CPAP Vs. Auto-Titrating CPAP. Which is better? Free Advice

[@MrTacticalReviews]

Wow, 12 years ago and still great advice! your videos have come a long way!

[@bhamptonkc7]

I love my auto sense, I have my own machine, I started 4-15 but after a few days I found near 10 to be the sweet spot so I bumped the pressure to 8-15 and now a week later 9-15 I like the idea if I have a good night the machine can use the least pressure to keep my AHI down, less than 1 by the way. I think the next level of machines will learn to modify and do pretty much what I have done. I also bumped my ramp pressure from 4 to 6 which gives a slight positive pressure and makes it much more comfortable to breathe. I had an interview then the next visit was a home study and the next will be an APAP

[@Freecpapadvice]

Possible reasons: Compliance because you need 7cmH20, (but a ramp would work just as well and be much cheaper) Maybe your sleep disordered breathing is treated at very low pressures. 5cmH20 is good for NREM sleep and 7cmH20 works better for REM sleep. My first thought to an autopap set for 5-7cmH20 is, why so restrictive on the upper end? That's a great question for your doctor to answer. Then ask, why restrict the upper end? Keep in mind that I haven't seen your report...

[@scottpatricknow]

My doctor noted my hemoglobin is at 17.4, the top of the range. This reading has been consistent for 8 years. He thinks it’s high. Going to go to pulmonologist to check night oxygen. I have a ResMed AirSense 10. Do I need another sleep study to adjust the CPAP? They are expensive. Any other options?

[@tikkihut58]

In the settings does it make a difference with humidity / pressure and the seasons... like winter, summer - etc.? Thanks.

[@Freecpapadvice]

Get an APAP. Philips Respironics System One APAP. It can run in CPAP mode too if you don't like APAP. Costs about the same (through insurance) as a CPAP. The pressure changes are gradual, but it is constantly changing (small changes) to find the best pressure. If you don't like it, then move to CPAP mode. It's data capable too, so you can use free software programs to read the data card. Join my forum for more. My website is in my other videos. Good luck.

[@Hharpreett]

Your videos has been incredibly helpful and has guided me to get my mother diagnosed with Sleep test... Test came positive and she does have a serious OSA. She has been advised 11cm pressure as part of her treatment with CPAP. Now here is the concern part: I should buy a normal CPAP machine that will take care of her situation as advised by her doc or I should to go for a auto CPAP? Does pressure keep changing normally ? Please guide as we need to get this soon.

[@bridgettriegerix4980]

New Thread so you get alert!! Oh thank you so much for the quick response (yesterday)!!! I think you will be a person I watch for so much information...I like your style of teaching! We are deciding between the newer Resmed Airsense 10 and the New Dreamstaion. Of coarse something I thought would be easy to chose is a big deal --> insert answer here _____. Husband SD wants a Resmed. Again, tech down talked APAP. What do you think about a tighter range....say they say target is 11 and have it set for 9-12 or is there not even a big enough difference from 9 to 11 in feel to even be an issue? My husband didn't show central (I think couple), but he did show frequent premature atrial contractions. Says he had index of 60 Apnea yet also says he had AHI 104.2 on back for 79.9min and AHI 20.3 on side for 81.6 min. They said he didn't get REM in study portion of test. But got think 51 min REM in Titration. He spent total time at 11 setting of 107min 79 arousal and 24 awakening in Tritration. Gosh, more less here is my life haha. So, other then my tight range APAP question above, are you saying get a APAP ONLY to self study yourself periodically? I don't even know if we will be allowed to do that for first 10 months that insurance has us chained? OH, BTW how crazy that we are not only going through the Sleep issue thing that we found you awesome on, but my husband is also trying to walk through the door on the "Down Under" issue that you oddly did a video on as well....you had my husband laughing!! Thanks soo soo much!

[@batmanx1751]

Jason I need some advice. my AHI is 94, so which machine is best for me? I've already had a home study but now they want a in house study, but AIM denied it so now they're talking about putting me on an apap machine. is this a safe move for someone as severe as me?

[@Freecpapadvice]

+Delano X You'll be fine. I like the DreamStation or the PR System One machines. The algorithm is much more conservative which is a good thing in my opinion. They'll put you on 5-20cmH20 most likely. That's too big a range long term, but for a month is fine so that you can zero in on the best pressure or pressure range. Monitor yourself with SleepyHead! Too many people get left on that wide pressure range for way too long. Good luck and let me know if you need any help.

[@batmanx1751]

TheLankyLefty27 Thanks bro i appreciate your help and your videos

[@uncleswing4046]

I’m still confused

[@Freecpapadvice]

This is one of my first videos about 10 years ago. It could probably be much more clear. Might be time for a refresh.

[@CHKhouri]

Jason, I was on a pressure of 12. They did the auto pap and its says the 90% pressure is 6.6, but I feel really horrible. I am always tired and not feeling well at all. Can you tell me what is going on?

[@CHKhouri]

+CHKhouri I am still on Autopap as of now

[@Freecpapadvice]

+CHKhouri Just replied to you. The pressure likely needs to be increased, but without data I wouldn't be able to say where to start. Download SleepyHead and communicate with me through my forum.

[@vikasgupta1828]

Thank you

[@elyunited]

Hello I just saw your video and found it to be very informative! My challenge is extreme dryness! I wake in great discomfort up after a couple of hours after going to sleep. Have always maintained the CPAP at the highest level for moisture. Any ideas??

[@Freecpapadvice]

Search my channel for "dry mouth". I cover this in several videos.

[@bridgettriegerix4980]

I will take the chance on this old video that you will reply!!!??? I seen in another video of yours (more recent) that you said "see in other videos why I like CPAP better". I have looked and can't not find a video on such. My husband just did sleep study and was at 60hr apenea and that was very quickly after fell asleep. They never let him go to REM to see. He was quickly fitted with CPAP and they decided level of 11. I was shocked because my husband carries all his weight in neck 17.5 for 5' 8" man 182lbs. Anyways, sleep study says CPAP and when I mentioned APAP kept wanting to talk me out of it. We have not got yet. My husband sleeps half on his back and half side, drinks couple times week, has nose issues, trying to lose weight. Should I get a CPAP set 11 and be done, Get a APAP and set to CPAP mode (their setting 11), or get APAP and set to auto with tighter spread, or get APAP and give wider spread? Will the newer machines (Resmed and Respironics) only do full data for sleepyhead in APAP version or both? Thanks so so much if you respond!

[@Freecpapadvice]

If it's a new thread I usually get a notice...usually. If it's a reply to a reply then I don't see anything. I have that information sprinkled throughout several videos. (maybe the best is the one titled: 4-20 is stupid(fish)) In general, APAP can over titrate (increase the pressure too much or too fast). Frequent fast pressure changes can also result in an unstable CO2/O2 balance...leading to central apneas. SO...I would still get an APAP for use and run it in CPAP mode. If you ever question the pressure you can change to APAP and see where the pressure requirements may have changed.

[@Freecpapadvice]

Part 2 (I missed the rest). Get APAP and set to CPAP mode. Newer machines are fully data capable. Some of the "only CPAP" versions are too, but I'm starting to not be as familiar with some of the features of each and every machine. Used to work more closely with them, but not so much anymore. APAP's aren't that much more expensive either, so it's just a safer and better choice.

[@stephenmeissner5081]

Hey Jason, I actually loop your videos on an iPad in my DME office for patients to watch as they wait between set-ups. Got a question for you, I work in a Sleep Lab/Doctor's Office/DME conglomerate type set-up. For the first time in a year, the sleep lab finally recorded a patient with complex and moderate centrals (I have no idea how it took 1 year to find only 1 patient). I run the DME side. The guy that owns the sleep lab ordered an Auto BiPap for him and went around my back. He obviously needs an ASV or Bipap S/T. My question to you is - How can I go about calling this sleep lab owner a fucking idiot. In your experience, how have you gone about dealing with DME/Sleep Lab people that have the brain power of a black olive?

[@Freecpapadvice]

+Sven Hapsfjord LOL!!!! I usually put it in the patients hands by connecting the dots for them. If the patient goes to them knowing that they received a machine that is inappropriate and they're going to likely have to purchase ANOTHER one....well.....just keep the camera rolling and post it to KZbin. ;^) To the patient, "huh....that's interesting. Patients with XYZ are usually put on ASV because it's the only thing that works." Maybe more subtle, but that's the gist. A lesser known quote, "Hell hath no fury like a very sleepy sleep apnea patient losing money and still not getting sleep."

[@Michael_in_Vt]

Auto is better. It removes the doctor and sleep center out of the equation and you become your OWN sleep specialist!

[@Freecpapadvice]

Man....this is an OLD video I did. I'd say Auto is better short term, but I am seeing some problem long term if the pressure isn't customized for that particular patient.

[@Michael_in_Vt]

TheLankyLefty27 That's fine, as long as the patient stays still in one position like in a sleep study, but in reality that is not the case. While wired up in a sleep study, most people subconsciously won't move during that study, and give you inaccurate results then say someone comfortable in their own beds, nice and relaxed. My auto corrects pressure for me if I'm laying on my back, laying on my side, if I decide to have a few cocktails at a late night dinner or take Nighttime NyQuil to help sleep due to a cold. No straight CPAP is going to do that. In a split second, my auto cpap adjusts to me, not me adjusting to it's pressure.

[@Freecpapadvice]

People move around all the time during sleep studies. That said, there are still really bad titrations with CPAP in lab. That's why I am a proponent for APAPs when appropriate (majority of people). The scenario that you're talking about (assuming you have Resmed...only APAP that increases extremely fast) doesn't work with everyone. About half have the pressure increased by 3cmH20 that fast and it results in some respiratory drive problems. APAP is great, but it's not a "set it and forget it" machine. It still needs monitoring and adjustment (that most patients are able to do on their own.)

[@heathermchaney7896]

Thank you so much for these videos; I really appreciate not only your time, but the explanations on a topic such as sleep apnea, can be really confusing; you offer explanations in a very clear, easy to understand, (also, the humor is my favorite!)and deciphering way that is invaluable! So many times I have found myself researching, looking for any and all good information about this topic only to be more confused and ultimately frustrated. I like to take my health into my own hands, I can't possibly get the most out of any therapy unless I have knowledge of the how and why. I trust my doctor, however, I feel the responsibility of being as proactive as possible when it comes to something as important as my health; it affects EVERYTHING! I have always been very healthy, danced ballet for a living so i have never been sedentary; little by little I found myself getting more and more fatigued in the daytime for no apparent reason. Long story short, here I am ,never saw this coming, never had any idea sleep and the WAY i am sleeping could be so connected to absolutely everything and really affect the quality of my life. Sorry for being long- winded! I just wanted to thank you, I turn to your videos everyday as I am new to all this, lots of questions, and now I turn to only your videos, information as I can always understand your explanations, I trust the info, and a lot of my frustration has since been alleviated! Thank you so much! Sincerely appreciated!!