CPAPtalk.com

I remember reading the clause about APAPs in the Medicare regulations. (I can't find it now either, grrrrr). The way I read and interpreted it was that APAP titrations were not considered adequate to establish the need for CPAP therapy. In other words, they were no more acceptable to establish OSA and need for CPAP therapy that an home sleep study or mobile facility sleep study. I saw nothing that said they were non-reimbursable or inadequate or unacceptable to provide CPAP therapy.

I'm sorry, but given the "service" I get and have gotten from my DME supplier $135 a month for 13 months (or is it 15, I've forgotten already) is at least $1755 for a less than $400 machine or even a $700 machine (those are cpap.com prices for equivalent Respironics and Resmed machines - and you know that cpap.com has to make some profit on the products they sell). Add on to that the sale of a heated humidifier and a mask and the profit margins on them they can EASILY "swallow" the difference in cost between a good data capable CPAP machine and an Auto.

I'm not saying that those DMEs who DO provide support and service and timely provision of needed equipment and/or maintenace "should" have to swallow the difference in cost, but an awful lot of DME suppliers should to make up for the crappy service, etc. they provide.

Furthermore, an AutoPAP 'is' a CPAP. They provide every bit of therapy a CPAP does as a CPAP does. No one, not even MattMan, whom I highly respect and appreciate, is going to sell me the bill of goods that to bill an Auto as a CPAP is fraud in any way shape or form. An Auto "is" a CPAP first and foremost. It just has some extra frills that are NOT illegal according to any Medical or insurance standards.

If these DMEs can in good conscience provide a $247 CPAP machine (again cpap.com prices w/their needed profit margin) rather than a $400 to $700 machine (and you know darn well most CPAPs sold by local DMEs aren't hitting the $700 price range (again cpap.com's prices) then they ought to just shut their trap and provide the Auto for the client who has an Auto script from their sleep doctor. Autos or even the more high end CPAPs don't make up that large a part of their business nor their CPAP business.

I understand what MattMan is saying and where he is coming about some service/equipment reimbursements are losers and some are very lucrative. But the logical thing is to reduce the number of losing reimbursement services and equipment. Just don't offer or handle them.

Straight CPAP w/or w/o C-Flex or EPR is NOT handling my apnea needs. This is very well documented. My sleep pulmo has decided I need an Auto. He's written the script. I haven't taken it to my DME yet. But in feeling them out when I went in to pick up a Medicare reimbursed replacment part (for the third time they still didn't have it) I felt them out about an Auto and they like to have hit the roof and were quick to scream Medicare won't pay for an Auto. Nothing about lots of necessary documentation, etc., etc. etc. Rather than go thru the hassle of getting Medicare approval thru this DME I was just gonna self-purchase an Auto thru cpap.com. BUT - now, my DME has ticked me off enough I do believe I'm gonna jump thru the hoops to get that Auto thru them just for spite. I'm tired of their LIES.

And yes, MattMan, they've lied plenty. Just ONE instance: my Humidaire 3i was in. Except when I went to pick it up it wasn't in. It hadn't even been ordered yet! Being told a couple of weeks later that it had come in. Another trip in to pick it up and they didn't have one and no record of my needing/having requested one. Yet a third trip in to pick it up because it had come in. Except they didn't have one in stock but they could have one for me tomorrow. At which point I told them to ship it to me or reimburse Medicare for the price they had been billed for it and I would buy one elsewhere. We'll see if one shows up via USPS or UPS. If it arrives at all it will probably be by donkey cart!

Thank God a fellow PAPper was generous enough to loan me his stand alone heated humidifier more than a month ago!!!

And, yes, my original script called for the Humidaire 3i but the one I received was defective. The DME "said" they talked to Resmed and Resmed would replace it. Yet when I called 2 weeks later to see if it had come in yet, it hadn't even been ordered yet!! I had to talk to Resmed myself and Resmed had to call the DME and instruct them to replace the defective one and return the defective one to Resmed. This is "service" from my DME???

End of rant. For now.

mattman wrote:To try to once again portray all DME providers as greedy pigs who don't care about the patient is simply UNTRUE.

YOUR words......NOT mine. I have NEVER used those words to describe DMEs.
I've also never used a DME (except for an over-the-weekend pulse-oximetry test).
All I have to go by are the horror stories I've read about on the forums......AND, the one from a relative who specifically asked for a Pro 2 (on my recommendation)......and they said "Oh, no, THIS is what YOU need!".......at which point they gave him a REMstar PLUS.....the one that doesn't even have C-Flex......and then charged his insurance about 4 - 5 times what CPAP.COM's price is. (the HH was about $400 extra)

DON'T try to tell me that they don't exist!!! Calling most of the DMEs "greedy pigs" would be insulting to pigs.

Den

mattman wrote: However, as to the real point at hand:

There is something to be said for APAP being a better machine. There is something to be said for the fact that some people absolutely do better on an APAP than on a CPAP.
However, where does the MAJORITY lie?

Is it at all fair to say that putting everyone on APAP would increase compliance? Is there even any way to know??
Is there any way to know if putting everyone on APAP would reduce the indirect problems assosciated with OSA (The car accidents and such you allude to)?

mattman

So my question to the 'exerts' on our fourm with years of XPAP experience is this; What would be the reason a person should go on an APAP versus a straight CPAP machine? Does APAP actually help or is CPAP the preferred method of treatment for most of us with OSA?

I went from CPAP to APAP because I thought that it would be better having only the pressure that I needed blowing in my face, rather than all 10CM blowing all the time, since I also have suffered from chronic insomnia and can't get to sleep for at least 45 min to 2 hours on some nights! My doctor simply said if you want to try it go ahead and he wrote the script. I really don't think he knows a thing about sleep apnea or treatment because he asked about the range of pressure I would need. I said, "why not from 5-12cm?" He said ok and put that down. I was tritated at 10cm from my sleep study. It seems that whatever I tell him he will do!

So, do I stay with APAP or switch the machine to CPAP mode with the ramp time being 40 minutes or so?

Jeff in TN

Jeff in TN,

Do you have the software to monitor your therapy? Since you list a current AHI, I would surmise that you do.

Since you've got a "multi-mode" machine, you could try it with different options and see which ones work best for you. THAT'S the best thing about having an Auto. For some of us (probably most), CPAP seems to do a good enough job in our therapy. For others, they feel that the APAP (Auto) mode works best for them.
I personally feel that a narrow range on an Auto probably works best......when you find out what it is.

Best wishes,

Den

Wulfman wrote:Jeff in TN,

Do you have the software to monitor your therapy? Since you list a current AHI, I would surmise that you do.

Since you've got a "multi-mode" machine, you could try it with different options and see which ones work best for you. THAT'S the best thing about having an Auto. For some of us (probably most), CPAP seems to do a good enough job in our therapy. For others, they feel that the APAP (Auto) mode works best for them.
I personally feel that a narrow range on an Auto probably works best......when you find out what it is.

Best wishes,

Den

Thanks for that suggestion. Currently I am using the Auto mode set from 6-10. When I wake up it is at 10 but I can hardly feel it. Wish it was that way went I went to bed, but slowly it works up from 6 so I can get used to it!
I have not yet bough the software but my DME gives me a card so I can have them check it every once in awhile. I want my AHI down to 2 or less!

Jeff in TN

I was on cpap for 10+ years and switched to apap about 14 months ago.

After thinking about it very honestly, I am not sure I am any better off or have any improvements.

But I am a techno person and the charts and downloads are very fascinating to moi.

My titrated starting pressure was 12 and I had immediate and dramatic results.
I gained weight and when my wife mentioned I was snoring, I inched it up to an eventual 13.5+
My apap shows most of the night I am at the lower limit of 10 and occasionaly up to 14-15. So I am probably in my initial range anyway.
APAP would probably have decided benefits for those who are not greatly improved on a constant pressure, but probably not in my case.

But I will continue on apap for the entertainment value and techno challenge.

Jeff in TN,

Since your machine is already programmed for a pressure of (up to) 10 and apparently it is quite tolerable to you, I would suggest setting your machine to CFLE mode with a pressure of 10 and a C-Flex setting of your chosing......for about a week or two and then have your card downloaded. What might be happening is that you have events happening at lower pressures which make your AHI higher.

Best wishes,

Den

Den,

I just might give that a try. I need a few more nights of decent sleep so I can put up with the change of getting used to falling asleep with the pressure at 10. This tryinig to fall asleep is killing me!

Thanks!

Jeff

jrfoster wrote:Den,

I just might give that a try. I need a few more nights of decent sleep so I can put up with the change of getting used to falling asleep with the pressure at 10. This tryinig to fall asleep is killing me!

Thanks!

Jeff

Please let me know how it works out.

Best wishes,

Den