I was recently diagnosed with mild sleep apnea, requiring 6 cm of pressure.
I'm supposed to get fitted with a machine soon. At that pressure, would a regular CPAP machine be adequate, or would APAP offer any advantages?
Thanks in advance for any help.
APAP for mild sleep apnea?
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apneaicinisrael
- Posts: 142
- Joined: Tue Jan 31, 2006 6:41 am
WELCOME!!!
There is a definite subset of us Mild Users here, always happy to have another member! I have been on CPAP for about 6 months, mild (AHI = 12 before CPAP), on a setting of 5. I tried a week on 6 but my numbers were the same.
Tell us a bit more about your sleep study results. How many apneas and hypopneas did you have an hour? Did you do a titration study? If so, what kind - in the sleep lab, or at home with an APAP?
In my case, my titration study showed a very regular pressure need, i.e. my pressure stayed the same all of the time, and at that pressure my AHI dropped to a reasonable number. There are some people who have pressure variation when in APAP mode, depending on if they roll on their back, right side, left side, etc. I got a straight CPAP machine, as it was felt that with such a regular pressure need, the APAP wasn't necessary. It was also a matter of the kind of insurance coverage I have. It would have cost me a lot more out of pocket to get the APAP.
IF I had different insurance, I would have requested an APAP anyway. Reasoning being that you can always set it to regular CPAP, but it is nice to have the APAP option. For instance, if I had an APAP machine I might from time to time sleep a few nights on APAP just to retest my pressures, see if the machine "chooses" different pressures for me than what I have been on. Also, in the Puritan Bennett machines at least, the amount of info that the software gives you is different betweent the CPAP and APAP. On the PB 420s, which I have, the information collected is more limited than on the parallel APAP machine, the 420e.
So, my opinion is that if money/insurance is an issue, the straight CPAP machine might be just fine for you. If your pressure needs were very consistent. Treatment wise I feel great with mine! But IF your insurance will cover an APAP, go for it. It gives more options/flexibility.
That's my 2 cents!
Best of luck,
AII
There is a definite subset of us Mild Users here, always happy to have another member! I have been on CPAP for about 6 months, mild (AHI = 12 before CPAP), on a setting of 5. I tried a week on 6 but my numbers were the same.
Tell us a bit more about your sleep study results. How many apneas and hypopneas did you have an hour? Did you do a titration study? If so, what kind - in the sleep lab, or at home with an APAP?
In my case, my titration study showed a very regular pressure need, i.e. my pressure stayed the same all of the time, and at that pressure my AHI dropped to a reasonable number. There are some people who have pressure variation when in APAP mode, depending on if they roll on their back, right side, left side, etc. I got a straight CPAP machine, as it was felt that with such a regular pressure need, the APAP wasn't necessary. It was also a matter of the kind of insurance coverage I have. It would have cost me a lot more out of pocket to get the APAP.
IF I had different insurance, I would have requested an APAP anyway. Reasoning being that you can always set it to regular CPAP, but it is nice to have the APAP option. For instance, if I had an APAP machine I might from time to time sleep a few nights on APAP just to retest my pressures, see if the machine "chooses" different pressures for me than what I have been on. Also, in the Puritan Bennett machines at least, the amount of info that the software gives you is different betweent the CPAP and APAP. On the PB 420s, which I have, the information collected is more limited than on the parallel APAP machine, the 420e.
So, my opinion is that if money/insurance is an issue, the straight CPAP machine might be just fine for you. If your pressure needs were very consistent. Treatment wise I feel great with mine! But IF your insurance will cover an APAP, go for it. It gives more options/flexibility.
That's my 2 cents!
Best of luck,
AII
your pressure requirement really has nothing to do with severity of OSA. That is simply the pressure found that is needed to keep your airway open. Your pressure could be 6cm and you could have severe OSA.
However, you would gain nothing with an autopap at that pressure. The Min. pressure would probably be set to your titrated pressure of 6cm. If your pressure requirement changed the autopap would automatically increase from the 6cm to what was needed.
An autopap is a harder sale to convince your doctor, dme and insurance it is medically necesssary even more difficult if your pressure requirement is only 6cm. 6cm is very easy to breathe against so you should be okay with any machine you use.
I would however request a new M series Remstar Pro machine. It is straight cpap but also has cflex feature (should your pressure needs increase a nice feature to have) and it also records sleep data so you would know if the machine is actually treating you properly vs. guessing (with optional software and card reader you must purchase on your own as it is not covered by insurance). The new M series Pro also displays AHI and pressure sleep data right on the LCD display, so needing software is really optional.
However, you would gain nothing with an autopap at that pressure. The Min. pressure would probably be set to your titrated pressure of 6cm. If your pressure requirement changed the autopap would automatically increase from the 6cm to what was needed.
An autopap is a harder sale to convince your doctor, dme and insurance it is medically necesssary even more difficult if your pressure requirement is only 6cm. 6cm is very easy to breathe against so you should be okay with any machine you use.
I would however request a new M series Remstar Pro machine. It is straight cpap but also has cflex feature (should your pressure needs increase a nice feature to have) and it also records sleep data so you would know if the machine is actually treating you properly vs. guessing (with optional software and card reader you must purchase on your own as it is not covered by insurance). The new M series Pro also displays AHI and pressure sleep data right on the LCD display, so needing software is really optional.
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apneaicinisrael
- Posts: 142
- Joined: Tue Jan 31, 2006 6:41 am
I am a great lover of APAP but in your case there isn't much for an APAP to do.
Much lower pressure and you may have trouble breathing (at 4 or 5), and there shouldn't be too much difference in the pressures required with different sleep positions. Not much to be gained from comfort either (having the APAP give less pressure alot of the night since you are already down pretty low).
Only reason in your situation to get APAP that I can think of is to check your titration in the future in case your needs change (and avoid another sleep study). For me, avoiding another sleep study both for the experience and cost might be enough, but you have to make that decision for you.
Also depends on who is paying and what your insurance coverage is. I agree it might be a very hard sell to get insurance to pay for APAP at a pressure of 6. If I were paying out of pocket for the whole thing, I would spend the extra $150 - 200 for the APAP to avoid additional sleep studies. If I had insurance and they would give me a CPAP machine that gave me data and would fight APAP, I would let it go at your pressure and get a good CPAP.
Much lower pressure and you may have trouble breathing (at 4 or 5), and there shouldn't be too much difference in the pressures required with different sleep positions. Not much to be gained from comfort either (having the APAP give less pressure alot of the night since you are already down pretty low).
Only reason in your situation to get APAP that I can think of is to check your titration in the future in case your needs change (and avoid another sleep study). For me, avoiding another sleep study both for the experience and cost might be enough, but you have to make that decision for you.
Also depends on who is paying and what your insurance coverage is. I agree it might be a very hard sell to get insurance to pay for APAP at a pressure of 6. If I were paying out of pocket for the whole thing, I would spend the extra $150 - 200 for the APAP to avoid additional sleep studies. If I had insurance and they would give me a CPAP machine that gave me data and would fight APAP, I would let it go at your pressure and get a good CPAP.
When I started CPAP just over a year ago, my AHI was 15 & the Dr said I only needed a pressure of 4. When that didn't work he increased the pressure to 6. (The DME had set me up with a Resmed S7 CPAP).
After about a month of being 100% compliant & not feeling a whole lot better & a sleep Dr that never wanted to hear my thoughts on the subject (I'm only the patient ... what do I know) I decided that maybe I didn't NEED the APAP, but I wanted one if I was going to have to work this out by myself.
I got a script for an APAP from my excellent internist, shelled out an extra $100.00 to the DME & got the machine I wanted. Now my pressure is a consistant 10.6, HI = 2.6, AI = .1. I feel so much better & have never regretted spending the extra money or getting the APAP.
Lyn
After about a month of being 100% compliant & not feeling a whole lot better & a sleep Dr that never wanted to hear my thoughts on the subject (I'm only the patient ... what do I know) I decided that maybe I didn't NEED the APAP, but I wanted one if I was going to have to work this out by myself.
I got a script for an APAP from my excellent internist, shelled out an extra $100.00 to the DME & got the machine I wanted. Now my pressure is a consistant 10.6, HI = 2.6, AI = .1. I feel so much better & have never regretted spending the extra money or getting the APAP.
Lyn
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arthuranxious
- Posts: 120
- Joined: Sun Aug 20, 2006 3:19 pm
Mild apnea & auto adjustable APAP
This discussion is of great interest to me, I am post diagnosis but pre-titration and have already formed the idea that an auto-adjustable would be advisable for me. The main reasons are (1) I have an overall index of 17 but only 6 in REM sleep, and fairly low during lateral sleep (which is much of my night) however during supine sleep the incidence of apnea shoots up to 52 an hour. Because of these very different levels it makes sense to me that I should be on APAP rather than CPAP, but, even though I have read a lot in the last few weeks about this new problem of mine, which caught me unawares, I am not a professional and will have to wait for the input of my pulmonologist and the techs of the sleep lab (2) I am trying very hard to lose weight and have taken off 10 lb. in the month since the initial sleep study and hope to get rid of another 30 lb. within the next half year, I think it is quite possible that my need for CPAP will be changing during this time.
My only real reason for feeling that I may be one of those who are helped by losing weight, is that my wife commented when I lost weight some years ago that my breathing during the night sounded more consistent and smooth.
Anyway, even if I am destined to stay on CPAP for ever the weight loss should help cut my risk of many other problems so hit the gym all the way down to 175 lb by next summer
My only real reason for feeling that I may be one of those who are helped by losing weight, is that my wife commented when I lost weight some years ago that my breathing during the night sounded more consistent and smooth.
Anyway, even if I am destined to stay on CPAP for ever the weight loss should help cut my risk of many other problems so hit the gym all the way down to 175 lb by next summer
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