APAPs -- are they becoming standard prescriptions from Docs?

[Sloop]

As I don't have one, I am curious as to how often they are prescribed? Seems like an awful lot of folks here have the APAPs. So -- for someone who has regular ole OSA (if you can define "regular"), are APAP prescriptions becoming the norm?

[SleepDepraved2]

I am newly diagnosed. I required a high pressure, so I was prescribed a BiPAP with a high pressure of 22 and the low at 17.

I saw the pulmonologist yesterday and when I told them about my problems with aerophagia, I was told I may "qualify" for an APAP. So apparently there are diagnostic standards that must be met before you are prescribed an APAP.

[jnk]

"For now, based on the available data from experimental studies on short-term effects only, the decision to use APAP versus CPAP may well depend on individual patient preferences, specific reasons for non-compliance, costs and other practical considerations that clinicians and patients will need to assess on an individual basis."--Ip et al.: Auto-titrating versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: a systematic review with meta-analyses. Systematic Reviews 2012 1:20. http://www.springerlink.com/content/h19 ... lltext.pdf

[chunkyfrog]

I started out with an S9 Elite, as my RX listed straight pressure.
I bought my S9 Autoset online (cpap.com) with a one size fits all RX. from the same doc's associate.
My pressures with my Autoset run between 2-4 cm lower than I was titrated at,
My comfort level is a quantum leap above what I had before.
I have informed my doc how much better I am being treated with this machine.
Hopefully he can learn.

[greatunclebill]

insurance companies may have diagnostic criteria that need to be met before they pay for apap. if one is paying out of pocket the doctor has no real reason to not prescribe apap, other than if he personally don't believe it to be the best treatment. my wife got an apap because of positional apnea. i got one because i couldn't handle straight pressure cpap that he had prescribed a year and a half earlier, with apnea, and new asthma and copd. by the time apap becomes the gold standard, it will be outdated by newer technologies.

[avi123]

There are more important issues against using APAPs in cerain situations than money. According to the AASM Report persons with several medical conditions should not be treated with APAPs.



(5) certain APAP devices may be initiated and used in the self-adjusting mode for unattended treatment of patients with moderate to severe OSA without significant comorbidities (CHF, COPD, central sleep apnea syndromes, or hypoventilation syndromes);

Patients with congestive heart failure, significant lung disease such as chronic obstructive pulmonary disease, patients expected to have nocturnal arterial oxyhemoglobin desaturation due to conditions other than OSA (e.g., obesity hypoventilation syndrome), patients who do not snore (either naturally or as a result of palate surgery), and patients who have central sleep apnea syndromes are not currently candidates for APAP titration or treatment. (Standard)



Certain APAP devices may be used in an unattended way to determine a fixed CPAP treatment pressure for patients with moderate to severe OSA without significant comorbidities (CHF, COPD, central sleep apnea syndromes, or hypoventilation syndromes). (Option)

Source:

Practice Parameters for the Use of Autotitrating Continuous Positive Airway Pressure Devices for Titrating Pressures and Treating Adult Patients with Obstructive Sleep Apnea Syndrome: An Update for 2007

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225554/

To those who feel like jumping and saying that the above Guidelines were in 2007 and the APAPs machines have been modified since then, my reply is this:

Take for example the Resmed S9 Autoset. Dr Michael Berthon Jones, Resmed's chief designer of their Autoset machines, applied for patents on the S9 Autoset operation and techniques (such as using the FOT) already in 1994. So any major modifications in this machine after 2007 (when the AASME Guidelines became effective), is doubtful.

[Sloop]

Excellent feedback -- thanks
Obviously, it is not a black and white issue, but I am beginning to understand the "particulars".

[poppi2]

My sleep doc's favorite DME provided a "brick". After I discovered cpaptalk.com, I saw the light. I then asked my sleep doc about the need for having detailed data to monitor my progress. He said, "Naw, I just go by how you feel."

I bought my current machine from cpap.com (my family doctor signed a copy of cpap.com's prescription form). Earl

[dragonflybeach]

I had to request my APAP because the sleep doc prescribed a straight CPAP pressure.
I'm a mover and a shaker when I sleep, never staying in the same place for more than hour or two.
The DME sent me a brick and I sent it back.
She refused to give me an APAP citing insurance and auditing issues. My insurance confirmed I could have the APAP (same code).
I had my general doc rewrite the prescription for an APAP and we used a different DME.
He wanted to know why I wanted the APAP and for me (and him) it made sense.
I'm not in the U.S., so access to DMEs is limited to the interent and phone.
I don't speak the language here (but I'm learning).
It took 7 weeks to get the sleep study, another 5 weeks for the titration study and 6 more weeks to get the machine.
If I ever need to be re-titrated, I can only imagine it will take another 6 weeks.
This way, with the APAP, I can either run the machine in auto-titrate mode or fixed cpap mode. It's a nice option to have access to.
I need this to be successful almost right out of the gate and if getting a better machine will help me achieve this, then it makes sense to go with an APAP.
And a bonus, the new DME sent me a full face mask, nasal mask and nasal pillow mask.

[-tim]

The difference between an APAP and CPAP machine from the main vendors is nothing other than software, a bit of plastic on the label and the price tag. Since every APAP can work as a CPAP but not the other way around, it seems odd that anyone would prescribe a CPAP machine without a track record that an APAP machine isn't correct. I expect that is costs more to make a ResMed s9 Escape than an S9 Auto because of the volumes sold and the extra engineering time to dumb down the product.

Most people have higher compliance with APAP over CPAP.

[Slinky]

... costs more to make a ResMed s9 Escape than an S9 Auto because of the volumes sold and the extra engineering time to dumb down the product. ...

Say WHAT??? Volume sold??? A LOT more Escapes are sold than AutoSets. A LOT more!!!! The VAST MAJORITY of CPAP patients haven't got the slightest idea of what features are available on CPAPs, heck they don't know ANYTHING about CPAPs except what their local DME supplier provides and tells them.

From my experience attending two different local apnea support group meetings most CPAP users can't even tell you what brand and model CPAP they are using, what their pressure setting is nor which mask they are using. *sigh*

Those of us in these various apnea support forums are a VAST MINORITY. Mores the pity.

[JohnO]

Very interesting thread, as I want to be armed with as much information as possible before seeing a sleep doctor and having a sleep study. I have some experience with nasal canulas blowing air up my nose, and can certainly state that at a low pressure it is OK, at too high a pressure, it is bothersome. It would seem having a machine that can adjust would be ideal. I also switch from side to side a number of times while I sleep.

John

[flatag]

S9 Autoset is what my doc prescribed. The DME is part of the same practice. I went in ready to do battle to get one and there it was already waiting for me.

Although I'm currently using it as a straight cpap, as I'm a new user, it's nice to have options.

[Ticman]

... costs more to make a ResMed s9 Escape than an S9 Auto because of the volumes sold and the extra engineering time to dumb down the product. ...

Say WHAT??? Volume sold??? A LOT more Escapes are sold than AutoSets. A LOT more!!!! The VAST MAJORITY of CPAP patients haven't got the slightest idea of what features are available on CPAPs, heck they don't know ANYTHING about CPAPs except what their local DME supplier provides and tells them.

From my experience attending two different local apnea support group meetings most CPAP users can't even tell you what brand and model CPAP they are using, what their pressure setting is nor which mask they are using. *sigh*

Those of us in these various apnea support forums are a VAST MINORITY. Mores the pity.

I believe you are correct Slinky. I know 14 poeple I work with that have Apnea. Myself and one other know anything about the machine and software. Several of them have data capable machines but have never downloaded the data. I think APAP and software should be the standard. Unless you need another type machine ie... VPAP, BiPAP, etc..

[akcpapguy]

Regardless if a patients Rx says a fixed pressure (CPAP) or a range of pressure (APAP) we only hand out Autos.