Auto Cpap question

garyland · Post by **garyland** » Sat Aug 06, 2005 9:05 am

I appreciate all of the good advice I am getting here but have a question about the auto machine. If my prescribed pressure is 10. Does the AUTOMATIC machine go above that or does it only go below that if it senses that you don't need that much pressure?

Thanks,
Gary

Guest · Post by **Guest** » Sat Aug 06, 2005 9:59 am

If you have an auto machine and use it in the auto mode, it can be set for a pressure range. If you use it for the full range, it can go anywhere from 4-20cm. If you choose to narrow the range (which seems to give better results based on what users have been reporting), you can set it to whatever gives you the best treatment. For example, if you were titrated at 10cm then maybe you'd want to try a range of 8-12. The auto machine will then adjust the pressure required as you are sleeping based upon your breathing patterns. It may use a pressure of 8 for just a few minutes, then maybe will go to 10 for 3 hours, then may go to 9 for 30 minutes, then may go to 11.... etc. Provided you have the software, you would examine your data on a nightly basis, experiment with a different set of ranges, and quickly discern the pressure range that results in the least apnea events.

One of the great things about the auto (APAP) is you aren't receiving more pressure than you need (as you may be with straight CPAP). When you think about it, your titrated pressure was based on a few hours in a weird (to say the least) sleep environment. Maybe you will discover through using the auto and evaluating your data, you consistently use 7 and never go above 9. That's the beauty of it! You use only what is needed and its all done for you while you sleep!

garyland · Post by **garyland** » Sat Aug 06, 2005 11:39 am

Ok, you had a great explanation. But this is where I still don't get it. The doc told the cpap people to set my rental REMSTAR CFLEX NON-AUTO machine to 10. So what does he tell them now on my prescription to cpap.com when I order my machine. Or does cpap.com decide the lower and upper limits of setting. Or do I set the limits.

Thanks,
Gary

ozij · Post by **ozij** » Sat Aug 06, 2005 12:16 pm

Your doc tells them what he thinks you need - either a single pressure, or a pressure range.

They set it up according to the doc's perscription.

You try it out, learn all you can about the subject and if you dont' feel better with the way the machine is set up, you look at your results (you are getting the software I hope) and discuss changes with your doctor.

Some people have been know to skip the discussion with the doctor. And at least one has the following agreement with the dr.

Craig wrote:.P.S The agreement I now have with my DME and Dr is that I will set the machine the way I think is best. Then I inform my DME who in turn will contact my Dr. who will fax the DME a prescription/order for the settings that I am using. This keeps everyone happy!

With the proper software, the machine is very cooperative, and will let you set any pressure range you want.

O.

loonlvr · Post by **loonlvr** » Sat Aug 06, 2005 12:45 pm

One other point about the Auto-it can be set at a straight pressure if need be. Some ppl find 1 pressure for whole nite is better. Everyone is differnt, thats why the auto is so great. The C-flex with the remstar is also great.

Guest · Post by **Guest** » Sat Aug 06, 2005 2:16 pm

So what does he tell them now on my prescription to cpap.com when I order my machine.

It is ideal for your doc to write a prescription for your CPAP machine with no expiration date. If you are doing this through insurance, be sure your doc includes a heated humidifier in the prescription. (While the humidifier itself doesn't require a prescription, it helps push through the cost to your insurance company). It is not necessary for the doctor to specify CPAP or APAP on the prescription. If you are only going to be ordering APAP machines, a pressure setting is not required on the prescription. It will come to you at 4-20. HOWEVER, the prescription must state the pressure level if you order a straight CPAP machine.

If you're doing this through your insurance (many don't; either they don't have insurance or they find it too big a hassle and not worth it because of the deductible), the billing code for the machine is the same regardless of APAP or CPAP (E0601 NU) and the billing code for the heated humidifier is E0562 NU.

You'll find cpap.com usually has the best prices and they always include the clinicians manual which has instructions for how to change the settings. If you're buying the software so you can conduct self-titration experiments with your new APAP, you will quickly learn the most appropriate range for the most effective treatment. There are some users who conduct these experiments and discover they receive the best treatment from straight CPAP set pressure. Since this is a possibility, some have queried, "Then why bother getting an APAP in the first place?" The answer is that you can revisit your decision as time passes and things change: i.e. weight gain/loss, different mask, change in altitude, etc. Maybe once every couple months the straight CPAP user will reset to auto mode to check to see if they do better at a different pressure.

Some say, "If the treatment is better at a very narrow range, then why bother getting an APAP in the first place?" The answer is that even within a narrow range, you are still getting only the pressure you NEED. If my range is set for 10-14 and I spend more of my night in the 10-12 range but occasionally go up to 13 or 14, I have never received more pressure than I required. This would not be true at a single set pressure, as there are times when it may be more than necessary, and times it may not be enough. So even a tight range is helpful.

Perhaps the best feature is the software that goes with it so you can see how you're doing. You no longer have to wonder if you're getting the best treatment possible, you no longer have to schedule a full PSG to check your results, you no longer have to make a drs. appt. every time you want to change your pressure, and you no longer have to pay exorbitant prices by making every move through a DME.

You will also no longer have to go back to your doctor for a new prescription if you'd like to try a different machine because cpap.com will keep the original (non-expiring) one on file.

Guest · Post by **Guest** » Sat Aug 06, 2005 2:45 pm

Me again! Just wanted to add that cpap.com suggests having your doctor write a very generic prescription, not specifying any particular manufacturer or model, and not containing any expiration date. Also, if you will only be buying auto-adjusting machines then the prescription doesn't need to include a pressure setting.

From cpap.com Q and A:

In addition to the basics (physician name, address etc) I suggest you ask for a generic listing. In other words ask for Nasal CPAP at 10 cm water pressure rather than Resblower model whatever. If you have it written up generically, you will be able to use it many years from now to procure the latest models without any confusion. It is probably a good idea to include "humidifier" on the prescription as well. It is legal if it does not have an expired expiration date.

and from cpap.com Prescription Upload:

Be sure you send a prescription and NOT the sleep study report. Also, the prescription should state the pressure level unless you are ordering an auto-adjusting CPAP.

garyland · Post by **garyland** » Sat Aug 06, 2005 6:52 pm

Thank you all for you help and Explanation. I finally get it! Monday I receive my script from the doc and will contact cpap.com to order my new machine.

Barb (Seattle) · Post by **Barb (Seattle)** » Sat Aug 06, 2005 7:15 pm

I thought autopap would use what ever pressure it take to prevent your apneas - they're set to a range? My autopap is set to one pressure for now (8)

neversleeps · Post by **neversleeps** » Sat Aug 06, 2005 7:41 pm

Barb (Settle),

Yes, an auto-adjusting machine (set in auto mode) functions within a pressure range. As I indicated above, if you have an auto machine and use it in the auto mode, it can be set for a pressure range other than the one that is preset at the factory, which is a minimum pressure of 4 and a maximum pressure of 20cm. If you choose to narrow the range (which seems to give better results based on what users have been reporting), you can set it to whatever gives you the best treatment. For example, if you were titrated at 10cm then maybe you'd want to try a range of 8-12. The auto machine will then adjust the pressure required as you are sleeping based upon your breathing patterns. It may use a pressure of 8 for just a few minutes, then maybe will go to 10 for 3 hours, then may go to 9 for 30 minutes, then may go to 11.... etc. Provided you have the software, you would examine your data on a nightly basis, experiment with a different set of ranges, and quickly discern the pressure range that results in the least apnea events.

SnoreNoMore2005 · Post by **SnoreNoMore2005** » Sat Aug 06, 2005 7:56 pm

Anonymous wrote:
If you are only going to be ordering APAP machines, a pressure setting is not required on the prescription. It will come to you at 4-20. HOWEVER, the prescription must state the pressure level if you order a straight CPAP machine.

My DME would not fill my Rx for an autopap without a pressure range from the doc. I had to go back to the doc's office and have them write a range (5 - 15) on my Rx.

Not sure if this varies state to state or not. I'm in FL (I voted for Bush AND Gore).

SnoreNoMore2005

neversleeps · Post by **neversleeps** » Sat Aug 06, 2005 8:18 pm

SnoreNoMore2005 wrote:My DME would not fill my Rx for an autopap without a pressure range from the doc. I had to go back to the doc's office and have them write a range (5 - 15) on my Rx.

Not sure if this varies state to state or not....

I don't think that is any state's law. (Prescriptions are federally regulated, I believe.) It was probably your DME's personal 'law.' Here is the scoop from cpap.com Prescription Upload.

Secure Prescription (Rx) Upload

To order a CPAP, APAP or BiPAP machine from us you will need to provide us with a prescription. You may do this by faxing your prescription to us toll free at 1-866-353-2727 or by using the upload feature on this page.

Important:

When you place your order from our website you will receive an email confirming the order and giving you an order number.
Reference your order number on your prescription. No cover sheet is needed.
Be sure you send a prescription and NOT the sleep study report. Also, the prescription should state the pressure level unless you are ordering an auto-adjusting CPAP.
_____________________________________________________________________
To see this at cpap.com click on:

Secure Prescription (Rx) Upload

BTW,

I'm in FL (I voted for Bush AND Gore).

I had almost forgotten about the great CHAD debacle! Dimpled chads, hanging chads, here a chad, there a chad, everywhere a chad, chad....

rested gal · Post by **rested gal** » Sat Aug 06, 2005 11:43 pm

neversleeps, I wondered who the "Guest" was that was giving such spot-on, clearly stated, perfect advice. Should'a known it was you! Very, very, VERY good posts.

neversleeps · Post by **neversleeps** » Sun Aug 07, 2005 11:52 am

too kind.....

sleepless · Post by **sleepless** » Sun Aug 07, 2005 11:28 pm

Auto paps seems to work best for ppl with sleep stage related apnea. i.e there AHI varies greatly between deep sleep and light sleep. For most this is not the case and a set pressure works perfect. RemStar c-flex is not an auto-pap and can only be set a given pressure.

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