getting Ins to pay for going from cpap to apap - suggestions

I'm sorry but I highly recommend you do more research. There are plenty of medical studies that support the use of APAP's and have show that they are as effective if not more effective than a PSG, they are easier to comply with do adjust for changes.

Here are a few studies,

http://ajrccm.atsjournals.org/cgi/conte ... 163/6/1295

http://content.karger.com/ProdukteDB/pr ... ?Doi=93156

http://ajrccm.atsjournals.org/cgi/conte ... /167/5/716

http://www.co-pulmonarymedicine.com/pt/ ... -00008.htm

http://content.karger.com/ProdukteDB/pr ... ?Doi=93156

Even Cigna (yes the insurance company) acknowledges the benefits in their Healthcare position paper.

here is the link to all their position papers. scroll down to O and you will find their paper for OSA.

http://www.cigna.com/customer_care/heal ... index.html

Research actually does support the use of an APAP.

sleepingBear,

I've read those articles and many more and I think if you read them closely, you will come to the same conclusions that I have.

There is a lot of excitement about APAP therapy and it hasn't proven to be less effective when combined with PSG titration. In the case of self-titration, concerns remain that treatment solely with APAP devices may leave some patients with sleep related disorders that APAPs don't detect at greater risk than those that receive PSG titration. The studies that have concluded that self-titration with APAP equipment is equally effective have included an educational component in a laboratory setting. Where is that eduction provided when self-titration is advocated on this forum?

Long term compliance has not been proven to improve with APAP therapy but there have certainly been many that have vocalized their preference for it. This sort of anecdotal preference for APAP equipment does not stand up to critical review when it comes to making blanket statements as fact.

I stand by my previous post as you have offered me nothing in evidence that APAP is superior.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, APAP

I currently use APAP with pressure 6.4 to 14. My original prescription coming from my titration study was CPAP at 14 cm. I can assure you that, if I still had that CPAP at 14 cm pressure, it would not be in use, as it was disturbing my sleep significantly. My average 95th percentile pressure since December 12 has been 9.2 cm. For this user, and I suspect many others, APAP has made the difference between effective treatment and no treatment.

Jim,

I think it is important that you believe in your treatment and do what makes compliance work. One the other hand, many of those that have posted in search of relief from PAP pressures are very new to PAP therapy. They may not have developed the proper adaptation skills for surviving therapy with CPAP or APAP. They simply want help understanding how others have adapted.

Overcoming aerophagia is often a learned adjustment in the CPAP therapy process. Some people tend to over-breathe and swallow air while they are adjusting to the machine. It can also start after a change, such as an increase in pressure or a new mask. The good news is that this wears off over time as you become more familiar with CPAP. Referring patients to machines and not their doctor does not help the situation because APAP equipment has not been shown to improve a patient's compliance with therapy or with side effects like aerophagia.

I offer a counter point to those that might rush to APAP therapy to solve more fundamental issues with PAP therapy. When studied objectively, APAPs have not solved these fundamental issues.

Cale

but it does solve the fundamental issue of providing the proper pressure at the proper time and changing the pressure based on your physiological needs.

sleepinginseattle wrote:Overcoming aerophagia is often a learned adjustment in the CPAP therapy process. Some people tend to over-breathe and swallow air while they are adjusting to the machine. It can also start after a change, such as an increase in pressure or a new mask. The good news is that this wears off over time as you become more familiar with CPAP. Referring patients to machines and not their doctor does not help the situation because APAP equipment has not been shown to improve a patient's compliance with therapy or with side effects like aerophagia.

Hmmm . . ., based on my own battles with aerophagia . . . I certainly haven't found this to be true . . . My own aerophagia hasn't worn off in well over a year since starting therapy. How much longer should I have to wait?

Cale, please provide links to studies proving this . . ., I'd be appreciative of any help you can offer for aerophagia. I'm sure many others here would be equally grateful, as well.

sleepinginseattle wrote:Long term compliance has not been proven to improve with APAP therapy but there have certainly been many that have vocalized their preference for it. This sort of anecdotal preference for APAP equipment does not stand up to critical review when it comes to making blanket statements as fact.

Anecdotal evidence . . ., hmmm . . ., I count two pieces of anecdotal evidence regarding my own treatment. I do much better with APAP than CPAP. My pressure needs change considerably throughout the night. (That's fact, by the way, not anecdotal evidence.) Most nights I need no pressure for about half the night, but then when I do need pressure, the pressure averages around 9 or 10 cm. Some nights though it hovers close to 15. It seems obvious from my own data that I truly need that higher pressure on occasion rather than the machine running away with pressure.

My personal anecdotal evidence involves TMJ issues and aerophagia. And there are many other folks here who experience these issues as well, both separately and in combination. TMJ issues are associated with changing pressure needs and aerophagia is greatly relieved for many of us when our machines respond with pressure only as needed.

sleepinginseattle wrote:I offer a counter point to those that might rush to APAP therapy to solve more fundamental issues with PAP therapy. When studied objectively, APAPs have not solved these fundamental issues.

And the advantages for CPAP are . . ., hmmm . . ., it allows your DME to make a higher profit . . . Not any other advantages, I see . . . The only folks here fervently in favor of CPAP over APAP seem to be the DME's who regularly post here.

And the advantages for APAP are
- Less aerophagia for many
- Less pressure throughout the night for many
- Ability to titrate/re-titrate without involving a sleep lab
- Ability to be used as CPAP if that provides slightly better therapy
- Avoids wasting lots of time with repeat calls and visits to physicians and DME's when adjustments are needed.

Oh . . ., perhaps the number one advantage to getting an APAP is the ability to be in charge of one's own therapy, from monitoring it to fine-tuning it.

Personally, I don't give a rat's patootie about studies when it comes to my own treatment. I paid for my second machine, a Remstar-auto, out-of-pocket and have no regrets about having done so.

Just my own anecdotal $0.02.

Regards,
Bill

sleepinginseattle,

I'm curious, what part of the medical community do you work in? DME? RT?

I appreciate the replies. I've been traveling for work and just got home so am just now reading them. I don't want an apap because my pressure is too high. On the contrary i'm worried that it isn't high enough and is maybe not stopping my apneas from occurring. During my sleep study I slept maybe 2-3 hours with the machine and really wonder if that was enough to set my correct pressure.

It seems that I will likely have to buy my own machine and foot the bill myself as my insurance is very adamant about not paying for one. Thanks again for all of the replies and suggestions.

My take on this subject---
For first CPAP, I wanted auto. BCBS rep told me they would supply whatever the doctor prescribed as necessary. Did talk dr into APAP and he said my extra expense would be an 20% of the additional cost. Insurance biller at sleep clinic said I pay all the additional cost of APAP.

After no insurance claim or billing showing up after 6 months I called clinic the other day. Sure enough, I had slipped through the billing system. When I teased her they should give me a "honesty discount", she did say they would not bill for extra cost for APAP.

So, whether the answer from ins company, doctor, or biller was correct I don't know.

Cale,

Auto machines can be set in CPAP mode. If that's what's best for the patient, then I certainly hope they set their machine that way.

sleepinginseattle wrote:Referring patients to machines and not their doctor does not help the situation because APAP equipment has not been shown to improve a patient's compliance with therapy or with side effects like aerophagia.

Cale,
While I went through my sleep center to change from CPAP to APAP, I wouldn't say I was referred to my doctor. The interpreting doctor, whom I have never seen, did write the order for the APAP. Turns out, after I had obtained the titration report in a visit with my primary care doc, that the titration study report, while mentioning a pressure of 14 on CPAP, also mentioned, in an earlier section, something like "patient will be placed on APAP." If I hadn't read up on aerophagia here and made the suggestions, likely they would never have caught their own error.

Don't know if APAP has been shown in a controlled study to improve aerophagia, but in my own single-subject study, the change was immediate; December 11, I slept with CPAP and had aerophagia pretty badly, even though I had illegitimately altered my pressure to 13 cm. December 12, I started with APAP (set at the time per script to the carefully thought-out range of 6 to 20 cm.) and had virtually no aerophagia. This problem has been minor, at worst, ever since.

Seems to me if you have enough anecdotal evidence (AKA single-subject case study,) at some point a critical mass exists that cannot be ignored. In my communication to the sleep center regarding the aerophagia, I listed several options for altered treatment. This communication occurred following gleaning information here, which led me to believe that APAP was the best of the options which I presented. (Hadn't really seen anything regarding BIPAP for this problem, and BIPAP is evidently not necessary for me at this time.)

I've worked in medical settings for 26(+) years, and have spent the last 9 1/2 years as an occupational therapist. Not that this is highly important, but my focus professionally has been on what works to enable the individual I'm working with to become more capable, whether that is improving physical ability via strengthening, improved coordination, or decreased nerve problems, via adaptive equipment, via environmental adaptations, or whatever else may be of benefit as long as it's legally, morally, and ethically responsible. I can do no less in pursuing my own treatment for OSA. If I left this in the hands of "my" sleep physician (whom I have never seen and with whom I have never had the opportunity to speak,) I would never have received the care and attention to detail needed to continue with this quite literally vital treatment.

Cale,

You seem to argue from a "your argument is wrong therefore my argument is right" point of view. I'd still like to see copies of some studies mentioning that APAP is worse than CPAP.

If there's just no proof that APAP is better, then fine, why do you get so worked up when there's no proof that it's worse? If they're the same then we're a bunch of loonies and its not going to hurt anyone.