Reasons to tell my doctor I need an auto

[james_in_baltimore]

So I am going in for my followup to get the equipment and am wondering how to convince my doctor that an auto CPAP is the right thing for me. Are there any medical articles I can reference or strong solid reasoning that will help convince her?

Thanks

[tomjax]

Explain to him
1- that an informed patient is a better patient.
2- That you participate in a forum with many very helpful patients who recognize that an apap is far superior to the plain cpap.
3- That you have learned that titration determined pressure is often much higher than a person needs a great majority of the night.
4- that you get data that shows your sleep architecture.
5- that any questions you have can be answered by very knowledgeable members who have much more time and concern than most docs and dme do not have or care to give.
6- that you can provide him with these data to help him better understand what the current ideas are this could help him better understand.
7- that you are ultimately in control of your health and you want to have a more active role. I am sure others can add to this.

Maybe print out the responses and give to him.

If s/he is not familiar with these capabilities, maybe I or someone can send you a pdf report on our reports to show him.

[james_in_baltimore]

This is great - keep them coming. I tried to find something like this by searching, but couldn't. I think it could be useful for a great many people. Of course, I could end up going into the doctor and she will say, ok without me even having to convince her.

[Brent Hutto]

I guess the obvious to ask of you is...why do you feel you need an APAP? Perhaps rather than trying to game the doctor into doing what you want you could accomplish the same thing with a direct approach.

[james_in_baltimore]

I'm not trying to game the doctor - I just would like to know if there is evidence that APAP works better. It sounds like there is - as far as maintaining an overall lower level of pressure, which would increase patient comfort, while still providing the higher pressure when needed.

[Brent Hutto]

I'm not trying to game the doctor - I just would like to know if there is evidence that APAP works better. It sounds like there is - as far as maintaining an overall lower level of pressure, which would increase patient comfort, while still providing the higher pressure when needed.

Well, if you're looking for evidence in medical journals and the like you'll need to pick one or two specific forms of "works better". You can support the average lower pressure just from the defintion of how an APAP works but lower average pressure per se isn't really a benefit.

I've come across at least one study reporting fewer patient complaints with APAP versus CPAP although it was a pretty minor difference. I didn't keep or write down the reference to the study because it wasn't what I was looking for.

The closest thing to what you're describing would be studies that found greater patient compliance with APAP treatment than with CPAP. If it can be shown tha patients use APAP more consistently than CPAP and that the outcomes of treatment with APAP are the same or better than with CPAP then you'd have something to work from. I think the literature is pretty strong on showing that APAP works the same or better than CPAP in terms of reducing apnea/hypopnea and there's probably similar evidence w.r.t. other outcomes like EDS. I don't know how easily you'll be able to find the "better compliance" part, that's not something I've come across yet.

In any case, whatever evidence you can marshal will be stronger for high pressures (over 10cm) than for lower. At lower pressures there really isn't that much difference in what the user experiences betewen, say, CPAP at 8cm versus APAP 4-9cm or something like that. The absolute strongest prima facie case for APAP is when there's a strong positional and/or stage dependency in your pressure-vs-AHI curve. For instance, my titration study showed that at 9cm CPAP the AHI was faily low except during REM/Supine sleep in which case it was still poorly controlled. So in that situation you're probably looking at something like 8-9cm for most of the night and potentially 11-12cm or more for an hour or two. That seems like an obvious win for APAP.

Do you happen to know if there was any similar position/stage effect in your titration study?

[Wulfman]

James,

Listed below are the insurance billing codes. As you can see, there is no code for an APAP.......because, the E0601 covers BOTH. If you're prescribed a fixed pressure, the APAP can come set up at a fixed pressure.....just like a CPAP. Then, over time, as you deem necessary, you can then set the APAP to a range of pressures and see if your requirements have changed. Also, some people do better with a range of pressures and some people do better on a fixed pressure. The APAP allows you to experiment with both methods. To me, whether you're using a CPAP or APAP, the critical component is the software for monitoring your therapy. Tomjax's advice is "right on the money".
If your insurance provider will reimburse you, I would recommend purchasing the equipment from CPAP.COM and you will be able to get what you want. Then submit a bill (from yourself) to the insurance provider. Even if your insurance provider balks at something like this, you STILL may be money ahead by purchasing the equipment out-of-pocket (considering rentals, co-pays, etc.).
Be sure to keep the original of your prescription that the doctor gives to you.

It's YOUR therapy and YOUR money. By ANY means, get what YOU want.

Best wishes,

Den


What are the CPAP, BiPAP and Sleep Apnea related billing codes?

* EO601 RR is CPAP rental.
* E0601 NU is CPAP purchase.
* A7034 is CPAP nasal mask, including all nasal masks, Nasal Aire, Breeze, Spiritus.
* A7032 is CPAP nasal mask cushion.
* A7030 is CPAP Full Face mask.
* A7031 is CPAP Full Face mask cushion.
* A7044 is CPAP Full Oral Interface.
* A7046 is CPAP Humidifier Chamber.
* A7037 is CPAP tubing, long and short hoses.
* A7038 is CPAP disposable filter.
* A7039 is CPAP gross particle (foam) filter.
* A7035 is CPAP headgear.
* A7033 is CPAP nasal pillows.
* A7036 is CPAP chinstrap.
* E0561 NU is CPAP Passover Humidifier
* E0562 NU is CPAP Heated Humidifier
* E0470 RR is BiPAP rental.
* E0470 NU is BiPAP purchase.
* E0471 RR is BiPAP-ST rental.
* E0471 NU is BiPAP-ST purchase.


Other CPAP items are listed under E1399, which is miscellaneous.

[Darth Vader Look]

James,

Below is the list I had when I wanted an APAP but luckily enough my sleep doctor told me that since I had tried the CPAP, she had no problem prescribing an APAP for me.

My Reasons For An APAP

1. Experienced 2 or 3 events where I was lying on my back and couldn’t breathe. This means my titrated value is too low for that particular position. An APAP would have sensed that and made adjustments to account for that.

2. Because I don’t sleep on my back that long I would not want to be at that constant level all night. An APAP would sense that I am no longer in need of that high a pressure and would ease down to a more comfortable level.

3. More people tend to be compliant with APAP than CPAP from what I have read.

4. With APAP I could monitor my own sleep therapy and learn at the same time.

5. With an APAP I could (if I decided to get the unit you use) hand over the raw data card or compile the data myself and show you at the next visit how I was doing.

6. I really feel that an APAP is the right way for my treatment to go for me.

Good luck with your fight.

[Bellcrest]

I too went to my Sleep doctor armed with the comments that Darth Vader Look quoted. The one that convinced my doc was the one about having events while on my back. He immediately agreed that the APAP would be good for me.

Recently had a follow up appointment with him and he is pleased with my progress. He commented that APAP was not for everyone, but apparently it was working for me as I was able to bring him some charts to see.

Good luck with your doc.

[james_in_baltimore]

Thanks so much for all the good information. I'll be sure to update you all on how it goes. This forum is such a great educational tool. I was miserable after my sleep study, but after reading for a bit, I realized that there probably is a mask or two out there that will work well for me. The doctors doing the sleep study really should have a wider selection and talk about the benefits/drawbacks of each one so that we can have a better idea of what we would want. In any case, I will definately have a good, honest discussion with my doctor stating the reasons why an APAP would work better, as I believe the reasons you sited make great sense. The other thing I can say is that I can keep it at the fixed prescribed amount of pressure initially and then have reports to judge how effective it is, then I can use the APAP to find the range that would work best and change as needed, with her consultation of course. This is something that would not be nearly as easy to do with a CPAP. The point about higher compliance with CPAP also does seem to be supportive in multiple studies. Thanks again.

[Brent Hutto]

James,

In my case, there was zero choice of masks for the sleep study. They use a disposable Respironics nasal mask in whatever size fits and then just do the study.

After receiving my prescription I went to the DME to pick up my machine and stuff and that's where the mask fitting took place. I've tried several different Resmed masks at the DME office which was a much more suitable place to do it (with plenty of time to decide) versus doing it in the sleep clinic which was sort of cramped and hurried plus I was sleepy.

My point being, if you get a good chance to try them when you pick up your machine you won't worry much about not having a choice at the sleep clinic. Or maybe it'll work out differently for you, hard to say.

[Bellcrest]

I was told to bring my own mask and hose for the titration study. My appointment is May 18, after being on APAP since Jan 17/06.

Seems backwards somehow, but by the time the titration appointment rolls around, I will have the mask and pressure range nailed already and will go to the appointment just to confirm that I got it right.

[sleepylady]

James,

When I asked my doctor to switch me from a CPAP to APAP I mentioned I was concerned my pressure may be off. They made me sleep on my back and that's the worst thing for apneas. Plus, I normally don't sleep in that position, well for a small amount of time. Most is spent on my tummy. Turns out after I got the APAP I found I was right. They originally titrated me at 14 and upped it to 16 when I was still very tired. After that we went to an APAP with a range of 12 - 17. I spend 87% of my time at 12, 10% at 13, just 2% at 14, and 1% at 15 on average.

Also, you may want to mention that you'll be able to see if you are having problems due to mask leaks, which may affect your overall treatment. This was one concern I did have.

Another would be if you are in the process of losing weight. An APAP is a better bet than having to get re-titrated every couple of months. On the other hand, if you should gain weight then you have an APAP which would let you know if you need to adjust the pressure.

Best of luck.

Melinda