Any hints on getting my doctor to prescribe APAP

Hi All,

I've been using a CPAP since September 2008 with relatively good results. However, I am convinced I can get better results and therefore better sleep and treatment results if my sleep doctor changes my prescription from a CPAP machine (ResMed S8 Elite II) to an APAP machine (ResMed S8 AutoSet II). I am seeing my sleep doctor tomorrow and will ask him at that time to change my prescription. I think I am fully armed with all the good reasons to change but in case I have overlooked any, I thought I would ask all of you for your thoughts. Does anyone have suggestions?

One reason I feel I am well suited for treatment using the APAP machine is that I get inconsistent numbers (although pretty good: AIs between 0.5 and 3.4 over the last 30 days, AHIs between 3.1 and 11.3 and leaks between 0.10 L/s and 1.04 L/s) which I feel are due to movement during my sleep and other external factors. I feel an APAP can adjust to the daily changes where the CPAP cannot and thus, result in even better numbers, better therapy and better overall health.

My doctor was going to give me a straight CPAP and I calmly requested an APAP so that we could set it on a range because I hadn't slept at all well during my study and titration nights. She wrote the prescription as as I requested with no arguments.

Good luck!

Mindy

It isn't usually hard to get the Dr. to write the script but you probably won't get insurance to pay for a second machine within 2 years. If you have your cpap script you can always buy your own auto from someone like Cpap.com. That's what I did.

Thanks for the information. I asked my primary care physician some time ago to change my prescription from a CPAP to an APAP so that my Medical device provider (Praxaire) would replace my CPAP with the APAP. He chacked with the Praxaire representative at the hospital and was told APAPs are only used for diagnosis and not for treatment so he refused to prescribe an APAP. He did however, set me up with my first appointment with my sleep doctor (tomorrow). I expect that if my prescription is changed to an APAP then Praxaire and my health insurer (Blue Cross/Blue Shield) will pay for the replacement and Praxaire will be stuck with my used CPAP (unless the want to sell it to me cheap as a backup unit).
I also know that APAPs are medically accepted for treatment of OSA, especially if the OSA is "severe" (mine is) and if it is an alternative treatment the doctor can justify based on the patient's needs (I am needy).
I also know I can use my current prescription to purchase the APAP machine I want including the manuals, humidifier, card reader and software at CPAP.com for a little less than $1,200.00. In fact, if I am unable to convince my doctor to get Praxaire and my insurer to change and pay for my APAP, I indend to just go ahead and purchase my APAP and put my CPAP on the shelf as a backup or use it at my vacation home and leave it there so I do not have to fly back and forth with a machine.
Does anyone have any other advice?

Presumably, your prescription was based on a "worst case scenerio", meaning it is the pressure needed to clear obstructive apneas that you had while in a supine position. If you are not an exclusive back sleeper, you may not need that high a pressure for the rest of the time you are sleeping. An auto would adjust, as needed.

Bev

I mentioned to the doctor that I needed a new machine. I planted the seeds that my then current machine didn't seem to be meeting my needs and that something that adjusted the pressure according to need would be better. I did not ask for a script at that time.

When I spoke with the DME I told them which machine I wanted (S8 autoset). A couple of days later, they said they would need a new script from the doctor specifying an APAP. I told them to go ahead and contact the doctor for the new script. I don't know whether or not they really contacted the doctor, but I did get the S8 autoset.


Hope all works well for you.

Thanks to this site, I have learned more about the devices available. Typically, in the past the DME would show me a few machines and ask me to pick one. (Like I know anything about the machines.) It is also helpful to know the frequency in which you can replace said machine. I have over 18,000 hours on one machine. I probably should have replaced it four or five years ago.

Did I miss your pressure?
As mentioned if your pressure is high it won't need to be HIGH ALL night long.

OutaSync wrote:Presumably, your prescription was based on a "worst case scenerio", meaning it is the pressure needed to clear obstructive apneas that you had while in a supine position. If you are not an exclusive back sleeper, you may not need that high a pressure for the rest of the time you are sleeping. An auto would adjust, as needed.

Bev

Hi Bev,

I am trying to post a response to you again. I guess my first effort failed so I will do my best to duplicate my failed attempt.

I am not convinced my sleep study obtained accurate results because it lasted 5 hours in one session conducted in a cramped hospital room in a tiny uncomfortable bed. I expect I slept on my left side during my entire sleep study as that tends to be my habit. My study and titration in that 5 hour session found that I had severe OSA but I have never been actually provided with a copy of my study in spite of my repeated requests for a copy. Maybe I will see it tomorrow with my sleep doctor. In any event, the study found that a pressure of 7 cm H2O (I am told that but have never seen the results) took care of my apnea events. My CPAP was delivered to me set at 7 cm H2O but at that pressure I have wildly varying results from night to night without any AI numbers even close to 5 (they were all mostly double digits) so I increased my pressure to 8 cm H2O to obtain the numbers I have been getting for over a month now. I did try setting my pressure a little higher but that did not improve my results.
I also try sleeping on my left side but I know I move around from time to time and spend some time on my back which probably explains the variations in my numbers to some extent. I just think an APAP will give me better treatment because it is able to make adjustments during the night. I have no problems related to comfort or adjustment to the mask and pressure so those issues are not contributing to my sense that I will receive better treatment with an APAP.

sam1234 wrote:I mentioned to the doctor that I needed a new machine. I planted the seeds that my then current machine didn't seem to be meeting my needs and that something that adjusted the pressure according to need would be better. I did not ask for a script at that time.

When I spoke with the DME I told them which machine I wanted (S8 autoset). A couple of days later, they said they would need a new script from the doctor specifying an APAP. I told them to go ahead and contact the doctor for the new script. I don't know whether or not they really contacted the doctor, but I did get the S8 autoset.


Hope all works well for you.

Thanks to this site, I have learned more about the devices available. Typically, in the past the DME would show me a few machines and ask me to pick one. (Like I know anything about the machines.) It is also helpful to know the frequency in which you can replace said machine. I have over 18,000 hours on one machine. I probably should have replaced it four or five years ago.

I sort of did try your approach except on advice of my RT, I aksed for a new script. I spoke with my RT and he said I needed an APAP so I should ask my PCP for a new prescription and then I went to my PCP and told him and asked for a change in my prescription - that's when my PCP told me that my RT's employer told him that APAPs are only used to diagnose and not to treat which resulted in my PCP refusing my request for a change in my script but setting me up for my appointment tomorrow with my sleep doctor.

Kenji -- I'm in MA, and last year had BCBS of MA. While I was doing my "due dilligence" I found the *PAP policy on the BCBS website. So, after my diagnosis, and prior to get the Rx from my sleep doctor, I had an idea in my head that an APAP would be hard to get (the BCBS policy says "APAP only when CPAP fails" -- but this is BCBS of MA).

I go into the sleep doctor and he tells me he'll be writing an Rx for an APAP. I said, "but what about the BCBS policy?" He said that he'd never heard of that before. He told me he'd write the Rx anyway and then let the DME figure it out. The first I heard from the DME is that the machine is covered. So whatever they managed to do seemed to work.

In general, it seems like it is no skin off the doctor's nose no matter what he or she writes. DMEs, according to others on this site, are the ones to resist, but if the doctor writes APAP, then there shouldn't be an argument.

My vote, if you are keeping track of them, would be to talk it over with your doctor. Explain your reasons for wanting an APAP. After all, in the end, you are the consumer that is paying for this.

Guy

GumbyCT wrote:Did I miss your pressure?
As mentioned if your pressure is high it won't need to be HIGH ALL night long.

My initial pressure was 7 cm H2O but long ago I increased it to 8 cm H2O so I am not using high pressure and there are no comfort issues concerning me.

GuyK wrote:Kenji -- I'm in MA, and last year had BCBS of MA. While I was doing my "due dilligence" I found the *PAP policy on the BCBS website. So, after my diagnosis, and prior to get the Rx from my sleep doctor, I had an idea in my head that an APAP would be hard to get (the BCBS policy says "APAP only when CPAP fails" -- but this is BCBS of MA).

I go into the sleep doctor and he tells me he'll be writing an Rx for an APAP. I said, "but what about the BCBS policy?" He said that he'd never heard of that before. He told me he'd write the Rx anyway and then let the DME figure it out. The first I heard from the DME is that the machine is covered. So whatever they managed to do seemed to work.

In general, it seems like it is no skin off the doctor's nose no matter what he or she writes. DMEs, according to others on this site, are the ones to resist, but if the doctor writes APAP, then there shouldn't be an argument.

My vote, if you are keeping track of them, would be to talk it over with your doctor. Explain your reasons for wanting an APAP. After all, in the end, you are the consumer that is paying for this.

Guy

Hi Guy,

I'm in Mass too and have BC/BS as well. My problem seems to be the Praxaire representative at Lahey Clinic who is telling my PCP that APAPs are only used for diagnosis and not for treatment. I know that is bull$#@& but also recognize that APAPs are only an accepted "alternative" treatment to CPAP based on the patient's needs. I also know that Mass BC/BS will pay for the APAP if that is what is prescribed. I think that since I was initially provided with a CPAP and if my prescription is changed so that Praxaire will have to replace my CPAP with an APAP, Praxaire if fighting it because they will end up only being paid for the APAP by BC/BS and will be stuck with a used CPAP.

You must get a copy of your sleep study. If you were, as you say, sleeping on your side for most of the study and the prescription was based on the pressures required to overcome obstructions while side sleeping, you may have very well been under prescribed. Either way, you are a good candidate for an APAP. Can you bring in reports that show your AHI to be reppeatedly over 5 with your old prescription? It is true that you are supposed to have "failed" CPAP before you are elligible for APAP, per BCBS.

Bev

OutaSync wrote:You must get a copy of your sleep study. If you were, as you say, sleeping on your side for most of the study and the prescription was based on the pressures required to overcome obstructions while side sleeping, you may have very well been under prescribed. Either way, you are a good candidate for an APAP. Can you bring in reports that show your AHI to be reppeatedly over 5 with your old prescription? It is true that you are supposed to have "failed" CPAP before you are elligible for APAP, per BCBS.

Bev

Hi again Bev,

I have keep written records for every night I have been using my CPAP recording my numbers daily and I do intend to bring that data with me tomorrow when I see my sleep doctor. I also will again request a copy of my sleep report and ask that we review the report while I am with my sleep doctor. I have recorded for every day since I started using CPAP my pressure setting, the mask I used, my leak rate, my usage in hours, my AI, my HI and my AHI.

OutaSync wrote:Can you bring in reports that show your AHI to be reppeatedly over 5 with your old prescription? It is true that you are supposed to have "failed" CPAP before you are elligible for APAP, per BCBS.

That Bev is one smart cookie! That's exactly what I would do. I would show them ONLY reports from the nights that I had the highest AHI as proof that CPAP was failing to meet my needs. I would also say (if at all true) that I was continuing to have issues with daytime sleepiness and fatigue. If you have observed that your pressure needs differ depending on your sleep position or have observed that your events tend to occur at a particular time during the night, that would also give weight to your argument for the need for a machine that would address those issues. Put that way, giving you an auto is cheaper than another sleep study, after all. Sometimes we have to stack the deck to play our cards right.

At my request that he prescribe an auto, my doc wrote: "patient may use an auto." In my case, that allowed me to argue that he had prescribed it.