Doctor says APAP machines are a waste...

[MrHumpty]

So I called and talked to my doctor to discuss using an APAP machine to replace my old CPAP Resmed I've been using for 6 years.

He said "I tell you what. How about you mail me half the money you'd spend on the machine and keep the other half. That way you save money and are better off"

He's a good doctor... but like all doctor's he's a businessman. I've noticed over the years that there are nights that I need extra pressure and it causes me to not breath/snore like the old days. Since my machine is getting older I wanted to replace it and APAP seems to make the most sense. For 6 years I've avoided sleep studies and doctor's visits and have been quite content.

So the question is... Do APAP's work? I'm going to be paying for the majority of the machine and I'm between a couple which will run me from $700 to $800. I'd rather not waste the money if they aren't worth it.

[Wulfman...]

So I called and talked to my doctor to discuss using an APAP machine to replace my old CPAP Resmed I've been using for 6 years.

He said "I tell you what. How about you mail me half the money you'd spend on the machine and keep the other half. That way you save money and are better off"

He's a good doctor... but like all doctor's he's a businessman. I've noticed over the years that there are nights that I need extra pressure and it causes me to not breath/snore like the old days. Since my machine is getting older I wanted to replace it and APAP seems to make the most sense. For 6 years I've avoided sleep studies and doctor's visits and have been quite content.

So the question is... Do APAP's work? I'm going to be paying for the majority of the machine and I'm between a couple which will run me from $700 to $800. I'd rather not waste the money if they aren't worth it.

ABSOLUTELY!!! They're a multi-mode machine (and they ALL collect data) so you can run them in either in a range of pressures or single pressure.

Problem is, most doctors don't understand them or know how to configure them.....they just want YOUR money and for you to have to depend on them.

Den

[Wulfman...]

By the way, they wouldn't sell them if they didn't work.....they're a medical device and have to be approved by the FDA.

Den

[papdaddy]

If you pay anything for retitration ,the Apap will save you the expense. Some sleep labs do not like them for that reason alone. It cuts down on their repeat business and like Wulfman said you can use the auto to find your average pressure and run it in cpap mode if you want. It's the best of both worlds.

Rich

[Goofproof]

Just take your current prescription, and buy it online. Then call up the Doctor, and have him get in touch with his favorite DME, and ask for his half of the money, that he didn't get, because you bypassed the money grubbers. Jim

[WNJ]

For me, APAP is a wonderful alternative.

I was titrated at 13 cm H2O. I rented a CPAP from a local DME for a while. I found 13 cm uncomfortable.

Long story short, I bought an APAP from cpap.com and have been very happy with it. I also saved a ton of money by not buying from the DME.

After experimenting, I finally settled on a range of 10 cm to 14 cm. The software shows that I’m spending the bulk of the night at 10 cm, which is very comfortable. It usually shows my 90% pressure as 12 cm, which is still tolerable. I rarely go to 13 or 14, but if I need it briefly, the machine gives me the extra pressure.

Wayne

[j.a.taylor]

Yes, in my opinion, for me an AutoPAP is worth it.

My average pressure is higher than the 10 cm the sleep lab prescribed.

My average is 13, and my range has been anywhere from 12.2 to 15.6.

I feel much better with the AutoPAP, have some self-monitoring capabilities, and can have a more accurate measure of my progress. On the straight CPAP, everything was subjective, the Dr. had to ask how I feel, but had no tools to measure with (and one or two nights in a sleep lab isn't an accurate measurement either).

I'm a data person. It amazes me that we're asked to evaluate treatment based on how we feel, without any hard data to provide an objective measure as well.

Seems a little bit like "witch-doctoring" to me.

[Titrator]

Greetings,

A standard cpap prescription with a fixed pressure number listed will qualify to purchase an AutoPAP.

The AutoPAP that, is in my opinion, the best on the market is the Respironics M Series Auto with A-Flex. As many cpaptalkers will attest, this machine is the cat's meow.

Here is the link on cpap.com.

https://www.cpap.com/productpage-bundle ... undle.html

Regards,

Ted the Titrator
cpap.com

[Ody]

Try using this link:

http://cflex.respironics.com/PDF/102581 ... erence.pdf

print it out, give it to the Doctor and ask him to read it and see if he still feels this way.

I showed this to my Doctor and said I thought I would be more comfortable and compliant with APAP. He agreed and said, "I will give you anything you want", and he did.

[Gerald]

Humpty....

I think Ted the Titrator is telling you right.......the AFLEX machine is what I'll buy the next time.

Get your hands on Encore Pro 1.8 software, add James Skinner's Analyzer software.....and you have the best.

Things have changed a lot in the past 5-years....Just look at how all kinds of electronics have advanced in quality and features.

Chunk the old machine....and get the new stuff. You won't be sorry!

[GumbyCT]

So I called and talked to my doctor to discuss using an APAP machine to replace my old CPAP Resmed I've been using for 6 years.

He said "I tell you what. How about you mail me half the money you'd spend on the machine and keep the other half. That way you save money and are better off"

He's a good doctor... but like all doctor's he's a businessman. I've noticed over the years that there are nights that I need extra pressure and it causes me to not breath/snore like the old days. Since my machine is getting older I wanted to replace it and APAP seems to make the most sense. For 6 years I've avoided sleep studies and doctor's visits and have been quite content.

So the question is... Do APAP's work? I'm going to be paying for the majority of the machine and I'm between a couple which will run me from $700 to $800. I'd rather not waste the money if they aren't worth it.

I have to ask the burning question no one else has -
If CPAP doesn't work - WHY did he prescribe it for you?
Really - is s/he some sort of quack?

I am still new to this sort of therapy but it seems to me that APAP is a fine tuned CPAP with an auto adjusting feature. With APAP you cut the docs & DME's profits. Have you had to go back to have your pressure adjusted? If you haven't had to, then stick to CPAP. I find that my pressures seem to be less than what the doc prescribed, which may explain why I felt no better with CPAP. Also it seems my ideal pressure may vary slightly each night. Could be my body position or mask seal, or something else; just not sure right now.

As mentioned above, the new machines are THE very best, to date. The nice thing is that you can use it in straight CPAP or use the auto feature. No need to pay to have the pressure changed, just to SEE if it will work.

But do what you will.

And oh, just how DID you get a prescription without a sleep study? Is this doc some sort of quack? Or was he keeping that portion of the savings?

Good Luck, whatever you decide,
GumbyCT

[cfdhome]

I have found that APAP was very helpful. In my case my titration was 16"h2o. I found that CPAP at 16 to be very uncomfortable. I bought a resmed APAP without insurance as insurance would not pay for it. With the APAP, I run at about 10""H2O. I actually have a lower AHI at 10, than I do at 16, an it is much more comfortable. There may be no mdical need, but for me it was much more comfortable, and more effective to boot.

[RosemaryB]

With the M-series Autopap with A-Flex you will get pressure relief on both inhale and exhale. This feature is only available on that machine. For many people, this makes a big difference in how well they can tolerate their pressure. For people with aerophagia this may make a big difference for them in the aerophagia. This feature is only available on the auto machine, even though it is no in itself auto.

It's true that some people do better on straight pressure, others do better with an autopap. There's no way to know until you try both.

I'm always amazed at doctors making pronouncements that are little more than rumor. They may base them on a few limited studies, but the doctors that make such rumor based pronouncements likely don't understand research very well. That's why they are going with the rumors and/or what they are told by the drug (or DME) lobby.

I know an MD (specialist) who also has a PhD in his specialty. He openly admits that the MD degree does not prepare a doctor to understand research. He says that the PhD was harder to get.

I believe it's part of the training for doctors to act sure of themselves even when they shouldn't be. There's a book called "How Doctors Think" by Jeremy Groopman. He details the kinds of errors in thinking that doctors make. This book is on my to read list, but I have a newspaper article that goes over the kinds of errors that doctors make.

Doctors are human beings. We should remember that, even when they don't.

Another advantage of a fully data capable auto is that you can do your own titration studies to find out what your current pressure needs are. (All autos are data capable). Since your sleep study was done so long ago and you think your pressure needs are changed, the auto would be great for that. If your doctor doesn't know how to do this it's because he hasn't kept up to date enough to find out.

I know how to do this after a few months of reading the posts on this board. Since I was mistitrated at 5.0, this was important to me. My doctor didn't know a thing about these machines, either, but was willing to let me show him my charts from the auto machine. My correct pressure is 8.5 or 9.0. At 5.0, my AHI is around 7, which puts me in the mild sleep apnea category.

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CPAPopedia Keywords Contained In This Post (Click For Definition): DME, auto, aerophagia

[mindy]

I am very pleased that I have the M Series APAP with A-Flex. I have a difficult time sleeping anywhere but at home. At the sleep lap I was titrated to a pressure of 7/8 after a PSG showed AHI of 8.9 on side and 13.6 on back. The study showed only hypopneas, no apneas (but I had only stage 1 and stage 2 sleep, 2.9% REM on side, 0% on back). Since I have a cardiac condition, they decided to put me on treatment anyway. I asked the doc what kind of machine she was going to prescribe and she said CPAP. I mentioned that I'm in the process of trying to lose weight and she then said I should get an APAP - so that's what she prescribed [the technique: say just enough to get the doc to prescribe what you want without telling them what to prescribe].

She prescribed a pressure range of 7-12. Once I started monitoring with EncorePro 1.8, I discovered that I was having more apneas than hypopneas and a pressure of 7 was too low. So I gradually increased it over about a month and finally ended up at 9-12. It may need to go to 10 for "ideal" therapy but I'll let the doc tell me that at next visit.

To make a long story short, I eventually need a single pressure since they've found that for heart failure and cardiomyopathy CPAP works but APAP either doesn't or doesn't work enough. By having an APAP, I can work with it to find best pressure and then set it as CPAP. Then if I need to, I can switch back to APAP as needed to re-titrate -- an example of why an APAP is useful even is a CPAP is "good enough"!

Mindy

[DreamStalker]

So I called and talked to my doctor to discuss using an APAP machine to replace my old CPAP Resmed I've been using for 6 years.

He said "I tell you what. How about you mail me half the money you'd spend on the machine and keep the other half. That way you save money and are better off"

He's a good doctor... but like all doctor's he's a businessman. I've noticed over the years that there are nights that I need extra pressure and it causes me to not breath/snore like the old days. Since my machine is getting older I wanted to replace it and APAP seems to make the most sense. For 6 years I've avoided sleep studies and doctor's visits and have been quite content.

So the question is... Do APAP's work? I'm going to be paying for the majority of the machine and I'm between a couple which will run me from $700 to $800. I'd rather not waste the money if they aren't worth it.

The thing to remind your doctor about is that if the APAP does not work as he suspects, it is quite easy to set to CPAP mode (so no biggie there). Also, the cost difference is not "twice as much" ... it is less than 50% more. In other words, about the cost of a couple of tanks of gasoline for your car (and that assumes you pay out of pocket -- there is NO difference if insurance covers the cost) ... your life is worth that much is it not?