Why S9 AutoSet so Popular vs. S9 Elite (Resmed)?

[Papit]

I'm seeing so many S9 AutoSet machines in use here and hardly any S9 Elite CPAPs. How come? Is there a good reason? Is the S9 Elite much newer and not as much in use for that reason? Or is the Autoset preferred because ???it can do everything the Elite can do and much more that the Elite cannot?

Thanks,
mikey Papit

[chunkyfrog]

The Elite is straight cpap; the Autoset is automatic, also having expanded reporting.
The Autoset can be run on cpap mode as well as apap mode, as can most other autopaps.
Both are excellent machines and can use all the same accessories.
For $50 difference, the ability to autotitrate is a 'no-brainer'.
Why go through an expensive sleep study if your machine can tell you your optimal pressure?

[Papit]

Thank you, chunkyfrog and anyone else who'd like to add to this thread. As the S9 AutoSet seems like a no-brainer relative to the S9 Elite basic CPAP machine, here's a follow-up question on the subject.

Are there any particular reasons why some DME's or Doctors or Sleep Centers, especially with respect to medical insurance issues, might be prone to prescribing/selling ResMed's S9 Elite CPAP machine instead of the more capable and versatile S9 AutoSet that I don't think cost much more? I'm not impressed by the tech gal in my sleep center who doesn't seem to want me, or even her, to have the future capability to make therapy adjustments that go beyond that of the S9 Elite CPAP, particularly since there's a good chance I may need apap or vpap. (The vast majority of my apneas night after night are Centrals, between 75% and 90% consistently. The sleep doc told me there's an even chance that conventional basic CPAP therapy won't cut it. So it doesn't make a whole lot of sense to me to buy a limited use machine.)

I have Anthem (BC/BS Federal program) health insurance. Is this really an insurance issue?

Thanks, --Papit

[Pugsy]

DMEs supply the least expensive model that they can get by with. $50 or so savings doesn't seem like a lot but multiply that by 100 or 1000 and the savings adds up and makes a difference in there bottom line because most insurance pay by billing code and not machine model. They get the same payment no matter which machine they supply.

Some DMEs see the light and do supply the Autoset routinely but many more supply the S9 Escape which has no useful data at all. At least the S9 Elite offers full data.

[Roger2]

Are there any particular reasons why some DME's or Doctors or Sleep Centers, especially with respect to medical insurance issues, might be prone to prescribing/selling . . .

My doctors always make those kinds of recommendations for all of my COPD and CPAP needs. I would personally never accept my DME’s (Apria) recommendation for anything without getting a some feedback from my physician. If you’re having apprehensions about this I would insist that the physician who wrote the script intervene for what he/she considers appropriate. Just a thought.

pax
Roger

[DocWeezy]

There's also the issue that a titration study is just one night done in a sleep lab and it may or may not reflect your true pressure needs. An auto gives you the option of seeing what your average pressure is over several days/weeks and makes it easier to make tweaks and adjustments to your pressure for optimal therapy.

My titration study was so bad that the doctor didn't even try to guess at a pressure...I only slept about 45 minutes. So he prescribed an auto and I learned how to track and read the data from the folks here. By the time I went back for my first follow up a couple weeks later, I had already adjusted the pressure and my AHI was way down. It wouldn't have been as easy to find my "sweet spot" if I'd had the straight cpap.

Weezy

[cowlypso]

The real question is why some doctors don't want their patients to have auto machines. My DME gave me the line (false, by the way) that I needed the doctor to specifically prescribe the auto machine in order to dispense one. I asked my doc to rewrite the prescription, and there was much reluctance. She told me that, since I was titrated with CPAP, there was absolutely no reason for me to have the auto feature. From subsequent events, I got the feeling that she just doesn't like and/or understand auto machines at all (when she said that she wanted to raise my pressure from 8 to 10, and I asked if maybe setting it in auto with that range to see if we really needed to go up that high, she said that there's no use running a machine in auto unless you set it wide open).

But, other than ignorance or fear, I'm not sure why a doctor would oppose a patient having an auto machine. DMEs, on the other hand, have a financial interest in sticking us with the cheaper machine.

[idamtnboy]

Are there any particular reasons why some DME's or Doctors or Sleep Centers, especially with respect to medical insurance issues, might be prone to prescribing/selling ResMed's S9 Elite CPAP machine instead of the more capable and versatile S9 AutoSet that I don't think cost much more?

As Pugsy said, money. They get paid the same for either machine. Both machines are the same insurance code.

I'm not impressed by the tech gal in my sleep center who doesn't seem to want me, or even her, to have the future capability to make therapy adjustments that go beyond that of the S9 Elite CPAP, particularly since there's a good chance I may need apap or vpap.

The Autoset is an apap. If there is a possibility the doc will want to move you to an apap you might as well save the hassle and get ahead of the curve and get it now.

Is this really an insurance issue?

Only if you want to move up to the VPAP. The doc has to specifically prescribe and justify it. It is a different insurance code. Above that is the ASV which will force you to breath. The doc may prescribe that if you have a severe CA problem that isn't resolved by the the other machines. It is megabucks more expensive, on the order of 6 to 10 times the price of an Autoset.

[Hose_Head]

Are there any particular reasons why some DME's or Doctors or Sleep Centers, especially with respect to medical insurance issues, might be prone to prescribing/selling . . .

My doctors always make those kinds of recommendations for all of my COPD and CPAP needs. I would personally never accept my DME’s (Apria) recommendation for anything without getting a some feedback from my physician. If you’re having apprehensions about this I would insist that the physician who wrote the script intervene for what he/she considers appropriate. Just a thought.

pax
Roger

Like Roger wrote! However, also be careful about what the physician has to say about it. Too often they have a direct conflict of interest in the issue because they own (or share ownership) of the DME. Also, some physicians (old school ones?) seem to have a dislike for auto cpaps (apaps). Their reasons for this are obscure, esp given that the literature seems to support the treatment efficacy of apaps (i.e. that they treat as well as a straight cpap).

My recommendation is that you hold out for an apap whether you want one or not and whether or not your physician wants you to have one. Apaps can still be run as straight cpaps, but a cpap can never be an apap.

Why insist on apap? There are a number of reasons:

- sleep labs seldom seem to be able to accurately titrate your pressure (used to establish the cpap pressure in your prescription). No one ever sleeps well in a lab sleep study and no one sleeps well with wires all over the place.

- your pressure may change from time to time. For example, you may gain or lose weight, possibly resulting in a necessary pressure change. With an apap, you can pick this need at home without need for another sleep study.

- some of us have positional sleep apnea, with a need for greater pressure when sleeping on our backs than when sleeping on side or stomach. Apaps automatically adjust for this.

- not all of us require the same pressure for the entire night. An apap will ramp up the pressure as necessary. For those who require higher pressures than most, this can provide greater comfort and easier adaptation to the treatment.

etc

Possible reasons NOT to insist on apap?

- if you're not insured (or under-insured), cost can be a factor. This is especially true for those of us who are not in the USA; our insurance rules likely are different from your's. And $50 can be a lot for some.

- some on this board prefer treatment with cpap, claiming it's more comfortable and/or that they have better results (it seems to be an individual preference)

- Simpler machine, less to go wrong (?) (I've never seen evidence to support this position as it relates to apaps)

- wider availability of options; some manufacturers do not make apaps.

Finally, NO MATTER WHICH YOU CHOSE, make sure that you get a fully data capable machine! A fully data capable machine will provide significantly more information about your therapy than one that cannot. A search of this board will provide a post, commonly updated, that lists which machines are fully data capable.

[Papit]

All of you: Roger, Pugsy, chunkyfrog -- you guys are GOLDEN. My instincts were telling me the same thing. Thank you very much for the valuable input.

This group is a great example of how discussion groups and their widescale access via the web can be so empowering to private individuals and patients who want and can take some responsibility for their own health and welfare, and not be so totally dependent on the competence and ethics of professionals.

Wonderful place, this is.

I'll have some stuff to share with you guys in a day or so about some head gear comfort and pillows leak reduction enhancements I have developed that are giving nice results.

--Papit

[archangle]

One reason the medical mafia dislikes Auto CPAP is that they make a LOT of money off of in-lab titrations to set the pressure vs. letting an Auto machine do it.

They also make a lot of noise about the data from home CPAP machines not being reliable for the same reason.

A lot of them probably believe what they are saying. People tend to believe in what gets them the most money. Also, when you repeat misinformation long enough, it takes on the ring of truth.

[StevenXXXX]

One reason the medical mafia dislikes Auto CPAP is that they make a LOT of money off of in-lab titrations to set the pressure vs. letting an Auto machine do it.

They also make a lot of noise about the data from home CPAP machines not being reliable for the same reason.

A lot of them probably believe what they are saying. People tend to believe in what gets them the most money. Also, when you repeat misinformation long enough, it takes on the ring of truth.

I think all of the above are true.

However, I really believe the #1 reason they do not like APAP is that it requires more of their time than just to say "I see you use your machine an avg of X hours per night. Continue doing that & come back & see me in 3 months." Just plain LAZY has a lot to do with it.

[Matty332]

Things must be quite different in the USA regarding insurance? I was under the impression here in Australia that there was no insurance at all for CPAP and you must buy it yourself. It is interesting that in the States you cannot choose which machine you want as well? The doctors prescription to me said "recommend CPAP treatment and weight loss" and that is all the dealer needed to sell one. I went to the dealer and she said "What machine would you like?" I replied - the auto Redmed please! Certainly wasn't cheap at $2500.00 AUS inc 5 year warranty (At the moment the AU dollar is same as US but everything is cheaper in the US!) for everything but they have some really good payment options available - up front payment, 12 month loan, 3 month loan, whatever you want. Anyone could afford one with their flexible options. Is the insurance in the USA provided by the government?

[Pugsy]

Is the insurance in the USA provided by the government?

Yes and no. Mostly no.
Medicare is sort of government but only for those over 65 (that have paid into Medicare in the form of taxes on wages for 10 years) or on a disability due to a medical problem and even then neither one is free. Roughly $120 a month comes out of the retirement check and there are deductibles, copays, and not everything is covered.

Medicaid...is state funded insurance for the poor who meet specific income guidelines and even then there can be co pays so not totally free medical care for the poor.

Bulk of insured are private insurance or group insurance through employers or groups. Most assuredly quite expensive either from employers paying the premiums or the individual.

Then there are the multitudes who fall in between with no insurance at all. Either can't be insured, make too much money to get Medicaid but not enough to buy private insurance and/or work for small company that doesn't provide insurance or are unemployed.

[hton]

One reason the medical mafia dislikes Auto CPAP is that they make a LOT of money off of in-lab titrations to set the pressure vs. letting an Auto machine do it.

They also make a lot of noise about the data from home CPAP machines not being reliable for the same reason.

A lot of them probably believe what they are saying. People tend to believe in what gets them the most money. Also, when you repeat misinformation long enough, it takes on the ring of truth.

I think all of the above are true.

However, I really believe the #1 reason they do not like APAP is that it requires more of their time than just to say "I see you use your machine an avg of X hours per night. Continue doing that & come back & see me in 3 months." Just plain LAZY has a lot to do with it.

I second all of this. And me too wants to thank everybody for the inputs and I am happy 'people empowerment' indeed exists thanks to the internet. So thanks to all who know more than newbies like us do to help us out, and thanks to the people who are running this board and are providing us with this place.

I am currently struggling (and am REALLY struggling) with the hospital here to get a decent machine (they gave me a Remstar 101M, a machine that was antique 5 years ago already when its successor came on the market, and this machine makes so extremely much noise, its impossible to sleep next to it. Let alone play CPAP-therapie with it). The hospital refuses, so I am now trying to get another hospital to help me out. It seems they will want to help me, but only with the Elite, although I asked for an Autoset. The Autoset is too expensive, so they said. Amazingly, whereas obviously in the USA the price difference seems to be only USD 50, over here in socialistic europe the price difference - according to the vendor - seems to be ...600 EUR (780 USD...)...

Next they told me 'Autoset is only necessary for central apnea', whereas it is now clear to me thanks to this forum and other places, this is only rubbish.

What strikes me most, however, seems to be that there is some sort of 'global apnea mob conspiracy' ( ) going on. After all, I can order stuff on Amazon that comes from the USA without problems, except for when it concerns something like an apnea machine. Suddenly vendors forbid export, USA shops don't recognize European doctor prescriptions, and so on. They made sure they are in control, not we. Which would not even be that big a problem of we had serious doctors and hospitals over here...