We rarely prescribe CPAP because it is an old technology. In fact, less than 2% of our patients of the last 3 years have received prescriptions for fixed CPAP. Instead, greater than 90% of our patients are now titrated with bilevel therapy, which supplies a higher pressure on inspiration and a lower pressure on expiration.
We believe that bilevel treatments as well as some of the newer technologies that provide auto-titrating technologies or "breathing assessment" devices are the clear wave of the future, and we expect that fixed CPAP will be soon recognized as a primitive treatment option that does not yield optimal results in the vast majority of SDB patients.
Thus, the Pearl that we leave you with here is to appreciate the possibility that you might never attain an optimal response while using fixed CPAP pressure. If you have addressed all the factors you think might be causing your lack of great results, you certainly should discuss how to proceed with your sleep doctor, and we recommend that you broach the topic of a bilevel titration or explore the use of the newer technological devices.