Can I ask Dr. to perscribe APAP instead of CPAP?

[Maddiestarr]

My Dr. has arranged a Sleep Study for 11/29. I have been reading this wonderful forum and have a question. The RN for my Dr. said they never prescribe APAP unless the CPAP is not effective over time. I would rather have a machine that will adjust with me as I loose weight etc. Insurance rents machine for 10 months and replace every 5yrs. Has anyone gotten an APAP script at initial sleep study? If so what can I say or ask the sleep study Dr. in order to get a script for the APAP, humidifier etc.? Thanks so much for this forum. It has taken away a lot of the frightening unknowns.

[tqpannie]

I didn't ask but was prescribed one after a second sleep study. However, my results were moderate sleep apnea with decreased SP02 saturation and I only got 12 minutes of restorative sleep a night. My sleep efficency was like at 18%.

[BlackSpinner]

The doctor works for you, not vice versa. If you know what you want (and you don't have any strange complications like central apneas) just insist on what you want. If they won't do it, take what they wrote to your GP or dentist and get them to write the prescription.

[tomko44]

I went to an ENT and they put me on BiPAP but not auto. Why? So they can charge my insurance every six months for new tests (over 1K each). My primary was shocked that I wasn't given an Auto-set machine and he said he would write the prescription for it. Oh... and the ENT never heard of APAP or Autoset... he relies on what the sleep center recommends.

[avi123]

Some physicians don't want to specify APAPs b/c of the extra diagnosis needed to exclude certain underlying medical conditions.

According to the AASM Report, of 2008, 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)

[Slinky]

Ask that you be given your prescription so that you may shop for the best buy and equipment from the local DME providers in your area yourself. Explain you will also need the script for when you are traveling out of state in case your CPAP or equipment is lost, stolen or broken.

Ask if he will script an auto-titrating PAP for you, tell him there is only about a $50 price difference between models. If he refuses, ask him why he refuses. Explain your reasoning about weight loss. If he still refuses then, assuming you have a good relationship w/your family doctor, ask that he re-write the script including a pressure setting 1-2 cms below the titration study scripted pressure and 2-3 cms above the titration study scripted pressure. The script does not have to say auto PAP or APAP, scripting 2 pressures is all that is needed to indicate an APAP is needed.

When I was switched to a bi-level PAP I told my sleep doctor up front I would not accept anything but an auto-titrating bi-level PAP and let him know I had already done some price shopping. He wrote the script for me.

[edm_msu]

It would really help if you got an APAP prescription, with a range specified, at the beginning. I didn't. After reading posts from this forum I requested an APAP prescription from my GP. She complied. The DME refused the prescription because a range wasn't specified. MY GP does not know a lot about sleep apnea so she could not specify a range. She offered another sleep study. Considering that these cost thousands of dollars, I did not do another sleep study. I went to a sleep specialist and requested an APAP prescription. He complied and wrote a prescription with a range of 6 to 10 cm H2O. My CPAP is 9 cm H2O.

It was worth the trouble, but it would've been easier if an APAP was specified from the beginning. An APAP is better because it can be run as a CPAP.

[zoocrewphoto]

I was lucky. Without knowing anything, I got a doctor who specifically prescribes machines with full data. And He has nothing against apap machines. I had a clear difference in ahi when sleeping on my side (73.6) and on my back (99). Also during the titration, it was clear that 13 would take care of just about anything on my side, but would not be enough for on my back. They went up to 15 during the titration, but I only slept on my back twice, so they weren't sure if 15 was enough. They recommended up to 17. So, my prescription is 11-17, and that works great for me.

A lot of people have more apneas while on their back, and require more pressure while on their back. When you have your followup with the doctor to make the prescription, ask about these numbers. If there is a big difference there, you can use that to your advantage to push for an apap machine.

Here is another possibility. I had an appointment with my regular doctor 2 days before my first appointment with my sleep doctor (after the sleep study). It just happened that way. My regular doctor told me she had my sleep study results. She didn't understand it all, but she did show it to me. Mine actually stated that it recommended an apap with settings 11-17. So, I knew before I went to the sleep doctor that I was getting an apap. If you have a good relationship with your regular doctor, and they are going to receive a copy of the sleep study results, you may have a chance to see them before going to the sleep doctor. That may tell you what they are planning to prescribe, and give you some time to look over the data and plan your argument if you see that they don't want to prescribe an apap.

I would also make sure that the prescription is written for the brand and model of the machine you want. It is so important to get the full data machines, so make sure they don't mess with you.

[Daisy004]

I think a lot of doctors (like mine) just dont know so as long as your insurance covers it tell him to be specific and write the script for an Apap. Mine was very generic in his original script and I had one heck of a time getting it switched. Good luck.

[johnthomasmacdonald]

my advice based on my very limited experience would be to try for a bi-level, a bipap or vpap. The difference for me in comfort between a respironics 560 system one apap and a S9 remed vpap s ( which is Not automatic) is night and day. I actually prefer the vpap to no machine at all while I loathed the experience on apap and dreaded the approach of going to sleep.

[Janknitz]

my advice based on my very limited experience would be to try for a bi-level, a bipap or vpap. The difference for me in comfort between a respironics 560 system one apap and a S9 remed vpap s ( which is Not automatic) is night and day. I actually prefer the vpap to no machine at all while I loathed the experience on apap and dreaded the approach of going to sleep.

Most insurers will not cover bilevels, bipaps, or vpaps unless you first "fail" CPAP/APAP. So don't even go there. It will be hard enough getting an APAP, which is ridiculous because an APAP can be run in straight CPAP mode.

Tell your doctor you've been studying up on CPAP machines and you would like an APAP because it has a full range of capabilities and data. If the sleep doctor refuses, as mentioned above, your GP or any other doctor can order it for you.

Please read my blog post "What you need to know BEFORE you meet your DME" so you understand what you need to know about your insurance and how to deal with the DME. Having a specific prescription for an APAP will make it MUCH easier.

[Sir NoddinOff]

There are as many different answers to your question as there are different types of sleep doctors, DME's and insurance companies etc. You can always ask... that costs nothing. Remember to document everything you do.

[chunkyfrog]

When you ask, it's best to be knowledgeable, but to offer to share the advanced data on future visits.
"---So WE can get my therapy tuned to optimal levels."

[lorraineg57]

Some physicians don't want to specify APAPs b/c of the extra diagnosis needed to exclude certain underlying medical conditions.

patients who do not snore (either naturally or as a result of palate surgery), ]

Really? Pt's who do not snore??? I barely snore at all, should I not be using apap?

[archangle]

Really? Pt's who do not snore??? I barely snore at all, should I not be using apap?

I've never heard of any problems for non-snorers with APAP.

Snoring may help you use APAP because many of us snore "before" we apnea and it makes it easier for the machine to find the right pressure, because most APAP machines will raise the pressure when they "see" a snore. However, if you don't snore, the machine will still adjust pressure upward when you have an obstructive apnea, hypopnea, or even flow limitations on some machines.