Curious about why CPAP over APAP with my S9

I completed my titration CPAP study last weekend and a night of observation a couple months back. Today I got a call from a local DME distributor to come in and pick up my CPAP. After having two sleep studies and now receiving a CPAP, note that I have never had a conversation with an MD or RN about my diagnosis other than the ENT who initially referred me to the sleep center. Kind of amazing that they just measure you, give you a machine, and send you on your way! I had to call and beg after the first study to get my detailed test results sent to me.

In any case, the DME person I spoke with said "your script is for CPAP at 9 mmH20 and an S9 Autoset machine." I asked why they would give me an expensive machine like the S9 if I wasn't using APAP. He confirmed they set up the S9 for constant pressure @ 9 mmH20 and didn't give any logical answer for the choice of machine. Just said something about it being what they had. In hindsight, I'm guessing the script said "CPAP @ 9 mmH20" and the DME chose the S9 to maximize their profit. I'm happy with the machine since it seems to be well-liked by others, my insurance paid for most of it, it can give me lots of data, and can do APAP if needed.

My question is: Now that I have it, should I get hold of the sleep doctor (whom I've never spoken to!) and request to get it switched to APAP mode? From my reading, I don't see any downside to APAP other than needing a more expensive machine. Since my machine can do APAP, is there a reason I should stick with CPAP mode? Perhaps a newbie should stick with CPAP for awhile to see how well it works before moving up to APAP???

Seeing that I've been given almost no guidance from the medical professionals, I think I'll be spending a lot of time on this board.

Thanks,
Leon

There are good reasons some doctors prefer CPAP over APAP. Each has it's advantages and disadvantages. (They've been cussed and discussed here at length!) But your non-experience with the sleep doc seems to indicate a one-size-fits-all mentality rather then a considered decision for CPAP. That's sad.

The DME gets paid the same for CPAP and APAP machines. The APAPs cost them more, so they make LESS profit by dispensing APAP. I have no idea why they gave you the APAP (maybe they had one in stock and not a CPAP...) But it was lucky for you. Now you have more options.

Just be grateful that you got the machine that you got... and try it the way that it is for a week before tweaking it. There may be a reason that the doc wanted it set to CPAP.

Yes, you're lucky they gave you an APAP........you will have more options in the future, if you wish to try them.
HOWEVER......you NEED to try your titrated pressure for a period of time to verify whether it is or is not correct. Using a range of pressures (in APAP mode) in the beginning can present a number of problems for new users......leaks and pressure changes disturbing sleep to name a couple. Getting good sleep is your primary objective right now (along with adapting to this new way of sleeping), so I would recommend saving the experimentation with ranges of pressures for a later time.

Welcome to the forum and good luck with your therapy.


Den

Take the S9 Autoset machine. The cost difference is not much and if you have insurance you may find that the cost is the same in any case.

First ask the Respiratory Therapist about the EPR and other settings that can improve user comfort. Often they stay at the factory default and most prescriptions do not address them one way or the other. In my experience there are often problems with the machine not being set up correctly.

It is totally appropriate for you to visit with your physician to understand his reasons. During the visit you might want to suggest a test where you use the CPAP setting for a month and then try an APAP setting. For example 5 to 16 cm.

When a constant pressure is rescribed it is often a compromise and may not be enough in some situations. This test would allow your doctor to understand if you would do better with a higher upper limit and if you could get by with the lower pressure for most of the night.

If you ask around you can get the clinician's manual and learn how to change the machine settings but first see if your physician is comfortable with this approach.

Welcome Leon, you're lucky to get that machine without a fight but you might do better on straight pressure for now as the changing auto pressures might be disturbing to you as you adjust to therapy. At least that was my husband's experience. Good luck.

Thanks, everyone! I'll get used to CPAP for a few weeks and then try to see the sleep doc to discuss how things are going.

-Leon

Thanks again, everyone!

I survived my first night. I woke up several times just from not being used to the mask and didn't have a very restful night, but the S9 said my AHI was only 3.5 in the morning (I was in the high twenties during my sleep study). My only side affect was feeling a bit bloated in the morning and burping a lot from swallowing air, though I had that much worse after my night of titration in the clinic.