APAP disadvantages?

I have severe sleep apnea and have been using a CPAP machine for 8 years now with a constant setting of 10 and ramp of 4 to 10 to get to sleep and am looking to upgrade my old machine. I went to visit the local Sleepmed business a few weeks ago and picked out a new full face mask, and the technician also told me some of the advantages of APAP over regular CPAP, and he himself uses an APAP machine. He recommended the Respironics M series Auto CPAP machine ($600 but my insurance covers half) and showed me how the data printouts can help determine periods of apnea episodes and sleep architecture. I became excited to get one, contacted my doctor to ask for a prescription for one but was warned against it. The doctor had recommended I get a Respironics C-flex Pro CPAP machine said that the changes in pressure from APAP can wake you up at night, the machine costs more than a regular CPAP machine, and the results in terms of mortality rates were the same for APAP versus CPAP. I was not led to believe that APAP was something desirable nor that the doctor would prescribe one for me.

Yet, I read often on this forum how APAP is preferable for many, how it can be used like a regular CPAP machine if desired, and how it allows one to sleep easier because it uses less pressure when it can, and adjusts to the level of apnea events occurring. These advantages plus the testimonials of APAP users make it seem desirable.

Thus, I would like input on what others feel about APAP versus CPAP and whether the points raised by the doctor are valid. Thanks very much.

I have used Cpap for 5 and a half years and just barely got a Apap machine and I can tell you that my therapy is soooooooooooo much better. I don't think the pressure change complaint is valid because it changes its pressure due to your apnea events. so you are either going to wake up because you are not breathing, or you are going to wake up because it changed the pressure on you.. but for me, I don't feel like it disturbs me. When I look at my detailed wave form reports from before apap and after I started, it looks like my breathing returns to normal much quicker after an event than it did before.

I don't know. its a matter of preference, but I cant help but be a little skeptical that your doctor doesn't have his own best interest in mind.. or perhaps he is just not informed as to what the technology is capable of.


Also, please know that while the M series is a good machine, its been discontinued and I would recommend either a Respironics PR System One Auto, or a ResMed S9 Elite Auto since they are the current models and offer much better therapy and reports in my opinion.

You are right in that an apap machine can be set to cpap or apap. If you have a cpap prescription, you do not need one for an apap on cpap.com. The PR system one auto is only a little more than the price you were quoted for the Respironics M series, newer and better from what I have read here. I am not sure re: your insurance covering it however. The Resmed S9 costs more but is a great machine as well as Blakepro has said.

It sounds like your doctor might not know what he's talking about or he's not wanting you to judge his decision about a CPAP.

I've never had my APAP wake me up vs when I have it set on CPAP. The only disadvantages of APAP is that it will increase your pressure. Why is that a disadvantage? It's actually an advantage really, because if you were titrated at 10cm and you have an Apnea at 11cm, then it can ramp up even further and increase the pressure to cover the 11cm Apnea. The downside however to this is that it is more pressure and some people can't handle the increase in pressure. That said, most of the time we only see a 1cm-2cm increase so it's not a massive increase, but it depends on what your baseline / minimum pressure is set to.

Personally I would go for the APAP because you have the ability to switch it back into CPAP mode if you want, so you get the best of both worlds. The APAP will help reduce Apneas even more, but sometimes Central Apneas can be induced by pressure increases and this might be what your doctor is hinting at without actually telling you about it.

Thanks
Dave

Began CPAP therapy Aug '07 with a data-less CPAP, a few hitches but did fairly well with slow recovery with a pillow mask.

Jan-Feb '09 have lost 45-50#s, becoming increasingly intolerant of pressure with sore ribcage, backsliding into apnea tho I didn't recognize it until joining here -- the joys of no data .

June '09 Sleep doc confirms losing therapy air (can't maintain seal in back of mouth) so gotta get FFM, do an APAP loaner -- gosh, best sleep since beginning CPAP therapy. Ongoing daytime sleepiness is really scary when driving. Get Hybrid mask in July...working well, no more lost therapy air! Doc & I begin request (battle) to get an APAP...insurance denies (medical rationing at its finest ).

Nov '09 I buy APAP and begin wonderful sleep. I have a lot of recovery to make up and it slowly begins. My 95thcentile is all over the place showing little leak, so my variable-volatile congestion is indeed my biggest CPAP therapy challenge. I sleep much much better with the APAP and the Hybrid lets me mouth breathe when necessary. I even slept on my back once with nary an increase in events...pressure up just a bit tho.

APAP rocks in my world! Your results may vary

PS There is a lot of difference between the ResMed and Respironics algorithms. One or the other will be ideal for you...tho I must say with the new S9, no one's posted yet on the difference other than initial reports here from users of both mfg's APAPs is that the S9 delivers better therapy with lower numbers.

Hi Paultool

I have been using a CPAP for almost 4 months. I noticed my AHI was changing all the time (the most when I traveled) and in the last weeks it was increasing enough to make me be tired.

My apnea is very positional, an APAP is the best for taking care of that with less aerophagia.

You are probably being offered a good price on the M Series Auto BECAUSE the S9s are out and the S9 would be considerably more expensive. I'm assuming we are talking local DME provider prices, not cpap.com prices.

Your sleep doctor is either clueless about the APAPs (which would NOT be surprising since that isn't their "field" or at least they don't consider it their "field", OR he is being "less than truthful w/you" for whatever reason I can't begin to fathom. Ignore his advice, get the APAP. It can be set in straight CPAP mode to satisfy his ignorance.

And now, for something completely different...

APAP has a built-in disadvantage in that it adjusts the pressure in response to events. It starts out at the minimum setting. When (not if!) an apnea event is imminent, it steps up. That step may or may not be enough to quash the apnea. It may take 2, 3 or more events before the APAP reaches an effective level. Then guess what? After a period of no events, it starts dropping back down until events begin again.

It's a bit like a thermostat that responds to your body shivering or sweating. The average room temp is just right, but you spend half the night either too cold or too warm.

On the other hand, CPAP at your 90 or 95% pressure doesn't cause or require events to do its job. Yes, it may be slightly overkill at times when you don't need as much pressure, but so what? It's not purposely allowing apneas as a "test" for the proper pressure at any given moment.

The best results FOR ME are achieved by running CPAP at my 90% most of the time, with a week or so every 6 months on APAP just to make sure my 90% hasn't changed.

Yes, doctors disagree on which is preferable. That doesn't make them ignorant. CPAP works better for some patients, APAP for others. I'd recommend trying both and comparing the numbers YOU get. I'm not saying APAP will kill you. At least not right away...

What are your thoughts on runing Apap min pressure at your 90-95% and setting your max a few notches above it to account for various changes. Seems like that might give the best of both worlds with what LinkC is saying.

Many, many times have we seen someone come here with a prescription for APAP set at pressure range 5 to 20cm. Now that is when you can say APAP does not work well!

I do not agree with your doctor's comments about APAP. My experience also seems to vary a bit from some others on this forum. No one size fits all in PAP treatment, so I am conveying my personal experience.

My pressure on APAP usually has been lower than the prescribed CPAP setting but occasionally is higher. I have not had any side effects of APAP treatment that were particularly negative. However, if you get a machine with APAP capability, you can switch back to CPAP without changing machines.

I switched from CPAP to APAP after a month and LOVE APAP. My CPAP pressure was 13 cm with a ramp of 4. The problem I had was that at 13 cm, I couldn't sync my breathing with the CPAP and I felt like I truly had a vacuum cleaner hose attached to my nose that was running at way too high a speed.

APAP adjusts to meet your needs at any given time, which in my case seem to vary widely from night to night. The sleep specialist recommended a range of 5-15 cm. If I check the readout before turning off the machine after sleeping, I can see the pressure. When I have been breathing comfortably with the machine, the pressure has ranged from 8 cm to 15 cm, sometimes even as low as 6 cm. I was surprised that a comfortable pressure sometimes is higher than 13, since I had such problems at 13.

I have never woken up due to a change in pressure, as far as I know. My sleep is more comfortable because of the automatic pressure changes that occur based on my needs at any given time.

I cannot imagine going back to CPAP with one pressure setting. The most sleep I ever got using a CPAP setting was 4 hours and I felt like I had been tortured most of that time. I have been able to sleep with the APAP machine for 11+ hours sometimes. I have never had the overpowering "vacuum cleaner blower" effect that I had on CPAP. I used CPAP for about a month and have used APAP for about 2 months now.

Whatever works for you, though, is what is important. I have two doctors who seem knowledgeable about CPAP machines and both preferred APAP based on my sleep study and experience with the machine at home.

If you get a machine with APAP capability, you have the flexibilty to use either APAP or CPAP. Also, some people who use it for CPAP use the machine for a home titration over a limited period using APAP when CPAP presssure does not seem to be working, then return to CPAP.

I have been very happy with the PR System One APAP machine I have. It is very quiet and easy to use. The newest APAP-capable machine is the S9, which many users here like very much. Be sure your doctor prescribes a data capable machine so you can be in control of your own treatment and see on a regular basis the AHI, leak rate, etc. of your machine. Both the System One and S9 are data capable. There is a discussion on this forum by people who have used both that should be informative:
viewtopic/t50624/Anyone-here-tried-BOTH ... -Auto.html

Insurance companies typically allow replacement of a CPAP/APAP machine every 3 to 6 years, depending on the company and policy, so try to get the newest, most data capapble machine possible as you will likely be unable to get another machine using insurance for a number of years.

If the doctor you are dealing with cannot be convinced to change the prescription to an APAP and data-capable machine, my experience with my DME has been that the prescription does not have to be written by a sleep specialist, but by any M.D. who treats your sleep disorder, including a primary care doctor.

Best of luck!!

roster wrote:Many, many times have we seen someone come here with a prescription for APAP set at pressure range 5 to 20cm. Now that is when you can say APAP does not work well!

Yep... when the range is set so large, it will take a long time to get to your needed pressure like LinkC suggests. But when the range is set more narrowly (e.g., I use 9-13), you will have a better experience in getting the pressure you need when you need it. Looking at my S9 pressure graphs, it appears to me that it is responding more aggressively (increasing the pressure more quickly) than my S8 did... I suspect this also varies between the brands and models. Bottom line is that an APAP machine can run in CPAP mode, so there is really no disadvantage to getting an APAP machine... you can try both modes and see what works best for you.

paultool wrote:I have severe sleep apnea and have been using a CPAP machine for 8 years now with a constant setting of 10 and ramp of 4 to 10 to get to sleep and am looking to upgrade my old machine. I went to visit the local Sleepmed business a few weeks ago and picked out a new full face mask, and the technician also told me some of the advantages of APAP over regular CPAP, and he himself uses an APAP machine. He recommended the Respironics M series Auto CPAP machine ($600 but my insurance covers half) and showed me how the data printouts can help determine periods of apnea episodes and sleep architecture. I became excited to get one, contacted my doctor to ask for a prescription for one but was warned against it. The doctor had recommended I get a Respironics C-flex Pro CPAP machine said that the changes in pressure from APAP can wake you up at night, the machine costs more than a regular CPAP machine, and the results in terms of mortality rates were the same for APAP versus CPAP. I was not led to believe that APAP was something desirable nor that the doctor would prescribe one for me.

Yet, I read often on this forum how APAP is preferable for many, how it can be used like a regular CPAP machine if desired, and how it allows one to sleep easier because it uses less pressure when it can, and adjusts to the level of apnea events occurring. These advantages plus the testimonials of APAP users make it seem desirable.

Thus, I would like input on what others feel about APAP versus CPAP and whether the points raised by the doctor are valid. Thanks very much.

I agree with your doctor.......to a point.
And, I agree with LinkC's post.
For many of us, the changing pressures during the night CAN disturb our sleep and make us feel less rested. I've seen this happen numerous times on the forum where someone has an APAP running in a range of pressures for months.....and feeling unrested......then, after being convinced to try a straight pressure setting, they finally wake up with that "WOW" sensation of having a night of good rested sleep.
I'm in the category of those, when using a range of pressures, it disturbs my sleep. I have all of mine set to CPAP mode.

HOWEVER....... I don't begrudge anyone from wanting or having an APAP. It's THEIR therapy and it's THEIR money. If they want to own and use an APAP in a range of pressures or in a single pressure, they should be able to have the ability to try to determine which mode works best for them. I (very) strongly recommend that APAP users have the software to interpret their nightly data. Without it, it's like flying blind.


Den

Wulfman, have you ever tried Apap with a very narrow min / max window? I'm curious if it would make you feel better than straight cpap. I'm talking a range of like 1 number or even a half number apart. Just giving your machine just a TINY bit of wiggle room to help when it sensed a problem. I would also be curious if such a small deviation would be something that disturbs your sleep or not.

blakepro wrote:Wulfman, have you ever tried Apap with a very narrow min / max window? I'm curious if it would make you feel better than straight cpap. I'm talking a range of like 1 number or even a half number apart. Just giving your machine just a TINY bit of wiggle room to help when it sensed a problem. I would also be curious if such a small deviation would be something that disturbs your sleep or not.

Sure. And by the time the range gets that narrow, it's silly to even use a range.......just pick a pressure and let 'er ride.
I've always set my minimum pressure to where my normal CPAP pressure has been. Any lower than that and there are more events. I wake up frequently and have typically had higher AHI numbers when using a range of pressures, too.
The only time I'll set one to a range anymore is when I'm deliberately going to take a nap......which isn't often.


Den