Canadians - What is the pressure range to qualify for A-Pap?

[Lannie]

I just recently had another sleep study after seven years and had been on a pressure of 9cm for a long time and doing well. That changed this past year and the sleep doc said I needed a pressure of 11-12cm. I tried a straight pressure at 11cm for 4 nights and was so sleep deprived, bad headaches that there is no way I can handle that with a cpap.

I brought in read outs that I had done months before on an apap which showed clearly that I was having more hypopneas and only about .01 to a max of .05 apneas. On the Apap machine I had it set at a pressure range from 9- 14. The highest it went was 11.5 and the lowest it went was 9cm.

I tried to explain to the respiratory therapist that 90% of the time I was between 9-10.5 and in 11.5 for shorter periods, probably while in REM or when I am stuffed up. I feel because I do not tolerate one straight pressure over 9 cm max, that an apap would be better for me so that I would have the amount of pressure I needed...when I needed it... and not when I didn't need such a high pressure. I have GERD and Atrial Fibrillation and it makes more swallowed air which doesn't help either. I am also a senior.

I requested that the sleep doctor would change the order from a cpap to an apap for the above reasons. The respiratory therapist showed him some of my readouts and told him I could not tolerate the straight high pressure. What did he do? He changed the pressure down to 9.5 - 10cm on a cpap. I was told he is not allowed to prescribe an Apap because the pressure range is not great enough. If the pressure range was between 9- 12 would that not be enough especially since he first prescribed a pressure of 11-12?
Since I have to pay 25% of the cost of a machine I am feeling like it is not about what is best for the person who needs the treatment.

What cm range is needed to qualify for an Apap if you cannot tolerate straight high pressure?

I hope someone knows because I am upset enough that when your machine breaks down they expect you to wait four months or more before you get a new prescription and in the mean time rent a machine from the DME for 145.00 per month. That is crazy. It profits the dme and robs the person who needs treatment. Do they really care? It doesn't look like it if they expect you to go four months without treatment. Now, if the prescribed pressure cannot be tolerated instead of prescribing an apap they just lower the pressure which will not reach the higher apneas which occur between 11-12 cm. Something is very wrong here.

Is 9-12 not eligible for an apap? If I go on the adjusted prescription it will not reach the apneas during rem or when I am stuffed up which is fairly often as I live in a damp ground floor unit. How do I convince the sleep doctor to change me to an apap?

Thank you in advance for any help in the pressure range needed for an apap elibility with ADP in Canada

[Julie]

Can I assume you have no insurance? Or that you haven't talked to them about this?

Can you afford to buy your own machine (if possible online from e.g. Cpap.com, a whole lot cheaper than up here, though Resmed equipment is not allowed to be shipped here)?

I'm not aware that there's a gov't ruling about pressures... where did you hear that?

[Nick Danger]

I have read other posts on the forum indicating the provincial insurance schemes can be pretty strict on this point. There are hard and fast rules (that vary by Canadian province) determining what they will pay for. I recall one post that mentioned one province's criteria for an APap. I'll see if I can track it down.

Tracked it down. Ontario's APAP requirements are below:

For APAP devices: Individual has a documented diagnosis of OSAS where there is a change in pressure of a minimum of 4 cmH2O on a prescribed fixed CPAP level of 10 cmH2O or more.

The change in pressure occurs between REM vs. NREM or supine vs. non-supine.

The link to the thread which has a lot of good info regarding how this works in Canada (though details appear specific to Ontario) is: viewtopic.php?f=1&t=95962&st=0&sk=t&sd=a

[Lannie]

Thank you Julie, and Nick Danger

I am covered for 75% but must pay the other 25% for ADP (assisted Devices Program) in Ontario.
I am not covered for supplies including mask seals 90.00 for Quattro pro seal. I am a senior turning 70 in a few months.
When my cpap machine broke down I was told by a dme I would have to rent a machine for approx. 4 months or more. I figured you could buy a new machine from U.S. for the cost of 4 months rental. I ordered an intellipap auto from cpap.com and my son drove me to Ohio where my daughter lives. It was there within 3 days so I have an autopap. The thing is, I had to use the money saved for my two pair of glasses, walking and bifocals, as I have macular degeneration. I had to put my glasses off for another 5 months. Because I am eligible for a machine at 75% off I want one to have as backup so I do not have to wait another 4 and a half months to get another five years from now.

Nick, I do live in Ontario. I don't see why the doctor cannot put a range of 8.5 to 12.5 so I can have a machine that will treat my AHI and allow me to have a comfortable sleep rather than lower my pressure which won't get the ones that come during rem or when I am stuffed up. Would that be illegal for him to do that? It would only be .5 lower and .5 higher than 9-12 range.

Thank you both, for responding

[Pugsy]

If you could get a RX for APAP and use your ADP program...how much would your 25% copay amount to?

[SleepWrangler]

I don't see why the doctor cannot put a range of 8.5 to 12.5 so I can have a machine that will treat my AHI and allow me to have a comfortable sleep rather than lower my pressure which won't get the ones that come during rem or when I am stuffed up. Would that be illegal for him to do that?

OHIP ADP is an insurance program and you have to meet their criteria to quality for funding. If you don't meet the criteria you get no funding.

Respiratory Equipment Policy and Administration Manual: http://www.health.gov.on.ca/en/pro/prog ... manual.pdf

Auto-Titrating Positive Airway Pressure Systems (APAP) Individuals requiring APAP systems must meet the Medical Eligibility Criteria for a positive airway pressures system (see 335) and the Medical Eligibility Criteria outlined below. The individual must have polysomnographically documented OSAS where there is a change in pressure of a minimum of 4 cmH2O on a prescribed fixed CPAP level of 10 cmH2O or more; and the change must occur between REM vs. NREM sleep or supine vs. sleeping on their side.

P.S. I buy my glasses manufactured and shipped from Pakistan. Blended prescription with all the coatings for less than $200 instead of more than $1000 from my optometrist.

[Julie]

And just another thought - if you get 'stuffed up' a lot, have you tried turning down your humidifier in case it's causing congestion as it can for some people (like me)? You certainly don't need to use it for therapy or compliance(!) unless you like it and it helps your Cpap experience.

[Lannie]

And just another thought - if you get 'stuffed up' a lot, have you tried turning down your humidifier in case it's causing congestion as it can for some people (like me)? You certainly don't need to use it for therapy or compliance(!) unless you like it and it helps your Cpap experience.

Julie, I haven't needed to use the humidifier over the summer as it is damp in my apartment unit already. I am on a wait list for another place as this bothers the arthritis too. I wear breathe right strips every night and sleep in an electric bed with top raised and feet raised somewhat as I am now having problems with swollen ankles too. Thank you for the thought though.

[Lannie]

I don't see why the doctor cannot put a range of 8.5 to 12.5 so I can have a machine that will treat my AHI and allow me to have a comfortable sleep rather than lower my pressure which won't get the ones that come during rem or when I am stuffed up. Would that be illegal for him to do that?

OHIP ADP is an insurance program and you have to meet their criteria to quality for funding. If you don't meet the criteria you get no funding.

Respiratory Equipment Policy and Administration Manual: http://www.health.gov.on.ca/en/pro/prog ... manual.pdf

Auto-Titrating Positive Airway Pressure Systems (APAP) Individuals requiring APAP systems must meet the Medical Eligibility Criteria for a positive airway pressures system (see 335) and the Medical Eligibility Criteria outlined below. The individual must have polysomnographically documented OSAS where there is a change in pressure of a minimum of 4 cmH2O on a prescribed fixed CPAP level of 10 cmH2O or more; and the change must occur between REM vs. NREM sleep or supine vs. sleeping on their side.

P.S. I buy my glasses manufactured and shipped from Pakistan. Blended prescription with all the coatings for less than $200 instead of more than $1000 from my optometrist.

Thanks Sleep Wrangler, I just found that out about an hour ago. I am wondering if I get a copy of my full titration study from the sleep lab maybe it will show that there is a 4 cm change. I can only hope. If not, I just won't waste my money on a cpap which I won't use. I personally think they should scrap them and just use auto/cpap machines so you can choose which to use, straight cpap or auto. Straight cpap is ok if your pressure is under 10 but above that doesn't work for me. Once I get a copy of my full titration study, and if it reveals a 4cm range I will make an appointment with the sleep doctor taking this titration study with me. I will also bring months ofdata proving apap works better for me (printed data from my machine), and reasons why it gives me better treatment in regards to bringing down my AHI. I will also give him reasons why, in regards to medical comorbidities, a straight pressure higher than 10, and especially a 11 or 12 which he first prescribed are not helpful for everyone, a straight pressure which I could not tolerate at all. Maybe my age also plays a factor, I don't know for sure. I am coming up to 70 in a few months.

I also plan to write to ADP, OHIP or Long Term Care to change the options for people who go above a 10cm pressure to be able to use an apap with a shorter range than 4cm over 10. If your best treatment range is 9.5- 12.5 that should qualify, otherwise you are not getting your full treatment and missing apneas that are at a higher range when using a cpap straight. I hope that makes sense. It makes sense to me because I have gotten my AHI down to 2 or 3 although my apnea is down to .01 0r .05 at highest now with apap.

One day in the future other people on here will be saying people used to be stuck with one straight pressure which kept them from getting the proper treatment they each individually needed. I'm sure glad it isn't like that these days! The reason things change is because of people, like the people on here, speak out and assist each other. This is a great site.

[Julie]

Your doctor should give you a copy of your Rx by law... but Ihave no idea if the lab will.

[Nick Danger]

Good luck, Lannie.

[Hawthorne]

Just for clarification - Julie said that Resmed would not allow shipment of any of their products outside the US but the same is true of Respironics products.

Secondwind, I think can ship here and that might be a way to go for a new or nearly new APAP. You need your prescription to buy, even from Secondwind, I believe.

[Julie]

To clarify - you can buy Resmed stuff from dealers up here (who charge a mint for the favour), but not e.g. from Cpap.com.

[Hawthorne]

Yes, you can get Resmed and Respironics machines from Providers in Canada. In Ontario, there are a lot of restrictions concerning new machines. You have to have a recent sleep study and a recent prescription. Even if you want to pay for it yourself, without these 2 criteria being met, you can't buy.

These 2 companies don't allow shipping from an online US supplier to individuals outside of the US. In some Provinces APAP are always prescribed I understand. I think that is in some western Provinces. Ontario sleep doctors where I live, will only prescribe APAP under very strict circumstances. I don't know what those circumstances are. As has been said, each Province in Canada makes their own rules about CPAPS.

I purchased my first APAPs online back when the "big 2" did allow shipping outside the US. Our dollar was worth more then too.

As I said, I think Secondwind will ship to individuals in Canada. They are a reliable company.

[BlackSpinner]

You can get a shipping forwarder who will ship what you order to Canada or anywhere else in the world. It is still cheaper then buying a new machine in Canada.