APAP -vs- CPAP

[pratzert]

Even though I have an APAP, my Sleep Doc wants me to keep using the machine set up as a CPAP.

He feels that the response time of any of the APAP machines is too slow to properly adjust pressure to stop/prevent an apnea event.

But I have not taken his advise as I was not comfortable with the constant higher pressure blowing thru the nasal mask.

Plus, I can see the machines response to my events using Encore Pro and I am more confident knowing the machine is adjusting the pressure as needed and I can monitor any "trends" in pressure needs.

What do you all think ? What has been your experience using your machines as CPAP's -vs- APAP's ?

[Slartybartfast]

My sleep doc has the same bias. But I showed him my data and he was OK with it. Before my last appointment, I slept about a week with constant pressure at the prescribed level, just to mollify him. Then I contrasted that with data in automatic mode. He carefully looked at the 95% pressure level and was satisfied that it was virtually the same as my titrated pressure. And that won him over.

[LSAT]

Using the auto feature is fine, but, don't set the min/max too far apart. Set the min 2 lower than your ave and the max 2 higher than your ave. If you have the settings at 4 min 20 max...your doctor may be right. It would take too long for the machine to adjust to your apneas.

[Janknitz]

The proof is in the pudding. How you feel, what your AHI's are, and how well you sleep are key. I agree with the above, try a week in the mode your doctor wants and then a week on your preferred settings and compare. If you do better on APAP, you can either duke it out with your doctor who will hopefully be open to your objective information, or just do what seems best for you. You're the one who has to sleep with it.

[HoseCrusher]

I believe the traditional optimum care for OSA is CPAP. The studies involving treatment usually involve CPAP because titration has been done in the sleep lab.

The idea of adjustable pressure is somewhat new, and less proven.

In my case my numbers are better with CPAP, so I use that. Every couple of months I switch over to APAP to check my pressure, but afterward I go back to CPAP.

[archangle]

I think a lot of people have bought too much into the APAP camp. Just set the machine at 4-20 pressure and you're done. Some of us think this leaves you on the edge of apnea all night long.

I'm more in the camp that you figure your best pressure and then go auto. i.e. You need 10 with the traditional titration/manual CPAP. Set your machine at APAP of 10-20 and check the results periodically to see if you're autoing up. Maybe lower your pressure occasionally and see if you really need 10, but don't go for days and weeks at a time with a pressure low enough that your machine needs to auto up during the night.

[Mary Z]

I prefer CPAP. My lab titrated pressure was 4/8, but the change in pressure aggravated me so I changed from BiPap back to CPAP. Tried AUTO, but my numbers weren't as good as with straight CPAP. Whatever works best for you and is the most comfortable is what I'd use be it CPAP, BiPAP, or AUTO. You're the one who knows best how you slept and how you feel during the day, and how your AI and AHI are. Good luck.

[pratzert]

Using the auto feature is fine, but, don't set the min/max too far apart. Set the min 2 lower than your ave and the max 2 higher than your ave. If you have the settings at 4 min 20 max...your doctor may be right. It would take too long for the machine to adjust to your apneas.

LSAT,

I have it set to 2 above and two above. My original titrated pre4ssure was 10 and I set it at 8-12. The majority of the time my pressure maintained 10 even with the APAP settings.

I had another titration at the beginning of the year and this time it was 14. I was shocked at how big of an increase there was in the pressure and I suspected something was wrong. Maybe I was the problem as I went into the study with a cold and was stuffed up. I guess that was a bad move. But the Tech at the last stuidy also insisted I try a FFM instead of the nsasal type I had always used. It leaked terribly. Her solution to stop the leaks was to tighten the straps so much my face looked disfigured. I'm sure that affected my study as well.

Anyway..... I went adjusted my machine to a straight CPAP at 14 and did not have a very good sleep for a week so I tried puttin git back to APAP at my original 8-12 and my stats showed I have been pretty consistantly at 11cm and NOT the 14 I was supposedly titrated at.

I guess I try setting the machine at a CPAP pressure of 11 and hope for the best since that is what Encore has shown my pressure to be.

With machine in APAP mode with a setting of 8-12 my AHI's have been an average of 1.8.... not bad.

As I said, that is one advantage of using the APAP is it will give some indication of the pressure the machine feels will help stop the apenea events.

Problem is... I still feel very tired and not wonder if therfe is some other problem affecting my "quality" of sleep.

[pratzert]

I believe the traditional optimum care for OSA is CPAP. The studies involving treatment usually involve CPAP because titration has been done in the sleep lab.

The idea of adjustable pressure is somewhat new, and less proven.

In my case my numbers are better with CPAP, so I use that. Every couple of months I switch over to APAP to check my pressure, but afterward I go back to CPAP.

Thanks for the input. I guess it woul dbe good to check my stats after using straight C PAP for a week and compare it to what the APAP has been.

The APAP setting have given me an AHI average of 1.8.

[pratzert]

I think a lot of people have bought too much into the APAP camp. Just set the machine at 4-20 pressure and you're done. Some of us think this leaves you on the edge of apnea all night long.

I'm more in the camp that you figure your best pressure and then go auto. i.e. You need 10 with the traditional titration/manual CPAP. Set your machine at APAP of 10-20 and check the results periodically to see if you're autoing up. Maybe lower your pressure occasionally and see if you really need 10, but don't go for days and weeks at a time with a pressure low enough that your machine needs to auto up during the night.

Many suggest APAP setting of 2 above and 2 below your titrated pressure and that is what I have been doing.

I wonder if I would do any different with a minimum setting exactly at my titrated pressure and then 2 or more above that pressure ?

[jimnsc]

I prefer APAP and my Rx is 9cm H2O. My doc allowed the change because I apparently impressed him with what I had learned on my first visit to him and expressed what my goals were. After a month of experimenting (because I'm impatient) I have settled on 8.5 low and 12 high and plan to lower the top # more as I've been cruising around 8.5 the majority of the nights lately. I am now consistently in acceptable range with my AHI's - best being 0.6 so far.

I can't stop there without expressing my belief that your interface is key! I'm using the Mirage FX, which has proven to be relatively leak-free for me. If you haven't settled on a good interface that works for you, I wouldn't change my pressures around much at all. In no case would I set them at 4 and 20. JMO

Different strokes for different folks

[pratzert]

I prefer APAP and my Rx is 9cm H2O. My doc allowed the change because I apparently impressed him with what I had learned on my first visit to him and expressed what my goals were. After a month of experimenting (because I'm impatient) I have settled on 8.5 low and 12 high and plan to lower the top # more as I've been cruising around 8.5 the majority of the nights lately. I am now consistently in acceptable range with my AHI's - best being 0.6 so far.

I can't stop there without expressing my belief that your interface is key! I'm using the Mirage FX, which has proven to be relatively leak-free for me. If you haven't settled on a good interface that works for you, I wouldn't change my pressures around much at all. In no case would I set them at 4 and 20. JMO

Different strokes for different folks

jimnsc,

Thanks for the info. I can understand not letting the bottom get any more than a couple cm below your titrated pressure.

I don't see what harm is done by having a high/higher Top end pressure .

I have been using the Mirage Activa nasal mask and have been overall very happy with it.

But when my last study showed a new pre4ssure of 14, the Tech and Doc almost insisted I needed a FFM at that pressure.

So I gave the Quatrro FFM a try and had a horrible time with it. Part of my newly found disdain for tha mask was the bad fitting that Crapria gave me. AFter I ended up getting the corret size, I still experienced too many leaks to be able to use the mask and went back to old reliable. The EncorePro stat indicated my pressure was NOT 14, but has been pretty much steady at 11. I think I would like to try some other FFM to find one that works for me, but it is just such torture to deal with Crapria that I shiver at the thought of having to go to their office again.

[Slartybartfast]

Many suggest APAP setting of 2 above and 2 below your titrated pressure and that is what I have been doing.

I wonder if I would do any different with a minimum setting exactly at my titrated pressure and then 2 or more above that pressure ?

No, that negates the advantage of the APAP. If you do that, you might as well run in straight CPAP mode. The advantage of APAP is to provide effective therapy at a lover overall pressure; providing higher pressure only when its needed.

Your titrated pressure determined at the sleep lab is the pressure at which all, or virtually all, of your obstructive events ceased to occur. It's sort of a worst-case pressure. However, for most of us, our obstructive events occur most frequently during periods of REM sleep, which happen appx. 4 times each night. During the non-REM periods of sleep, when obstructive events tend to occur less frequently, the pressure can be decreased without causing the airway to collapse entirely. Less pressure means better sleep. So if you can breathe well during times when higher pressure is not needed, that's an advantage. However not everyone responds the same way. You really should try it both ways and see what the numbers say, and check how you feel the next day and make your own decision about what to do.

The best advice I can offer is the same as others have advised you. Set the minimum pressure about 2 cm below your titrated pressure and the maximum pressure either a couple cm above your titrated pressure, or just don't set an upper pressure limit. I've never had my machine run away with me, and left open like that, the maximum pressure has never exceeded 2 cm over my titrated pressure, anyway.

[Pugsy]

I wonder if I would do any different with a minimum setting exactly at my titrated pressure and then 2 or more above that pressure ?

You could do this that you mention. You could also give straight CPAP a trial.
Won't know if it makes any difference till you try.

I use APAP and it suits my needs. Pressure changes have never bothered me though. Sometimes I do have events in REM sleep where my pressure has to increase dramatically. Sometimes I have nights where it doesn't increase at all.

In all honesty, what works for me or the next person may be entirely different from what works for you. I do think that if a person uses APAP that the minimum pressure is the most critical and sometimes just a tiny bit of change can make a world of difference. In my case I found at even a drop of 1 cm from 10 to 9 cm minimum pretty much doubles my AHI. While still technically okay with AHI of around 4 I see clusters of events which are probably in REM (I am documented much worse in REM) , when I use 10 cm minimum that AHI gets cut to less than 2 and often now less than one and I do feel that slight difference and only have rare events and no clusters. I do leave the max wide open for those nights when I do seem to need much higher pressures and it isn't because of leaks. Again, it suits my needs and I understand what is going on. If your pressure never raises much, in all honesty it doesn't make any difference what that maximum might be because the machine never goes there. But some people are sensitive to the slightest variations in pressure so it would make sense to limit those variations as much as possible.

Nice thing about APAP is that you can still use CPAP if you want to try. You can even mimic cpap with a very tight range.

Finally if you still don't "feel" the "good numbers" no matter what you use, sometimes we just have to sit back and take a hard look at the other things that can affect our restorative sleep. Fragmented sleep for any reason, even with the best of numbers will surely give us a crappy day. Hours of sleep. There are any number of other reasons that can impact how we feel that may not even be related to OSA and cpap.

[LinkC]

I wonder if I would do any different with a minimum setting exactly at my titrated pressure and then 2 or more above that pressure ?

I was going to respond, but slartybart nailed it. The key advantage to APAP is it allows you to use a lower pressure for most of the night, rising ONLY to head off apneas that require more than that. (The key disadvantage is it can miss events that CPAP would not have allowed.)

I get the best results with CPAP at my 90% pressure and the higher pressure doesn't bother me. I switch to APAP for a week every 6 months or so to insure my 90% has not changed. My numbers are usually slightly worse for that week.