Experience with new autotitrating nasal continuous positive airway pressure machines.

Since the introduction of nasal continuous positive airway pressure (nCPAP) in the treatment of sleep apnoea, enormous technical improvements in nCPAP devices have been achieved. nCPAP has become the most effective and widely used standard therapy for obstructive sleep apnoea. Recently, machines that automatically titrate the effective nCPAP pressure have become available. The question now is, whether and how they work and what the benefits and limitations of such devices are. The algorithms that control the machines are quite different and so is their effectiveness. Even in devices that generally work well, there may be some principal limitations. The algorithm may be mislead by artefacts, especially leaks. Apnoeas and arousal may occur because the pressure increase is too slow or breathing disturbances reoccur after a pressure decrease. Autotitrating nasal continuous positive airway pressure may reduce the work required to determine effective pressure. It is a valuable treatment option for patients who need high and variable nasal continuous positive airway pressure. It should not be used as an unattended pressure titration tool because this will lead to a loss of quality in patient care and a reduced acceptance of nasal continuous positive airway pressure, as pressure determination is only a small part of the adaptation of the patient to nasal continuous positive airway pressure.