CPAP Vs. APAP Vs. BPAP

[Bookbear]

Well, after all day on the phone with BC/BS, the medical clinic where I have to go, and DME the clinic works through, I have some additional information. There is only one DME my insurance and clinic work with, and they only carry one brand of CPAP...Respironics REMstar +, and one brand of masks (also Respironics). That DOES give me a range of choices, although the insurance considers anything other than the base REMstar + (w/o c-flex or humidifier) to be "a comfort item, not medically necessary", even if the doctor writes it on the script. That goes for masks, too...only the least expensive full face mask is covered. I am still trying to nail down if they will do the cost of the base model and let me pay the difference for the more expensive, or whether its a take it or leave it proposition. So here is my question (yes, there really IS a question in all this!):

Assuming a needed pressure of between 8-10, is it advisable to spring for the additional cost of an auto adjust unit? A bi-level unit? I already know I will have to buy the humidifier separately on my own; but if I stay with the Respironics line, I at least have the chance of getting some of this paid for by the insurance. If I go with another brand (GoodKinght, etc.) I will have to assume the full cost on my own. How user-adjustable are these units. I read about people adjusting units until they get just the right amount of pressure...can the REMstar units be adjusted this way? Advantages of a Pro model? Any additional thoughts?

(P.S.) One of the people at BC/BS I spoke with earleir today actually used the phrase, "A CPAP is a CPAP is a CPAP...it really doesn't make any difference what model you get, they all work the same."

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, humidifier, C-FLEX, CPAP, DME, auto

[DME_Guy]

What DME company do you have to use? Sounds like Apria.

You may be fine with the Remstar Plus. Many people are. I personally prefer the Remstar Auto with C-flex and I would pay extra for it. I also prefer the Resmed Ultra Mirage full face mask over the Respironics comfort full 2. If you have to use a full face mask, you will probably need heated humidification as well.

A BiPAP is a different machine and is a lot more expensive. It also adjust expiratory pressure. Unless you doctor says you need it, I wouldn't pay extra for it.

I'm a big believer in the auto CPAPs. The comfort level is much better (Especially with C-flex) and the pressure automatically adjusts based on your need.

I don't recommend changing the pressure setting on a basic CPAP. You won't have anyway of knowing if the pressure is therapuetic.

As for all CPAP working the same - yes and no. That's like saying all cars are the same. Yes, they all get you from point A to point B but all cars are not the same. Some CPAPs allow you to record data, some automatically adjust for altitude, some are better for traveling, some auto-titrate, and of course some are more reliable than others.

I hope isurance companies wise up when it comes to home medical equipment. Anything that helps a patient be more compliant keeps the patient healthier. This may be not having to pay for hospital stays and high BP meds. Paying a couple hundred more for a better CPAP would actually save them money.

[dsm]

IMHO

A Remstar PLus will do the job ok at 10-12 CMS. An AUTO is a luxury & as with all luxuries, if cost is not an issue then why not ?.

Don't worry about a BiLevel - I doub't it matters much if you are on 10-12 & can handle the pressure ok.

One consideration though, is that unless the Remstar + has a full datacard recording (which only the Pro model has) then I would recommend the AUTO just for its detailed data.

Cheers

DSM

[ozij]

The Pro 2 is the non-automatic machine which records and reports data we users would be interseted in. Beware of the Pro that only records compliance data, and not breathing data.


O.

[brasshopper]

What DME company do you have to use? Sounds like Apria.

You may be fine with the Remstar Plus. Many people are. I personally prefer the Remstar Auto with C-flex and I would pay extra for it. I also prefer the Resmed Ultra Mirage full face mask over the Respironics comfort full 2. If you have to use a full face mask, you will probably need heated humidification as well.

My ancient CPAP is an old Remstar - it has been all over the world and all that.

I have heard of people being diagnosed and then given an auto-CPAP - no titration study at all. But the point is that you want to have the least pressure that will stop your apnea - because the CPAP itself can be an issue.

That, in my opinion, is the best argument for both a titration study and an auto-cpap. You will then have a maximum pressure that your doctor agrees is acceptable for you, and a CPAP that is capable of reducing the pressure when you are having a good day.

What is the risk of CPAP? Well, think about scuba diving. In Scuba diving, you tell people who are learning to dive to breathe constantly and never hold their breath, because full lungs and a short rise can result in overpressure, air embolism, and symptoms which mimic stroke, among others. The ultimate downside could be death! Air could leak into the bloodstream and block the blood to the heart or the brain.

In hundreds of dives, I had the misfortune to witness this effect once. ('m inusual - most people have never seen a dive accident.) The diver collapsed with hemiplegia (one sided paralysis) and probably was close to death. Most of the effect was quickly eliminated by allowing the diver to breathe 100% O2. This kept the diver alive until we got to port, and recompression to 165 FSW (Table 6a) resolved most of the rest of the symptoms.

We would tell people to be most careful near the surface because the smallest physical rise would give result to the largest volume rise. CPAP mimics this lung overpressure, but in a controlled, limited amount. But the reality is that there is some risk - and the more pressure, the more risk.

My current pressure is "10" (CM H2O) I have been told that my new pressure will be 17 - but that study was questionable - I believe it was done with a bipap in timed cycle mode (and I do not have CSA) and I will know my new pressure on Tuesday. But for pressures above 10, now that such things are available, I will feel a lot more comfortable, safety wise, with APAP. I want to know that I actually need that much pressure to stop "events" and now I can know that.

(I'm not a doctor, of course, and am speaking as a layman, as I understand it.)

I believe that sleep is important, but over-medication, in this case, over pressure, represents a small but unneeded risk. That is, you need a certain amount of pressure to stop your apnea. That pressure is required risk. The risk from untreated sleep apnea probably exceeds the risk from the pressure.

But each person needs a certain amount of pressure to stop them from having events of apnea. They need that much pressure, but not more pressure than that.

Once you are not having any apnea events, more pressure just represents more risk, and no improvement in treatment.

The advantage of the APAP is that the risk is more limited than a constant pressure CPAP. It can back off when the full pressure is not needed to stop your apnea. The downside may be that you will have to have some apnea for it to detect so that it will crank up. I've long ago stopped (for example) using the ramp on my machine. It just did not blow hard enough for me to get full breaths when it was ramping. I probably stopped using the ramp within three-six months.

Judging by the reports of other users, the apneas while it is finding a pressure is not a problem - and it is more comfy. All I have to do is repeat my original diagnostic test so that Medicare will rent me one.

But the reality is that I would pay the difference between the machines were the APAP not covered because I think I am worth it. Is the risk so low as to be insignificant? As was explained to me by a sleep doc a long time ago, if that was true, they could just let everyone run at a pressure that would work for 99.9 percent of people, say, 25, and only reduce pressure for compliance and comfort - and only stop when symptoms came back. They don't do it that way, because to minimize overall risk you want the lowest effective pressure, and the risk is not so low that the test is not justified.

[Bookbear]

Thanks for the information. DME_guy, yes, its Apria. Given that I have a full, fairly heavy beard, I thought (and the sleep technician agreed) that something like the Comfort Lite 2 or the Breeze would be a good choice to start, rather than the FF. My regualr doctor is the one who said that heated humidification would be needed since the b/p med I take dries out my mouth and nasal passages so much. He felt that the extra drying of dry cold air being blown in all night would cause real problems. Is heated humidification NOT a good idea with the nasal pillow type masks, or can it be used with any style?

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CPAPopedia Keywords Contained In This Post (Click For Definition): breeze, nasal pillow, DME

[Moogy]

Heated humidification can be used with any type of mask.

Moogy

[Guest]

The Pro 2 is the non-automatic machine which records and reports data we users would be interseted in. Beware of the Pro that only records compliance data, and not breathing data.


O.

The M Series Pro will have the advanced data.

It's pretty much
Old Remstar Plus = Remstar Plus M no card
Old Remstar Pro = Remstar Plus M with card
Old Remstar Pro 2 = Remstar M Pro
Old Remstar Auto = Remstar Auto M

[REMmaster]

grrr.....damn login