What are reasons to NOT get an Auto machine?

-SWS, nice to see your more regular postings again! You have tremendous insights that I benefit from anytime you post.

The other benefit I like from APAP mode is that, as with all of us, our nature changes from month to month and the APAP changes with us. I've recently lost 33 lbs. and the pressure requirements to support my therapy have diminished. I was talking to Titrator the other day and he mentioned that with his weight loss his pressure needs have diminished greatly. The APAP will accomodate this easier than straight CPAP.

I like to have an occasional glass of wine or two, although I refrain from doing this after 8:00 PM based upon the advice of a local sleep doctor, and the APAP adapts itself to this change in my physiologic state.

There are other examples I'm sure. But I think it's safe to say that the APAP mode, given that it treats your breathing patterns appropriately, changes itself to match changes in our lifestyles and from that standpoint protects us better from planned obsolescence.

mister_hose,

I very much agree with your assessment of ego-driven doctors. Mine was fit to be tied when I told him that I had changed my prescribed pressure of 18 to 10.
As far as YOUR range settings, I think I would go 2 or 3 below and 2 or 3 above your titration setting of 13.


-SWS (or anyone else that cares)

As far as MY one-week experiment with my Auto.....
First of all, I set my range at 10 - 15. The VAST majority of the time I spent at 10. Only on one night did it ever get to 15 and that was only for a minute and a half. I DID spend some hours at 11, 12, 13, and 14. My average AHI was somewhat higher during that week (I don't have the figures in front of me, but I think it was somewhere between 1.1 and 1.5)......where I had typically been about 0.8 at my fixed pressure of 10.
I had bumped my (fixed) pressure to 12 in mid-March, and it DID cut the snoring index to about an average of 3.0, but it didn't have much significant change in the AHI. I DID notice that my "Variable Breathing" rate went from an average of about 25 at 10 cm to close to 30 at 12 cm.
I didn't exactly have "runaway" pressure increases, but it went upwards to where it would silence the snoring. Oddly enough, my snore index for that week was about twice as high as on a fixed pressure of 12.
Anyway, on the 9th, I went back on my old pressure of 10 to see what would happen the rest of the month. I'm happy to report many nights of 0.2, 0.3, 0.5 numbers.....which has brought my monthly average back down to about 0.9 (with a few more nights to go).
We WON'T discuss my Snore Index.....
(lets just say it's "healthy", but I'm sleeping good)

In summary, I did NOT feel any worse being on an APAP range, but the "numbers" weren't any better than on straight pressure. Also, the pressure increases to 13 and 14 didn't lessen the apneas and hypopneas either. In fact, it seemed that more were occurring at those pressures.
(typically, I only have ONE apnea on any given night that they occur....once in a great while I'll have two.....of 12 sec. or less duration)

Best wishes (and apologies to JCraig for hi-jacking his thread).

Den

Mister_hose

When you do find out what type of doc your sleep doc is AND if he/she is not to your liking, always remember that you don't need a sleep doc to prescribe CPAP stuff. Your regular doc, if you are more comfortable with him/her, can do it instead. Since you sound like you are really into dealing with these sleep issues yourself and tinkering, you might find that if you have a good regular doc (like I do) you might stop paying the sleep doc if you feel you have it under control.

mister_hose wrote:I'm intrigued by APAP for a somewhat unorthodox possible application. My CPAP machine was set to my titration value, 13 cm, but I wonder if it'd be a good idea to buy an APAP and set it up with a range of, say, 13 to 20, or perhaps something more moderate like 13 to 16. This would be like "CPAP Plus". It never drops below my prescribed CPAP pressure of 13, yet can punch the pressure up if necessary for any rare, extreme events that may occur.

mister_hose, what you've described is the reason I've been running my autopap at 9 - 16 for the past year or more....minimum pressure set up high enough that it would be like using cpap at the "prescribed" pressure, yet having some leeway up above if/when needed occasionally. In my case, 9 or 10 would probably be my prescribed pressure. The machine sometimes makes brief forays up to 13, so that's there, if needed, as you say.

mister_hose wrote:However, the question then would be, would the pressures above 13 cm, and the process of changing upward to them and downward away from them (back to 13), cause problems for me?

Probably wouldn't bother you a bit. I'd bet you'd sleep fine. If you didn't, then the autopap could always be operated in cpap mode.

mister_hose wrote:What do you guys think about this "CPAP+" idea, of setting an APAP range from your CPAP titrated pressure to a bit higher?

Excellent idea for many people, imho. That's part of the beauty of using an autopap and its software. If you're a person who wants to take up the reins of your own treatment, with or without a doctor in the loop, autopap/software is the way to do it. Experiment with ranges, experiment with single pressures...experiment, experiment, to find what works best for you.

mister_hose wrote:Ego-driven docs feel threatened or challenged by highly-informed, scientifically-minded patients, and get annoyed and assume a "parent-to-child" tone in the conversation. The best docs, when you tell them what you're doing, will get a grin a mile wide, a grin that says "oh thank God, I've finally got a SMART one!", right before they excitedly start talking to you in the "we're equals" tone.

You've got THAT right...about both types!

Snoredog wrote: <snip>
I think you have the runaway machines bss aackwards, what are the known runaway problems with the Remstar Auto that you refer to?
<snip>

I think SWS answered this pretty well.

DSM

The best docs, when you tell them what you're doing, will get a grin a mile wide, a grin that says "oh thank God, I've finally got a SMART one!", right before they excitedly start talking to you in the "we're equals" tone.

You really had me going until that last part! I can buy the grin part and the "finally got a smart one" part. I have had some docs like that. But the "we're equals" part? Heck, docs are brainwashed in med school to never, ever believe that.

I have read this thread with interest.... I am starting my 4th month on cpap. I had an AHI of 17, 3 apneas and 90 hypopneas and a respratory rate of 20-22 during my first sleep study. I had 321 limb movements nonrem and 9 rem for an index of 58.7 % with 191 limb movements causing arousals which was an index of 38.5 for a total arousal rate of 67.2. Snore count was 5 and a rate of 1.0 for an index of .9 The doc said I had moderate apnea, severe periodic limb movement and upper airway resistance syndrome.

With the cpap in the lab set at only 5 all of this resolved!!! My respirations were at 10-12. No apneas, hypopneas or limbmovements were recorded.

I got a plain resmed plus with heated humidifier and swift mirage nasal pillows. This mask was different than in the lab and I am not sure it is at the right pressure. Does the mask make a difference in the pressure setting? I had no choice, that I knew of at the DME and wonder if I should have a better machine.

Anyway I have greatly improved over the 3 months, no pain, and I have my faculties back so to speak. But I am still concerned that the pressure is right. (I had abdominal laproscopic surgery 10 days before my cpap study and was on 800mg ibuprophen but they said that would have no effect on the readings.) However sometimes I feel like there just isn't enough air. I pull the mask away and there is air flow but I am not convinced that I always have enough air. I still wake up alot and some nights are better than others.

So with this "debate" going on here, do you folks think I would benefit from a machine that would judge what I need or at least record what the AHI is? I have no idea if my ins. covers it. I know I am due for a new mask at 3 months and I wanted to research this a bit before I see the DME. I just want to know that this is not wasted effort and that I am getting the right pressure. How can they be sure with one night's study? My husband can tell if I am not sleeping right because I start "dancing" and wake him up.

What can my resmed plus tell me that I don't know how to access? What kind of machine would be the least costly to get this type of info or apap capabilities if I have to make up the difference from insurance to get a better machine? You folks seem to know alot about what's out there.

Thank you very kindly.

jesica5,

With a pressure of 5, I don't think you need a Bi-Pap. However, if you feel like you can't breathe, then your pressure might need to be bumped up to 6 - just to try.

Call your DME and see if he can change it. Or, if you own your machine and don't have to answer to anyone or your insurance, then you might change it yourself.

It won't hurt you to go up to 6, so don't worry about that. And if it doesn't make you feel any different, then you can change it again.

If money is no object, then buy a Remstar Auto and the software. Then you can get your reports and know for sure what the correct titrated pressure should be.

A solid reason not to get a APAP is because the doctor doesn't order one.If you don't have faith in your Dr or prefer anthers philosophy better, fine. Keep in mind that the vague explanations of a tech or Dr's reasoning for titrating you to a certain pressure are not the same as seeing factors such as sleep architechture, arousal indexes, blood oxygen saturations, and many other factures used to determine your optimal pressure. 1 centimeter of water pressure can make a huge difference for some people, not as much for others. APAP is a wonderful thing , but it is a source of therapy that that is adaquit for some and not for others.Everybody's different.
Also lets not forget that while we are sleeping its not really possible to get an acurate assessment of anything past feels better or feels worse(aside from simple side effects and what-not). A little grogy could mean anything from remaining obstruction to insufficiant ventilation to arousals from who knows what. Sleep studies in a laboratory use EEGs, EMGs, EOGs, resparatory gauges, , end tidal co2 monitors, all kinds of stuff to see what works for you.stuff the APAPs can't do yet.
Drs seem to think some need all this, some not so much.
A lot of people read of cases were APAPs were adequate and in some cases better then other PAPs, but those reports don't mean that sleep medicine in respect to sleep disordered breathing is that simple.
Thats what i think, anyway.

I will ask them about that. I have no idea how to change it myself. I hope it is just that this mask fits like it is supposed to. I am glad we can research and help each other here. I THOUGHT I knew enough before but I amalways learning how to deal with this!

You really had me going until that last part! I can buy the grin part and the "finally got a smart one" part. I have had some docs like that. But the "we're equals" part? Heck, docs are brainwashed in med school to never, ever believe that.

Okay, I could've worded that better. What I meant to say was that they change from "summary mode" to "detail mode", or you could say from "ignorant layman mode" to "decently-informed, highly-read layman mode". They don't talk to you like you're a random person off the street anymore, or worse yet, like a child. They don't hold back on the big words, or on some of the more complex reasonings for their decisions.

They'll never think you're a literal "equal" because obviously, unless you're a sleep doctor, you're nowhere close. I didn't mean "equal" in knowledge and experience, I meant nearly "equal" in terms of interest in the topic and ability to reason and absorb and process complex information.

To use a Windows analogy, most docs talk to you in "Wizard Mode" (click here and shut up and I'll take care of everything, don't ask complex questions please, you don't need to know and wouldn't understand anyway) until you show intelligence and that you're well-read. Then the good ones switch into "Advanced Mode", while the bad ones will get defensive and condescending.

You can be a doctor's equal, or near-equal, in general intelligence, having a mind for science, and having the ability to perform detailed observations and complex reasoning based on those observations. He has far more knowledge and experience about this topic than you do, but if you're in the same general intellectual league, and he's not an egomaniac, it can be a beautiful doctor-patient relationship. =)

Guest wrote “getting an autopap, you will be stealing money right out of your doctor's wallet, how will they ever be able to make their Mercedes and Porsche payments.” How can this be so, when CPAP machines come from a DME and not from the Doc? Please explain.

Snoozin' Bluezzz said ” Budget constraints are the only conceivable reason not to get an Auto. It only adds function, it does not subtract function.” It could be that you can get an auto CPAP machine and save you and your insurance carrier money. How? Because the DME’s and insurance carriers have agreed on ridiculously high reimbursements. In the case of my carrier, $ 1,260 over 12 months for a $ 545 machine. So the carrier and I collectively pay $ 1,260 over 12 months. I pay $ 252 over 12 mos and the carrier pays the rest. A top-of-the-line auto CPAP will cost “us” around $ 700 on an outright purchase. I pay $ 175 and the carrier pays $ 525. Talk to your insurance carrier’s CSR. Your insurance carrier might like the idea of saving money.

You will still have to deal with the issue of finding a proper mask. That’s where the DME’s have things locked-up. They will change out masks until you find one that works. Also, I noted that the arrangement between my insurance carrier and Lincare prices out masks at less than cpap.com's prices.

Everyone is different but after reading many postings here and not being able to get a good night sleep I gave up on my basic REMstar through my DME at $666 ($33 per month and $33 per month from the insurance company) I spent $750 for the REMstar Auto with humidifier and ~$140 for the software.

Best money I ever spent whether I get any back or not. It was a expensive trail if it did not work but I would pay 5 times that for the way I feel now.

I hope you find your combination soon.