Getting first machine: Should I try to get an APAP?

I have completed the sleep lab and cpap titration study. I will be picking up/receiving orientation on a machine tomorrow. The doctor has prescribed me with a Resmed AirSense 10 CPAP. I'm assume the titration study results indicated that I only need cpap and not an apap. (My untreated AHI's were 27. The titration study says I need 11cm pressure. I change positions alot during sleep and know there is a huge difference in the level of obstruction depending on position.)

Having read a couple of hundred threads here, including the "what to know before meeting with the DME" thread, I am concerned that having apap capability going forward would be beneficial. What I would really like is the Resmed AirSense 10 AUTO. It has apap capability and, I think, it has advanced software.

Should I try to get the apap machine? According to the DME it costs about $200 more than the cpap model. How should I go about convincing the Dr to "let me have it"? I would be willing to pay the difference if necessary.

Please help me as soon as possible. I am running out of runway to make this change.

Thanks!!

Always go for an Apap because it can be set in Cpap mode if necessary, but a Cpap machine cannot do Apap.

And don't believe your DME (they all lie!) because the same code is used by insurance co's for both machines, and therefore prices are the same (and if I'm wrong, someone will come along very soon and say so ).

BeachbumKW wrote: Resmed AirSense 10 CPAP.

whatever you do, don't get the CPAP model, elite is fine, autoset is fine.

but the that says "CPAP" is dumbed down.

I think you have a better chance of convincing your doctor that you should have APAP than you do the DME. Maybe even just a call to their office would be good for a modified prescription.

sc0ttt wrote:I think you have a better chance of convincing your doctor that you should have APAP than you do the DME. Maybe even just a call to their office would be good for a modified prescription.

What argument should I make? The truth is that I want the ability to study the results and what I experienced and how I feel and make adjustments. I know that will not work with them.

If I say "what if I really need apap, and it wasn't determined in titration study", they will say they will replace my cpap with apap when the time comes.

Thanks to all.

I have a related question. Will the online xpap vendors (cpap.com-second wind- etc.) sell an apap if the original Rx only specifies a cpap machine ? Or, do I have to go the "black market" route to get one ? My current dinosaur only records hours of use.

Gasper62 wrote:I have a related question. Will the online xpap vendors (cpap.com-second wind- etc.) sell an apap if the original Rx only specifies a cpap machine ? Or, do I have to go the "black market" route to get one ? My current dinosaur only records hours of use.

Yes they will and not be breaking any rules to do it.
An APAP capable machine is just a CPAP machine with an additional mode of operation available and that is the auto adjusting pressure mode that we call APAP.
APAP is just a single pressure like CPAP only the pressure will auto adjust instead of being fixed.
APAP mode capable machines all have that other CPAP mode available and the RX can be satisfied by setting the machine to CPAP mode at so and so pressure....once you get the machine home then you can change it to APAP mode if you wish.

Guest wrote:

sc0ttt wrote:I think you have a better chance of convincing your doctor that you should have APAP than you do the DME. Maybe even just a call to their office would be good for a modified prescription.

What argument should I make? The truth is that I want the ability to study the results and what I experienced and how I feel and make adjustments. I know that will not work with them.

If I say "what if I really need apap, and it wasn't determined in titration study", they will say they will replace my cpap with apap when the time comes.

Thanks to all.

Full data recording and APAP aren't the same thing - lots of folks are fine with CPAP and you can read the data and make adjustments to the constant pressure - APAP just makes automatic adjustments in the same night. People who need APAP usually have different pressure needs based on sleeping position, or sleep stage... or they have a need for high pressure (say 18cm) at some times that is uncomfortable for all night. If your study said you did fine at plain old 10-12cm then maybe you don't need APAP. But you can certainly buy your own APAP with a CPAP prescription and learn how to program it yourself...maybe the DME won't sell it to you but CPAP.com will, and you can always look for used.

Any of those sound like you?

The problem is that in my case the Dr and DME are “in bed together”. So much so that the Dr keeps the DME’s inventory at their location. I was never even supposed to go to the DME’s office, except I found out who they were and went to see them anyway.
So I will be dealing with the Dr only on this one. Is it still my right to purchase the apap? I am willing to pay the extra.

Once you get your machine in your possession it becomes a lot harder to get it swapped out for a different machine.

The AirSense 10 CPAP machine....is not full data...it does offer AHI but that's pretty much it..and there is no event category breakdown so you won't know what the AHI is made up of. There's no leak data or anything else other than hours of use.

Check with your insurance company to see if there are other DMEs in your area that will work with your insurance and call them up and ask them if they will supply the ResMed AirSense 10 AutoSet. Some DMEs dispense APAPs as standard protocol and there might be one in your area that will do it.

I don't know your insurance coverage but you might also call them up and ask them if upcharges are allowed or not because most of the time if an insurance company has a contract with a DME that upcharge is against the rules..
and the DME wanting to charge you $200 more for the APAP is against the rules.
If your insurance happens to be Medicare....totally against the rules.

Now if they will dispense the AirSense 10 AutoSet for that $200 upcharge and no one else in your area is available and you are willing (and able) to pay that upcharge just so you get what you want and when you want it...that's up to you....but be sure and do the math...figure out exactly what your total out of pocket expense is going to be and do the math because often that machine can be bought privately for much less than what it costs going though DME...depending on equipment coverage, copays and deductibles.

Oh....you can still use a DME for masks and other cpap supplies even if you don't buy a machine from them.
I have never bought a machine from the DME that I use...I bought all my machines privately without insurance.
In my situation (for my first machine) I paid out of pocket cash to a seller who had a zero hour machine that was exactly what I wanted and his asking price was just about what my co pay and deductible would have been...plus I got exactly what I wanted..when I wanted and didn't have to fight with anyone about it.

I was aware of the capabilities and differences of apaps vs. cpaps and also figured that most of the new, upper tier machines would be data capable. I just wasn't sure about how strictly the Rx's were adhered to by vendors. It's likely that I'll be paying out of pocket for an apap so, I just would prefer obtaining one from an auth. dealer with manuf. warranty in force. I like "tried and true" stuff so, I'm thinking that an AutosetS9 is gonna' be a good fit for me. (I like the display better than that dark little hole that I've come to hate on Respironics !)

Gasper62 wrote:I was aware of the capabilities and differences of apaps vs. cpaps and also figured that most of the new, upper tier machines would be data capable. I just wasn't sure about how strictly the Rx's were adhered to by vendors. It's likely that I'll be paying out of pocket for an apap so, I just would prefer obtaining one from an auth. dealer with manuf. warranty in force. I like "tried and true" stuff so, I'm thinking that an AutosetS9 is gonna' be a good fit for me. (I like the display better than that dark little hole that I've come to hate on Respironics !)

OK, so here's my little itemization I made when I got my unit - do some on-line shopping for the one you want and fill in the blanks and then you'll know if the DME's offer is one you should walk away from or not. It's hard to say if they'll be motivated to cut you a deal but generally you'll come out better if insurance picks up part of the cost... unless you're buying used.

Gasper62 wrote:I was aware of the capabilities and differences of apaps vs. cpaps and also figured that most of the new, upper tier machines would be data capable. I just wasn't sure about how strictly the Rx's were adhered to by vendors. It's likely that I'll be paying out of pocket for an apap so, I just would prefer obtaining one from an auth. dealer with manuf. warranty in force. I like "tried and true" stuff so, I'm thinking that an AutosetS9 is gonna' be a good fit for me. (I like the display better than that dark little hole that I've come to hate on Respironics !)

My education about the differences in cpap vs apap were really mainly for the OP in this thread since he is so new to all this stuff.
By all means if you are more comfortable buying from an authorized dealer then do so. I realize that is important to a lot of people and that is just fine.
Cpap.com can get you whatever APAP capable machine you might want with a CPAP script though. It's clearly stated in their RX policy. They can't do a bilevel device though without bilevel RX even though most of the bilevels have cpap mode available...bummer.