CPAP user - need help evaluating switch to APAP

[nrei]

Hi, all,

Looks like a great/helpful board! Never knew this existed.

I'm hoping some of you can help with my decision-making about switching to APAP and which machine would be best. I have to decide NOW in order to use my insurance coverage before end of year.

So here goes....

Been on CPAP 5 yrs with pressures 9-12. Don't feel rested after 8-9 hours sleep on 9 cm, so just had a 50/50 sleep study. (2 hours off/3 hours on)

Sleep study showed pressure of only 7 cm needed.
Great if it's true, but I have my doubts. DS said I sometimes snore mildly on CPAP (9 cm) which went away when increased to 10. It seems like having an APAP machine would help see what's going on; whether pressure needs are changing. Since my pressure is low, doc doesn't think an APAP would be worth the expense (but isn't opposed to it).

I would like to be able to see my pressure, AHI, and whether I'm having any leaks. (At the beginning of my sleep study, with mask check, it showed that I was leaking but I thought I had a good seal. I couldn't hear or feel ANY leak with my Swift.)

Current sleep study showed only hypopneas, no apnea.
AHI 18
But 58/hr respiratory and snore related arousals. (Isn't that significant?)
More PLMS on CPAP, whatever that means.
(My AHI during REM was 40; 16 NREM. But that was only 9 min REM during the 2 hours w/o CPAP).
I don't think I've ever had any central apneas.

Previous sleep study 5 years ago was a higher AHI and both apnea and hypopneas. You know...the whole can't-remember-what-a-restful-sleep-feels-like-anymore, gasping, choking bit w/o CPAP.

These are the machines I'm considering. I want to get 1 billed thru insurance THIS MONTH and 1 for travel/backup. (Maybe only 1 necessary to try/start out?)
--Intellipap Auto (Looks great! Are SmartCode reports available only temporarily or can be printed later?)
--S8 Autoset II (Can you really see leak, AHI, pressure info on the display each day?)
--S9 Autoset (if it really adds much. Doesn't look like you can read any more info than the S8 auto w/o special software? Don't think I need the CA detection. I hear the power supply is very heavy, even though the machine itself is <2#.) If it's worth it, could get just the machine w/o humifier.
Looks like I couldn't print anything for the Resmeds.
Only use humidifier sometimes, during winter, so that's not a make-or-break issue.

If I don't need APAP, I guess I'd go for an Elite S8 or S9?

I will have 100% of the allowable covered by insurance, no required rental first, if I order this month thru an in-network provider. But some of the local DMEs charge an upgrade fee for an autoset (up to $300!) or any Resmed CPAP above the Escape. I think I can get 1 thru one DME (or online) for less than that $300 even with my lower out-of-network coverage. Hard to say for sure, since BC won't tell me what their allowable is. ($1000?)

So I guess my questions are:
Is APAP a good idea for me? Am I a good candidate?
If I can get the S8 autoset II, is that sufficient...or is the S9 auto really that much better?
Would the Intellipap be sufficient as a full-time machine, not just travel?
Is the humidifier covered under the same code/charge as the machine?

Anything else I should be considering/looking at?

Thanks for any help/input you can provide!

nrei

[LinkC]

Yes, by all means go for the Auto machine. If you later find you do better at a fixed pressure, you can run the Auto in CPAP mode. APAP gives you options a CPAP won't.

Further, APAP all the time is like a home titration every night. It reacts to needs as they arise. Get yourself an APAP for Christmas!!

[cflame1]

If you're going for the Resmed... by all means get the S9... the S8's card reader is very hard to get.

And stay away from ANYTHING labelled ESCAPE or COMPACT with Resmed. All that it will tell you is hours used.

[BusyLyn]

Why should you be charged an upgrade fee to get an apap rather than a cpap when the prescribing code for both is the same? I think you have at least one unscrupulous DME.

[nrei]

BusyLyn,

Yes I wonder about those upgrade fees too!
They say it's because the APAPs and better CPAPs cost more, but since the code is the same they don't get any better reimbursement. But if the DME does get $1000 from my insurance and charges me $300, they get more than their cost and more than the CPAP w/humidifier thru CPAP.com. And the upgrade fee is charged regardless of whether you get a humidifier or not. I found one (out of 4-5) that said no upcharge, but need a script that specifies APAP. (Why?) The others all charge some upgrade fee. If I can't get one thru this one DME, my insurance said they can call and find out why the nearby DME is charging an upgrade fee. They say it may be ok for them to charge a fee and they won't know 'til they talk to them.
In 2005 I was charged an upgrade fee (above 100% insurance coverage) for my S8 Escape, which I guess was new at the time.

Thx.

nrei

[dtsm]

If you're going for the Resmed... by all means get the S9... the S8's card reader is very hard to get.

And stay away from ANYTHING labelled ESCAPE or COMPACT with Resmed. All that it will tell you is hours used.

Two key non-negotiable elements to any cpap:
1. should be apap
2. should have full data capability

The S8 autoset II is a great unit, I have two of them - one via DME/insurance, the second I bought on my own as backup and travel unit. But cflame1 is right, the card reader is very very hard to get these days. You can get daily readouts on the unit that include: pressure, leak rate, Ahi, hi and ai. But you can't download, etc. without the card reader.

[nrei]

Thank you for detailing what is viewable on the S8 Autoset II! I could only find info that said AHI, pressure, leak but not AI, HI. I think that might be enough for me. I could just log the info in a notebook.
Does it come with the data card, if I want to take data to my doc? My DME will also print out reports for me.

[brazospearl]

Welcome to the forum, nrei! If you're in the US and your DME is charging you an "upgrade" fee for an apap, you should probably be looking for a new DME. Unless your insurance is an HMO, which is a different thing altogether. Anyway, I vote for getting an apap because it gives you more choices. The S9 is a better choice than the S8; the price is practically the same, but accessing data is much easier with the S9. There are several users here who really like the Intellipap, too, and it appears to be able to provide excellent therapy.