Newbie help with CPAP vs auto

[sleepgeorgiabrown]

Greetings to all,
I just had my sleep study done at a local hospital. They want me to come back for a second night to fit me for a cpap and adjust the settings. I was told by a sleep technician that if I was really interested in an auto adjustable machine, the second night isn't really needed. The technician intimated that the doctors here are pretty much of the cpap only mentality and suggested that I get my referring physician to prescribe an auto machine.
I would like your collective input regarding the necessity of the second night or should I just go directly for an adjustable machine?

I appreciate all the shared knowledge of this board. The internet is a great thing!

[Babette]

I would go for the second night, AND demand an APAP or BIPAP, depending on what that second night's study shows.

Are you paying for it out of pocket? If so, I can understand just skipping the second night and getting an APAP. HOWEVER... If you have Centrals or other things I'm not familiar with, THE APAP WON'T BE THE MAGIC CURE ALL. You might need a BiPAP. I don't know all the ins and outs of BiPAP and why it's required for certain conditions. Hopefully someone will chime in here with more knowledge in that department.

If you've got medical coverage, I highly encourage you to go for the second night and find out if you're having centrals or whatever the heck stuff that requires a BiPAP.

No more sense getting stuck with an APAP when you need a BiPAP, than getting a straight CPAP.

Good luck!
Babs

[AuntieNae]

I would go for the second night of the sleep study .. if anything it will rule out other things plus give you a baseline for your Auto.

I would also ask your Dr to write a prescription for the Auto so there are no questions after that.

just my 2 cents

AuntieNae

[Sleep4aHealthyLife]

I agree with the others as well. As a previous sleep technician, I would definitely recommend getting the titration study done (so long as it is covered by insurance) to get the proper pressure parameters unique to you. Then I would DEMAND an Auto-titrating machine, whether it is APAP or Auto-BiPAP depending on your study results.

Many DME (Durable medical equipment) companies do not like to supply "Auto" machines because it costs them a little more money, but it is well worth the fight for your comfort!!! Just get your doctor on your side and have his/ her office tell the DME company that they are prescribing an Auto machine and there are no substitutions allowed. Then they are bound by law to supply that machine.

I have personally used CPAP and APAP, and APAP is the only way to go. It will automatically adjust to all of your needs, i.e. sleeping on back needs more pressure than on the side, if you ever have to take a muscle relaxant, have any alcohol before bed on weekend, etc, etc. APAP is the Cadillac of the industry and I would HIGHLY recommend.

Hope this helps.

[sleepgeorgiabrown]

Thank you Ladies. I have a high deductible health care plan. I'm in the middle of figuring the coverage out.

[Guest]

Good advice Sleep4aHealthyLife. The hospital here charges $3,000.00, and I had to pay $500.00 of that. I am unsure about their coverage of the second night.

[nomoore]

If you just get an APAP without getting titrated your doctor will probably set the pressure at min 4 and max 20, in other words wide open. Some doctors will do that anyway when you ask for an APAP, even if you've had the titration. What you really need though is for the min pressure to be set a lot closer to your optimum pressure, say, 2-3cm below optimum. There are two reasons for that. First a lot of people will feel like they are suffocating at a pressure as low as 4. Second, with the min pressure set closer to optimum the machine doesn't take as long to raise up to the pressure needed to stop a series of apneas. So, if the pressure needed to stop a series of apneas is 11cm then a machine that is set at a minimum of 9cm can reach 11cm a lot faster than a machine set at 4cm. Also, the titration study may show that you start getting central apneas at a certain pressure in which case you would set the max pressure just below that point. Some doctors will set it up better from the beginning though.

So, if you can afford it I would say definitely get the titration study.

I think you should first talk with your doc though. Tell him you want an APAP. He may need to request something special for the titration study. Find out if he is even willing to work with you on getiing an APAP and prescribe you one so your insurance will cover it. Then ask him if info from the titration sleep study would affect the settings he would prescribe for you with an APAP or if he would just set the machine at a min pressure of 4 or 6 regardless of the study. The doctor may find the titration information useful. Also, the titration study would give you an idea of where to start if the doctor won't prescribe you an APAP and you choose to buy one out of pocket and adjust the pressures yourself.

[Georgio]

I started with CPAP and failed to adapt, APAP is the only way to go. My mother had the same experience. I would go for your second nite to establish a "titrated pressure" at least for a baseline. Then get your auto machine and you're ready to go.

Depending on your deductable, some find it better to purchase their own machine from cpap.com. Some insurance companies will re-imburse you for purchase of your machine from cpap.com. You have to do some homework here, but get the auto machine, you will be using it every night, all night for likely 5 years or more. If your sleep doctor, for any reason does not want to write you a prescription for an auto machine, you have the option of requesting that prescription from your primary care doctor, if you have a good relationship there. You should also be aware that equipment costs at local DME's may be three times the cost online.

Good luck with your therapy.

Georgio

[sleepgeorgiabrown]

Many thanks to all. So far, the only doctor I've talked with is my primary. He and I have a good relationship, so he's fine with writing a prescription for the APAP. In short, the second night is all about pressure, both on my airway and pocketbook! I will see what unfolds with insurance.
I sincerely appreciate the depth of knowledge on this forum. I just found the site yesterday. Great reading.

[Babette]

Yer a lucky person to have such a good PCP. Now go register for the forum so we can peep at you in more depth.

Welcome!
Babs