CPAP or APAP?

[chopper06]

Who decides if you should have a CPAP or APAP? What would lead one to believe an APAP would be better or medically necessary ? I want to be sure to get the right machine....I am still early in the process, and going to try another machine on Tuesday....it will have EPR.
APAP sounds like it would be the easiest to adjust to....true? Who usually gets APAP? Thanks for all your help!

[derek70]

You can set APAP for CPAP mode.
It's better choose a APAP machine with data capable and breth relief.

[Pugsy]

Someone who might have variable pressure needs during the night for some reason would benefit from using APAP. Like someone who needs more pressure when supine sleeping or perhaps more pressure in REM sleep and not so much pressure needed in the other sleep stages.

I am worse in REM sleep. When using APAP if my REM sleep events need more pressure the machine will go up there to prevent them. My minimum pressure is 10 cm....I have seen the machine go to 18 cm for some stubborn events. I don't need 18 cm all the time though...sure wouldn't want to use 18 cm all the time when I can use 10 to 12 till REM sleep events drive the pressure up and when the machine senses no longer a need for the higher pressure...it reduces down to something a lot easier.

Not everyone will have greater pressure needs supine or in REM sleep though.
It is nice to have APAP available though...just in case. If I was using a straight cpap machine I would either have to use 16 to 18 cm all the time to prevent those stubborn events or use the lower pressure and just let those events happen.

[dtsm]

Most folks agree the best machine has two basic features:

1. apap
2. full data capability

Insist on getting the above, regardless of the brand [most folks go with resmed, respironics]. There are other threads that discuss the various models to consider, including the ResMed S9 autoset II. I don't know the comparable respironics model but others can jump in and help.

[rottyjohn]

This is exactly what I am waiting to see... I not sure who decides but in my case I know DME refused to change my machine from a straight CPAP. It seems to be a dollar and cents thing! Cutting into their profit margin. Grrrrrr

[DoriC]

I don't think there is an Autoset II? The S8 had one though. The other consideration for using an apap is if you happen to lose/gain weight your pressure needs may change and you can do a mini-titration yourself. Or if you have some medical issues crop up in the future that can mess with your pressure and may need adusting. And of course, positional apneas, higher in supine, lower on your side.

[gasp]

My rationale besides loving APAP is that the APAP machine can do both APAP and CPAP letting you choose, whereas a CPAP does not have APAP and does not let you chose.

I love the exhalation relief settings on the APAP and use it all the time at the highest setting. I enjoy having a natural breathing experience.

[Pugsy]

Respironics APAP.... PR System One Remstar Auto CPAP with AFlex

ResMed APAP....S9 Autoset

Avoid anything with "Escape" in the model name in the ResMed machines...either no useful data or very limited data.
Avoid the PR System One Auto IQ ....it only has APAP mode available for 30 days.

DMEs could supply APAP with a CPAP RX if they just would because it can be set in CPAP mode at prescribed pressure.

[chopper06]

Ok....I am going to see the DME guy on Tuesday. Do I ask him if I can get an APAP or do I say I would like an APAP? Thing is...my pressure is only set at 8, so I don't know if I would be eligible for APAP. I do know that I continue to struggle with a pressure of 8...cannot get used to the exhalation. Feel like I have to work so hard to breath out against the flow. What is the price difference in the machines roughly? I just want to get this right....want to make sure I have the most comfortable machine that will do the job. Thanks for all the advice!

[rottyjohn]

I hope I am understanding your question Chopper06...

There are folks way more experienced that I hopefully will chime in... and I only have only used PR S1 machines. The exhale function on my machine has nothing to do with using either an APAP or a CPAP really. That is a function on my machine called C-flex which was explained to me as when you exhale the machine turns pressure down either 1-2-3 cm. Allowing easier more comfortable exhale with out losing therapy. Depending on the setting. So in my case I have it set on "3", its 13 cm normally and 10 cm when the machine senses i exhale. If it was me I would push as hard as possible to get an APAP anyway.

Good Luck.

[Pugsy]

We don't have anyway to know the price difference for the machines that the DME might pay.

From online suppliers like our forum host cpap.com the cost difference between CPAP and APAP is roughly $100.
The PR System One Auto CPAP with AFlex and humidifier can be purchased at cpap.com for $619.00
The ResMed S9 Autoset with humidifier can be purchased for $1,072.00

PR System One PRO CPAP machine with humidifier...$519....straight cpap with full data.
ResMed S9 Elite (straight cpap full data) machine with humidifier...$1,012.00.

These are online prices though..Can't really judge what the DME wholesale cost is but probably around $100 or so. DMEs charge a lot more because there are other "services" and overhead costs built in that online sellers don't incur.

Depending on your insurance, co pays and deductibles...you might be better off buying the machine online. You would need to do the math to see if it would be a benefit to you.

You can still use the DME for masks and supplies if you wish. Especially the mask return policy.

It might help you if your DME would let you try the other brands to see if their exhale relief is any easier for you than your current machine. You might or might not like one over the other and testing it out is the only way to know how it suits you.

[archangle]

If you have a sympathetic doctor, see if you can get him to prescribe a pressure range like 6-10. That forces the DME to supply an APAP.

The PRS1 Auto in auto mode collects more data than the PRS1 Pro. (Pugsy, I think you pointed this out. It's something like flow limitations and RERAs that only appear in Auto mode.)

Even if the prescription lists a single pressure, the DME can fill the prescription with an APAP set to manual CPAP mode. If a doctor later decides to prescribe a pressure range, you already have a machine that can do that, instead of having to pay again. Check who the in-network DMEs in your area are and shop around for one that will give you the CPAP you want.

Do not let the DME sell you a PRS1 AutoIQ instead of a PRS1 Auto. The AutoIQ only does Auto for up to 30 days, then becomes a manual CPAP.

[robysue]

The PRS1 Auto in auto mode collects more data than the PRS1 Pro. (Pugsy, I think you pointed this out. It's something like flow limitations and RERAs that only appear in Auto mode

Flow limitations are only recorded on the PR S1 machines when they are running in auto mode. RERAs are always recorded. If you use SH, only the VS2 snores are recorded in CPAP mode; both the VS and VS2 snores are recorded in auto mode.