Hi, Ziggytosh.
(I just saw this thread... don't know if you'll see this before your appointment, but I'll give it a shot.) I've been working on putting info together about why getting an APAP Rx is better than getting one for CPAP, piecing it together from a number of articles and threads in our forum. Although I'm not completely happy with the way it's arranged, I do feel very comfortable that the details are accurate, and I thought it might help you with your sleep doc.
A caution: The document itself (everything below the line of asterisks) is loooooong. If you cut & paste it into a Word or Word Perfect document, it comes to about 1.5 very full pages, using 10-point Comic Sans and the following margins: 0.625 top, 0.5 bottom and 1.0 left and right. Throwing blank lines between the various points might make it look less crammed, but of course it'll be longer.
If you think your doc would be receptive, you could give it to him/her. I'm pretty sure that nothing in it is deragatory about docs or DMEs.
BUT if you don't think your doc would be very receptive, don't give it to him/her. It could be counterproductive and only result in his/her eyes glazing over and ears closing. He/She might decide to be insulted by the
perceived slight of being told anything by a "civilian" (even though that wasn't your intention). Proceed gingerly. We all have egos, and some are more easily threatened than others. You might find it best to only use it yourself just in pre-appointment preparation or as a reference when talking with your doc. Or you might decide to pare it down to the bare-bones details. At any rate, you're welcome to any/all of it.
IMO, the best argument is that a lot can change in five years, which is the usual minimum amount the insurance companies require to pass before they'll replace a machine, and any of us very well might need APAP within five years even if we only need CPAP now. I would NOT mention that I knew or could find out how to switch it from CPAP to APAP, how to change the pressure, etc. I WOULD mention I understood that DMEs are supposed to change the settings (mentioning you understand something commits you to nothing), and at least this way you'd have the possibility of using APAP if you'd need it within the next five years. I'm not saying to lie, but communicating that you want to work with your doc won't hurt a bit. (If a doc at some point demonstrates he/she doesn't want to work with you, that cancels all bets. JMO.) I'd also emphasize that the DME is going to get the same amount of money, no matter if it's a CPAP or an APAP. Both are submitted under the same insurance billing code. (Your doc should know that.)
Above all else, be nice, be positive and don't get into a debate. Please post back to this thread and let us know how things went for you.
Marsha
P.S. If anyone sees anything that could be improved or needs to be corrected, please let me know. Thanks!!
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IN SUPPORT OF PRESCRIBING AN APAP MACHINE (centered when stored as a separate document)
Research:
-- American Journal of Respiratory and Critical Care Medicine: “Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?” Determination: Home self-titration of CPAP is as effective as in-laboratory manual titration in the management of patients with OSA.
http://ajrccm.atsjournals.org/cgi/conte ... /167/5/716
-- Otolaryngology-Head and Neck Surgery: “Nonattended home automated continuous positive airway pressure titration: Comparison with polysomnography” Determination: 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.
http://www.sleepsolutions.com/clinical_ ... o-CPAP.pdf
The most common indicators for prescribing APAP therapy are:
-- Twenty events per hour or more, depending on the oxygen desaturation rate.
-- Relatively wide difference in titrated pressure requirements when sleeping on the side, as opposed to supine sleeping.
-- Regular daytime drowsiness.
A patient’s pressure requirement can fluctuate:
-- With significant weight increase or decrease.
-- With changes in sleeping positions.
-- When he/she is congested due to sinus problems, illness or climate/humidity changes.
-- Normally during the night.
-- With a mask change, mask leaks or adjustments to the fit of the mask.
A different pressure setting might be needed because of difficulties during the titration study:
-- Titrated pressure may have been only an educated guess due to the patient’s lack of sleep at all levels during the titration study.
-- During the titration study, the patient might experience more REM sleep than he's/she's had in years, which would result in an REM rebound effect and require higher pressure. Once on xPAP therapy, sleep patterns would return to normal, and the pressure would then be too high.
-- Untreated sleep apnea may cause swelling in the mouth and throat and require a higher pressure setting in the lab. With xPAP treatment, the swelling may go down, and a lower setting would then be needed.
-- If the patient had nasal congestion during the titration study due to allergies, a cold, chemical sensitivity, cool air or trying both heated and passover humidified air flow, a higher pressure setting may have been required in the lab than the patient actually needs.
-- During the titration study, if the patient slept poorly and had little or no REM sleep or didn’t sleep on his/her back, the technician might have estimated the setting rather than rescheduling the test and reported an estimated pressure that is actually too high or too low.
Insurance companies rarely replace machines for at least 5 years after the initial rental period. The patient’s needs very possibly could change during that length of time.
-- A titration study is an expensive way to fine-tune pressure requirements, and it carries the added risk of the patient not sleeping normally in the lab setting.
-- Using an APAP machine at home often results in more accurate readings, enabling the doctor to determine the best single pressure setting for CPAP therapy or range for APAP therapy.
-- Using an APAP machine may reduce the frequency of doctor, sleep lab and DME visits, thus saving money both for the patient and the insurance company.
-- Working with a doctor and periodically using an overnight recording pulse oximeter, which can be prescribed, the patient can test for oxygen levels at home and report to the doctor for his/her interpretation.
When a patient is informed, responsible and willing to work appropriately with his/her doctor, better compliance is reported with APAP rather than CPAP machines because:
-- Patient involvement leads to improved treatment, higher satisfaction levels and a sense of controlling his/her condition rather than being controlled by it.
-- Patients often need a lower, and therefore more comfortable, overall pressure with APAP.
-- With daily monitoring, the patient can detect and assess the volume of mask leaks and test his/her existing or new mask adjustments, which also leads to added comfort.
-- APAP machines enable patients to get the full benefits of therapy. Otherwise, the patient may not feel as well if using a particular pressure setting and because of that be tempted to give up.
When APAP machines are prescribed:
-- Either CPAP or APAP therapy can be utilized.
-- When the minimum pressure is set close to the Rx pressure, many patients require a slightly lower pressure for most of the night, and events are still controlled. Higher set pressures may lead to more mask leaks or aerophagia, resulting in less comfort and poorer therapy.
-- The number of titration studies, which are expensive, can be reduced or even eliminated.
-- With the machine's data capability, the patient can do mini-sleep studies as needed in the comfort of his/her bed, which often leads to more accurate readings and helps the doctor to adjust the patient’s therapy to what helps the most.
-- If it’s determined that the patient does better on straight CPAP, the CPAP mode can be used until the numbers would indicate a need for a change.
-- Without changing the baseline lower pressure, the upper pressure setting can respond to the upper range of events and lead to more effective therapy.
-- Using a range of pressures, APAP can identify events that would be missed by a fixed CPAP pressure that is too low and would lead to poorer therapy results.