Help!? Auto-Cpap

My doctor ordered a sleep study for me, but unfortunately I didn't sleep during it. (Funny, how you have to sleep to be diagnoesed with a sleep disorder.) Unfortunately, because I didn't sleep they weren't able to diagnose me with apnea. (Even though I know I have it pretty bad.)

My doctor will prescribe a Cpap for me, but insurance won't pay. I'm willing to pay out of pocket, but don't want to go through another sleep study to have it titrated. Is it true you can get an auto-Cpap that can be set without an additional sleep study? Which model would you recommend? How do you set it up? Can you purchase one used?

Don't let the Doc order a plain CPAP for you . Get a AUTO . The auto will adjust to your daly needs not the worst case as the plain cpap is set for..

Do read other posts about this subject.

Do Not let the Doc hand over your script to a salesman who just happens to be in the office. Get the script and order online. Buy the best auto unit and mask . Pay out of your pocket. It will hurt at first but you willl soon realise
what a great deal you made.. auto unit, mask, books, case, and software if you want it for less than your co-pay if you go to a DME thru insurance. You are looking at $750-$1000 . Max. And you will get what you want not what they are pushing..

Surf this site and ask alot of questions. We've been there and learned the hard way. Take control of your therapy.

Cheers,
Chris

Chris,

I agree completely! thanks!

Guest,

I ordered from cpap.com. they gave me all the info one needs to set up the machine. They also have have a toll free help line where you can talk to a live person till 10pm CST and they really help you, not just try to get you off the phone.

You will never regret taking charge of your healthcare and not relying on a salesperson to decide what works for you.

The poster hasnt even been diagnosed with sleep apnea. It's prudent to be proactive, but there are many other reasons why one can have sleep issues. I am amazed your doctor will prescribe you a CPAP without a definite diagnosis (sleep study). I feel that is negligent on his part. He's prescribing treatment without knowing the cause.

Do the sleep study and wait for the results. At least do the overnight oxymetry (spell?). Don't do anything unless you have a sleep study. No point spending the money on a machine that may not treat your condition. I would want a definite confirmation before i get and get a cpap machine.

And one more thing, because most of my apneas are in the form of hypopneas, I do need CPAP not an autopap because the auto's dont respond fast enough to the hypopneas. Like me sleep doc says, these machines are "not smart enough".

Hi Miko,
All the posts I have read on this forum indicate that auto-pap is best for any OSA inculding Hypoapnea. Hypoapnea is what I have. How sure are you about what your doctor said? Is it really true that autopaps are not fast enough for Hypoapneas? THIS IS NEW TO ME. I am really interested to know
Thanks.

Hi Snamvar,

Yes, my sleep doc mentioned this several times and even afger I became familiar with the machines. In the lab and with the Resmed Autoset, I required 12cm. The Resmed blew me away at it's accuracy. So, that's a real good in-home sleep study.

During the night, I still had night sweats, but not as intense as without cpap. I checked the data from the machine and it confirmed that the machine detected the hypopneas but was not able to treat them because the pressure was too low because my respiration was fine. Accordingly, the machine dropped it's median pressure, then when it sensed I had the hypops it slowly increased the pressure so I had many more events while the machine was trying to adjust. These auto machines are designed to *slowly* increase the pressure. So, in my case, a straight cpap is what I require to prevent the hypops from happening all together.

While having a full PSG study is preferable, I don't know that it's such a bad thing for a doctor to go ahead and prescribe cpap (preferably an auto-titrating cpap...commonly called an autopap) for a patient who has not had a sleep study but is showing definite symptoms of OSA.

If a probable OSA sufferer wants to try an autopap and is willing to pay for it, I say "go for it". But I'm not a doctor. As for wasting money on a machine that might not be right for the individual....well, I think a lot of people who have gone through sleep studies and have followed their doctors' recommendations to a T have ended up wasting a lot of money, too (their own, or insurance) as they struggle to find the right machine, right mask, etc. Because the doctor wasn't always right after all.

Regarding autopaps not treating hypopnea intensive cases well, hypopneas (and limited air flow) are my problem. The Puritan Bennett 420E autopap handles them fine preventively for me. The 420E furthermore has two "limited flow" triggers that can be individually left on by default, or turned off in the Advanced settings. That was exceptionally handy in my case since my normally slow, shallow breathing could produce air flow that is normal for me but looked like precursors to hypopneas and could confuse the machine. With one of the limited flow triggers (IFL1) turned off, the 420E settled into perfect treatment for me. Another brand of autopap that I got as a backup machine - the Respironics REMstar auto - has been doing a fine job too.

I do understand the advisability of a complete sleep study for many people. However, for those who are obviously suffering from plain vanilla OSA (even if it's characterized moreso, or even exclusively, by hypopneas than by fully obstructive apneas) an autopap is capable of giving good treatment, or at the very least can provide information to guide the doctor/patient to another type of machine.

Some sleep doctors are very much against autopaps in principle. Studies can be cited either way - pro and con, autopap vs straight cpap. Sleep "specialists", no matter how educated or how well regarded in their field, are human and can have biases and erroneous notions just like the rest of us. It's been my personal experience with two different brands of autopap that autopaps can, indeed, work very well to prevent most of my hypopneas - not just scramble to react to them after they occur. The key is often in the settings, and it sometimes takes a good bit of tweaking to arrive at what works best for some patients. Most doctors don't have the time or inclination to get into such customization. They prescribe a machine they're familiar with, or that creates the least hassle with insurance, and then hand the patient off to a DME for the equipment. "See me in six months."

I agree with Miko that a full sleep study is best. But I don't agree at all with the doctor's opinion about autopaps not treating hypopnea intensive SDB (sleep disordered breathing) well because they are "not fast enough" or "smart enough". I'm sure there are some patients who need a particular type of machine, like Miko, be it straight cpap, bipap, autopap - or even a particular manufacturer's autopap since algorithms are different in each brand. But a blanket pronouncement that autopaps in general can't handle hypopneas well .... I don't buy that. What I will buy is another autopap when the time comes again.

Miko, I'm glad you're getting good treatment with straight cpap. Just curious...what was the pressure range set at when you were using the autopap?

rested gal,

I've had the same good experience with my hypopnias and my auto-pap as you've had. Things have been going very well. In a conversation I had with the equipment guy at the sleep clinic I used he said "those auto paps don't work...if you leave the settings wide open they just sit there at 4(cm) and don't do anything" After a successful 3 months later on my auto-pap I'd love to call him and fill him in but I know I'd not get a satifactory response,

Miko,

The auto-pap I have can be set to a straight cpap mode if ultimately that was what worked for me.

AutoCPAP is working for my apnea(s) and hypopnea(s)...I may be one of the fortunate ones to have this work without much trouble. I did not have one of those 'horrable' sleep studies...however, I do have quite extensive airway management experience/knowledge...access to pulse oximetry...a great bed partner who finally convinced me that I have a major problem!

The informal at-home study which I took....scared the @#$%! out of me!! My oxygen saturations were into the 65% to 82% for much of the night...this is LOW...anything under about 90% in the medical/anesthesia world is aggressively treated.

I agree with the post of Rested Gal...ditto...however, this can only be achieved with the proper knowledge, understanding and support!

My autoCPAP performs like a Ferrari...it conforms to my changing airway needs promptly and effectively!! The accessable data proves it! Good Luck.

BigE

rested gal wrote:Miko, I'm glad you're getting good treatment with straight cpap. Just curious...what was the pressure range set at when you were using the autopap?

rested gal, unfortunately, I am not on any CPAP, I can't tolerate any machine (i have several threads here posted). The most benefit although brief was with straight CPAP. I attempted the 420E because it was logical (to me) that the extra inner hose would do a better job of responding to the hypops. I really had nothing to lose, but that was a failure. The hose/machine is one of the loudest I have ever had and I could not rest whatsoever.

Of the other autopaps that i tried, again, i felt a little wee bit better with the straight cpap. Since I like to read the data, the data supported how I felt. I even narrowed the settings between low and high and the results were the same, I needed straight cpap. So, i just changed the mode on the machines to straight cpap.

Each person's results and experiences will vary, however, I dont trust the medical community, but these techs and professionals in the sleep field see a lot more and have much more empiracle data to support the fact that autos don't work well for the majority of people with hypopneas. The autos do have a benefit especially at this time of year when we tend to go out to parties and have a few drinks (require more pressure), during weight fluctuations, and having your own in-home sleep study.

The auto's do a great job of increasing the pressure when necessary, but they are still slow in responding. If I analyze the AHI index, I can clearly see that. If one wants to justify an auto, then one can argue that changes in pressure are worth the benefits, but not in my case or in the eye of the sleep medical practioners.

rested gal wrote:
Regarding autopaps not treating hypopnea intensive cases well, hypopneas (and limited air flow) are my problem. The Puritan Bennett 420E autopap handles them fine preventively for me. The 420E furthermore has two "limited flow" triggers that can be individually left on by default, or turned off in the Advanced settings. That was exceptionally handy in my case since my normally slow, shallow breathing could produce air flow that is normal for me but looked like precursors to hypopneas and could confuse the machine. With one of the limited flow triggers (IFL1) turned off, the 420E settled into perfect treatment for me. Another brand of autopap that I got as a backup machine - the Respironics REMstar auto - has been doing a fine job too.

Hi RG,

I'm wondering what the auto-cpap is doing for you. I also have mostly hypopneas, and am leaning towards forking over for an autopap machine, but I'm wondering what you mean by "preventatively" treating the hypopneas? Is that a case of finding the base pressure that gets rid of the hypopneas, and leaving the machine there? Is the pressure of the machine actually varying when you use it? Or do you like the autopap mostly for it's statistical features - getting a reading on what is happening for you when you sleep?

Thanks,

Rob