Can I just ask for an Auto CPAP?

[Sleepy Pilot]

Hey gang,

I head back to see my sleep doctor for a follow up after my first prescription. I have never met him, just two phone sessions and a faxed prescription. I wanted to collect two weeks for data and discuss it with him. He has me on a straight CPAP at 10cm. Although, I have been feeling much better, at times I feel it’s not enough and when my allergies are acting up it is hard to exhale. After many days of research here and various sites, I believe the best solution for me, long term purchase, is to have an Auto machine. My 14 nights vary from AHI average of 0.6 to 6.49 with up to 18/hr, PB 0.6% to 4.0% with PB events from 1 to 8 per night, OA events range from 1 to 43, and CAs from 1 to 11 per night.

Will I benefit from an APAP like the Resmed S9 Auto with EPR?
What are the differences / benefits of a BiPAP versus a Auto CPAP with EPR?

I feel like the doctor is easy to throw a prescription at me and the DME is, like any DME you read about here, maximizing profit before customer satisfaction. I don’t want to get stuck with a “good enough” machine when the rental period is over. Should I ask my doctor to prescribe a machine of this level? I feel it will serve me better over time.

[bap400]

Your prescription has to say auto on it in order to get one. The insurance codes are the same for both types of machines. So DME's will always try and sell you a cheaper machine for more profit. I never saw the sleep doctor at all and his script was for straight cpap. I wanted auto and asked my regular doc if he would write a script for one. He had no problem as I assured him I had done my research. ANY doctor can write a prescription for a machine. Good luck!

[DreamStalker]

Just ask the doc to Rx a min and max pressure and not just a single pressure.

[chunkyfrog]

You may need to have him/her enter a range instead of a single pressure--just to keep insurance/Medicare on board.
Try to get the RX for the EXACT machine you want, with "dispense as written", so they can't do what they do so well.
Don't let the RX say S9 Auto; you might get an Escape Auto! Ask for S9 AutoSET. That is the good one!

[Sleepy Pilot]

Thanks ChunkyFrog, I will insist on a prescription that reads S9 AutoSet, H5i and Climate Line. Is the order code 36025? What will the doctor say when I ask? Will he even care?

[chunkyfrog]

I am not familiar with this "order code" of which you speak; probably a proprietary item number from ResMed or the DME.
There would be 3 HCPCS codes: (insurance, Medicare)
Machine, (Cpap or Apap): E0601
Heated humidifier: E0562
Heated tube: A4604
I can't look at model numbers now, as I am away from home.
Just have the doctor write out the full name of each item--numbers are for the other guys.

[Julie]

The codes don't concern you or the doctor, only the DME who submits it to the insurance co... not your 'business' except to be able to remind the DME that the price is the same as far as the insce. co. goes.

[StuUnderPressure]

Thanks ChunkyFrog, I will insist on a prescription that reads S9 AutoSet, H5i and Climate Line. Is the order code 36025? What will the doctor say when I ask? Will he even care?

36025 S9 AutoSet w/ H5i & ClimateLine

But, with that number you will get the non-dishwasher safe water tub in the H5i Heated Humidifier.

If it were me, I would order the following:

36005 ResMed S9 AutoSet
36901 H5i Humidifier (with the dishwasher safe water tub)
36995 H5i Climateline Heated Tubing.

[avi123]

Hey gang,

I head back to see my sleep doctor for a follow up after my first prescription. I have never met him, just two phone sessions and a faxed prescription. I wanted to collect two weeks for data and discuss it with him. He has me on a straight CPAP at 10cm. Although, I have been feeling much better, at times I feel it’s not enough and when my allergies are acting up it is hard to exhale. After many days of research here and various sites, I believe the best solution for me, long term purchase, is to have an Auto machine. My 14 nights vary from AHI average of 0.6 to 6.49 with up to 18/hr, PB 0.6% to 4.0% with PB events from 1 to 8 per night, OA events range from 1 to 43, and CAs from 1 to 11 per night.

Will I benefit from an APAP like the Resmed S9 Auto with EPR?
What are the differences / benefits of a BiPAP versus a Auto CPAP with EPR?

I feel like the doctor is easy to throw a prescription at me and the DME is, like any DME you read about here, maximizing profit before customer satisfaction. I don’t want to get stuck with a “good enough” machine when the rental period is over. Should I ask my doctor to prescribe a machine of this level? I feel it will serve me better over time.

Reply,

There are certain medical conditions for which APAP should NOT be used:

(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); (6) 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); (7) patients being treated with fixed CPAP on the basis of APAP titration or being treated with APAP must have close clinical follow-up to determine treatment effectiveness and safety; and (8) a reevaluation and, if necessary, a standard attended CPAP titration should be performed if symptoms do not resolve or the APAP treatment otherwise appears to lack efficacy.

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225554/

[chunkyfrog]

Fortunately APAP's ALL can run on straight CPAP mode, giving you BOTH machines in one package.
You can run it whichever way works to the best effect --for you. (I prefer auto with a tight range).
And my doctors concur--both of them!

[Bons]

To answer your other question, a bipap operates differently from an auto pap. The maximum pressure difference between inhalation and exhalation on a cpap or autopap is 3cmH2O. Pressure increases are determined by apnea events during inhalations (I think). The bipap is set for two prescribed pressures for inhalation and exhalation, and often for more than 3cmH20. Often that is done because the doctor is recommending a needed pressure difference for therapeutic reasons, as opposed to the comfort feature of the EPR feature on a cpap. Pressure settings on bipap (I think - I know it is true for my ASV) are determined based on the needed exhalation pressure.

In order to be prescribed a bipap, there needs to be evidence of necessity to make the insurance company believe that the expense is justified. Most insurers require a period of time on cpap first to show that the cpap/autopap is not beneficial, and then a night in the lab to titrate for bipap. I only had three weeks on cpap, because it was pretty obvious that my AHI was increasing on cpap, all due to centrals.