convincing Dr.'s for apap?

hello all,
I'm seeing my Dr. on thursday for a follow up and to return my apap and get set up on my own equipment. How hard is it to convince them that you want to stay on the apap? I'm finally getting along with this equipment and sleeping through the night and don't really want to make any changes. So do you volunteer to pay the difference in the price of the machine? Or is there a good way to convince them to keep you on the apap? It would also be nice to have the softare to be able to monitor what I'm doing in my sleep any thoughts or ideas that worked for you? And how much difference in price is it? I've heard 2-3 hundred dollars more? thanks again.... Rich

My insurance didn't hesitate to pay for an APAP when my doctor prescribed one. I've found that most doctors are willing to do what the patient asks within reason. I'd say to your doctor, "Doc, I've read where a lot of people really like APAP machines better than CPAP. I'd like to try one." Most will say yes. They don't want to lose a patient. They also don't want to be liable if they refuse a request by a patient and the patient suffers problems due to it.

APAP versus CPAP Research
Google APAP vs. CPAP studies. A few research articles:

http://thorax.bmjjournals.com/cgi/conte ... uppl_3/S49

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

http://64.233.179.104/search?q=cache:ij ... dies&hl=en

Reasons to use APAP
Does your prescribing physician think that an APAP is a medical necessity? From your sleep study report, what is the level of your obstructive sleep apnea – mild (5 or more events per hour), moderate (15 or more events per hour), or severe (30 or more events per hour)? You might check the accuracy of this with your physician: Medicare guidelines, which most insurance companies follow, require that the patient have at least 20 events per hour to qualify for an APAP machine, but this number is related to your oxygen saturation rate as well. What is your oxygen saturation rate? Does your AHI exceed 20 events per hour when you sleep on your back? How long are your apneas and hypopneas? Do you have daytime drowsiness which may also qualify you for an APAP? Do you have other related health conditions making successful xPAP treatment (compliance) all the more critically necessary? Do you have the skills and willingness to cooperate with your doctor in managing your sleep therapy, or family or friend to help you?

1. An APAP machine offers a “two-fer.” It can be set to a straight CPAP mode, giving the advantages of a constant pressure plus the other advantages of APAP (home titration), without the disadvantages of CPAP (undetected wrong pressure setting).
2. In the APAP mode, the machine automatically adjusts pressure to meet changing pressure needs when you change positions from side to back, are in various sleep stages, are extra tired, have a blocked nose due to a cold or allergy, or have taken alcohol or sedatives. (A CPAP setting to handle these situations would probably be too high for comfortable continued use.)
3. Without changing the comfort of the baseline lower pressure, the upper range of the APAP pressure setting will respond to the upper range of apnea/hypopnea events (requiring higher pressure) making APAP therapy more effective. A titrated fixed pressure that is too low may miss a sizable number of events on straight CPAP, labeling them as non-responsive, leading to poorer therapy results.
4. APAP automatically adjusts pressure when you change masks, develop a mask leak, or experiment nightly with various mask fitting adjustments. Theoretically, pressure settings should remain the same with any mask. Practically, full face masks usually leak more than other types and may require lower or higher pressure settings.
5. Studies have shown that often a user needs a lower overall pressure on APAP than the original titrated pressure. A lower pressure is more comfortable for the patient.
6. Studies have shown that there is better compliance with APAP than with CPAP. Possible reasons may be more comfortable treatment from a lower pressure setting or range, and (with machine display or software) immediate feedback on treatment leading to higher levels of satisfaction and improved treatment.
7. Self-titration. If the patient has a smart card and optional software (or ready access to a DME for printouts) and the requisite skills, willingness, and ability (or a helper), he/she can monitor his/her pressure settings and results and find the optimal pressure setting for straight CPAP, or narrow range of settings for APAP, in consultation with the physician. Research:

American Journal of Respiratory and Critical Care Medicine, Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?
http://ajrccm.atsjournals.org/cgi/conte ... /167/5/716 Quote: Home self-titration of CPAP is as effective as in-laboratory manual titration in the management of patients with OSA.
Nonattended home automated continuous positive airway pressure titration: Comparison with polysomnography http://www.sleepsolutions.com/clinical_ ... o-CPAP.pdf Quote: Nasal APAP titration in this study correctly identified residual apnea equivalent to the use of PSG. This correct identification allows the physician to accurately access the efficacy of treatment.

8. Once optimal pressure settings are found, with software the patient can monitor his/her progress. Software reports provide specific data for the doctor’s analysis.
9. Use of an APAP reduces the need for doctor visits (and probably DME visits) if the patient is responsibly managing their own therapy.
10. Use of an APAP reduces the need for subsequent expensive sleep tests since the patient is auto-titrating. Working with a doctor and periodically using a pulse oximeter (borrowed, rented, or purchased), the patient can test for oxygen levels at home with the report interpreted by the doctor.
11. With APAP software, the patient can detect and assess the volume of mask leak and test his/her mask adjustments. The same holds for the patient’s new mask trials.
12. Lower APAP pressure settings may do a better job of reducing or eliminating aerophagia (swallowing air) than higher CPAP pressure settings.
13. Some of the Respironics APAP machines have exhalation relief, called C-Flex, for patient comfort and resulting better compliance. (The current ResMed machine does not have EPR exhalation relief in the APAP mode.) C-Flex provides some degree of exhalation relief at a much lower cost than a BiPAP machine, although a BiPAP provides a greater degree of relief for those who require it.

battlin_blazes wrote:hello all,
I'm seeing my Dr. on thursday for a follow up and to return my apap and get set up on my own equipment. How hard is it to convince them that you want to stay on the apap? I'm finally getting along with this equipment and sleeping through the night and don't really want to make any changes. So do you volunteer to pay the difference in the price of the machine? Or is there a good way to convince them to keep you on the apap? It would also be nice to have the softare to be able to monitor what I'm doing in my sleep any thoughts or ideas that worked for you? And how much difference in price is it? I've heard 2-3 hundred dollars more? thanks again.... Rich

I just told my sleep doc that I had been educating myself on the internet and developed a concern because I slept on both my back and my side which may have an effect on the pressure needed to prevent an apnea event. I also told him that I intended to begin an exercise routine to lose weight with my new found energy level and that as my pressure needs change, it may help to have the APAP to avoid having to come in for frequent sleep studies to re-titrate. He bought off on it and swaped my CPAP for an APAP.

- roberto