"But Mike, with APAP you don't have to get another sleep study done, it will save me all kinds of money!" While as a generalization it might have some truth, it still does not apply to everyone. First off, APAP's have gotten a LOT better in determining what is actually happening over the course of an evening, but they are not 100%. They have a limited number of sensors to determine the events. Additionally, each manufacturer has a different way of trying to treat these events. On another forum there have been folks that have found that a particular brand of APAP doesn't work for them, but a different one does. Because of these variables, simply stating that APAP is the best treatment is not accurate in all cases. It might not be a bad idea to get a sleep study done with your APAP to ensure that it is treating you properly. (i.e. your apnea/hypopnea could be resolved with APAP, but someone with persistent hypoxemia (low oxygen levels in the blood) would still be in trouble, as well as someone having periodic leg movements that aren't resolved from restoring airway patency.)
"But Mike, I have graphs that say I am getting good treatment!" Folks often put a lot of stock in the detailed data that comes out of APAP's. While there is a lot of data that they do give, we often overlook a critical factor in determining the usage of this data. ACCURACY. It really doesn't matter how pretty the graph is, if the machine that collected the data is not collecting ACCURATE data for the events that actually transpired. While the machines have gotten a lot better at figuring out what happened, they often can mis-score events. For example, one particular manufacturer scores snore events in such a way that if you rub the hose a certain way, it gets scored as a snore, this obviously affects the accuracy of the collected data.
I do think that APAP is a step in the right direction for therapy, and as I said, I use one nightly, but we need to be careful with generalizations, there is a HUGE Sleep Apnea population out there and unfortunately there is not a one size fits all answer.
If you want to do some reading, here is are some guidelines from the American Academy of Sleep Medicine
APAP GUIDELINES It is a few years old, but it is still good reference.
And the other end of the spectrum is Dr. Phillips. I agree with her in that folks need to get diagnosed and treated, and APAP is a means to this end, but she also indicates that the treatment with an APAP needs to be monitored. PowerPoint Presentation by Dr. Phillips
And a conclusion from a study a few years older
Quote:
Conclusions: Despite advances in auto-CPAP machines, there remains a
large minority of patients with OSA and UARS in whom these machines
do not accomplish treatment goals. Of the two machines compared, the
Respironics Tranquility was successful slightly more often than the
ResMed AutoSet T . This study does not address tolerability and compliance
with the different auto-CPAP machines.
Evaluation and Comparison of Two Autotitrating CPAP Machines
So, is APAP a good thing? Yes! Does it treat EVERYONE with OSA? Unfortunately it isn't the answer for everyone.
I hope this clears this up.
