S9 CPAP vs. S9 APAP for me?

[CAsleep]

Hi all.

I called my DME and told them I want a better machine. The one I have now does not even record my AHI. I have been using CPAP for about 5-6 weeks, and so far have not seen a reduction in my sleepiness during the day. I am also still sleeping through my alarms, sleeping 10-12 hours a night.

Anyways, they told me that for $295 I can upgrade to the S9. I asked them whether that was the CPAP or APAP (there is an S9 for both). They told me it was the S9 CPAP machine. So my main question is if I should try pushing for the APAP (more details below).

My current pressure is set at 7, which was determined in my second sleep study (sorry, haven't seen the study, so I don't know if that was determined on my back or side....I wanna say I slept on my back that night. Working on getting those results). My OSA is considered at the borderline between mild and moderate. So I was set at (what I think is) a low pressure, and my pre-therapy AHI was not severe by any means (though my symptoms are, considering I am disabled by fatigue).

I read in the Wiki tool about the differences between CPAP and APAP. I really just want to know my nightly AHI and my leak rate, because it's better than the data I'm getting now, which is nothing. And I'd like to be able to tweak things based on the data I will get back. However....since I will be paying almost $300, I feel like I should go for the gusto and try to get the APAP, since it seems like it could potentially do more? Theoretically, if I get this great CPAP machine and I'm still not feeling better, would I wish I would have gotten the APAP?

I am just wondering what you guys think. Since I'm already paying about 1/3 of the price of the machine, should I try for the APAP, which is what I am perceiving as the choice that can "do more?" Or is there no reason for me to bug the DME about that, given what I've told you all?

I am supposed to be going in there late Friday afternoon (today).....now I'm wondering if I should push the appointment to next week, so I have more time to decide if I should take the S9 CPAP or ask for more, jumping through whatever hoops I may need to (like get my script written differently...)

Also, here are some of the advantages of APAP, as listed in the Wiki tool:

"8. Once optimal pressure settings are found, with software the patient can monitor his/her progress. Software reports provide specific data for the doctor’s analysis.

9. Use of an APAP and software may reduce the need for doctor visits and DME visits if the patient is responsibly managing their own therapy.

10. Use of an APAP may reduce the need for subsequent expensive sleep tests since the patient is auto-titrating. Working with a doctor and periodically using an overnight recording pulse oximeter (borrowed, rented, or purchased), the patient can test for oxygen levels at home with the report interpreted by the doctor. "


My question is, wouldn't the S9 CPAP give me those benefits too??? What is this about "auto-titrating," and why can't I do that with CPAP? It makes it sound like auto-titrating is something the patient does, not the machine?

Then this quote was under "Qualifying for APAP" in the Wiki: "Do you have daytime drowsiness which may also qualify you for an APAP?"

I do have severe daytime drowsiness....is this implying that APAP is preferable for those with daytime drowsiness over CPAP? Or is it just suggesting that if you've tried CPAP and are still drowsy, then try APAP? I am wondering if that question is misleading.....

[echo]

From what I have read here, the insurance codes for an APAP and a CPAP are the same, so THEY will get the same money regardless of which machine they give you. In theory they should NOT charge you more for an APAP. But others here can give you more sound info on how to convince them of this! In any case , given the choice, and if the cost is the same, get an APAP, it will give you more flexibility. An APAP in my mind is more of a convenience than anything else, but others will say it is critical for their sleep because their pressure needs are different throughout the night. The only way to know whether you do better on APAP or not is to actually try it.

By the way, a couple of comments that may have already been made before:
-The severity of your apnea has no correlation with your pressure need. While your apnea may only be "mild", the pressure you need to keep your throat open may very well be higher, eg (just pulling a number out of the air) 12 cm.
-Have you already checked for mouth breathing? That can be one very good reason that your therapy "blows" even if you are set to the correct pressure. Try mouth taping for a night, if you can/want.

[echo]

In the meantime you may want to read previous posts on this topic. A quick search for "insurance codes" will give you lots of hits. For example:
viewtopic.php?f=1&t=54544&p=512894&hili ... es#p512894

[CAsleep]

Thanks.

Reading all I can, including the insurance topics and other APAP topics in the archives. This decision is really stressing me out.

What is "self-titration", and why can't I do it with the S9 CPAP? Is that referring to what the APAP does (change pressure), or is that referring to some other benefit that I am missing? I keep seeing "self-titration" in people's descriptions of why APAP is great....but I am confused as to what it means.

[CAsleep]

I'm thinking I might just push for the APAP since I can set it to CPAP mode.

So let me replace all those questions above with a simpler one.....is there any reason to NOT push for the S9 APAP? Would that backfire in any way?

Thank you for being patient with me!

[echo]

Don't stress too much! You will not die if you don't get an APAP.

Self-titration can apparently mean two things:

I use that term to mean: pick a pressure (or pressure range), stick to it for a week, track your AHI and leak data daily, as well as how you feel during the day, and from that determine whether you need to raise or lower your pressure. Repeat weekly until you find ideal pressure (or range). Change by 0.5cm or max 1cm per week.

Others may use this to mean (what i would call) auto-titration. Put the APAP at a wide range (eg 4-20 or perhsp 6-15), track that for a week. The software will report at which pressure you spend 90%/95% of the time or more at night. The 95% pressure can then be used as either (a) the straight CPAP pressure to use, or (b) the minimum pressure for the APAP or (c) subtract 2cm from the 95% pressure and use that as the minimum pressure for the APAP.

Does that help?

[echo]

I'm thinking I might just push for the APAP since I can set it to CPAP mode.

So let me replace all those questions above with a simpler one.....is there any reason to NOT push for the S9 APAP? Would that backfire in any way?

Thank you for being patient with me!

NO, it will NOT backfire at you (clincially speaking). You can always run an APAP in CPAP mode, but not the other way around. So, the APAP gives you the most flexibility without sacrificing any of the features of a CPAP.

[echo]

Thank you for being patient with me!

Been there done that! That's what the forum is for

[CAsleep]

Don't stress too much! You will not die if you don't get an APAP.

Self-titration can apparently mean two things:

I use that term to mean: pick a pressure (or pressure range), stick to it for a week, track your AHI and leak data daily, as well as how you feel during the day, and from that determine whether you need to raise or lower your pressure. Repeat weekly until you find ideal pressure (or range). Change by 0.5cm or max 1cm per week.

Others may use this to mean (what i would call) auto-titration. Put the APAP at a wide range (eg 4-20 or perhsp 6-15), track that for a week. The software will report at which pressure you spend 90%/95% of the time or more at night. The 95% pressure can then be used as either (a) the straight CPAP pressure to use, or (b) the minimum pressure for the APAP or (c) subtract 2cm from the 95% pressure and use that as the minimum pressure for the APAP.

Does that help?

Thanks! Yes, that helps. I think what people were meaning in their posts (in the archives) was the second explanation, but I was taking it as the first explanation........sheesh!


I hope this isn't a dumb question, but I'll throw it out in case anyone knows. Do either the S9 CPAP or S9 APAP make that "computer-running" noise? Just wondering, since they store so much data, if you can "hear" all that extra technology. Kind of like the fact that my DVR (aka "Tivo" which records live TV) hums slightly because it's recording my TV constantly. I realize the sound of the air in the tubes would drown that out, but I'm just wondering if this thing will be like a computer (minus the tubes of flowing air) or what, acoustically. Strange question, I know.

[echo]

Interesting question. I don't think they make such a noise because they don't use hard drives, but rather solid state storage cards and internal memory (no physical moving parts like a traditional hard drive). The mask on the other hand...!

[CAsleep]

ps--to answer the mouth breathing question....my husband claims he witnessed me mouth-breathing one morning (more like, heard). So I have been taping my mouth since then.

[CAsleep]

Interesting question. I don't think they make such a noise because they don't use hard drives, but rather solid state storage cards and internal memory (no physical moving parts like a traditional hard drive). The mask on the other hand...!

Okay, great! Because if say...the APAP did make such a noise, but the CPAP didn't....that might be a deciding factor too.

[cflame1]

Just make sure that if they press a S9 CPAP on you that it doesn't say "Escape" or "Compact" on it.

[greg-g]

Just my thoughts
I had to purchase my machine outright (Well my insurance in Australia paid the first $500).
I have no regrets in paying the extra for APAP.
I need different pressures on my front compared to my back.
The S9 Autoset runs on the minimum pressure of 6 for about 2/3 the night, but for an hour or more it rises to about 9 - 13.
I have more issues with leaks when the pressure rises.
I suspect I eat more air (Can't remember the term) when the pressure is higher.
I would always go for the APAP, far more flexibility. You are the master of your machine. If your needs change, the S9 will change with them. I only download the data every few days, but its always interesting to see the variations in daily results, no two are ever the same.
The APAP can always be run as a CPAP, but the reverse isn't possible.
I believe the machines are identical apart from the controlling electronics. The S9 is certainly very quiet.
Everyone is different, and for me every night is different.
Sorry about the rave.

[mayondair]

My pressure needs vary a lot from night to night, so an apap is best for me, just something else to consider. I turned in my straight cpap after tracking data and talking with my new doc. Just remember, you are in charge, if you don't get what you want/need get a new DME, get a doc who will work with you. I fired the first of each, am doing better now.