What Ontario needs to know about APAP, in detail & Verbatim

If you want to be covered by the ADP program in Ontario, here is what you have to do specifically:

(Note I got a prescription for APAP but STILL could NOT get the machine from the Vital Aire outlet due to below)

--------------------------------------------------------------------------------------------------------------------------------

1. Must have a diagnosis of OSAS (duh)

2. Must have received a Level 1 Polysomnogram in an ADP-Registered Sleep Lab

3. Medical Eligibility Criteria:

- Min pressure change of 4 cm H2O
- Prescribed fixed CPAP level of 10 cm H2O or more
- Change must occur in REM vs. NREM sleep OR
- Supine vs. sleeping on their side

4. Special ADP authorization is required

- Letter addressed to ADP documenting the above medical criteria
- Hand ADP letter to client along with prescription for APAP

-----------------------------------------------------------------------------------------------------------------

Min pressure change of 4 cm H2O => This was the only tricky one for me, number 4 was the one my dumb Sleep Doctor didn't like, she didn't want to have to do up the letter and "be responsible".

So first she sends me home with a pressure that was guessed at (There was no titiration in my initial study, just an observation study with all wires hooked up to see if I had OSAS). So she guessed at 7-8. Get home with rental machine, first night snoring with mask on. Lovely. THANK GOODNESS they at least gave me an APAP machine (set in CPAP though). Of course they dont show you how to use it AT ALL. There is where the internet came in. I figured out how to change the setting to APAP and SELF TITRATED myself (with some guidance from here, thanks all) and starting sleeping better, which is what I should have done from night one!!! What a stupid system in Canada, sure glad I didn't wait to do this, my pressure turns out to be TWELVE (with an APAP range of 10 - 13 working best), a far cry from 7-8.

I can't imagine how many stories like this there are, only many of the people go home with the wrong pressure and stay with it for weeks until they go back in to the outlet where they bought/rented the machine to have them analyse the data. You should have seen the Technicians face when I did finally go back, looked at me like I had 3 heads when I told her I had been adjusting my own pressure.

In the end, I would of had to keep waiting and waiting to get in the Hospital for a proper Titration only to find out what I probably knew already from my own Titrations at home, my pressure usually varies maybe 3 cm H2O from 10 to 13 or so and not USUALLY more (again giving people wrong diagnosis based on one night of sleep in a strange Hospital bed etc, etc, what happens if you sleep differently that night than normal...). So likely I would not have qualified based on that ridiculous criteria after waiting to find out.

Oh another silly note about this, if you don't qualify for APAP or haven't tried and do qualify for CPAP, they will cover you $780 of the CPAP machine. If you want them to just apply the $780 to the APAP and you pay the difference, they won't do it. Nice. Nothing extra out of their pocket, but nope, they won't do it. Typical Government logic here and totally ignoring the other benfits to having an APAP machine.

See here for some of the differences APAP vs CPAP

viewtopic.php?f=1&t=58735&start=15

Good luck to all you fellow Canucks out there.

Some people find straight Cpap is more effective for them, and many MD's believe it is better. It's what works for you that counts.

And as far as ADP goes - there is only so much money to go around, so they have to have some criteria.

Just a correction - the Assistive Devices Program is NOT Canada wide, nor is anything else in healthcare in Canada, since each Province makes its' own health care rules, etc.

The Assistive Devices Program is in Ontario and there MAY be something similar in other Provinces. I am not aware of it but Canadians from other Provinces can let us know.

I know that some Provinces give no financial help for cpap machines at all.

I am editing to add another point - In Ontario is it very usual to have the PSG (study without the mask and machine) for intital diagnosis of sleep apnea. A second separate night is usual to use a mask and machine to set the pressure (to titrate). If a person exhibits very bad sleep apnea during the PSG they may have what is called a "split night study". In this case, the tech will come in, wake the person and put a mask on them- attach the machine of course, and titrate all in that first study.

Why do people from Ontario think that they are all of Canada?? As has been posted above each province has different rules re CPAP. In Manitoba they use only one DME. Only one machine is available. Currently it is a F&P 234 with heated humidifier. Period . I think someone else posted that in Alberta there is no coverage for the machine. I would gladly accept the $780 dollars that Ontario is offering. If you look on Craig's list for TO there are some DME's advertising APAP's and somehow the $780 is applied.

Bob

The answer for Alberta is NO, THEY DO NOT PAY ONE RED CENT!!!!

N

What is lacking in Canada and maybe even in the USA is a group that speaks for CPAP users. Not necessarily for fund raising like say the Heart And Stroke Foundation but rather to publicize the disease and the devastating effects on those who do not get diagnosed. I wonder how many Health Ministers in Canada even know about Sleep Apnea? If such a group exists they sure must keep a low profile.

Bob

I don't want to re-start an old, unproductive debate, but...

What happened to the "wonderful" Canadian socialist medicine system that provides equal access for all?

LinkC - It is a very unproductive debate and really has no place on this forum, in my opinion.

What you think or don't think about our health care system is irrelevant.

You said you don't want to start that old unproductive debate again and yet you did!

What debate? I'm just asking about the differing thoughts expressed then and now.

Nothing in my post expressed MY opinion at all. That's irrelevant!

Hawthorne wrote: and yet you did!

That's your irrelevant, unsolicited and inaccurate opinion...

Unless you can answer the question, feel free to not respond.

Oh I think your opinion was very clear when you posted.

Somehow I knew you would respond this way.

Don't worry. I have nothing more to say about our health care system except to respond to questions and comments Canadians make in this thread, if I know the answer or can clarify in some way.

Julie wrote:
And as far as ADP goes - there is only so much money to go around, so they have to have some criteria.

"The problem with socialism is that eventually you run out of other people's money." - Margaret Thatcher

Julie, Glad to see that you are gradually starting to see the light.

Thanks for this thread JayJ. It is timely.

My husband has been diagnosed with OSA with AHI of 50.1 and oxygen desaturation of 82%, and the starting trial Rx is 7-8. He was given a firm NO! when I asked the doctor about an Auto Rx. This whole process took 4 weeks. (From sleep study to seeing the sleep doc.) The same DME gave me an Auto locked on straight CPAP, and we got ripped off paying $300 for nasal pillows.

He started therapy Dec 30, and couldn't get enough air at this pressure when on his sides, so was forced to sleep on his back for 3 nights, and didn't get much restful sleep, and because of the holidays/new year, the office was closed, so I couldn't speak to anyone.

Considering my DH also has a history of heart arrhythmia, and how significant sleep apnea is to putting more pressure on the heart, this meant that I/He should take charge of HIS therapy without delay. I found the software and checked his AHI for those three nights, and put an order in for a oxygen-pulse oximeter.

AHI was greater than 14 each night, and I saw a few central apneas and some periodic breathing which was never mentioned. I changed the Auto to 7-10. He fell asleep on his side for the first time with that setting. The next morning AHI was 8.8 cm h2o, and 90% was at 10 cm h20. The following night, I changed the auto to 8-12, and 90% was at 11 cm h2o, and AHI was 3.3, a far cry from the 14. According to the data, he IS getting therapy at 4 different pressures, and his average is 9.6 cm H20.

Will run it like that for the next week and see what happens.

Oh, I called the doctors office yesterday. He will not talk to a patient or their spouse until after the titration study. No changes in pressure are allowed until the titration study. Or so the secretary said. She offered to bump up the study date though. I think it's better that hubby gets used to the nasal pillows and machine. He mentioned to me that the PR1 sends a puff to him that wakes him up from time to time. Will also be looking at an S9 Auto. After all, OHIP only pays for 1 titration study, so make it a good one!

One thing I will mention to anyone in Ontario: Get your family/primary care doctor onboard in this therapy, and ask them if they will write you a prescription for cpap, humidifier and mask after you have your first study/finding done. This way, you can use that prescription and keep your options open to buy from the US, and not be forced into a sale here. His Doc also recommended a Respiratory Therapist who also is setup as a DME and will work with you and your sleep Doc. We will see how this process goes in our case.

I'm not sure if it's the extra paperwork/red tape that turns these Doctors off the 'Auto' ADP-Process, or,if it really is in the best interest of the patient.

Taff wrote:Thanks for this thread JayJ. It is timely.

My husband has been diagnosed with OSA with AHI of 50.1 and oxygen desaturation of 82%, and the starting trial Rx is 7-8. He was given a firm NO! when I asked the doctor about an Auto Rx. This whole process took 4 weeks. (From sleep study to seeing the sleep doc.) The same DME gave me an Auto locked on straight CPAP, and we got ripped off paying $300 for nasal pillows.

He started therapy Dec 30, and couldn't get enough air at this pressure when on his sides, so was forced to sleep on his back for 3 nights, and didn't get much restful sleep, and because of the holidays/new year, the office was closed, so I couldn't speak to anyone.

Considering my DH also has a history of heart arrhythmia, and how significant sleep apnea is to putting more pressure on the heart, this meant that I/He should take charge of HIS therapy without delay. I found the software and checked his AHI for those three nights, and put an order in for a oxygen-pulse oximeter.

AHI was greater than 14 each night, and I saw a few central apneas and some periodic breathing which was never mentioned. I changed the Auto to 7-10. He fell asleep on his side for the first time with that setting. The next morning AHI was 8.8 cm h2o, and 90% was at 10 cm h20. The following night, I changed the auto to 8-12, and 90% was at 11 cm h2o, and AHI was 3.3, a far cry from the 14. According to the data, he IS getting therapy at 4 different pressures, and his average is 9.6 cm H20.

Will run it like that for the next week and see what happens.

Oh, I called the doctors office yesterday. He will not talk to a patient or their spouse until after the titration study. Or so the secretary said. She offered to bump up the study date though. I think it's better that hubby gets used to the nasal pillows and machine. He mentioned to me that the PR1 sends a puff to him that wakes him up from time to time. Will be looking also looking at an S9 Auto. After all, OHIP only pays for 1 titration study, so make it a good one!

One thing I will mention to anyone in Ontario: Get your family/primary care doctor onboard in this therapy, and ask them if they will write you a prescription for cpap, humidifier and mask after you have your first study/finding done. This way, you can use that prescription and keep your options open to buy from the US, and not be forced into a sale here. His Doc also recommended a Respiratory Therapist who also is setup as a DME and will work with you and your sleep Doc. We will see how this process goes in our case.

I'm not sure if it's the extra paperwork/red tape that turns these Doctors off the 'Auto' ADP-Process, or,if it really is in the best interest of the patient.

You are top notch! I would take you anytime on my team!

I edited the title, sorry I forget that Healthcare rules are NOT Nationwide and rather Province wide.

Julie wrote:Some people find straight Cpap is more effective for them, and many MD's believe it is better. It's what works for you that counts.

And as far as ADP goes - there is only so much money to go around, so they have to have some criteria.

I really wonder how anyone can get better therapy on a "dumb machine" versus one that actually compensates for how you are breathing, it is possible I suppose but I think it is more possible that that is just an old way of thinking.

As for the money, if the Government had any sense at all, they would cover the same amount for APAP that they would for CPAP IF you are willing to pay the difference. If costs them nothing more and patients get a better machine and often the one they REALLY need (as in my case and thousands of others I'm sure)

Hawthorne wrote: I am editing to add another point - In Ontario is it very usual to have the PSG (study without the mask and machine) for intital diagnosis of sleep apnea. A second separate night is usual to use a mask and machine to set the pressure (to titrate). If a person exhibits very bad sleep apnea during the PSG they may have what is called a "split night study". In this case, the tech will come in, wake the person and put a mask on them- attach the machine of course, and titrate all in that first study.

Yes I can confirm this as well. I had a friend who just recently had this happen, they thought he was severe, and put the mask on in the initial study. They also rushed him into buying a CPAP machine the next day. I really don't think very many people are going to vary more than 4cm H2O during the night which is why you see almost all Canadians with CPAP.

It also confirms that yes most of the people have to wait MONTHS for their second study which is the titration which is obviously not optimal and autimatically rules them out of having the APAP machine. The whole system needs serious help.

Taff wrote:Thanks for this thread JayJ. It is timely.

My husband has been diagnosed with OSA with AHI of 50.1 and oxygen desaturation of 82%, and the starting trial Rx is 7-8. He was given a firm NO! when I asked the doctor about an Auto Rx. This whole process took 4 weeks. (From sleep study to seeing the sleep doc.) The same DME gave me an Auto locked on straight CPAP, and we got ripped off paying $300 for nasal pillows.

He started therapy Dec 30, and couldn't get enough air at this pressure when on his sides, so was forced to sleep on his back for 3 nights, and didn't get much restful sleep, and because of the holidays/new year, the office was closed, so I couldn't speak to anyone.

Considering my DH also has a history of heart arrhythmia, and how significant sleep apnea is to putting more pressure on the heart, this meant that I/He should take charge of HIS therapy without delay. I found the software and checked his AHI for those three nights, and put an order in for a oxygen-pulse oximeter.

AHI was greater than 14 each night, and I saw a few central apneas and some periodic breathing which was never mentioned. I changed the Auto to 7-10. He fell asleep on his side for the first time with that setting. The next morning AHI was 8.8 cm h2o, and 90% was at 10 cm h20. The following night, I changed the auto to 8-12, and 90% was at 11 cm h2o, and AHI was 3.3, a far cry from the 14. According to the data, he IS getting therapy at 4 different pressures, and his average is 9.6 cm H20.

Will run it like that for the next week and see what happens.

Oh, I called the doctors office yesterday. He will not talk to a patient or their spouse until after the titration study. No changes in pressure are allowed until the titration study. Or so the secretary said. She offered to bump up the study date though. I think it's better that hubby gets used to the nasal pillows and machine. He mentioned to me that the PR1 sends a puff to him that wakes him up from time to time. Will also be looking at an S9 Auto. After all, OHIP only pays for 1 titration study, so make it a good one!

One thing I will mention to anyone in Ontario: Get your family/primary care doctor onboard in this therapy, and ask them if they will write you a prescription for cpap, humidifier and mask after you have your first study/finding done. This way, you can use that prescription and keep your options open to buy from the US, and not be forced into a sale here. His Doc also recommended a Respiratory Therapist who also is setup as a DME and will work with you and your sleep Doc. We will see how this process goes in our case.

I'm not sure if it's the extra paperwork/red tape that turns these Doctors off the 'Auto' ADP-Process, or,if it really is in the best interest of the patient.

Good work! Thanks goodness for the internet or we would really be lost with the way they have things setup.