CPAP vs. APAP

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CPAP vs. APAP

Postby LoriForbes » Sun Jul 30, 2006 1:08 pm

I was wondering if anyone could help me explain something to my son. He just had his sleep study last night, and they came in during the night and fitted him with a full face mask. They wouldn't tell him much, but they did tell him he spent more time not breathing than he did breathing.

He did some research beforehand and has said that he wants an APAP, not a CPAP. I was looking around on here trying to find some info about this but couldn't really find any comparative info. I do know the difference in the machines -- what I want to know is why and APAP wouldn't necessarily be good for everyone.

I was just diagnosed a month and a half ago, and when I started describing the symptoms, etc., to my son, he decided to go in as well. Obviously he has the same thing! We have many of the same physical issues and also look like clones except for the obvious difference (gender!!).

Of course, I gave him the link to this site since it has been a real life-saver for me and since the people here are so incredibly kind and helpful. In fact, I found this forum first and haven't even looked for others -- everything I need is here! :)

But anyway ... any help with the question above would be most appreciated!
Began CPAP Therapy 6/15/2006
Respironics Remstar Pro M Series with
Heated Humidifier, Ramping Feature, and C-Flex
Weinmann Somno Plus mask
61.5 events/hour / Pressure setting: 13 cm
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Re: CPAP vs. APAP

Postby Daniel » Sun Jul 30, 2006 7:40 pm

LoriForbes wrote:I was wondering if anyone could help me explain something to my son. He just had his sleep study last night, and they came in during the night and fitted him with a full face mask. They wouldn't tell him much, but they did tell him he spent more time not breathing than he did breathing.

He did some research beforehand and has said that he wants an APAP, not a CPAP. I was looking around on here trying to find some info about this but couldn't really find any comparative info. I do know the difference in the machines -- what I want to know is why and APAP wouldn't necessarily be good for everyone.

I was just diagnosed a month and a half ago, and when I started describing the symptoms, etc., to my son, he decided to go in as well. Obviously he has the same thing! We have many of the same physical issues and also look like clones except for the obvious difference (gender!!).

Of course, I gave him the link to this site since it has been a real life-saver for me and since the people here are so incredibly kind and helpful. In fact, I found this forum first and haven't even looked for others -- everything I need is here! :)

But anyway ... any help with the question above would be most appreciated!


Did he say why he wanted an APAP ?

APAP, works on an algorithim which attempts to spot an apnoea event in advance (or mid event) and deliver sufficient air to clear it. There are two algorithims in operation, one developed by Respironics and one by ResMed............each company maintaining that theirs is the correct one. I believe (subject to correction) that one algorithim works on air flow and the other works on breathing disruptions. Unfortunately these two algorithims are the industry standards and there does not appear to have been any changes in them over the years.

CPAP just delivers air at a constant pressure, thereby splinting the airway open continuously, while APAP delivers sufficient air to clear individual events, so the air pressure fluctuates.

A good number (some say the majority.........can't verify) of sleep specialists are unhappy to prescribe APAP, the main reason being that it does not clear all events for some patients. There are cases (some posted here) where maybe someone with severe OSA, with an AHI of say 50/60, using APAP, have found that they are left with an AHI of 11/14 while using APAP...........that means that they still have mild apnoea, and may suffer from some symptoms.

First port of call is usually straight cpap, and I believe it is the most effective treatment. APAP has proven to be a big help in helping compliance, but I think it important to monitor progress closely if using it (to ensure that all events are cleared. This can be done via a data card and suitable software. He might consider cflex(Respironics) (or ResMed equivalent) which would give exhalation relief.

It's very much an open arguement. I think personal choice is more likely to help him become compliant........if he needs PAP.

Kind regards,


Daniel.
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Re: CPAP vs. APAP

Postby LoriForbes » Mon Jul 31, 2006 12:07 pm

Daniel wrote:Did he say why he wanted an APAP ?


Daniel,

Thank you so much for your answer, which is extremely helpful.

Ian (my son) said the reason he wanted an APAP is that according to what he has read, it treats the events as they happen, which seems to him to be better than the CPAP. He didn't put it exactly like that, but the gist of the matter was that he felt after doing some reading that the APAP was in general a better way to treat the condition. (I do wonder, though, if the info he read was on a manufacturer's web site.)

I suspect that he will have a high AHI. I say this because I have heard him when he's asleep, and also because he and I seem to have the same physical ailments and mine AHI was 61.5. But of course that's just my guess -- the actual number could be far from that!

Your reply will be extremely helpful to him as he continues his research. Thank you very much. I always enjoy your well-thought-out responses.
Began CPAP Therapy 6/15/2006
Respironics Remstar Pro M Series with
Heated Humidifier, Ramping Feature, and C-Flex
Weinmann Somno Plus mask
61.5 events/hour / Pressure setting: 13 cm
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Re: CPAP vs. APAP

Postby OhTwo » Tue Aug 01, 2006 2:57 pm

LoriForbes wrote:according to what he has read, it treats the events as they happen, which seems to him to be better than the CPAP. He didn't put it exactly like that, but the gist of the matter was that he felt after doing some reading that the APAP was in general a better way to treat the condition. (I do wonder, though, if the info he read was on a manufacturer's web site.)


You may want to mention to him that yes, APAP treats events AS they happen, but CPAP treats non-events BEFORE they happen, actually before they ever BECOME events! =) APAP can miss fast-onset apneas because it can't respond fast enough... but that depends how the APAP is set up:

1. Traditional range setup (starting value is below patient's titrated CPAP pressure, ending value is above it). This may miss fast-onset apneas because it can't react fast enough. CPAP may be superior because it preempts these. This range setup is used when people dislike the CPAP's constant high pressure. It provides lower average pressure, but misses some apneas. However, if the patient CAN tolerate his prescribed CPAP pressure, we can do this alternate range setup:

2. CPAP-or-better range setup (starting value is patient's titrated CPAP pressure, ending value is above it). This preempts fast-onset apneas just as well as CPAP would, because the minimum pressure it uses is the patient's titrated CPAP pressure. However, if the patient temporarily needs more pressure during the night for some relatively rare position or other circumstance (congestion, swelling, etc.) then unlike CPAP the machine can punch up the pressure to handle those more demanding events.

Personally, given that I don't mind my titrated CPAP pressure at all (at least when I have C-Flex), I'm considering buying an APAP and setting the range to #2 above. This would give all the benefits of CPAP, plus more.

Personally I would NOT, however, do #1 above. Letting the machine drop below my titrated CPAP pressure is pointless (since I don't mind that pressure!) and may allow fast-onset apneas to slip through.

Just some things to think about. I'm almost sure I'm buying an APAP for use with strategy #2 very soon.
"Start with the things that you know, and the unknown will be revealed to you." --- Rembrandt
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Postby MelindaR » Tue Aug 01, 2006 3:14 pm

Lori,

I think if your son feels he'd do better on APAP, then that's what he should get. The great thing with an APAP is that it CAN be set to work at a straight pressure. Also, he'll be able to monitor his treatment if he'd like to. Now not that I'm saying CPAP won't work great as it does for many people. For me, I did start out with a CPAP, however, it didn't work for me.

I have severe osa and started out with a CPAP titrated to 14. I found I was still exhausted, so it was upped to 16. Still exhausted, so I asked for an APAP. I received my APAP and it was set at 12 - 17 (two below my original titrated pressure). After three months of being exhausted, I upped it to 13 - 17. After another month of find myself tired, I increased it to the current 14 - 17. I found this to work well for me. In other words, CPAP didn't work but my APAP is working very well. My apneas fluctuate from night to night based on how exhausted I am, sleeping position, how many times I'm awoken from my boyfriend moving around, etc. I do have software and keep track on my stats and have found I have never stayed at just the starting number. Also, my apneas and hypopneas are in the "normal" range so this makes me very happy.

Best of luck with your treatment, as well as your sons.

Melinda
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Postby OhTwo » Tue Aug 01, 2006 3:21 pm

MelindaR wrote:[I] started out with a CPAP titrated to 14. [...] I increased it to the current 14 - 17. I found this to work well for me.

You're doing exactly what I mentioned in approach #2 above (see my last post), it can be considered a sort of "CPAP-Plus". Hey, glad to hear it's working well for you, because it's exactly what I intend to do! Thanks for the datapoint!
"Start with the things that you know, and the unknown will be revealed to you." --- Rembrandt
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Thank you

Postby LoriForbes » Tue Aug 01, 2006 4:09 pm

Thanks very much, 02 and Melinda. This info will be very helpful for my son.

He is apparently going tomorrow to get his equipment. He had his study this past Saturday night, and this morning he feel asleep while driving, which prompted him to call and beg for an appointment as soon as possible!

I've given him the address of this thread, so I'm sure he'll be checking. I appreciate very much you guys taking the time to respond. :)
Began CPAP Therapy 6/15/2006
Respironics Remstar Pro M Series with
Heated Humidifier, Ramping Feature, and C-Flex
Weinmann Somno Plus mask
61.5 events/hour / Pressure setting: 13 cm
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Re: CPAP vs. APAP

Postby LoriForbes » Tue Aug 01, 2006 4:12 pm

OhTwo wrote:Personally, given that I don't mind my titrated CPAP pressure at all (at least when I have C-Flex), I'm considering buying an APAP and setting the range to #2 above. This would give all the benefits of CPAP, plus more.

Personally I would NOT, however, do #1 above. Letting the machine drop below my titrated CPAP pressure is pointless (since I don't mind that pressure!) and may allow fast-onset apneas to slip through.

Just some things to think about. I'm almost sure I'm buying an APAP for use with strategy #2 very soon.


02,

Are you thinking about changing because you're symptomatic, or just because you think you could improve on something that's working pretty well already? Just curious. I personally am on CPAP and tolerate the pressure setting of 13 quite well (assuming I can use the ramping when falling asleep the first time at night). Being still somewhat exhausted, though, I can't help but wonder if this would help me, too.
Began CPAP Therapy 6/15/2006
Respironics Remstar Pro M Series with
Heated Humidifier, Ramping Feature, and C-Flex
Weinmann Somno Plus mask
61.5 events/hour / Pressure setting: 13 cm
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Location: Louisville, KY, area

Postby MelindaR » Tue Aug 01, 2006 4:15 pm

Ok my goodness Lori...he's ok right? That is definitely a big worry to those who haven't gotten started on treatment. I'm glad he's going to get his equipment. One thing for him to know, if his dr. doesn't prescribe an APAP then the DME will most likely not give it to him. Also, if he has a certain APAP in mind, he needs to make sure the dr. prescribes that machine or the DME will give him whatever they get the best deal using. My DME has a contract I believe with ResMed and I had a hard time getting the P&B 420e APAP I have. Of course I made sure to let them know my dr. had prescribed that specific machine and if they didn't want to do business with me then I'd go to another DME my insurance works with. One thing to remember, you are the customer and DME is the "store" in which you buy your items from.

Please let us know how you both are doing.

Melinda
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Postby MelindaR » Tue Aug 01, 2006 4:20 pm

Lori,

Since you've been on CPAP about 6 weeks and are still exhausted I would suggest you contact your doctor. You may need your pressure increased. I think you should try this before wrangling your dr. to switch to an APAP. NOW, after giving your new pressure a try for a couple of weeks and not feeling better, you may then want to sit down with your dr. and discuss trying an APAP. It's all about balance and getting the right one in your treatment is definitely a fine line at times.

Melinda
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Postby ian » Tue Aug 01, 2006 4:40 pm

hello everyone. i'm loriforbes' son.

thanks for all the advice you've given for me via her thus far!

Having poisoned myself with research on the net before I went to the sleep study, I decided that I wanted an APAP because I read several places that patients' AHI (and pressure needs) almost always varied according to sleep position. Since I toss and turn constantly, I figured this was a good match. Now, 3 days after the study, I am understanding that many folks no longer thrash about after starting treatment, so it may not be helpful/necessary.

After my little "incident" this morning, I have gotten over my initial cpap snobbery and wanting this or that, and am ready to accept a used shop-vac set to reverse shoved down my throat, as long as I can stay awake the following day as a result.

The kind lady at the sleep center threw me a bone this morning and gave me a little info on my results, RDI of 71.6/hr and o2 nadir of 72 were the highlights. Happily, once they hooked me up to the blower those numbers improved to 1.7/hr and 95, respectively.

I begged and pleaded my way into picking my gadgetry up tomorrow morning, so whatever they have for me I'll take and use, and if my results aren't satisfactory i'll cross that bridge when I get there, but i'm keeping my fingers crossed that they will be!

thanks again (and in advance) for your past and future help!
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Re: CPAP vs. APAP

Postby OhTwo » Tue Aug 01, 2006 5:37 pm

LoriForbes wrote:
OhTwo wrote:Personally, given that I don't mind my titrated CPAP pressure at all (at least when I have C-Flex), I'm considering buying an APAP and setting the range to #2 above. This would give all the benefits of CPAP, plus more.

Personally I would NOT, however, do #1 above. Letting the machine drop below my titrated CPAP pressure is pointless (since I don't mind that pressure!) and may allow fast-onset apneas to slip through.

Just some things to think about. I'm almost sure I'm buying an APAP for use with strategy #2 very soon.


02,

Are you thinking about changing because you're symptomatic, or just because you think you could improve on something that's working pretty well already? Just curious. I personally am on CPAP and tolerate the pressure setting of 13 quite well (assuming I can use the ramping when falling asleep the first time at night). Being still somewhat exhausted, though, I can't help but wonder if this would help me, too.


Hey Lori.

I just started on CPAP 2.5 weeks ago. So far I haven't experienced any big improvement, and other people in my situation *have* once they switched to the "CPAP Plus" setup on an APAP (bottom number being your CPAP number, upper number a bit higher).

I know 2.5 weeks isn't long enough to judge, but I get the feeling my titrated pressure isn't always sufficient, and this will provide more pressure when needed. I suspect it will improve my treatment, so I'm going to give it a shot.

Plus, I want to have two machines, one as a backup. The APAP will be number two.
"Start with the things that you know, and the unknown will be revealed to you." --- Rembrandt
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Postby Daniel » Tue Aug 01, 2006 5:38 pm

ian wrote:hello everyone. i'm loriforbes' son.

thanks for all the advice you've given for me via her thus far!

Having poisoned myself with research on the net before I went to the sleep study, I decided that I wanted an APAP because I read several places that patients' AHI (and pressure needs) almost always varied according to sleep position. Since I toss and turn constantly, I figured this was a good match. Now, 3 days after the study, I am understanding that many folks no longer thrash about after starting treatment, so it may not be helpful/necessary.

After my little "incident" this morning, I have gotten over my initial cpap snobbery and wanting this or that, and am ready to accept a used shop-vac set to reverse shoved down my throat, as long as I can stay awake the following day as a result.

The kind lady at the sleep center threw me a bone this morning and gave me a little info on my results, RDI of 71.6/hr and o2 nadir of 72 were the highlights. Happily, once they hooked me up to the blower those numbers improved to 1.7/hr and 95, respectively.

I begged and pleaded my way into picking my gadgetry up tomorrow morning, so whatever they have for me I'll take and use, and if my results aren't satisfactory i'll cross that bridge when I get there, but i'm keeping my fingers crossed that they will be!

thanks again (and in advance) for your past and future help!



Ian,

Your excellent attitude will help you over the initial hump. Nice to read from someone who knows where and how they want to get to.

Should you decide on cpap............look at cflex as an option. It gives exhalation relief. If you decide on APAP, remember it can be set up to work as cpap also.

Best of luck.

Daniel.
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Postby OhTwo » Tue Aug 01, 2006 5:46 pm

ian wrote:hello everyone. i'm loriforbes' son.

thanks for all the advice you've given for me via her thus far!

Having poisoned myself with research on the net before I went to the sleep study, I decided that I wanted an APAP because I read several places that patients' AHI (and pressure needs) almost always varied according to sleep position. Since I toss and turn constantly, I figured this was a good match. Now, 3 days after the study, I am understanding that many folks no longer thrash about after starting treatment, so it may not be helpful/necessary.

After my little "incident" this morning, I have gotten over my initial cpap snobbery and wanting this or that, and am ready to accept a used shop-vac set to reverse shoved down my throat, as long as I can stay awake the following day as a result.

The kind lady at the sleep center threw me a bone this morning and gave me a little info on my results, RDI of 71.6/hr and o2 nadir of 72 were the highlights. Happily, once they hooked me up to the blower those numbers improved to 1.7/hr and 95, respectively.

I begged and pleaded my way into picking my gadgetry up tomorrow morning, so whatever they have for me I'll take and use, and if my results aren't satisfactory i'll cross that bridge when I get there, but i'm keeping my fingers crossed that they will be!

thanks again (and in advance) for your past and future help!


Hey there, Ian!

I'm glad to hear you're getting treatment soon. Keep in mind that APAP isn't "clearly superior" to CPAP; the issue is a lot more subtle and complicated than it seems at first glance. At first glance, a "smart" and "auto-adjusting to patient needs" machine seems clearly superior to a "dumb" fixed-pressure blower, but that's not necessarily so. Read more on this forum, and on others (I probably shouldn't mention them here because of competition, but use Google a bit), and you'll start to get a clearer picture of the CPAP vs. APAP issues.

Yes, start with whatever they give you, and start to wake up during the day! Great treated ASAP (no, I didn't mean to say APAP :), and THEN worry about details like what kind of machine.

If you tolerate your prescribed CPAP pressure *and* you start to feel better, and your numbers (if any) look better, you may not need APAP. And in fact, some people actually do *better* on CPAP than on APAP. If you can't stand your prescribed pressure on CPAP, you may need an APAP (conventionally configured, with your prescribed pressure in the middle of its range) because of its lower average pressure. If you don't mind your prescribed CPAP pressure but still feel tired, perhaps give APAP a try with the "CPAP Plus" sort of range (your prescribed CPAP pressure at the range's lower end).

Daniel mentioned C-Flex, above. Keep in mind that both CPAP and APAP modes are helped by it (it's a technology that reduces pressure during exhales). It raises comfort very significantly for most people. Most major manufacturers offer some form of it on their CPAP machines (ResMed calls it EPR, for instance, while only Respironics calls it C-Flex), however I believe only Respironics offers it in APAP mode. I've not heard of another APAP brand that offers it while in APAP mode.

It's a journey. Get any gear they give you, and take the first step. Keep us updated on what happens! Don't get discouraged. It may really suck at first, be prepared for it. But, once you adjust and eventually find the type of therapy that works the best for you, it'll be part of your daily routine and no big deal. Keep the end in mind, and remember that eventually it'll almost certainly be no problem for you.

However, talk with your sleep doctor about any changes you want to make, and follow his/her advice. Don't do anything, including anything mentioned above, all by yourself. Trust the experts.

Good luck!
"Start with the things that you know, and the unknown will be revealed to you." --- Rembrandt
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Postby MelindaR » Wed Aug 02, 2006 12:38 pm

Welcome Ian,

You have a great attitude!!!! It's always good to try CPAP in the beginning, especially if that is what your dr. prescribes. Plus that will get you in a machine even faster. If your pressure is high, you may want to request a machine with EPR or C-Flex right then and there. I hear it can help a person tolerate the pressure better. I do hope CPAP works for you right out of the gate. I tried it to begin with, but after two months found I needed an APAP. Of course with my DME I had to wait, so I didn't get my APAP until I had been in treatment for 4 months and I can say CPAP still didn't work for me. I think my apnea is hereditary as my sister also has it, though she's on a BiPAP.

Best of luck and please check in and let us know how you're doing. I'd be curious to know what machine you end up with.

Melinda
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