Should I fight to get an APAP rather than CPAP?

[baldbaby]

I was just diagnosed with sleep apnea and the doctor's prescription is for a CPAP with EPR. I only used a machine for one night while wired up with all the electrodes, microphone, etc. and didn't really like it that much, but that's not really a normal environment so it's hard to say whether I can get used to it or not. I was hoping to get an APAP machine run it in CPAP mode, and if the CPAP wasn't doing it for me I'd have the APAP option, but my regular doctor doesn't think he's qualified to give a script and the sleep doctor who did the original won't change my script.

I'm wondering if I should try some more convincing on my sleep doctor or just go with his CPAP suggestion and hope for the best. I'm anxious to try something soon for my wife's sake!

Dan

[SharkBait]

I'd certainly try for good data capabilities if it doesn't look like you can get APAP. Don't fall for them saying it has compliance data and a smart card only to find out that it's only logging blower hours. Research the machines and make sure you get one that records leak rates and AHI so you can track the effectiveness of your therapy.

[Sleeprider]

I have an APAP machine, but as time has gone by, find I run it in a fairly narrow pressure range. Very close to CPAP. I appreciate the exhalation relief (C-flex) and something missing from your script is a humidifier. You might want to get that corrected, its a common oversight. The APAP machines have great data and that is a real advantage and motivator in understanding your progress in therapy. You could ask your doctor to script the APAP since it would result in a better machine that helps you track your progress and offer better feedback to him. Definitely get the humidifier. I don't think most doctors know that the end-cost for the better equipment is about the same. The DME may see a higher margin on less sophisticated machines.

[rested gal]

my regular doctor doesn't think he's qualified to give a script

That's too bad that your regular doctor feels that way. All it would take from him is scribbling "APAP @ 5 - 15 cm H2O and heated humidification." But if he doesn't feel comfortable prescribing cpap stuff, so be it.

and the sleep doctor who did the original won't change my script.

That's really too bad. Since an autopap can be set to operate in straight CPAP mode, the sleep doctor is playing "god" imho -- refusing a reasonable request from you for an autopap.

On the bright side, however, you can get perfectly good treatment and can monitor and tweak your own treatment yourself (if you want to) with a straight CPAP machine, as long as you choose one that can give AHI and leak data.

My list of machines that record "full data" (AHI and leak info) and those that don't -- as of October 2008:
viewtopic.php?p=307168#p307168

DME might not understand what "Full data" is.
viewtopic.php?p=344265#p344265

[baldbaby]

Thanks for you responses. I guess I should have mentioned that my 2 choices would be either the Resmed S8 Elite II (CPAP) or the Resmed S8 Autoset II(APAP). I'd get a humidifier too. The EPR mode is also on the perscription. I notice that the CPAP is on the link from Rested Gal as recording full data.

The equipment supplier was pretty honest with me and said that he would actually make less money if the perscription was for APAP rather than CPAP but thought it might make sense for me to try to get the script changed. He said it would be best to get the doctor to despense an APAP but call for it to be used in a CPAP mode with my setting of 6cm/H2O. I'm not sure if locking out the APAP option makes sense or if they would want to do that.

[ww]

Thanks for you responses. I guess I should have mentioned that my 2 choices would be either the Resmed S8 Elite II (CPAP) or the Resmed S8 Autoset II(APAP). I'd get a humidifier too. The EPR mode is also on the perscription. I notice that the CPAP is on the link from Rested Gal as recording full data.

The equipment supplier was pretty honest with me and said that he would actually make less money if the perscription was for APAP rather than CPAP but thought it might make sense for me to try to get the script changed. He said it would be best to get the doctor to despense an APAP but call for it to be used in a CPAP mode with my setting of 6cm/H2O. I'm not sure if locking out the APAP option makes sense or if they would want to do that.

Sounds like good advise from your DME. It leaves all options open down the line, which can be very important!!!

[Hawthorne]

If you can get an APAPand it's set in cpap at your titrated pressure,and you are "locked out" of the Auto mode, that would be great.

If you wanted to use it in auto mode in the future, just come here and we'll be glad to tell you how to "unlock" the auto mode and use it effectively.

Try for an auto. If that isn't going to happen, at least get a data capable machine form Restd Gal's list and come here for help in using that one effectively.

[RipVW]

APAP saved my life, since my sleep study titration was WAY too low. So, I'm an APAP proponent. And, with APAP, you have the option to run it in CPAP mode if you prefer. The APAP auto titration gives you the option to let the machine find your pressure "sweet spot." With CPAP, you don't have that option. Good luck!

[tdm5032c]

I would DEFINITELY fight for the AUTO machine. I had to for mine with both my sleep doc and Apria. Both wanted to give me just a straight CPAP machine. I didn't ask them, I TOLD them what I wanted. It's YOUR money and YOUR life at stake here so you have the right to get what you want. Just insist on it. Call higher up at Apria and your insurance if you need to. Give yourself all the advantages you can in your treatment.


Tracy

[baldbaby]

I talked to the sleep doctor again about getting the APAP in case I needed that function later. He was getting a little annoyed at my persistance and basically said he knew what I needed and he wasn't going to budge. He also said he had to justify the APAP to the insurance company and he couldn't do that. He said that there is better compliance with APAP, a fact I'm seen disputed on this forum, and that people sleep better with a CPAP. He implied that APAP was a way for manufactures to make more money. I was disappointed but really didn't know enough to say he was wrong.

Oh well, I'm going to give in and get the CPAP so my wife can get some sleep.

Dan

[carbonman]

He was getting a little annoyed at my persistance and basically said he knew what I needed and he wasn't going to budge. He implied that APAP was a way for manufactures to make more money. Dan

...just curious, is your alleged doctor associated in anyway,
w/the DME that is supplying your equipment?

Oh well, I'm going to give in and get the CPAP so my wife can get some sleep.
Dan

...how sad.

[baldbaby]

I don't think it's a matter of money for the DME. The DME actually suggested that I try to get the prescription changed and admitted that he'd be making less money if it was changed.

I'm trying to find out how much insurance is going to pay. I'm starting to wonder if I should just order one and pay for it myself.

[Wulfman]

My opinion......
If your pressure of 6 cm. is correct, or even close to it, you don't "need" an Auto. In fact, at that pressure you wouldn't even need exhale relief (EPR or C-Flex)......unless you have some serious lung impairments. What you DO need is a data-capable machine that can tell you if your doctor "guessed" your pressure correctly (if your titration was any good).


Den

[wasColette]

As long as you get the ResMed S8 Elite II you should be ok. It's straight CPAP, but still has data capability which is what you really want!

[rux1960]

Yes you should...Doctors have to learn we are partners as best not compliers in our health issues...Of course I was recommended first a cpap a but luckily with this site with the research I've done I learned why apap is a better choice whether you will use it in apap or cpap mode...I assume that doctors must be paid some % for each machine and possible this is more of a business decision( they might want to sell more cpaps maybe)...so insist it makes a difference I have a respironics which has relief on both inhalation and exhalation for me it made a difference in being able to get used with the machine,,,not that now I have a great treatment...
good luck

Rux