Auto Cpap vs fixed pressure

Those of you that have used both, which do you prefer and why? Does the auto change throughout the night? I've only used fixed.

We don't sleep the same each night.
Some people need more pressure when they are on their backs or in REM sleep. For some people the difference in what they need is quite remarkable. My OSA is worse in REM (which is very common) and in REM I might need 6 to 8 cm more pressure to keep the airway open.
REM normally amounts to about 20% of the night. If I were to use a fixed pressure machine I would have to use 6 to 8 cm pressure all night long just to deal with that 20% of the night stuff. It's doable but not much fun. It would mean using something like 15 to 18 cm all night long instead of my usual 8 to 10 cm that I use for 80% of the night. That simply isn't going to happen. That's a big difference and not comfortable at all.

Auto/apap machines can be used in cpap fixed mode should a person decide that works best for them but a cpap fixed only machine can't do auto adjusting should a person be like me and need different pressures during the night.
It's all about options...better to have something and not need it than need it and not have it.

I use auto adjusting mode and let the machine go up only when it needs to go up and the rest of the night I use a lower pressure...and I sleep through all of it.

I have yet to see a compelling reason as to why one would want Fixed (CPAP) over Auto (APAP).

APAP monitors your needs current needs through out the night and night by night, and delivers the pressure needed at the time.

Possible reasons our needs change:

• Sleeping position (back vs side)
• Sleep stage (for many REM, requires more pressure)
• Alcohol use
• Recreation drug use
• Prescription drug use
• Illness
• Weight gain/loss
• and more....

APAP will adjust to our changing needs.

To be more specific, lets assume Apnea sufferer (we'll caller her Shitzy, because she loves Shih tzus) requires pressures about 12 cm when in most sleep stages, but requires pressures about 17 cm while in REM.

If Shitzy sets her pressure to 12, pressure will clearly be inadequate to address her Apneas while in REM. If she sets her pressure to 17, for most of the night she is has to tolerate pressure considerably higher than she needs. If Shitzy finds a compromise, say about 14 than she is using more pressure than she needs most of the night, and not supplying enough pressure while in REM.

Shitzy will be grumpy.

However with APAP, she sets her minimum to 12, her pressure addresses her apneas without overwhelming her with too much pressure, as she enters REM, her pressure increases to about 17 and addresses her increased need.

Shitzy will be in a much better mood.

Be like Shitzy, use APAP.

Hi,
Good elaborations Pugsy and Dog Slober. It my case, treating my UARS for some 6 months, now pretty much worked out everything, BPAP, may be different. However, some 1 month i suddenly found out would much better set a fixed IPAPmax (=EPAPmin+PS, no bit more). That simply because auto bumps/leaks in pressure, particularly associated with false obstructions following awakenings, and preventing me from quickly get back to sleep, appears to be much more deleterious than eventual absence of pressure somewhere somereason. What would be important, maybe, is to fine tuning an ultimate EPAPmin and PS that bring an optimum How you feel. You know, we UARS people, are too hypensensitive. Still experiencing on this, but Very happy thus far.
Good luck.

...forgot this, even more important: majority of my awakenings follows Unflagged RERA's of some sort, so that machine does not increase pressure where it should do, whereas increase where It should not, where I don't need it.
gl

Pugsy wrote: ↑

Wed Oct 30, 2019 7:54 am

We don't sleep the same each night.

We don't even sleep the same during the night.

CyclonePap wrote: ↑

Wed Oct 30, 2019 7:01 am

Those of you that have used both, which do you prefer and why?

Auto, 100%
I started out with a fixed pressure machine, I was fine for a while, then I noticed I wasn't feeling as good anymore, tired, etc. I looked at the data, which I hadn't done for a while.. (stupid, since if you're on a fixed cpap, you NEED to monitor your data, things change, it won't) and my AHI had been getting steadily worse for the last month.
I immediately started looking for an auto machine, one that would respond to my changing needs. Best sleep decision I ever made.

CyclonePap wrote: ↑

Wed Oct 30, 2019 7:01 am

Does the auto change throughout the night? I've only used fixed.

From a thread on the front page, look at the pressure line:
viewtopic/t177401/Brand-new--looking-fo ... ttips.html

I have to ask... do people just not ever look at any of the other posts on the forum?

CyclonePap wrote: ↑

Wed Oct 30, 2019 7:01 am

Does the auto change throughout the night? I've only used fixed.

From a thread on the front page, look at the pressure line:
viewtopic/t177401/Brand-new--looking-fo ... ttips.html

I have to ask... do people just not ever look at any of the other posts on the forum?
[/quote]

Wait, there is more than 1 thread?

Thumper68 wrote: ↑

Wed Oct 30, 2019 5:04 pm

CyclonePap wrote: ↑

Wed Oct 30, 2019 7:01 am

Does the auto change throughout the night? I've only used fixed.

From a thread on the front page, look at the pressure line:
viewtopic/t177401/Brand-new--looking-fo ... ttips.html

I have to ask... do people just not ever look at any of the other posts on the forum?

Wait, there is more than 1 thread?
[/quote]

wait, reading someone else's problems and solutions may help ME!?!?!?

zonker wrote: ↑

Wed Oct 30, 2019 8:02 pm

palerider wrote:

Thumper68 wrote: ↑

Wed Oct 30, 2019 5:04 pm

CyclonePap wrote: ↑

Wed Oct 30, 2019 7:01 am

Does the auto change throughout the night? I've only used fixed.

From a thread on the front page, look at the pressure line:
viewtopic/t177401/Brand-new--looking-fo ... ttips.html

I have to ask... do people just not ever look at any of the other posts on the forum?

Wait, there is more than 1 thread?

wait, reading someone else's problems and solutions may help ME!?!?!?

Apparently not.. seems to be a radical concept.

I have a few different reasons why the auto really helps me.

One, I need higher pressure when I am on my back. So, my minimum pressure is 11, and that does well most of the night. I will havea few spikes to 15, and on rare occasions, a spike or two close to 17. So, it does well most of the night at the lower pressure.

Two, and this one is really big for me. As the pressure goes up (while I am on my back), my cheeks start to inflate a little, which will start to bother me, and I turn back onto my side. So, the increased pressure actually helps me go back onto my side with very little disturbance. Without cpap, I would probably sleep much more on my back, but the cpap helps me stay on my side.

And other reasons. If I take a muscle relaxer, I may need more pressure. If I have a cold or my asthma is acting up, I may need more pressure. The auto takes care of it. My ahi isn't any higher, but a look at the pressure data shows that the machine worked a bit harder for me. The only time I have to change my settings is if I have a bad cough. Then I need to bump the minimum up to 13 so that I don't feel short on air during a coughing spasm. Once the cough is gone, I can lower it back to 11, and I am fine.

I switched from Auto to fixed.

When I was in Auto, the machine would typically adjust me to around the 15CmH2o mark and pretty much sit there all night. Every once in awhile, it would want to take me to 16 or just over. But I found a pattern of pretty bad aerophagia every time the machine was at 16 or higher. My starting pressure kept creeping up until it was at 14 (I don't use ramp or EPR). I was looking at it one day and figured that starting out at 14 and limiting the top to 16 (to avoid aerophagia) was not much of an adjustment at all. And since the machine normally liked to chug all night at about the 15 mark, I just changed to fixed mode of 15CmH2o. I still get a bit of aerophagia, but not bad enough to wake me -- I just realize it when I wake up burpy in the morning.

So this means that there will be an occasional instance where the machine would otherwise want to raise the pressure had I left it on auto. But the Aerophagia was bad enough that I'm happy to make that trade. My AHI is still acceptable and I'm still sleeping better than I would without a machine at all. But to be sure, if I could figure out how to stop the aerophagia, I'd go back to auto with a minimum at 14-ish and a max as high as the machine can go.

-JD

JayDee wrote: ↑

Thu Oct 31, 2019 6:26 am

I switched from Auto to fixed.

My AHI is still acceptable and I'm still sleeping better than I would without a machine at all. But to be sure, if I could figure out how to stop the aerophagia, I'd go back to auto with a minimum at 14-ish and a max as high as the machine can go.

-JD

Hi, JD
a curiosity...what would be your AHI about? only OSA? do you have FL/RERA's (flagged and unflagged), with Max column > 0,10?
good luck

@JayDee, why do you have EPR off? FWIW, my fiancée found that EPR helped her aerophagia quite a bit. We are still working on nudging her max pressure up slowly to get her into the range she needs, but EPR was a big step forward. I don’t have a big problem with aerophagia; I use pressure support for other reasons, but I have a little trouble with it at 0 also.

Others here are more qualified than me to advise you, should you decide to post Oscar data, but it seems to me like you probably have better options available.

mper!? wrote: ↑

Fri Nov 01, 2019 4:28 am

Hi, JD
a curiosity...what would be your AHI about? only OSA? do you have FL/RERA's (flagged and unflagged), with Max column > 0,10?
good luck

Usually, my AHI is 1-something or less. There will be an occasional night where it will reach 3 to 4 something. The machine wil register all types of events, but as with most, when you start looking at the actual events, you see they are either sleep/wake junk, incident to a large leak, or a registered event when the graph shows absolutely nothing going on and you wonder why it flagged an event. So, I tend to take the AHI and the registered events with a fairly ample-sized grain of salt. Now, that being said, I only fire up Oscar when I have some reason to be curious about a night and I haven't done that in awhile -- I've reached a comfort level where I'm sleeping good and I feel good during the day. My personal concern for my OSA has dropped down the priority list as I feel fairly confident PAP therapy has it under control. Nowadays, my biggest sleep issue is back-pain and there's not much that can be done about it but learn to tolerate it. Not bad enough for surgery, bad enough to be a constant aggravation.

-JD