Who would be a good canidate for an AUTO pap?

[YawnGirl]

I have read about the apap's but am still a little confused why my doc did not prescribed me one. I have mild apnea until I reach "dreamstate", that's a direct quote from my sleep doc. I assume he means REM but probably thought I was too stupid to know what that is. Anyway, during my "dreamstate" I have "very severe apnea", another direct quote. It seems an APAP would be good for me since I really don't need much air until I get to REM. Am I mistaken? Would I still have apneas because of the delay of the machine? Could some APAPers enlighten me please?

Thanks in Advance,

-Paula

[Muse-Inc]

I sleep much much much better with an APAP that's why my doc said medically necessary for me. I also am losing wt; with my dumb CPAP (ie, no data), I started losing air via loose lips and didn't know what was happening -- that happened after losing about 45#s. If I'd had data, I'd have seen the increasing leak trend and could have taken action then instead of fumbling around for 6 months and backsliding in my recovery. Because I have a lot more wt to lose, with an APAP now I will be able to track my data and note trends in case my pressure requirements are reduced as they were after losing 53#s -- so far it looks like my SDB is mostly due to my excess wt. thus I need a data-capable machine to watch trends in my therapy.

[timbalionguy]

I will preface by saying I am not a sleep doctor, so take this advice with the appropriate caution. I am going to take a wild guess here, and say that the reason your CPAP pressure is so high (14 is pretty high for straight CPAP) is that is what is needed to kill your apneas during REM sleep. If you do not have much apneas during non-REM sleep, you probably need a lot less pressure, say, 10 cm/H2O. For you then, an autoPAP machine might be an excellent choice. Better comfort in normal sleep and apnea suppression in REM sleep. And, any auto machine will be fully data capable, so you can see what is going on and make adjustments accordingly.

A prescription for a straight CPAP machine is also good for an autoPAP machine on sites like the sponsor of this board, CPAP.COM.

[YawnGirl]

I will preface by saying I am not a sleep doctor, so take this advice with the appropriate caution. I am going to take a wild guess here, and say that the reason your CPAP pressure is so high (14 is pretty high for straight CPAP) is that is what is needed to kill your apneas during REM sleep. If you do not have much apneas during non-REM sleep, you probably need a lot less pressure, say, 10 cm/H2O. For you then, an autoPAP machine might be an excellent choice. Better comfort in normal sleep and apnea suppression in REM sleep. And, any auto machine will be fully data capable, so you can see what is going on and make adjustments accordingly.

A prescription for a straight CPAP machine is also good for an autoPAP machine on sites like the sponsor of this board, CPAP.COM.

During my triation study, the tech had my pressure at 6 or 8 until I hit REM, then it was adjusted to 14 to stop the apneas. I think I will request an APAP from my DME tomorrow. My doctor already wrote me a "generic" prescription because I thought I would have insurance problems. I am still within my 30 days and have to pay my $500 deductible plus 20% so what could it cost me, another $25. I think I'll risk it.

Thanks for the explanation.

-Paula

[elg5cats]

During my triation study, the tech had my pressure at 6 or 8 until I hit REM, then it was adjusted to 14 to stop the apneas. I think I will request an APAP from my DME tomorrow. My doctor already wrote me a "generic" prescription because I thought I would have insurance problems. I am still within my 30 days and have to pay my $500 deductible plus 20% so what could it cost me, another $25. I think I'll risk it. Thanks for the explanation

You may have an additional workable option. If you must pay $500 plus 20% of DME charge or charge reduced by insurance, you may pay less or at minimal gain some equipment control, by an online purchase. Check out the auto on CPAP.com get some feedback about machines, and compare prices between your DME and online!!! I like my ResMed Auto very much and it can be used in CPAP mode if needed as others can too!!!

https://www.cpap.com/advanced-find-cpap ... ting-CPAPS

elg5cats

[YawnGirl]

During my triation study, the tech had my pressure at 6 or 8 until I hit REM, then it was adjusted to 14 to stop the apneas. I think I will request an APAP from my DME tomorrow. My doctor already wrote me a "generic" prescription because I thought I would have insurance problems. I am still within my 30 days and have to pay my $500 deductible plus 20% so what could it cost me, another $25. I think I'll risk it. Thanks for the explanation

You may have an additional workable option. If you must pay $500 plus 20% of DME charge or charge reduced by insurance, you may pay less or at minimal gain some equipment control, by an online purchase. Check out the auto on CPAP.com get some feedback about machines, and compare prices between your DME and online!!! I like my ResMed Auto very much and it can be used in CPAP mode if needed as others can too!!!

https://www.cpap.com/advanced-find-cpap ... ting-CPAPS

elg5cats

I checked that possibility. But my current set up is gonna be $598 out the door through my DME. If I ordered the same set up (including mask) through cpap.com it would be $722 and out of network for which my deductible is $1000. So I'm estimating my DME will be "allowed" to charge me about $100 more for the APAP. Which would cost me approximately $20 (20%) more. Bringing my total to $618 through my DME. My insurance, Humana, is pretty heavy handed when it comes to what they allow providers in their network to charge. I wish they would let me purchase from whomever I wanted as long as it was within their "allowable" amount for that machine, but they will not, has to me in network. I spoke to a rep there at length who actually is on CPAP himself, so I thought I had investigated every possible avenue.

If you know of another way for me to get this cheaper, I am open to investigating all suggestions

[kteague]

I started with a bare bones cpap machine, went to an apap, now using the same machine as you - a data capable cpap. The good thing about having an apap is having the option of either mode of delivery. Not everyone does well with fluctuating pressures, others find it a godsend. If 6 or 8 is the pressure you need during nonREM and 14 during REM, I'd venture to say you will not be able to enjoy that lowest pressure AND address REM events efficiently. That's a pretty wide span. But if you are having pressure difficulties, dropping just a few could improve your comfort level and still be therapeutic. Watching your data could help you dial in your best range. My thinking is switching machines depends on how much trouble you are having at 14.

[YawnGirl]

I started with a bare bones cpap machine, went to an apap, now using the same machine as you - a data capable cpap. The good thing about having an apap is having the option of either mode of delivery. Not everyone does well with fluctuating pressures, others find it a godsend. If 6 or 8 is the pressure you need during nonREM and 14 during REM, I'd venture to say you will not be able to enjoy that lowest pressure AND address REM events efficiently. That's a pretty wide span. But if you are having pressure difficulties, dropping just a few could improve your comfort level and still be therapeutic. Watching your data could help you dial in your best range. My thinking is switching machines depends on how much trouble you are having at 14.

True, I would like to option to try the Apap in case it would be better for me either now or down the road as my needs change. It seems from what I've read here, cpap therapy changes and I would have more options with the Apap as it can be set to be a straight cpap also, correct?

[Muse-Inc]

...seems from what I've read here, cpap therapy changes and I would have more options with the Apap as it can be set to be a straight cpap also, correct?

Yup to both.

[Wulfman]

I started with a bare bones cpap machine, went to an apap, now using the same machine as you - a data capable cpap. The good thing about having an apap is having the option of either mode of delivery. Not everyone does well with fluctuating pressures, others find it a godsend. If 6 or 8 is the pressure you need during nonREM and 14 during REM, I'd venture to say you will not be able to enjoy that lowest pressure AND address REM events efficiently. That's a pretty wide span. But if you are having pressure difficulties, dropping just a few could improve your comfort level and still be therapeutic. Watching your data could help you dial in your best range. My thinking is switching machines depends on how much trouble you are having at 14.

I agree with Kathy. The pressure changes MIGHT disturb your sleep......REM or otherwise. Do you currently have the software to see how your present machine and pressure are doing? I was titrated to 16.....doctor prescribed 18, but with a data-capable CPAP machine and software, I discovered right off that I could get good therapy with much lower pressures. After about a year, I had a chance to buy a lightly-used REMstar Auto......subsequently found that the pressure changes disturbed my sleep......AND, (with both machines) found that my titrated/prescribed pressures were "wrong".
APAPs and CPAPs both fall under the very same insurance code, so there should not be a difference in price from the DME.
I don't try to dissuade people from getting or trying an Auto as they're a multi-mode machine, but try to warn people that they're not necessarily the "end all, be all" machine for everybody......in Auto mode.


Den

[YawnGirl]

I agree with Kathy. The pressure changes MIGHT disturb your sleep......REM or otherwise. Do you currently have the software to see how your present machine and pressure are doing? I was titrated to 16.....doctor prescribed 18, but with a data-capable CPAP machine and software, I discovered right off that I could get good therapy with much lower pressures. After about a year, I had a chance to buy a lightly-used REMstar Auto......subsequently found that the pressure changes disturbed my sleep......AND, (with both machines) found that my titrated/prescribed pressures were "wrong".
APAPs and CPAPs both fall under the very same insurance code, so there should not be a difference in price from the DME.
I don't try to dissuade people from getting or trying an Auto as they're a multi-mode machine, but try to warn people that they're not necessarily the "end all, be all" machine for everybody......in Auto mode.


Den

I have ordered the smartcard reader, but not the software yet. I am very stubborn about paying $139 for $20 software. I'm not sure I would understand smartcard reading anyway. My machine just says my AHI's are 1.3 and my leak rate is 36 (acceptable for my mask). I hate waking with a stomach ache from all the air and I have to restart my ramp when I wake, as I cannot go back to sleep with 14 pressure. I thought about lowering my pressure by 1 cm, but I see my sleep doc on the 24th and have to take my smart card with me.

I just thought since my insurance will pay, somewhat,for one machine, I should get a more versatile machine. It is just like the one I'm using now except it is the Auto instead of the pro.

[Pugsy]

I am much worse in REM sleep also. Only 11 AHI in non REM but 53 AHI in REM. Desats to 73%. I use an auto unit with a minimum of 10 cm and max at 20 cm. Most of the time I will average around 12cm but sometimes I must get some really stubborn events in REM (you can watch the REM pattern with the software report graphs) and it will kick up to 15-18cm. These times are getting less and less frequent so I may be adjusting somewhat. The minimum pressure setting needs to be close enough to whatever therapy pressure is needed to get the events dealt with. The pressure increases are really rather slow and if starting too low it won't have enough time to get to the real theraputic range before the event becomes full blown. Gotta find a happy medium

It is nice to have the lower pressures for the majority of the night that I am not in REM and don't seem to need huge pressure increases. Does my way ever let a few events sneak past? Yeah, but not nearly as often now as it did at first. There was some discussion that perhaps I was in REM rebound and causing things to be worse and now that some time has passed (started May23) that I may not be needing the REM rebound.

If the pressure changes don't bother you then it doesn't hurt anything to leave the max open because the machine won't try to go there unless it thinks it needs to for some reason. Changes don't bother me, do not disrupt my sleep that I can tell. So the ceiling is there just in case. Your body may not adapt well to the pressure changes and if that happens you can limit the window to what seems to be the best thing for "most" events and see if the rogue events (that may need higher pressures) materialize or simply go away and don't come back.

Whatever brand you get, be sure to get the software because it is invaluable in isolating the patterns of events that may be occurring in REM sleep. Mine was pretty obvious. May 1 o 2 events in first 2 hours of sleep then wham, 15 or 20 in 30 minutes. This cycled that wall all through the night.

I use the Respironics M Series AFLex auto machine. Quite happy with it. Should you go that route drop me a note as I use the software and can help you out along those lines and with what to look for on the reports.

And yes, the auto units also offer the straight cpap mode as well as the auto mode. So you get 2 machines in one.
Some people find they do better in cpap mode. Some people seem to do better in apap mode. No one really knows which might be best if they don't give each a try... So go for it. Do plan on the software though.
Let me know if I can help.

[YawnGirl]

I am much worse in REM sleep also. Only 11 AHI in non REM but 53 AHI in REM. Desats to 73%. I use an auto unit with a minimum of 10 cm and max at 20 cm. Most of the time I will average around 12cm but sometimes I must get some really stubborn events in REM (you can watch the REM pattern with the software report graphs) and it will kick up to 15-18cm. These times are getting less and less frequent so I may be adjusting somewhat. The minimum pressure setting needs to be close enough to whatever therapy pressure is needed to get the events dealt with. The pressure increases are really rather slow and if starting too low it won't have enough time to get to the real theraputic range before the event becomes full blown. Gotta find a happy medium

It is nice to have the lower pressures for the majority of the night that I am not in REM and don't seem to need huge pressure increases. Does my way ever let a few events sneak past? Yeah, but not nearly as often now as it did at first. There was some discussion that perhaps I was in REM rebound and causing things to be worse and now that some time has passed (started May23) that I may not be needing the REM rebound.

If the pressure changes don't bother you then it doesn't hurt anything to leave the max open because the machine won't try to go there unless it thinks it needs to for some reason. Changes don't bother me, do not disrupt my sleep that I can tell. So the ceiling is there just in case. Your body may not adapt well to the pressure changes and if that happens you can limit the window to what seems to be the best thing for "most" events and see if the rogue events (that may need higher pressures) materialize or simply go away and don't come back.

Whatever brand you get, be sure to get the software because it is invaluable in isolating the patterns of events that may be occurring in REM sleep. Mine was pretty obvious. May 1 o 2 events in first 2 hours of sleep then wham, 15 or 20 in 30 minutes. This cycled that wall all through the night.

I use the Respironics M Series AFLex auto machine. Quite happy with it. Should you go that route drop me a note as I use the software and can help you out along those lines and with what to look for on the reports.

And yes, the auto units also offer the straight cpap mode as well as the auto mode. So you get 2 machines in one.
Some people find they do better in cpap mode. Some people seem to do better in apap mode. No one really knows which might be best if they don't give each a try... So go for it. Do plan on the software though.
Let me know if I can help.

I did not wake during the pressure changes in my sleep study but I don't know how sudden they were. The Respironics M series Alfex auto is exactly the machine I want. I really don't see what I have to lose in trying it ( except the $20). If I hate the auto adjusting or if it doesn't work for me, I can always go back to straight cpap.

I appreciate your offer of help. I will probably be PMing you in that regard as soon as I get my card reader.

Thanks again,

-Paula

[jules]

you keep thinking $ 20 -- you think the apap will be billed at 100 more and you pay 20 % of that -----

you got a lot more homework to do and questions to ask

the code for apap and cpap are the same - if the script doesn't say apap on it you might not get an apap period from the local DME -

if you can get an apap with a cpap script they can charge YOU whatever they want extra ------ ain't going to be any insurance money in that - all YOURS

I go to the drug store with my rx for a brand name drug - a generic is available - if I demand the brand name on the script, I pay my copay plus the difference between the generic and brand name cost to the pharmacy -- if I have a generic on the script there is no way I can get the brand name unless there are some more calls made to my prescriber and all - more games - more paperwork - more red tape - and do I win? hell no

[DoriC]

[ .....subsequently found that the pressure changes disturbed my sleep......
Den

I don't think I ever asked this question before, I've just observed that Mike does better on straight cpap and is more restless on auto. Of course when I ask him about it, he just says "something's not right". So what are the disturbances you feel?