Has anyone had a DME give you an APAP?

[froger25]

Some of you have been reading my posts and know what I have gone through so far. Well I have been on the VPAP III for about a week and a half now and I have learned how to fall asleep on it. However the noise of the machine still wakes me up at least once a night. Then my wife tells me that I am still snoring a significant amount (pressure of 16) and I wake up for some other reason that isn't related to the noise as far as I can tell.

Also, shouldn't I be dreaming more now? If I am truely in REM sleep like I am supposed to be??? If that is the case then I certainly don't.

I was told by my DME once again that it is rare to issue an APAP. The reason I am wanting one of those is because I slept well on the one I was "tested" with and I was told by my wife that my snoring was minimal compared to the other 2 machines that I have had. Here is the bonus, I SLEPT ALL NIGHT ON IT!!!!!!!!! I feel like it has been too much to ask to have a full nights sleep.

I am almost to the point that I am going to just buy the APAP on my own. Also can anyone explain to me why BPAP's are so much more expensive than APAPs??? I feel like my insurance is being dwindled away on all of this playing around when I feel like I know the answer. My DME max for a year is 2500 but they are eating that up and of course every sleep lab study is another $100 out of my pocket in copay. This is all so frustrating.

[NightHawkeye]

Also, shouldn't I be dreaming more now? If I am truely in REM sleep like I am supposed to be??? If that is the case then I certainly don't.

Many of us have experienced that in the first few weeks of starting xPAP treatment. That seems to vary from person to person. At any rate, once your sleep pattern normalizes you forget the dreams anyway, so it seems to be mostly a transient phenomenon.

I was told by my DME once again that it is rare to issue an APAP. The reason I am wanting one of those is because I slept well on the one I was "tested" with and I was told by my wife that my snoring was minimal compared to the other 2 machines that I have had. Here is the bonus, I SLEPT ALL NIGHT ON IT!!!!!!!!!

From what I've gathered reading this board, it is the policy of all DME's to not provide an APAP unless all other possibilities have been exhausted. Even when the prescription states APAP, some folks have had problems.

I am almost to the point that I am going to just buy the APAP on my own.

I'm amazed that more folks don't just buy the darned things. I guess it depends on what you think your time and aggravation is worth. It's a personal choice.

Also can anyone explain to me why BPAP's are so much more expensive than APAPs???

I suspect the answer lies mostly in economic theory. The BiPAP machines are slightly more complex, but I doubt that fully accounts for them being twice the cost of APAP's. Fewer BiPAP's are produced, so the mass production cost savings are smaller.

Since you're already using a BiPAP, but dislike your current machine, you might consider the Respironics BiPAP-auto. It is a very quiet machine. I never hear my BiPAP-auto at night, just the wind through the mask. It might be easier at this point to request the BiPAP-auto than going back to an APAP. I say that because your DME might find it easier to swallow. The DME would definitely be reimbursed more than with an APAP. You could always directly ask them if reimbursement from insurance is more to their liking with the BiPAP-auto. )

Best of luck, froger25. It does sound like you're making progress though working your way through the maze.

Regards,
Bill

[Brent Hutto]

My doctor prescribed APAP 7-12 as my initial treatment. The DME would have provided one and billed it to my insurance under the CPAP code until such time as my doctor determined that CPAP would suffice instead of APAP. Then they would have swapped out their APAP for a CPAP that I would own. The particular models were S7 Autoset (APAP) and S8 Escape (CPAP).

Since I wanted an S8 Vantage APAP rather than the S7 model and I wanted to keep it permanently, they charged me a couple hundred dollars to cover the difference. I had my 30-day checkin with the doctor and he wants to continue with APAP treatment for a while so if I had accepted the S7 I would not have had to return it (yet). But I like the S8 much better, it's a very well thought out machine.

[froger25]

Since you're already using a BiPAP, but dislike your current machine, you might consider the Respironics BiPAP-auto. It is a very quiet machine. I never hear my BiPAP-auto at night, just the wind through the mask.

I will ask them about it. In my opinion the VPAP III sounds like a vaccum cleaner. I am curious what pressure they have you on that machine. If it is a lower pressure, have you turned it up to hear what it is like as far as sound at a high pressure?[/quote]

[froger25]

Hopefully when I PCP calls I can inform them off all of my experiences. I am hoping that they will play as an advocate for me to get an APAP. If they keep it up at me DME I may consider dropping them and going to a different company.

[reval]

Since you're already using a BiPAP, but dislike your current machine, you might consider the Respironics BiPAP-auto. It is a very quiet machine. I never hear my BiPAP-auto at night, just the wind through the mask.

I will ask them about it. In my opinion the VPAP III sounds like a vaccum cleaner. I am curious what pressure they have you on that machine. If it is a lower pressure, have you turned it up to hear what it is like as far as sound at a high pressure?

Unfortunately with most brands it is a matter of luck whether your machine is quiet or not. Even machines of exactly the same type can have very different noise levels.

[pj1016]

Supposedly, the DME will be delivering my choice of APAP tomorrow afternoon.

It was prescribed by my sleep doctor, and BCBS is covering it in full.

pj

[NightHawkeye]

I am curious what pressure they have you on that machine. If it is a lower pressure, have you turned it up to hear what it is like as far as sound at a high pressure?

Excellent question because it points out the difference between the BiPAP-auto vs a regular BiPAP. I have the maximum IPAP pressure set to 14 cm and the minimum EPAP pressure set to 6 cm. With these settings I believe the machine starts out with IPAP of about 8 cm before I go to sleep. I only experience apneas during REM sleep so the pressure increases usually only happen while I'm asleep.

In your case that would probably be true as well. After you got to sleep, then the pressure would increase as needed, just as the APAP did that you say allowed you to sleep so well.

Before I fall asleep the pressure and noise are both low. I have awakened a few times when the pressure was much higher, of course, but even then I was never aware of machine noise, only the wind noise. Also, my wife has never mentioned anything about the noise from either the Remstar-auto or the BiPAP-auto. She has, however, complained about mask noise a few times.

Regards,
Bill

[NightHawkeye]

Unfortunately with most brands it is a matter of luck whether your machine is quiet or not. Even machines of exactly the same type can have very different noise levels.

That is certainly true of the 420 you had trouble with, reval, as many others have also pointed out with the Puritan Bennett machines. That does not seem to be a problem with Respironics machines however.

Regards,
Bill

[froger25]

With these settings I believe the machine starts out with IPAP of about 8 cm before I go to sleep. I only experience apneas during REM sleep so the pressure increases usually only happen while I'm asleep.

THis sounds like the "ramp" settings on the ResMed machines. Are you familiar with "ramp"? Mine starts off at 10 and over the course of 25 minutes it increases my pressure until it is at the prescribed IPAP & EPAP which is 16max 11min for me. The Ramp setting did allow me to start falling asleep on this machine, however I must sleep a little lighter at some point in the night because I will wake up to the noise of the machine. Last night it sounded like the machine was going to die it was so loud.

These are all reasons I want an APAP, it would adjust for periods of light sleep versus heavy sleep. It would only be noisy when it needed to be. I never once woke up when I was on the APAP and was always rested when I got up in the morning. Now I am never rested, and wake up about 3 times a night.

[NightHawkeye]

THis sounds like the "ramp" settings on the ResMed machines. Are you familiar with "ramp"? Mine starts off at 10 and over the course of 25 minutes it increases my pressure until it is at the prescribed IPAP & EPAP which is 16max 11min for me.

No, not ramp at all. The BiPAP-auto is a true auto and the pressure increases I see with it follow exactly the same patterns of pressure increases I see with the Remstar-auto, which is an APAP. I suppose I should have made that clear. Perhaps we should call the BiPAP-auto an ABPAP to make it clearer. .

The BiPAP-auto does have a ramp feature also, but that is not what I was describing.

These are all reasons I want an APAP, it would adjust for periods of light sleep versus heavy sleep. It would only be noisy when it needed to be.

Exactly the sort of operation I was trying to describe with the BiPAP-auto. .

Regards,
Bill