Titration Study - APAP vs CPAP

I'm about to have another titration study. My last one was nearly 10 years ago. Recently maxed out my out-of-pocket expenses with my insurance, so figured why not go ahead and get another titration study and let insurance pay for the CPAP/APAP machine.

My wife is a RPSGT who did my original study (split study). She has always claimed that she couldn't get an accurate assessment of my sleep during the second half of the study because I didn't sleep that much due to a thunderstorm, power going off, etc. in the sleep lab. I was set with a pressure of 7. As I have gained 50 pounds since that study, I do think a full titration may be helpful.

My wife absolutely hates APAP machines. She says that I don't need one because I'm a side sleeper. When I changed from my ResMed S9 Elite to an AirSense 10, I prescribed my own APAP machine. Through Oscar/SleepyHead, I was able to adjust my pressures from the base of 7 to a max of 12. My AHI was 14.2 initially, and now averages <0.5 on most nights. Occasionally it goes up to a 1.

Interestingly, my original study's respiratory events were 0 obstructive, 25 hypopneas, 1 central, and 0 mixed. Longest respiratory event was 62.0 seconds with a lowest saturation of 90%. I had moderate to loud and intermittent snoring.

With the CPAP of 7,I had an AHI of 0 but was only observed for 15.8 minutes. This is why my wife said all along that I needed another study.

Sorry for the lengthy post, but my question is this: how does one determine if CPAP is best vs APAP? Will a titration study determine this? I seem to be doing well with an APAP of 7-12 and most of my pressures now stay in the 10 range with the APAP. Again, the only reason I'm getting a titration study is to (1) satisfy the wife, and (2) have insurance start paying for my CPAP machine and equipment. They won't pay for it without another study.

Thanks for all the help everyone has provided over the years. As an emergency physician, I am not the most familiar with sleep medicine. All of it has been self-learning and help from my wife, who hasn't practiced in 8 years.

You do know that all apap machines have a fixed cpap mode don't you?
There are no fixed cpap machines with an auto adjusting mode though.

There are times when auto adjusting mode is useful and sometimes a fixed pressure might work better for a person. It all depends on the person.

Example...myself...my OSA is worse in REM stage sleep (which is common) and sometimes I need 6 to 8 cm more pressure in REM.
REM amounts to about 20 % of my sleep. What would you want to do if you were me and only needed 8 cm during non REM and 16 during REM??? Would you want to use 16 cm all night just for that 20 % of the night?
I know I sure wouldn't. Using auto adjusting pressures lets me use less pressure if it isn't needed and when it is needed it goes up and does a good job.
This same thing can happen with supine sleeping but not everyone will see such a marked difference between side sleeping and supine sleeping....again some do and some don't.
I did some experimenting some years ago with supine and side sleeping....no real difference in pressure needs except when in probable REM sleep where per the in hospital lab study my OSA was about 12 in non REM and 53 in REM.

Get yourself an apap machine...make wife happy by at least trying fixed cpap mode and then you decide which works best for you.

BTW....in lab titration came out with RX for 8 cm...good enough for non REM sleep but no where needed for REM sleep and my sleep doctor agreed than in my case auto adjusting was better choice....and she hardly ever prescribed auto adjusting mode.
Have auto mode available....just in case. Comes in handy if someone does gain (or lose) weight and they think pressure needs may have changed.
If you get a cpap only mode machine....you have no real options to help you sort out potential times when pressure needs may have changed.
The reason they didn't get my RX right during the titration.....I didn't get enough REM stage sleep to really evaluate things...out of nearly 8 hours I only had 6 minutes of REM. Just couldn't sleep well enough to get to REM.

I'm aware all APAP's can be set to CPAP mode only (done that initially with my AS10). However, insurance won't pay for an APAP unless it's prescribed. I'm not going to prescribe it myself and then have insurance cover it as I think that opens up issues with fraud.

southerndoc wrote: ↑

Sat Jun 26, 2021 11:09 pm

insurance won't pay for an APAP unless it's prescribed. I'm not going to prescribe it myself and then have insurance cover it as I think that opens up issues with fraud.

Who told you that?
Where do you live?

Insurance in the US pays by HCPCS billing code and the code for the fixed cpap is the same as for the apap capable
E0601

Insurance companies don't care whether apap capable or not...nor brand..nor model number. Just the HCPCS billing code.
They pay the same for either cpap or apap because the billing code is the same.

Are you aware that a lot of DMEs (who actually have patient care number one on their list) will actually dispense the apap capable machine with a fixed cpap RX and just set it to cpap mode????
Nothing illegal about it either.
The apap capable model machine is a "cpap machine" anyway...at least per HCPCS billing codes.

Someone is feeding you a load of BS if you are in the US.

This came from the DME provider BC/BS of TN referred me to.

Will see what the pulmonologist prescribes. I'm saying me prescribing my own CPAP or APAP machine (either one) and billing it to insurance could be seen as fraud. If another physician prescribes APAP and I submit to insurance, that's different. If I'm paying myself, I can prescribe myself.

That DME flat out lied to you. Plain and simple.

Look up E0601 or for that matter look up the other codes as well.
There's just 3 main codes
There's E0601 which are the cpap/apap capapble machines.
There's E0470 which are the common bilevel capable machines but without backup rate.
There's E0471 which are the bilevel machines with a backup rate.

That's it. Call up your insurance company and ask them how they pay for these machines. They will tell you by HCPCS billing code...that's it. Everything is by that billing code.

https://aasm.org/clinical-resources/cod ... ine-codes/