I have never felt less intelligent than I do reading about all of these machines.  I'm seeing some things about APAP machines but not  a lot -- they seem to be a really great thing.  Does anyone use them, have info on them, etc.?  To me it seems like a "smart" version of the CPAP.  Am I just confused and quite frankly, overtired? :)

APAPs are also called auto PAP. Yes, they are a bit "smarter" than a straight CPAP in that they can adjust the pressure they provide w/in a set pressure range as needed by the patient.

They can be used for an in-home titration to determine your pressure needs and if you are at your optimum pressure setting. And they have the added advantage of being able to be used in auto mode OR in straight CPAP mode.

However, a good many autoPAP users find the constant pressure changes actually interrupt their sleep and that they do better going back to straight CPAP mode. So there are pros and cons to whether it is worth the battle to get an autoPAP rather than a CPAP from your local DME supplier.

More important is to get a full data capable xPAP. Not all CPAPs are fully data capable AND not all autoPAPs are fully data capable. The full data capability IS WORTH fighting for.


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Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

I second ChronieToo's emphasis on a fully data capable xPAP machine.  If you or your doctor never feel a need to look at the data, fine.  But much more often, people wish they HAD the data, it can be very helpful in getting PAP therapy to be as effective as possible.

Be certain to request fully-data capable AND to be shown how to see the AHI leak rates on the machine's display.  The doctor must script both of these requests.  If the doctor just scripts "full data capability", many DMEs assume the capability is for the doctor, and not for the patient.  Don't take possession of the machine unless you're satisfied you can see the AHI and leak rates each morning.

And don't be fooled into taking a "machine with a Smart Card".  Many machines record compliance only data to the smartcard and are NOT fully data capable.  It is an old trick to sell a low-end machine.

I also concur with ChronieToo's mention of auto CPAPs often being fine-tuned to a fixed pressure or perhaps a very small range of pressures (3-4 cmH2O spread).  While it isn't true in all cases, many times a range does not produce optimal control of events.  An auto CPAP set temporarily with a wider range, is useful for initial data gathering and for periodic validation of currently prescribed pressure settings.  It is ten returned to a single pressure or small range and monitored for ongoing effectiveness.

Blessings,
--pseudonym

I hope this post is not too far off the subject, but I need to ask for some advice.

I live in a small market without a lot of choices. My doctor is clueless about equipment and initially prescribed a pressure range of 4-20cm. (My previous CPAP titration was 11cm) My DME does not handle any ResMed machines except a single basic CPAP model. I had to force them to order the new AutoSet II and, as a result, they are also clueless beyond basic set-up following the clinical guide.

I use the 3i humidifier and a ResMed Quattro FF mask. After 3 weeks I am getting some strange (to me) results. Three weeks ago I raised my min. pressure to 10cm, set EPR to 2, and kept the max. pressure at 20cm. My AI and leak rate are dropping (last night AI=1.6; LR=0.10), but my 95% pressure and HI are climbing (last night pressure=15.4; HI=12.. I am a pretty patient person who does not freak out over one night results and I try to give changes time to take effect.

I don't know if I am missing something or if I potentially have a problem I'm not aware of. I don't suffer from a lot of the pressure related ailments others often mention. My mask fits and is reasonably comfortable. It's just the strange trend in results.

Can you suggest anything or help me with an explanation of what might be happening?

Thanks in advance.

It is time to narrow the pressure range. Resmeds can be a bit more aggressive than some of the other brands in chasing hypopneas.

However, since I have COPD I've not been one to mess w/my pressure settings much. Hopefully, RAM-Sleep will reply to this post. Understand that he cannot make specific comments to your situation but he can share some thoughts that might be of help to you.


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Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

Thanks, CrohnieToo. I'll hope that RAM-Sleep posts his comments. I do understand that no one can or should make specific recommendations. I totally agree. I wouldn't change my own pressure if I were confident about the doctor and DME.

I too have early COPD and Asthma. Can you tell me how that affects your xPAP therapy? Maybe I should be more watchful of signs resulting from those factors.

Well, when I was started on CPAP therapy it was on a straight CPAP, the Resmed S8 Elite. 3-4 months or so into CPAP therapy we ran an overnight oximetry whilst on CPAP and that resulted in my being put on 2L of 02 in additon to the CPAP therapy. I did purchase a Resmed S8 AutoSet Vantage when I got "auto fever" but to be truthful ended up using it only as a travel xPAP. I felt I had to stay compliant on the Elite purchased by Mediare at least thru the 13 month capped rental. Then earlier this year I was brought in for another titration and was switched to a bi-level, the new Resmed VPAP Auto which is an S8 II.

I was fortunate to have an excellent sleep lab and interested, responsive doctor so I just kept pushing him if I didn't see definite improvement w/each change in therapy once I had adjusted to and mastered mask fit and comfort. I can certainly understand if you haven't a responsive sleep specialist or helpful DME's RT! My first local DME supplier was a real dense sheister. I would do just as you intend to do were I in your situation.

As money permits I would suggest that you purchase the S8 ResLink and the Nonin oximeter and finger sensor for the long run as well as the ResScan 3.4 software and cable reader. If you have Vista on your 'puter you need the newer version of ResScan software which I think is 3.5  On the other hand, depending on the progression of your COPD you may never need them. I'd still get the software and cable reader tho.

Once you get your CPAP therapy stabilized you can always ask even your family doctor to script an occaisonal overnight oximetry just to keep on top of things. Or your pulmonologist if you have one. You may find that your nightly results are a little more erratic than most due to your COPD. I don't have asthma but I do have some emphysema, of course.


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Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

My stats change quite a bit, depending on weight, eating patterns, sleeping schedules etc. For instance, when I eat supper late I will usually see the next morning that my 95% pressure was relatively high. When I take a nap in the early afternoon on the weekend, I see that I often have extremely low pressures and sometimes 0 leaks and 0 apneas. My OSA is mild-moderate and treated with a fairly low pressure but over the past 2 years I have seen pressures as low as 6.8 and high as 11.6. To me that is one of the main arguments in favor of using an autopap rather than a straight CPAP, it allows for changes in your sleep breathing to be compensated.


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Arthur
Sleeping with a curvaceous blonde autoPAP (Resmed autoset). Hope springs eternal.....

I have the Autoset S8 Vantage.  My sleep Doc is open to new technology and knows how much research I've done.  He was hesitant at first to put me on an APAP, but after a year on Bi-PAP and some messy results, he was willing.  

Originally, I was supposed to have the pressure set at 4-20, but from what I have read here and in other forums--that was asking for trouble.  I reasoned with him to set the pressure limits according to my most recent sleep study.  Occasionally, and I mean very rarely, I would need a pressure of 15.5.  But this would kick the Central Apneas into high gear for me.  The minimum pressure he wanted on CPAP or Bi-PAP was a 12.  So we settled on 12-16 for the APAP.  This way, I get the minimum pressure--he's happy, and if I need a bit more on occasion-the machine adjusts upward to accommodate--I'm happy.

I have never experienced what some describe here as "runaway pressures" or "runaway APAP's".  That's where the pressure on the APAP get's stuck on high for a long period of time, and from what I've read here--wakes the person up.  Narrowing the pressure can minimize this if you happen to experience it.  Again, I never have.

BTW Everytime I take my data card into the doctor--he's very happy with the results.  The data functions work really well for showing compliance.


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Sleep Well and Prosper!!!

Marcopolo

ResMed S8 Vantage APAP w/ Humidaire 3i
ResMed Swift LT
12-16 cmH2O