buy an apap?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
I'mSewTired
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buy an apap?

Post by I'mSewTired » Thu Jul 14, 2005 3:29 pm

I am thinking about buying an apap. I have a few questions that I hope some of you who use apap, and monitor can answer. First of all, does your pressure ranges change day to day enough to justify the cost of the apap? I mean if my alergies are acting up more today that the day I was tirtated, would the pressure I am using be not as good as what an apap would give me? I would guess the pressure would be different, based on conditions. But, would these differences cause a much higher AHI. Also, would the severity of sleep apnea make a difference in the differences in AHI. Which could mean that someone with severe sleep apnea would have a bigger difference in AHIs that someone with less severe sleep apnea.

My history, titrated 12/03 at 18/13 bipap. Titrated at different lab 6/05 at 13 cpap. I think there is a large difference in these two titrations. How do I know if I were retitrated today that the result would not be totally different? At first with the first titration I felt great, but this would come and go. Now, with the new pressure, I still seem to be waking up in the night, 6 times last night. But, I have a few better days. I wonder why I wake up so often some nights, and if I were using an apap would I wake up so often. I don't have trouble falling back asleep, but the more I wake up, the more sleep time I need, and I have other things to do besides sleep!

Also, I already know my doc isn't fond of apaps, I asked. Am thinking of asking for an rx for a back up machine, and buying the apap. Would think a back up machine would be wise anyway. What would happen if mine gave up the ghost on Friday night? Plus the DMI I have been using is slow as a seven year itch, so how long would it take to get a new machine here?


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littlebaddow
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Re: buy an apap?

Post by littlebaddow » Thu Jul 14, 2005 4:01 pm

I'mSewTired wrote:My history, titrated 12/03 at 18/13 bipap. Titrated at different lab 6/05 at 13 cpap. I think there is a large difference in these two titrations. How do I know if I were retitrated today that the result would not be totally different?
That's pretty much the key point, you don't know! An apap should accommodate the differences. I can't comment on allergies, because thankfully I don't suffer from any, but my titrated pressure on cpap was 11 and the first machine I had was a cpap set at 10cm.

When I switched to apap, by monitoring the pressure I have settled on a range of 6cm to 10cm and spend most of the night at the lower (more comfortable) end of the range, yet I'm still getting good treatment. My average AHI is 1.2 and I feel human again.

There is strong (though not universal) support for apap over cpap in this forum, based on the experiences of users. Sadly, that support isn't mirrored in the medical community.


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ozij
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Post by ozij » Fri Jul 15, 2005 5:56 am

First of all, does your pressure ranges change day to day enough to justify the cost of the apap
?

In my case the answer is a resounding yes for the vriability.
I probably have mild sleep apnea (at leas according to the one night test).
My pressures vary much from day to day (night to night actually) and withing the nights as well. Some nights I dont' reach the paek range at all, some nights I do.

O.


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Im2tired
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Post by Im2tired » Sat Jul 16, 2005 9:03 am

I just had my 1 month checkup with my sleep dr. I asked about the Auto since I have a lot of other conditions and feel that that could affect what pressure I need every night. Having been a type 1 diabetic for almost 32 years, I'm well aware of how your body's needs can change from day to day sometimes without any apparent cause. He agreed that that was possible and wrote the script (of course at this point I was crying and maybe he just wanted to get me out of his office). I called the DME and they told me I would need another sleep study showing that I benefited from the Auto to justify buying it since it was about $1500! I said that's ridiculous since my insurance paid $1900+ for the last one I had with a CPAP! I called my insurance and they said they would not make me do another sleep study (I just had one in May and then early June) and if the DME would call them with the code for the machine they could check to see if it was covered. When I go my insulin pump I spent a lot of time comparing features, etc. and I feel right now that I don't have the brain power to do that. I keep looking at different machines and masks and I just can't remember much. I know this will get better as I get more good sleep but it's just frustrating right now.

I was wondering if there were any studies on Auto vs reg CPAP and what % of people are OK with some titration.

Laurie

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Post by Im2tired » Sat Jul 16, 2005 9:05 am

Correction to may last post (did I mention lack of brain power?).

How many people are OK with one titration?

Laurie

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Post by NeurosurgeryNP » Sun Jul 17, 2005 9:34 am

I was titrated with a straight cpap machine. However, I wantd the flexibility of monitoring myself. I was titrated at 9. I have that set as my minimum, and 15 as my max. For the most part, I hang around 9 most nights with an occasional spike to 10-11. This however, I notice especialy when I have a few drinks. So, I do like having the auto -I can know exactly what is upwith my treatment. Jen

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SnoreNoMore2005
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Using APAP

Post by SnoreNoMore2005 » Sun Jul 17, 2005 10:22 am

I've been using an APAP for three nights. I had been using a CPAP for three weeks before. The APAP is a huge improvement. I've been sleeping throughout the night since switching to APAP which is very unusual for me. I've also awoken feeling more refreshed than with CPAP.

IMHO the APAP is worth the extra $100 especially considering an APAP can work as a CPAP if you prefer the single level titration.

Just my 2¢ worth.

SnoreNoMore2005


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tomjax
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dme prices

Post by tomjax » Sun Jul 17, 2005 3:09 pm

I too am considering an autopap since my dv 9001D Died a couple of nights ago and I am using my practicaly new remstar plus.

My wife said I snored thru my mask last night, so I bumped it up to 13.8 from 13. Original study setting was 12.

My question to myself is whether I want to go ahead now and get an auto- not sure what type I want or wait a while and hope for some better technology on the auto in a year or so. Decisions- Decisions.

You can buy an new remstar auto/c flex for 297.00 or the new resmed S8 escape for buy price of 274.00- maybe less since it is auction.
These prices mat be less than copay etc and aggravation of the dme in some cases.

Breeze going for about 50.00

who needs the evil DME.

Just for fun, I called apria and asked their price for a breeze without insurance.
They said $729.00.. wow


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Post by Im2tired » Sun Jul 17, 2005 3:16 pm

One of the reasons for trying the APAP would be to see the impact of alcohol and other changes (blood sugar, blood pressure, joint pain, fatigue, lightheadedness, etc.). Of course for somethings you wouldn't know if it was the cause or effect. My dr. said no sedatives and no alcohol but didn't say what no meant (is one drink ok or ok if it's earlier in the day). I was drinking about 1 glass of wine in the evening. I'm not suppose to drink because of being on medication that can be hard on the liver but feel one drink can't hurt. Plus I have gone to a gluten free diet in the last 18 months because of being dx'd with celiac disease. I can only give up so much at one time! I can't have regular beer because of the barley and there are very few gluten free beers.

I was curious why if my titrated level is 7 that my doctor would set that as my lower level instead of a number maybe a little lower to see if I actually need less some days?

Laurie

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rested gal
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Post by rested gal » Sun Jul 17, 2005 4:06 pm

Im2tired, you asked:
I was curious why if my titrated level is 7 that my doctor would set that as my lower level instead of a number maybe a little lower to see if I actually need less some days?
I'm not a doctor and this is just my guess... I'd say your doctor wants to make sure your throat stays open, thus he wants you to have at least your prescribed 7 cm H20 all the time. Setting the high of your autopap range somewhat above that will (hopefully) accomodate times when you might need more....when meds, things you eat/drink, a more stressful day, allergies, illness, etc., might cause you to need more than 7. A pressure of 7 is not difficult for most people to handle, so the doctor probably also saw no real benefit in setting the lower pressure down further for you.

I guess there are several ways to look at how to use an autopap. Most who are prescribed higher pressures than your "7" probably use theirs with the low pressure set below their "prescribed" pressure... in order to not have to spend all night up at or near the prescribed pressure.

Some find autopap treatment works best for them if the low pressure is set almost (or at) the prescribed pressure, expecially if the prescribed pressure is easy to use.

Regardless of how the lower pressure is set, setting the higher pressure a couple of points (or more...even on up to 20) above the prescribed pressure is usual to give a bit of headroom if conditions change.

Personally, I think it's better to keep a leash on the high pressure, setting it at not more than, say, 5 points above the prescribed pressure. I don't think it's a wise idea to use a "wide open" range with 20 set for the top...at least not until you see how a particular autopap is going to behave for you. And you'd have to have the software to see that.

A person can look at the value of using an autopap several ways - being able to set the low as low as is comfortable below the prescribed pressure. Or, as being able to set the high to take care of changing conditions that might need more than the prescribed pressure. Ideally, we can get both benefits from an autopap. Most autopap users do get both.

You can also look at the value of autopap as taking a lot of the guesswork out of some nagging questions: "Is this single pressure I was prescribed really right for me?" "Is it more than I need most of the night?" "Right for me all night, every night?" "Still effective months or a year later?"

I use a range of 8 - 15. That's just three points below and four points above what would probably be my "prescribed" pressure -- which according to the data from all three different brands of autopaps I've used appears to be 11. That's the usual "90th" and "95th" percentile pressure every autopap has come up with for me. In other words, 11 AND LESS takes care of events for me 90 or 95 percent of the time. Doesn't mean it took a steady 11 to handle things 90, 95 percent of the time.

The range I settled on lets me spend at least half the time each night at my low of 8, and most of the remaining time using 9 or 10. I have brief periods of time (literally just a few minutes) most nights when the machine uses 11 or 12. I have my upper range set at 15, which it never comes close too. It rarely uses even 13.

If I set the low below 8, I have a lot of snores show up on the data. Perhaps no big deal since I feel just as good on those mornings, but if using a pressure ( 8 ) that doesn't bother me anyway will knock them out, I'd just as soon not see snores in my results.
Last edited by rested gal on Sun Jul 17, 2005 4:31 pm, edited 1 time in total.

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Post by littlebaddow » Sun Jul 17, 2005 4:31 pm

I was prescribed 11cm, based on one night with all the wires attached and a further 5 nights using a loaned apap.

My first machine was a cpap set at 10cm. When I switched to an apap a few weeks later, set 'wide open' at 4cm to 20cm, I immediately felt more comfortable getting to sleep and started to feel better in the morning. A few weeks later, I purchased the software and discovered that I spent most of the night at 6 to 8 cm and rarely went to my prescribed setting. I now have six months of use and have spent a matter of minutes at 9 10 11 or 12 in that time. I therefore set my range at 6 to 12, and recently changed it to 6 to 10 and have an average AHI of 1.2.

When I showed my doc some of the results, he was at a loss to explain why the apparent improvement and it was only some weeks later, prompted by a thread about side v back sleepers, that I realised it was probably because I had been given a terrible mask for the tests and had only been able to sleep on my back. Soon after, I purchased a more comfortable mask and reverted to my more normal position of side sleeping. I'm now pretty certain this is why my pressure requirement reduced.

Without the apap and software, I'd still be using 10cm. This is not a particularly high pressure, but I find it much less intrusive to fall asleep at 6cm. I'm also confident that, whatever position I sleep in or should my pressure requirement change for any other reason (eg should ir lose the weight I keep promising myself I will ) than the machine will adapt.

Given the choice, I can think of no reason to choose a cpap over an apap.


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Post by rested gal » Sun Jul 17, 2005 4:55 pm

Excellent point, littlebaddow (and excellent sleuthing for "reasons")...
it was only some weeks later, prompted by a thread about side v back sleepers, that I realised it was probably because I had been given a terrible mask for the tests and had only been able to sleep on my back.
Most clinics do run their sleep studies to look for "worst case scenario", which generally means when a person is sleeping supine...sleeping on one's back.

Thus, the insistence of many sleep techs, "Stay on your back as much as possible." That's good, in a way, as that position will turn up a high AHI which can lead to insurance or medicare paying for treatment. Even if "on the back" is not the person's usual sleeping position at all, it's still good to find out what happens when they are on their back. What if the person were hospitalized, and did have to stay on their back all or most of the time? Best to know what pressure it takes to handle OSA while flat on one's back.

On the downside, that "worst case scenario" way of titrating a "necessary" pressure does indeed result in higher than needed pressure for people who truly don't sleep much on their back at all at home...the inveterate side sleepers. It usually takes less pressure to keep the throat open when sleeping on one's side.

Viva autopap! Which can adjust automatically all the time, accomodating any changes in sleep position.

Oddly, I've noticed something new about my sleep habits, even though I've been a side sleeper as long as I can remember (probably became a firm habit during a lifetime of trying to get more air while sleeping.) After a year and a half of being on autopap and sidesleeping exclusively, I recently have found myself turning onto my back occasionally.

I still sleep on either side much more than on my back, but it's interesting to see how easier nighttime breathing is apparently making my body realize it can sleep supine now if "on the back" happens to be a comfortable position at any point during the night.

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dsm
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Re: dme prices

Post by dsm » Sun Jul 17, 2005 6:25 pm

tomjax wrote:I too am considering an autopap since my dv 9001D Died a couple of nights ago and I am using my practicaly new remstar plus.
Hi tomjax,

I am interested in your opinion of the 9001D - I know you are dissapointed it died but other than that what did you think of the features & useability ?

Is it on a par with a RemStar (more in the quality dept than in a comparison of features)

Is it a 'quality' machine (ignoring the reason for its sad recent departure) ?

How long did you have it ?

Cheers

DSM
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dsm
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Back sleeping vs side sleeping - novel side issue

Post by dsm » Sun Jul 17, 2005 6:37 pm

littlebaddow wrote: When I showed my doc some of the results, he was at a loss to explain why the apparent improvement and it was only some weeks later, prompted by a thread about side v back sleepers, that I realised it was probably because I had been given a terrible mask for the tests and had only been able to sleep on my back. Soon after, I purchased a more comfortable mask and reverted to my more normal position of side sleeping. I'm now pretty certain this is why my pressure requirement reduced.
I have always found back-sleeping to produce worse apnea than side sleeping, by a large margin. I am sure this is why most sleep clinics want patients to spend a large portion of their sleep study on their back. This allows them to obtain the worst case scenario for OSA.

Before I went on CPAP my wife would tap me on the shoulder when I was on my back, & I was trained enough to roll on my side - she used to have to say 'Darling you have stopped breathing or Hey, you are snoring too loud rollover - training me with a shoulder tap saved her having to speak

But since I have gone on CPAP and if I am on my back, she now says, 'Darling your machine is straining, roll on your side please'

I find this really funny.

DSM

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Post by rxforsleep » Mon Jul 18, 2005 11:41 am

I have also found the APAP extremely helpful in titrating my own pressures. With the help of the Encore software and Derek's MyEncore add-on I have been able to figure out that my best (so far) pressure settings are at 8-12cm H2O. I usually have an AHI between 10-20 but actually had 2 days last week in the single digits - a 5 and an 8!!! I can't believe how much better I feel when my AHI gets down to those levels. My first sleep study showed an AHI of 65 so obviously I have made some vast improvements. When I first got my APAP, I used it with the pre-set settings of 4-20 and after struggling with nightly pressures of 16-19cm H2O and AHI's of 30+, I started tinkering with the settings and discovered that if I lowered my settings I could get my AHI down. So now I don't have to deal with all the leak issues I was having at the higher pressures and I am feeling much better. I would still like to figure out how to get into the single digits on a regular basis but it's a work in progress.

I can't thank the people on this message board enough for all the helpful tips and useful information I have learned over the past 7 months!

Thank You!!!
Rx