CPAP or APAP

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cdowis +0 points · 9 months ago

Having completed my in home sleep study, I need advice on which one I should get to have the best chance for success.

Thanks

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sleeptech +0 points · 9 months ago Sleep Commentator

A good question. APAP (or Auto as we often call it) doe not treat your OSA any better than fixed pressure CPAP. In fact, because it has to see obstruction before it can respond to it and increase the pressure, it can be slightly worse (although for most people it's just fine). Also, it can be fooled by some things into increasing your pressure way more than necessary. If you have twitchy legs, for example, your auto will think that this is obstruction and increase your pressure, but because it doesn't stop the legs twitching it will keep on increasing the pressure until it maxes out. So for this and other reasons auto doesn't work for everyone, but it is fine for most. The benefit of an auto is that it keeps the pressure as low as possible for as long as possible. This can make it more comfortable in some cases. That is all well and good, but an auto costs about 2 - 3 times as much as fixed pressure CPAP, which is a lot of money for a possible slight increase in comfort. Of the thousands of patients I treat every year, maybe 1 or 2 will actually need auto to tolerate CPAP. The rest all manage just fine with normal CPAP (all of which have ramps, humidifiers and other features to help). So use an auto by all means if you think it's helpful and worth it, just bear in mind that you'll be paying a LOT more for that increased comfort, and that most people don't need it. If possible, see if you can try for yourself before purchase. Or possibly rent before buying if that's not too expensive (although rental can often be ludicrously expensive in an effort to force you into a purchase).

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wiredgeorge +0 points · 9 months ago Sleep Enthusiast

Would this issue not be addressed in a doctor's prescription?

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sleeptech +1 point · 9 months ago Sleep Commentator

Not in my experience. Usually the doctor prescribes the pressure and leaves the rest of the details up to the supplier. It can take weeks or months of trial and error before finding out whether and auto may be called for. Suppliers are always keen to use an auto whenever they can get away with it because they make more money from the sale. Most doctors don't really know much detail about how various machines and modes work - that's what we techs are for. Also, retailers and, in many cases, doctors only get their information about CPAP machines and how they work from the manufacturers, and the manufacturers just tell them it always works fine with no problems because they want to sell more expensive units. I know this sounds a bit cynical, but unfortunately I see these things happen all too often. One of the reasons I post on this site is in the hope that, by better educating patients, more people will get the best and most appropriate treatment rather than being sold a machine that costs 3 times as much when they don't need it.

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cdowis +0 points · 9 months ago

I have more confidence in a machine that can make adjustments without going to the Dr's office on a regular basis to check the ideal pressure. Perhaps avoiding the cost of office visits will offset the additional cost of the machine.

For those who have insurance, the additional cost may be very cost effective. In my case I only pay 20% co-pay, so even an additional price of $300 is only a $60 copay, almost the cost of an office visit. Over the years, the machine will adjust to the changes in my needs.

Just my thoughts.

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sleeptech +0 points · 9 months ago Sleep Commentator

For the vast majority, once properly set, a fixed pressure machine doesn't need to be adjusted for years, so there should be no unnecessary visits to the doctor or anywhere else. Your perception of your sleep, combined with data from your machine, should be enough to indicate if anything needs adjusting. Having said that, if you prefer auto and understand all that involves, then by all means use one. Where I come from, the difference in price is more like $2000, which is something most people can't afford to waste. And visits to the doctor are generally free. My concern is that people know what they are spending their money on, that is all. The best thing is whatever works best for you.

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Oregonrain +0 points · 6 months ago

An APAP is affordable. I don't know why Sleeptech thinks there is a $2000 difference in price as the cost for an APAP is not that high. I recently bought online a brand new sealed in the box Phillips Respironics Dreamstation Auto Cpap with humidifier and heated hose for $400, paid for by myself, not with insurance. It works great, and was really easy and comfortable to use.

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sleeptech +0 points · 6 months ago Sleep Commentator

I think they cost $2000 more because where I am, in Australia, they do. That's just how it is. I often advise people that they can get equipment much cheaper by ordering online from America but, in Australia, if you buy local (as many people do) you will pay through the nose for an auto. A fixed pressure machine is $1000 - $1500 and an Auto is around $3000. Obviously that is in Australian dollars.

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Marco +0 points · 6 months ago

I had a sleep test about 5 years ago and was diagnosed with mixed sleep apnea, about an AHI of 50. Between my sleep doc, respiratory therapist and equipment provider I got almost no useful assistance in sorting out masks, pressures and machines. I had zero confidence in my "sleep doctor" who was a retreaded psychologist. He had no interest in working with me so that I could optimize my pressure settings. The sleep center I used was a joke and seemed to be only interested in maximizing their insurance payments.

I did my own research online and found another forum that helped a lot.

I now have 2 auto adjusting machines, a ResMed S9 and a Respironics System One. After significant trial and error I discovered that the auto adjusting algorithms for each machine are somewhat different and I need to use different pressure settings on each machine to get good results. My AHI is now pretty consistently between 1.5 and 2.5 with almost all of the events classed as hypopnea. Typically I show 1 or none OA and 1 or 2 CA each night. I get 7.5-8 hours of sleep each night. I have gone from using a full face mask that looked like the old diving helmets to using a Respironics Dreawear nasal mask. I have gravitated to pressure settings of 5-11 (S9) and 7-11 (System One). Recently I decided to try running my machine in standard CPAP mode and after a bit of experimenting have landed on a therapy pressure of 9. My results have become more stable and slightly better (lower AHI) than in the auto mode and I feel like I wake less frequently in the middle of the night.

I am glad I went through this process because I need to understand stuff, but I am more persistent and analytically oriented than most. I would expect that most folks presented with the awful assistance I received from my sleep care providers would have given up long ago. Wow, what I would have given to have someone like sleeptech working with me.

For those that are starting out, I advise that this stuff works and the effort is worth it. Knowing what I know now I would work harder to find someone like sleeptech to help me.............even if it meant going all the way to Australia.

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WanderLit +0 points · 5 months ago

All it takes is a visit to an online PAP retailer site to see for yourself that there is no difference in price between CPAP and APAP. However, an APAP machine can be programed to be used at a set pressure (like a CPAP) while the CPAP can't be programed to be used as an APAP.

Get more for your money! Get the APAP and if it doesn't work for you, have your doc prescribe a set pressure for it.

Bonus! There is also the newer "For Her" algorithm for APAP that responds sooner to more subtle breathing events than standard APAP. This gives your yet a 3rd. programing option. (You don't have to be a woman to benefit from an APAP algorithm developed to respond to the more the more subtle presentation of sleep apnea typically associated with women's symptoms.)

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sleeptech +0 points · 4 months ago Sleep Commentator

I just checked 10 online retailers and they all charged more for autos that fixed pressure. Also, I can tell you that, regardless of whatever price they are retailed at, the manufacturer charges more for an auto than a CPAP. If you can get one cheap and want to do so then go right ahead. Not everyone is in that position though and some people really need to save money wherever they can.

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S2S +0 points · 4 months ago

An APAP is the best option every time as it can do both. Set an APAP to cover 90 to 95% of your events and let it take of the others using the APAP settings. If you do not need a machine that is required for more complex sleep apnea an APAP is the best option.

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