CPAP vs. AutoPAP?

[sampt]

I have sleep apnea and am trying a "loaner" AutoPAP from the Sleep Clinic so the RT can determine the prescription for a CPAP machine. This is all new to me. A friend said to request an AutoPAP but the RT said no. He said apnea episodes can still "sneak" through with Auto, whereas with CPAP there's the continuous flow of air to prevent. Is there a noticable difference between CPAP & AutoPap? I'm claustrophobic and the thought of continuous airflow concerns me. I'm using the nasal pillow mask they gave me with the "loaner". The RT said he'd fax the prescription to a DME and I said I'd like the prescription so I could purchase where I'd like, but again he told me to let him know the DME I want to use & he'd fax. He seemed to get a little defensive when I asked for the prescription. As a beginner is it probably wise to purchase through a DME versus on-line in case I have issues as I don't know much about the equipment? I have been reading this forum trying to gather information and I'm just getting more confused, hence stressed. I have no one to discuss, certainly not the sleep clinic Dr. or RT as they seemed more like salesmen than medical. I check with one DME & they said I'd be looking around $2600.00 for the CPAP, humidifier, & accessories. I have a high deductible insurance plan and was told I (applying towards my high deductible) couldn't purchase outright but a on a "rent to own" basis. Is that standard? Any information, suggestions or direction I would appreciate. Thank you.

[dtsm]

Welcome.

Start here: our-collective-cpap-wisdom/23/Selecting ... pment.html. Most folks here will strongly recommend you get an apap rather than straight cpap machine. And one that is has full data capability. The reference I provided, along with the other sections give you more details.

[Pugsy]

Rent to own is common. Length of time can vary with insurance company. During that time DME needs to provide compliance data to the insurance company to prove you are using the machine. Medicare's rental time is 13 months, many insurance companies will mimic Medicare.

Given your high deductible I would suggest standing your ground and get the RX in your hand and purchase from some place like cpap.com. Get the machine that you want. Get an APAP. If the minimum pressure is high enough apnea events won't slip through. If you find that CPAP works better for you the APAP can be set in CPAP mode. So you would have 2 machines in one.

Check with your insurance company because a purchase from an online source could possibly even be applied to your deductible. Cpap.com will provide the necessary paperwork to file to your insurance company.

Your RX is part of your medical record and if an oral request doesn't get it produced, a written request has to be honored just like any other medical record request. Any doctor can write the RX. If you have a friendly primary care physician then it can be easily obtained. It doesn't have to be the sleep doctor or RT services.

While it is preferable to have a DME that will work with you, in all honesty they can be difficult to find. I found one that I could get masks from even though I bought my machine through other sources.

Try not to get too stressed. While all this information can seem overwhelming at first, it does become clearer and it will eventually sink in and you can most certainly become comfortable with all this. Ask questions. Lots of good people here will be more than happy to answer and offer support. My doctor didn't want me to have an APAP either. I got one anyway along with the software. Come to find out after we saw the data I had some needs that were better addressed with an APAP so I got the doctor's blessing with my choice. If I had got CPAP first, effective therapy would have been delayed by at least 3 months.

Get what you want. Don't settle for anything less. It is your body, your health and your money.

[Slinky]

*sigh* "Your" RT is either 1] less than truthful or 2] not very knowledgeable in his/her field or 3] just plain stupid. PAP stands for positive airway pressure. An APAP provides positive airway pressure, its just that the amount of pressure can vary thru out the night as needed vs one constant pressure thru out the night. You would do well to ask this RT why or how he/she can determine your pressure need w/a loaner APAP if apnea episodes can still "sneak" through with an Auto.

A CPAP can only provide one set pressure as programmed whereas an APAP can be run in straight CPAP mode OR in auto mode.

Very nicely request your equipment order (script) AGAIN, this time casually mention that it is part of your medical records and you have a LEGAL RIGHT under HIPAA (actually your legal right only extends to COPIES, but a copy will do you just as well if necessary). To ease the pain you could mention that you will need the script when you are traveling just in case your equipment gets lost, stolen or broken.

Yes, most insurances purchase your PAP on a rent to own basis varying anywhere from 3 - 13 months. You would pay your copay monthly. The accessories, mask, hose, humidifier; would be paid for right up front and your copay for them would also most likely be due at time of receipt as well. While I HIGHLY RECOMMEND that first timers buy from a good local DME provider for the support they can receive IF YOUR COPAY is going to be about $2600 by all means you are much better off buying AT LEAST the APAP and humidifier online.

[LinkC]

What your RT was telling you is that the APAP adjusts your pressure up and down to meet your needs. It depends on pre-apnea events to adjust. It responds very quickly, but if the bump isn't quite enough, it can allow apneas to "slip thru". Then, if there are no further events, it will eventually bump back down, repeating the same cycle. The key is to keep the range narrow.

That being said, some do very well on APAP, others do better on CPAP. The good news is an APAP machine can be run in both modes. That's why you should push for the APAP.

[sampt]

I would like to thank everyone for their input. Something else I forgot to mention...my ENT said I do not reach the 3rd or 4th stages of sleep & didn't think CPAP would help. So he referred me to a neurologist he heard at a lecture once not knowing he no longer practiced neurology but just reads sleep studies (he now owns sleep clinics). So I ended up seeing an MD that worked there. He read my report, asked me to open my mouth, said I had OSA & never addressed not reaching the 3rd or 4th stages of sleep. From there he sent me to the RT who gave me the auto for 2 weeks so he could get my pressure so he could write a prescription. I called my ENT & left a message if he could refer me elsewhere as I wasn't "comfortable" with the Dr. & RT he referred. My ENT called back & left a message apologizing that he wasn't familiar with that particular sleep clinic & for me to set up an appointment to discuss further. In the meantime, I'm using this auto just as the RT set it up for me to take home. I've had side effects that I don't know are common... sore/scratchy throat, dry cough, congestion, earache, sore gums/sensitive teeth, not to mention a nose that looked like Rudolph and my hair breakage from the headgear. I turned the humidifier up but that was a mistake, I was congested all the next day. I have it turned down a notch lower than what the RT set, and just have a scratchy throat now. Re-adjusted the nasal pillow/headgear from the way he fitted me so now my nose isn't as sore. I thought I broke the cartilage in the lower nostrils as they were so sore I couldn't even touch. He told me to use the medium size nasal pillow but it was uncomfortable so I switched to small. I apologize for using this site as a sounding board, but I have no one to discuss. I feel like I'm flailing. Thank you for your suggestions & taking the time to respond! I assume you've all been where I'm at now when you first started so hopefully you can understand my stress.

[greg-g]

Just my opinion, but the way some sleep clinics try to discourage people from using APAP because some episodes may sneak through to is rubbish. With a CPAP machine to a certain extent your flying blind as far as pressure is concerned, and the only real way to check is to go back for another sleep test that costs (makes) someone a lot of money. An APAP machine can with a little care be used for self-titration in your home environment which I think is far more accurate. (To do this you must have a fully data capable machine, the software, and an interest in your own progress. Something that applies to most using this forum. Help is only a post away.)
Most APAP machines have a default pressure range of 4–20. I’ve never met anyone who has their machine set to this range. Personally I started with mine set from 6–20, but after 6 months I’ve now increased it to 7-20 as it feels more comfortable. My pressure stays at about 7 for most of the time, rising to about 10 once or twice per night, and occasionally as high as 14 when I’m sleeping on my back. Where would you set my CPAP pressure? My minimum pressure is adequate to catch most episodes.
I now average less than 0.5 events per hour compared to my sleep test that recorded 35 events per hour.
I also use a recording SPO2 meter about once per month to check all is OK. These are available from reputable dealers in China for about $100.

[Pugsy]

Sore nose is common when the nasal pillows are too tight. Loosening will help. Also some additional moisture added to the nostril area (even inside) can help. Lansinoh nipple cream (found in the baby care aisle of most stores) is one that a lot of users use. Doesn't take much. Avoid Vasoline products though. They can harm the mask and harm your lungs.

Sore throat??? Hmmm, just since starting therapy? Is it possible that you are breathing through your mouth? When I first started therapy I was using a nasal pillow mask system and I was breathing through my mouth and this caused dryness and a sore throat till I figured out how to keep my mouth shut.

Humidifier setting needs are indeed very personal. Some need lots of humidity (like me) others do much better with less. Sounds like you already figured that out.

Sore gums and teeth could simply be from the pressure exerted by the too tight nasal pillows on the teeth and gums.
Earaches can be from the pressurized air being blown into the nasal cavity. There are tiny passageways that connect the nasal cavity and sinuses to the ears. This explains why some people get an ear infection along with a normal cold.

Discuss your symptoms with the ENT, especially the ear thing. The sore nose and sore teeth should improve with the loosening of the nasal pillows but the ear thing should not be allowed to go unaddressed if it persists. When I first started CPAP I had some popping in the ears and a bit of discomfort similar to what a person feels when flying at high altitudes. I was able to relieve it by swallowing and yawning with my mouth shut. The ear thing didn't last long with me though. Maybe couple of weeks. You might try the swallowing and yawning trick to see if it helps. Sure won't hurt.

BTW, which nasal pillow system are you using?

Rule out mouth breathing for the sore throat issue.

[Jayjonbeach]

I have sleep apnea and am trying a "loaner" AutoPAP from the Sleep Clinic so the RT can determine the prescription for a CPAP machine. This is all new to me. A friend said to request an AutoPAP but the RT said no. He said apnea episodes can still "sneak" through with Auto, whereas with CPAP there's the continuous flow of air to prevent. Is there a noticable difference between CPAP & AutoPap? I'm claustrophobic and the thought of continuous airflow concerns me. I'm using the nasal pillow mask they gave me with the "loaner". The RT said he'd fax the prescription to a DME and I said I'd like the prescription so I could purchase where I'd like, but again he told me to let him know the DME I want to use & he'd fax. He seemed to get a little defensive when I asked for the prescription. As a beginner is it probably wise to purchase through a DME versus on-line in case I have issues as I don't know much about the equipment? I have been reading this forum trying to gather information and I'm just getting more confused, hence stressed. I have no one to discuss, certainly not the sleep clinic Dr. or RT as they seemed more like salesmen than medical. I check with one DME & they said I'd be looking around $2600.00 for the CPAP, humidifier, & accessories. I have a high deductible insurance plan and was told I (applying towards my high deductible) couldn't purchase outright but a on a "rent to own" basis. Is that standard? Any information, suggestions or direction I would appreciate. Thank you.

Things will be a bit of a battle at first but fight through it!

He said apnea episodes can still "sneak" through with Auto, => RUBBISH like others suggested, would only happen if you set your pressure wrong.

Also, 2600 is WAY too high for a machine. A good APAP can be had with humidifer for 1100 at most in USA and a mask is like 200 most.

I would highly recommend secondwindcpap as well where they have really good quality used machines at lower prices and some open box new machine for good prices as well, and their service it outstanding as many have attested to.

Good luck and stick with it!

[sleepyb]

$2600 is way too much to pay for a CPAP or APAP. You don't have to be stuck with a DME. You can shop around. (I did this by phone) I called up, said I have OSA and want a Resmed System One APAP or Resmed S9 AUTO. Can I get that from you? If the answer was no I hung up and called another. Finally a nice DME told me of a DME nearby that would get me what I wanted. She said she felt bad but the company she worked for wouldn't sell those and she had OSA and went to this other DME.
You can also negotiate with them but you need to bring data. (costs online for the machine you want, what your insurance pays for it, etc.) Expect to pay more than the online price for the service but Do your homework. I do this, My DME already knows that he will not get the normal 20% copay from me and if the mask etc is too expensive I will just buy it online. Im looking at a backup machine. Went to said DME and mentioned that. He is working on figuring out how much more than the online price he can charge and still have me buy it from him. (He didn't say that but...) Then again I am loyal. I buy from him first if the price is not outrageously higher.
Finally, if your copay is very high you can ask the DME if he has a lower priced used machine. Some have these from people who (like I did) return their first machine for a different one. My DME sells used machines for cheap. ($100-300)

[LinkC]

I don't want to start the old CPAP vs APAP debate again, because neither is ALWAYS better for EVERYONE.

However, APAP does indeed allow an occasional apnea to "slip thru". If APAP catches EVERY apnea, then everyone on APAP must have a 0 AI, right? There's your "rubbish"...

If you do better on APAP, that's great, but let's not pretend APAP is perfect...or the best solution for everyone.

[Janknitz]

APAP's will let a lot of apneas slip through if SET INCORRECTLY. Some professionals seem to think a wide-open range (e.g. 4-20) is a "good thing" and that forces the machine to "chase" the apneas, so apneas can slip through. A properly set range can easily catch all the apneas it needs to catch.

Some people still do best on CPAP rather than APAP. There's nothing wrong with setting an APAP to CPAP mode and using it that way. If problems occur, you can run the machine in APAP mode for diagnostic or titration purposes if they ever become necessary. If all you have in a CPAP, you cannot do that, and will need either a full-blown $leep $tudy or you'll have to rent an APAP for a while.

It sounds like your ENT is willing to work with you. Ask your ENT to write a script for EXACTLY the machine you want--then your RT and DME cannot second-guess the DOCTOR.

And, you really should look into whether buying online will help you meet your deductible. If so, you'll spend less than half of what the brick and mortar DME wants to charge you--it may take more time to meet your deductible, but less out of pocket from you. Furthermore, even if your ENT will only prescribe a CPAP, you can get whatever you want online with a CPAP prescription.

[Jayjonbeach]

I don't want to start the old CPAP vs APAP debate again, because neither is ALWAYS better for EVERYONE.

However, APAP does indeed allow an occasional apnea to "slip thru". If APAP catches EVERY apnea, then everyone on APAP must have a 0 AI, right? There's your "rubbish"...

If you do better on APAP, that's great, but let's not pretend APAP is perfect...or the best solution for everyone.

Well thats a bit of a silly arguement Link.

The doctor was obviously referring to apneas slipping in VERSUS CPAP which IS total rubbish.

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Of course no therapy up to this point completely eliminates apneas, so they all "let apneas slip in"

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The HUGE benefit of APAP that a lot of people always fail to mention is that it has an algorithm which acts PROACTIVELY to PREVENT apneas before they happen. The Resmed S9 for example, when it sees flow limitation increase which is often a precursor to an actually apnea, will jack up the pressure which is proven to help your airway from closing.

The problem with CPAP is it uses no technology whatsoever, if you are choking in the middle of night having apnea after apnea (in a cluster for example) it does NOTHING to compensate, APAP does.

Of course a lot of people with a properly set constant pressure do fine on CPAP, but some like myself will still see clusters of events that APAP can and will prevent or at least lessen. The only reason not to use APAP AFAIAC is if the pressure changes actually bother you and potentially arose you which does happen to some people, thus they are potentially better off on CPAP. Other than that, I'm not sure I've seen any other reason to be on CPAP, old tech....

[LinkC]

The doctor was obviously referring to apneas slipping in VERSUS CPAP which IS total rubbish.

Yes, of course he was. Perhaps my argument wasn't explicit enough.

For some people, a properly set CPAP will provide lower apnea numbers than a properly set APAP. It's the "new tech" that is letting them thru.

My 90% is 17.8cm. The best I could do on APAP was 6 AHI (30 day avg) at a range of 17-20. CPAP @ 18 gives me .2 AHI with one or two ZERO nights per week. I NEVER got a zero night until I switched back to CPAP. My sleep doc explained that APAP "often" lets apneas thru (compared to CPAP) due to the way APAP adjusts...as I explained above. I'm guessing that the OP's RT and my sleep doc have a more experience with different patients than most of us here. I'll trust their knowledge over the opinions of individual patients who deal in absolutes and call any conflicting data "rubbish".

If that's "rubbish", how do YOU explain my results?
What is your clinical evidence that APAP never lets apneas slip thru (compared with CPAP)?

[nanwilson]

I agree with Link. I have 2 machines, 1 a straight cpap the other an Mseries auto, so I can use whatever I want. I prefer the straight cpap at 11, but I will do a test for awhile with my apap just to make sure I'm okay. Yup, just did a test this week with the apap and low and behold I had my range set at 9 to 13....test showed I was at 10.4 most nights with an ahi of .9 (that's POINT nine - damn good). Obviously my straight cpap at 11 is doing the job. I don't like the up and down flow of air with my apap, prefer it straight, at 11. When I go traveling I take my M series, but I usually set it to straight cpap at 11.
Nan