Auto-titrating continuous positive airway pressure, or AutoCPAP therapy, is useful for the treatment ofobstructive sleep apnea.
It is similar in some ways to other therapy modes, including CPAP and bilevel.
There are pros and cons to using AutoCPAP therapy.
Brandon Peters, MD
Explore the potential benefits and risks and consider whether it might be the right treatment for you.
It is helpful to understand AutoCPAP in this context.
The simplest version of PAP therapy iscontinuous positive airway pressure (CPAP).
The soft palate, uvula, and tongue base are suspended to keep these tissues from occluding the airway.
This resolves snoring and obstructive sleep apnea.
Unfortunately, this may not be the pressure that is needed throughout the night.
In fact, it might be too high for much of the night.
The proprietary algorithm is not disclosed by manufacturers, but the rationale can be theorized.
This increases resistance to the flow of air.
If detected, an AutoCPAP will respond by increasing the pressure of the airflow.
The algorithms seem to err on the side of increasing the pressure.
The setting of these pressure ranges is discussed further below.
The rig self-adjusts based on measures of resistance.
The pressure is higher as someone breathes in and lowered as they breathe out.
This can make it more comfortable to breathe out and may reduce mask leak and aerophagia.
It may also reduce central sleep apnea and may improve treatment of obesity-hypoventilation syndrome and other respiratory-related neuromuscular conditions.
Much like AutoCPAP, it is able to adjust through a range of preset pressure options.
There is often a maximum inspiratory pressure, called IPAP.
This is also known as both auto servoventilation and adaptive servoventilation, by Philips Respironics and ResMed, respectively.
In some cases, cost or insurance coverage may be a consideration.
Pros of AutoCPAP Therapy
There are some clear benefits to the use of AutoCPAP therapy.
This dynamic adjustment may optimize response to therapy, lowering theapnea-hypopnea index (AHI)to its treatment goal.
As noted above, it also may reduce some of the side effects that interfere with compliance to treatment.
This variance matches the treatment to need, leading to a better overall experience for many users.
Cons of AutoCPAP Therapy
There are some potential risks to the use of AutoCPAP therapy.
This may lead to additional sleep apnea events and associated symptoms.
Therefore, the tweaks become more important when allowing the unit to work through a range of options.
In some cases, auto-titrating devices may be a problem.
For example, the use of Autobilevel devices is discouraged in obesity hypoventilation syndrome.
Pressure configs
One might wonder: What pressure should an AutoCPAP be set at?
Moreover, how might someone know if the PAP pressure needs adjusting?
How is this determination made?
Some guidance may occur with the help of an in-center study called a PAP titration polysomnogram.
If a person is living with severe obesity, a slightly higher range may be set.
If the pressure is too low, snoring or sleep apnea may persist.
The AHI should be as low as possible, and normal is less than 5 based on diagnostic testing.
High pressures may exacerbate mask leak, dry mouth, aerophagia, and intolerance to treatment.
In some cases, simply turning down the pressure relieves many of these problems.
Understanding your individual risk factors will lead to the best possible outcomes of therapy.
As these technologies advance, they will become optimized to improve breathing during sleep.
2014;25(2):164-168. doi:10.1016/j.ejim.2013.11.009
ResMed.What is APAP?
And how is it different than CPAP?
