Time to upgrade from CPAP to APAP (hopefully)

I am headed to my GP this afternoon to get an Rx to go for a new sleep study. Its been about 5 years since a last had one. More importantly, I think I need a new machine. My trusty REMStar Plus seems to be showing signs that it is wearing out. I've had it for 6+ years. It often makes noises like the motor is straining and I am not sure its still providing adequate flow. Plus, after reading so many positive things about APAP here, I would really like to upgrade.

My question is: did most of you have to insist that your docs write the Rx for APAP or is it becoming the standard? Also, is there anything else I should ask my Dr to include on the Rx (besides a humidifier - that's a MUST)?

I can only speak to my particular case. My doctor wrote a prescription that simply said, "CPAP machine set at 13 cm H2), with heated humidifier and mask." When they faxed the prescription to my DME, he called and asked me to come in so he could show me the machine and I could get fitted for a mask.

I was given the Respironics, Remstar Series M straight CPAP machine. Through trial and error I found a mask that appeared to give a good seal and the humidifier was the one that came for the CPAP machine. I knew nothing about the machines; had never seen one before; and didn't know anyone who was using one. I just took what I was given and wen forward with it.

I have since learned that had my doctor just wrote XPAP or APAP on the prescription, I could have gotten one. I asked my doctor this past fall why he didn't do that and he said he just went by what was on the sleep study report he was given. He had no objections to me having the APAP.

What I have read from more knowledgable folks on this forum is that the DMEs get a flat price from most insurance companies for the XPAP machines. The more standard and cheaper the machine they give you, the greater their profit. The more expensive the machine (APAP, etc.), the less their profit. Therefore, unless they are specifically instructed by Rx to give you a APAP, most will not.

I happen to have a great RT at my DME who is good to work with and very concerned about his clients' health, but he follows the instructions the doctors give him and only questions them when something doesn't appear right.

An in-home sleep study with an APAP in December made me a believer and I just switched to an APAP earlier this month. It's great!

Discuss with your doctor what you want and he believes is medically "OK." When I first got CPAP they just wrote "CPAP with pressure 10." DME decided what machine and mask I got that met those minimum requirements. After 4 years, I wanted to try APAP and after talking to doctor he wrote it specifically for the Series M APAP with A-flex and set the range. That is what I got too. Doctor was very agreeable. Many of them don't use the equipment or have a preference and will accommodate you. Wish I had known this the first time. I can say the switch from the straight CPAP to the Series M Auto with A-flex was a big improvement! It was much more natural breathing and easier to use.

Do some online research of machines before you talk to doctor. Get features you want or think are important - know what to ask about.

Just my experience.

John