that an APAP had been set to operate from 5.6 to 9.6. The APAP would be able to compensate for needed pressures up to 9.6. If your pressure frequently hit 9.6, data read-out (optimally, via software and a card reader) would show this to be the case. Then, depending on your preference, you would be able either to contact your doctor regarding changing the APAP pressure minimums/maximums (and I personally can't imagine having a minimum below 6) or resort to underhanded tactics to change it yourself. (Another benefit of APAP, IMHO, is that no one's pressure needs remain constant throughout even one night, let alone over the course of days, weeks, months, and years.)

In short, barring conditions such as significant central apneas, yes, an APAP would have auto-adjusted to your needs and you would likely not have needed the second titration study. (All this, of course, within the imperfect ability of your given APAP to detect events and compensate with appropriate pressure.) You do evidence a good understanding of how APAP works.

Whether an APAP will be forthcoming from your DME on request may be another matter, but it wouldn't hurt to ask.

Offerocker · Post by **Offerocker** » Sat Feb 17, 2007 9:51 am

JimW wrote:...(Another benefit of APAP, IMHO, is that no one's pressure needs remain constant throughout even one night, let alone over the course of days, weeks, months, and years.)...

Jim, that was excellent; I just wanted to echo what I like best about my apap

tomjax · Post by **tomjax** » Sat Feb 17, 2007 10:17 am

Your question probably has an implied answer that gets to the crux of the matter.

If a person had an apap and learned enough from this and other forums and took the time to be truly informed, then there would be no need for visits to the doctor and the $$$$ that keeps the sleep labs going.

This may be a bit simplistic and does not address the slight possibiility that additional problems may be detected by another study, but virtually no postings I have read tells of other conditions being diagnosed in subsequent studies.

The good part is that there is such a very large number of NEW patients needing studies that the industry should be happy with a one time study and prescribing an apap and letting the patient live happily ever after.

$$$ is likely a big part of this equation, IMHO.
I could be wrong
tomjax

erik67 · Post by **erik67** » Sat Feb 17, 2007 8:03 pm

Thanks all for the input. I figured that $$ was an element in this issue. I am an engineer by trade, and would LOVE to have data readouts that I could load onto my PC and look at. I assume that the readouts can tell you if you have mask leaks?

Anyway, I will push my MD to write a scrip for an APAP. Dare I ask for machine recommendations? I may be paying out of pocket on this one....

Thanks!

Erik

Goofproof · Post by **Goofproof** » Sat Feb 17, 2007 8:12 pm

You already have the HH, The remstar Classic Tank APAP, is the best idea. I like it's software best too. Jim

Slinky · Post by **Slinky** » Sat Feb 17, 2007 8:24 pm

The two leaders in the field of xPAP therapy are Resmed and Respironics. That's NOT to say the Puritan Bennet and others don't make good machines, just that these two are the leaders and therefore there's more support available for them.

That being the case, if you are buying out of pocket, its hard to beat the RemStar Auto w/C-Flex, either the "classic" or the newest "M" series. If insurance is going to pay for it then also give some consideration to the Resmed S8 Vantage. Either would be a good choice. But the Resmed, due to their recent online selling policy is considerably more expensive.

The "classic" RemStar Auto w/C-Flex is being phased out in favor of the newer "M" series RemStar Auto w/C-Flex. I've been seeing the "classic" offered for sale, brand new, in the box, sealed, w/humidifier, manualS and data card selling for $450 at yahooauctions. Software and reader are easily available for the Respironics "classic" and "M" series. You have to be a bit more innovative to get your hands on the Resmed software and reader due to Resmed's new online selling policy. Local brick & mortar DME's can NOT sell you the readers and software for either brand, you'll have to buy them online.

On the other hand, the Resmed's have a clear, good size LED screen and you can easily access the night's average pressure, average leak rate, AHI, AI, HI, hours used, and total hours and days used - as long as you access that info BEFORE NOON. These machines all work on a 24 hour noon to noon clock. After noon that night's averages go into the total averages unless saved via software and reader or manually into your own method of record keeping. The Respironics' LED screen is not as easy to read (at least not the "classic"'s) plus they don't give quite so much info via the LED screen as the Resmeds.

But then the Respironics have lots of support here via two additional free software programs, EncoreAnalyzer and MyEncore, both of which do require Respironics' EncorePro software which they enhance.

snoregirl · Post by **snoregirl** » Sat Feb 17, 2007 9:06 pm

If you are paying out of pocket for this you don't need a new prescription.

You can use one that says Cpap online with CPAP.com for any cpap, auto or otherwise.

Linda3032 · Post by **Linda3032** » Sat Feb 17, 2007 10:53 pm

Snoregirl is right. If you have your original prescription, you can fax it to cpap.com and buy any machine you want.

I also recommend the Remstar Auto with cflex - the tank is tried and true.

Wulfman · Post by **Wulfman** » Sat Feb 17, 2007 11:36 pm

I put more emphasis in the data recording capabilities of the machines and consequently the software to interpret your nightly statistics. And, for that, I believe that the Respironics machines (REMstar) come out ahead.

The APAPs (Autos) are great (I have two of them) but not absolutely necessary for your therapy. You can always turn an Auto into a straight-pressure CPAP machine, but not the other way around.
I use straight pressure even with my Autos because I found it gives me better therapy (pressure changes seem to disturb my sleep). Others find that a range of pressures serve them better.

Comparing exhale relief in the Respironics and ResMed autos, the Respironics machines can offer C-Flex in auto mode, but ResMed machines (EPR) cannot.

There are currently four Respironics machines that offer data recording capabilities and two ResMed machines.

Best wishes,

Den

WillSucceed · Post by **WillSucceed** » Sun Feb 18, 2007 7:58 am

Slinky wrote:

The two leaders in the field of xPAP therapy are Resmed and Respironics. That's NOT to say the Puritan Bennet and others don't make good machines, just that these two are the leaders and therefore there's more support available for them.

Just curious Slinky... what do you base this statement on? Personally, (and yes, I'm only one person) I have gotten great support from PB. Significantly better support than I did from Respironics and ResMed. ResMed was, in fact, terrible for support. However, having gotten better support from PB than the other manufacturers would not give me the confidence to make a blanket statement ("the two leaders in the field...").

Admittedly, all of the machines are good and most people will get good treatment. However, I'd strongly encourage that anyone who is contemplating buying an APAP do so based on their OWN experience by trialing the different machines BEFORE making a purchase. This is the ONLY way to know which machine is best for your individual sleep disorder needs.

I know that not all equipment suppliers will loan machines for a trial period and, you might have to pay out-of-pocket (like I did) for a trial but, for me, this was money well spent. I wanted to buy a Respironics APAP because I already had their heated humidifier. I'm glad that I trialed the other APAP's first because I found that I got much better overnight treatment from both ResMed and PB machines.

JimW · Post by **JimW** » Sun Feb 18, 2007 9:12 pm

WillSucceed wrote:Slinky wrote:
The two leaders in the field of xPAP therapy are Resmed and Respironics. That's NOT to say the Puritan Bennet and others don't make good machines, just that these two are the leaders and therefore there's more support available for them.
Just curious Slinky... what do you base this statement on? Personally, (and yes, I'm only one person) I have gotten great support from PB. Significantly better support than I did from Respironics and ResMed.

My guess is that she's talking about support here on the forum, not from the manufacturers.

Guest · Post by **Guest** » Mon Feb 19, 2007 2:15 am

WillSucceed wrote:Slinky wrote:
The two leaders in the field of xPAP therapy are Resmed and Respironics. That's NOT to say the Puritan Bennet and others don't make good machines, just that these two are the leaders and therefore there's more support available for them.
Just curious Slinky... what do you base this statement on? Personally, (and yes, I'm only one person) I have gotten great support from PB. Significantly better support than I did from Respironics and ResMed. ResMed was, in fact, terrible for support. However, having gotten better support from PB than the other manufacturers would not give me the confidence to make a blanket statement ("the two leaders in the field...").

WillSucced: Slinky may have been referring to SALES VOLUME in her reference to "leaders", especially since there was no reference to QUALITY.

Slinky · Post by **Slinky** » Mon Feb 19, 2007 4:54 am

WillSucceed, I agree in an ideal world we would all be able to try several brands and machines before being "stuck" w/one particular machine. However, there aren't too many of us that have that opportunity. I know I wish I could try out several different machines to find which one works best for me! BUT - I am NOT financially able to do so and the DME I am "stuck" w/isn't very cooperative even w/the equipment that I have from them. When my sleep pulmo ordered a loaner AutoPap the DME gave NO choice of brand or model and wouldn't (they said couldn't) even provide ANY type of humidifier at all w/it. So far, the ONLY thing they've done "right" is to suggest the ComfortLite 2 mask for me.

And JimW is quite correct, I did mean there is more support available for the Resmed and Respironics models in this forum than the other brands (especially for the Respironics). In addition to which, support is more readily available in this forum than from any of the manufacturors simply because there's pretty much someone here around the clock, 24 hours a day, instead of just the 9-5 business hours of most, if not all, of the manufacturers.

WillSucceed · Post by **WillSucceed** » Mon Feb 19, 2007 7:10 am

erik67:
I believe that an APAP is a good choice for anyone for a couple of reasons:

APAP's can run in CPAP mode if, for any reason, APAP does not suit you.

APAP's can flex pressure as much as necessary during the course of the night so that, hopefully, the user gets lower pressures overall while times when higher pressure is needed get addressed.

APAP machines (most of them) collect data regarding how the sleeper slept, and the information can be obtained from the device for some analysis.

However, an APAP does NOT fully replace a sleep study. During the sleep study, the sleeper has belts around the chest and diaphragm which give data regarding respiratory effort. An APAP does not have this and, as such, the APAP is making it's best "guess" regarding the occurance of a central apnea. Also, there is value to the observational data that can be offered by the technician who ran the sleep study -hopefully, the tech. is a skilled one.

I have read several posts commenting on the lack of options for renting/borrowing/trialing different APAP machines BEFORE the purchase is made. The "conclusion" that some of these posters come to is to just buy the Respironics APAP because it is the "best."

Well, admittedly, I don't live in the US and don't know what things are like dealing with an equipment supplier in the US. But, I do know that I would rather cough up some coin (like I did when I was trialing machines) out of my own pocket so that I could make sure that I was getting the best machine FOR MY NEEDS, not the machine that is best for someone else.

I am amazed by the passion that some folk show for their Respironics machine. I guess that they are getting really good treatment and are thankful for this, which is great, and that they want others to get the same good treatment. Their desire for this, however, is no guarantee that it will magically translate into it actually happening. So, when I read the "quick, run out and buy a RemStar with C-FLEX, it is the best" mantra, I have to respond.

So, while all of the manufacturer's machines are good, and it is likely, even highly-likely, that any machine will work well for any individual, there is absolutely no guarantee that any particular machine will work for any particular individual.

The only way that you will know for sure is to advocate for yourself with as much vigour as you possibly can. Do whatever you can, make calls, nag, spend a bit of money out of your own pocket, so that you can trial several different manufacturer's APAP machines. I know that when one is struggling with the symptoms of OSA it can be hard to find the energy to tough it out with a supplier to get what you need. If that is the case, get someone to help you. Beg, plead, cajole, make noise, make calls, go over someone's head and speak to the boss, DO WHATEVER IT TAKES to access different machines so that you get the one that is best for you. Don't sell yourself, or your treatment short, by giving into the "it's difficult to trial different machines so just buy the Respironics" party-line.

When you come across the "buy a Respironics, it is the best" free advertising that some users are offering on Respironics behalf, bear in mind that it is only an opinion, NOT a guarantee. YOUR results could be different and the only way you will get close to a guarantee that your treatment will be "best" is to trial machines and buy the one that gives you the best treatment.

Cognitive dissonance is alive and well in the world of Respironics.

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