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Hose_Head wrote: Possible reasons NOT to insist on apap?

- some on this board prefer treatment with cpap, claiming it's more comfortable and/or that they have better results (it seems to be an individual preference)

I'd be very interested to learn more about this, since my local doctor refuses Autopap 'because of all the contraindications' (to his bank account, maybe ).

Does your doctor understand that all APAP's can run on CPAP mode, using the APAP mode for occasional re-checking?
(in case of weight loss or weight gain, for instance)
The efficacy data is the most important feature, however; for without leak and event reporting,
you are as bad off as a diabetic on insulin without a glucometer.

Roger2 wrote: ". . . My doctors always make those kinds of recommendations for all of my COPD and CPAP needs. I would personally never accept my DME’s (Apria) recommendation for anything without getting a some feedback from my physician. If you’re having apprehensions about this I would insist that the physician who wrote the script intervene for what he/she considers appropriate. Just a thought. . . ."

--And a very good thought, Roger. That's exactly the right way to handle it imo.

archangle wrote:One reason the medical mafia dislikes Auto CPAP is that they make a LOT of money off of in-lab titrations to set the pressure vs. letting an Auto machine do it.

My orginal sleep doc refused a APAP Rx and said all his patients do better with CPAP. He also had an interest in the in house DME.

He told me there are two groups of people who like APAP, big government and the socialized health care crowd.

A bit harsh i thought

~UB

Not going to this guy any more?
I suspect the main reason why PAP data doesn't get accepted like glucometer data, is that no one is getting 80 cents a day for it.
Big Pharma probably had a say in glucose testing availability.

Cost of the S9 Elite is $1,200 + tax. The cost of the S9 Auto is $1,500 + tax. Both have the same insurance code and are reimbursed at the same rate of $940 (at least under my plan).

Is that with or without the humidifier and hose?
With, it's not so bad; without: .

chunkyfrog wrote:Is that with or without the humidifier and hose?
With, it's not so bad; without: .

______________________________________________________________-

$1,200 (Elite) & $1,500 (Auto) is just for the CPAP machine. The humidifier is $325 + tax. Same insurance code for the humidifier on both machines. The reimbursable amount is $283.14 (under my plan). Do you want fries and a coke with that? Add another $200.

It kind of annoys me that so many people on this forum insist that their sleep docs all have vested interests. My sleep doctor - who i rate very highly - is not against apap in general but more against the data that the machines produce. He is of the assumption that the only true titration results can come from a proper study in a sleep lab. He basically told me that all xpap machines are pretty dumb and their results shouldn't really be trusted - all marketing hype. Now, let me just say that my sleep doc gave me a long list of sleep labs for my sleep study as well as a long list of places to either hire or buy my machine - certainly no vested interests in any one lab or company. Who am i going to trust? A sleep doctor who has had years of medical training or a xpap manufacturer (such as ResMed) who refuse to let their machines be sold at a reasonable price outside of the USA and then actively threaten other companies who try to sell their machines internationally at reduced prices? Who's the one being greedy here? I'm sorry, but who has the vested interest in trying to make you believe that particular xpap machines can replace a proper titration study in a sleep lab?

I've also just changed from hiring the F&P Icon auto to the S9 auto to decide which machine is better before i finally purchase. If xpap machines were so accurate in reporting data, why then am i getting such different results from either machine when the pressure ranges are identical? Think i'll leave hte more accurate reporting to a proper titration study thanks. And yes, i do prefer the s9 but will be buying it from the US where it's half the price than here in Australia where the machine is manufactured. Go figure!

Sorry for the rant

My sleep medicine practice group is very clear about the fact they don't have a financial interest in the DME provider located next to their office. They freely provide all of their patients with a long list of DME providers. I know that I'm not going to lose any sleep over who has a financial interest in what. I think a person needs to always follow the "buyer beware" approach and ask good questions about the equipment and why a certain machine may or may not be recommended. -Chuck-

lullaby wrote:It kind of annoys me that so many people on this forum insist that their sleep docs all have vested interests. My sleep doctor - who i rate very highly - is not against apap in general but more against the data that the machines produce. He is of the assumption that the only true titration results can come from a proper study in a sleep lab. He basically told me that all xpap machines are pretty dumb and their results shouldn't really be trusted - all marketing hype. Now, let me just say that my sleep doc gave me a long list of sleep labs for my sleep study as well as a long list of places to either hire or buy my machine - certainly no vested interests in any one lab or company. Who am i going to trust? A sleep doctor who has had years of medical training or a xpap manufacturer (such as ResMed) who refuse to let their machines be sold at a reasonable price outside of the USA and then actively threaten other companies who try to sell their machines internationally at reduced prices? Who's the one being greedy here? I'm sorry, but who has the vested interest in trying to make you believe that particular xpap machines can replace a proper titration study in a sleep lab?

I've also just changed from hiring the F&P Icon auto to the S9 auto to decide which machine is better before i finally purchase. If xpap machines were so accurate in reporting data, why then am i getting such different results from either machine when the pressure ranges are identical? Think i'll leave hte more accurate reporting to a proper titration study thanks. And yes, i do prefer the s9 but will be buying it from the US where it's half the price than here in Australia where the machine is manufactured. Go figure!

Sorry for the rant

Selling a machine with the right algorithm for data and doing that at a high price isn't mutually exclusive / conflicting, argument wise

This is not to say that your doc isn't any good, he may very well be. But it seems he is a rare species

My first sleep study specified 9cm H2O, so my general practitioner prescribed a regular CPAP. Then I read about Auto CPAP here. The DME said I needed an Auto prescription so I requested that from my general practitioner. She sent a prescription for an Auto CPAP. The DME said a range needed to be specified so they did not accept the prescription. This was outside my general practioner's expertise and comfort so she said that she would prescribe another overnight titration study if I wanted.

Instead, I set up an appointment with a sleep specialist. After consideration, she decided to give me an Auto CPAP prescription of 6 to 10cm H2O. My AHI on my back (supine) is over 60. My overall AHI is 24. The 9cm H2O was set for my back. Logically thinking, a lower pressure would be needed for my side. I was not sleeping well. She figured if I was at a lower pressure, I would sleep better. She wanted to help me out because she could tell that I was taking the apnea situation seriously.

Basically, get an Auto prescription to assure you will get an Auto CPAP.

BTW, my DME charges Blue Cross Blue Shield $285 per month (250 for the CPAP and 35 for the humidifier) for 12 months. They are charging $3,420 for something they paid less than $1,000 for. I do not feel bad at all if the DME makes $100 less for an Auto CPAP.

Ed M.

Sorry for this belated post in reply to your question, Papit. I just earned an AutoSet Rx from the pulmonologist after a 7 week trial with a loaner S9 AutoSet. (I'm still in the rent-to-own period for my Elite that has been sitting on the shelf).
What I get from my doc is that his primary concern with initially writing for an AutoSet is the risk of having it supply pressures that pose a risk for Central apneas. It is my understanding that Centrals are serious in that they have the potential of causing death in extreme cases. He also feels that the machines are limited in their ability to accurately measure Central events. They use a somewhat indirect method of estimating Centrals and thus the phrase clear airways rather than central. Hope this helps a bit.

chunkyfrog wrote:Does your doctor understand that all APAP's can run on CPAP mode, using the APAP mode for occasional re-checking?
(in case of weight loss or weight gain, for instance)
The efficacy data is the most important feature, however; for without leak and event reporting,
you are as bad off as a diabetic on insulin without a glucometer.

I think he might have read it in the sales brochure

I have to get into a fight with the insurance company & the doctor one side, and tiny little me on the other side, because the gave me this S9 Elite to try for 1 week, and now I have to get back to them to tell them I still want an APAP/Autoset (which they refuse because it is way more expensive over here).

As it is short day I am afraid I don't have the time to do a thorough reading of tens or hundreds of pages, and I am sure there are many people here so experienced and knowledgeable that they have all the relevant information in their head and can 'spit' it out immediately. Of course, I would be more than willing to return the favor

Thank you in advance for your replies,

Bye,

Papit, off the subject, I know, but it's killing me.
I have to ask.
What is that paperclip looking thing sticking out of your Swift FX?