What gets prescribed the most? Auto or regular CPAP?

When I called to get results of the study this person called me back and gave me the info over the phone. He's not the contact person for the equipment though. That's another person. This fella, Lee, is very good at trying to verbally solve my issues. I'm sure that's probably his specific job. We contact myinsurance.com and they're going to email us back with info about whether or not they reimburse for out of pocket as well as what my DME limit is.

If the insurance only pays a set rate irregardless of the machine, let's say $400 (out of the air!) then I can see why the sleep center tries to put you into a CPAP, being the least expensive of the xPAP's. They probably save those for people who don't have insurance? So they can charge full price.

I didn't specifically ask if I would need a new sleep study if I went over 3 settings. But I can see that's where they make the lionshare of THEIR money is from the sleep studies. Since insurance effectively doesn't seem to care about patient, and this is the feeling I get because they're willing to pay for unlimited sleep studies rather than just pay for the machine you really need. Anyway, since they don't really seem to care beyond the dollar amount I'm having to do alot more thinking and leg work than I would if they just fitted me with the machine that would work best for me. I know the APAP is no substitute for a sleep study but over time it seems like it would be more accurate than CPAP due to sensing exactly the bare minimum that you need.

Hmmmm Pressures for masks? At 13, my pressure is enough to blow my mouth open right now. Perhaps at a lower setting it would not be. I don't know. I have no risk of every sleeping on my tummy. I NEVER do that. I sleep mostly on my back with a switch to my sides to get more comfortable.

I have not tried tape because I'm allergic to it. Just a little of it on an incision last year caused me to get infected and a bunch of other jazz. Tape would be easy to apply though. The chinstrap isn't. If the full-face mask wouldn't leak like a sive then I would be perfectly fine overall. I could probably deal with my Remstar Plus M Series easier that way.

I'm now down to setting 3 on the C-Flex and still ended up removing it. I'm keeping notes. Time will tell. Thanks for the thoughts and encouragement!

GoofyUT wrote:So listen: There have been NO STUDIES that demonstrate that APAP provides more effective treatment than CPAP does (there are studiues which show that it is AS EFFECTIVE, but not more so). There are NO STUDIES that demonstrate that APAP does a better job of titrating pressure than a PSG does ( there are studies that show that APAP does as good a job as a PSG).And, there are those that believe that APAP is contraindicated for those who have experienced heart failure. May believe that lotsa folks simply do better on CPAP (though its true that APAPs can be run in CPAP mode).

Umm . . ., that's not exactly true. I seem to recall that the exact wording was more along the lines of . . . "APAP therapy was at least as effective as CPAP therapy". That's not exactly a subtle distinction, Chuck. An equivalent wording would be . . . "CPAP therapy may not be as good as APAP therapy". The researchers deliberately underplayed the distinction.

It is an unarguable fact, that by getting an APAP machine, one's chance of therapy success increases. Some of us do much better on APAP than CPAP. Are we in the minority? Maybe. I've also found that I do even better on fixed pressure BiPAP than APAP.

My recommendation to everyone is to start with APAP and work backward into CPAP if you find that CPAP works slightly better for you. If you buy the machine online, your cost difference is maybe $200. If you get the machine from your DME, the cost difference is nothing compared to the aggravation and expense of changing machines later. Even DME's should be able to figure this out, yet they apparently haven't.

Regards,
Bill

Rastaman,

I know what you mean about insurance companies not caring. The thing with my insurance is if I needed a sleep study regularly due to losing weight then I'd be paying a lot as I have a deductable of 250 and then they pay a percentage AND then I have to pay the whole sleep specialist fee for reading the study, which comes to 350 alone. In other words, it would cost me 650 per sleep study. What I'm planning on doing is using my APAP with software while losing the weight. When I get to the point I want to be then I'll go and get another "official" sleep study OR if I get to the point where my pressure is extremely low. I was originally diagnosed at 14 and then upped to 16. Right now my APAP is set at 13 - 17, so I have a ways to go before thinking about getting retested. Everyone is, of course, different.

Too bad you're allergic to tape. All kinds?? If that's the case, you may want to ask in a new thread about specially molded mouth pieces. I believe I read a thread on another forum where Rested Gal is now using a mouth piece instead of taping. She may be able to give you some ideas.

As for removing your mask while sleeping, most of us have done it. I've done it less than a dozen times in 8 months. Some times I'm dreaming and it comes off, while other times I have no idea. Just be sure to put the mask back on when you find it off. I found that helped me and I now haven't taken my mask off in a couple of months...knock on wood.

Update:

My wife called my insurance company and determined that I have no limit on DME equipment. And they accept out of network billing. Now, I'm not exactly sure how this works but if this is true, and it's not a "reimbursement" for out of pocket expenses, then I want to possibly go another route. I'm going to give my DME the option of upgrading me to the Remstar Plus Auto with Cflex. If they will do that, then I will get it through them. If not, then I won't. It's just that simple.

Here's how I feel: CPAP's are fine if you only have this problem short term. If you're going to have it 5 years or longer, then it's not going to account for weight changes. I don't want to have to do another sleep study everytime I lose 30 lbs. It's cheaper for the insurance company to give me the "deluxe" option and let me and the software do the work.

Sure, I'll need a script for an APAP possible IF I go to another vendor. But this is MY life we're talking about and while I'm grateful for the sleep study, through all my research I've determined that an APAP would be better. Why use 13 as a catch-all, when 6 to 11 might do just fine in a few weeks. I'm looking for the minimum pressure for MAXIMUM comfort. At these prices we're not talking about Porsches and Lamborgini's. We're talking about a Honda Civic or a Honda Accord here. That's how I feel. Sure a Civic will work but a Accord will work better. And sure, I could be wrong in my assessment but I'm also assuming some of you (maybe just one but maybe more) actually work for these type of companies and when you STEER us away from APAP for no real apparent reason, it makes me wonder about you

I could buy an automatic vehicle or I can buy a stick shift. Stick shifts give better gas mileage and are overall better cars. Automatic works fine for some people. And that's great. I just don't want to sell myself short when an APAP does both CPAP and APAP and logs everything for me.

What do you think?

Anonymous wrote:

GoofyUT wrote:There have been NO STUDIES that demonstrate that APAP provides more effective treatment than CPAP does (there are studiues which show that it is AS EFFECTIVE, but not more so). There are NO STUDIES that demonstrate that APAP does a better job of titrating pressure than a PSG does ( there are studies that show that APAP does as good a job as a PSG).And, there are those that believe that APAP is contraindicated for those who have experienced heart failure. May believe that lotsa folks simply do better on CPAP (though its true that APAPs can be run in CPAP mode).

Doesn't an APAP give you a lower AHI than a CPAP because it can change throughout the night as your pressure needs change?


Not necessarily. Might give you a higher AHI. Depends on each and every individual case.

Chuck

Rastaman,

You are pretty much were I am in philosophy. I too am at the heavy end of where I want to be weight wise. I also don't enjoy doing sleep studies. My in network deductable is $618 then I pay 20% so a sleep study costs me a lot of money. In addition, I sleep in a number of positions and my study showed very different pressure requirements for each. I also have sensitive ears. The more pressure I have going, the more my hearing diminishes as I swallow. I am finding that my ears are still a bit stuffy during the daytime, I can handle that for the benefit of good sleep, but want as little hearing impact as possible. I have to believe that less pressure, if the max isn't necessary (due to time of night, stage of sleep, sleep position and eventually weight loss) will be easier on my ears.

It is great that you have out of networkcoverage. Be careful to understand the limits of that though. My deductable for out of network is significantly ($1500 or so) higher than in network (local DME) and the percentage co pay jumps to something like 35% or 40%. So, at that point they would cover none of the machine (due to hight out of plan deductable).

If you buy at cpap.com your script for cpap is sufficient for APAP (don't need a new one). I assume that you asked for you scirpt from the doctor even if you don't plan to use it? Good to have, then if you ever do need to buy something you have it.

I use the swift most of the time but have an ultra mirage FF mask that I like and used for my sleep study. Others may have opinions on what they like best. Fit is important. While you are still working with the DME ask for a sizing. They have these little cups that they try on you that are the footprint of the mask so they can tell without an actual mask what size you need. Takes 30 seconds if you are there anyway.

Somehow that didn't sign me in and the above message is from me.

Rastaman,

I'd just like to chime in that the sleep lab's assumption that as you loose weight you will *poof* like magic need less pressure is one I'd be careful of. One of the best reasons to get a data-capable machine is to fend off assumptions. I'm a newbie... a full-fledged newbie. But it really gets my goat that people automatically assume that the weight loss will make this disappear. I've talked to more skinny people with OSA (including my mom) than I can count.

Use the DATA to help you determine when and if you need to change your pressure. Data... data.. data.

(getting off my soapbox)

birdiebaby,

It's actually not so much an assumption on the part of the sleep disorder center, as it is on the part of myself and other posters here. While it's true that thin people have OSA as well, we all have it to different degrees and just changing positions seems to need different pressures. Not just one overall pressure. My machine has no data. No one showed me the sleep study. On my last doctor's visit he asked if I had completed the study yet and I gave him an update. On my next visit (which is usually every 3 months or so) I plan on getting that info from him.

I got a "brief" description of my OSA as severe and was told the number of occurences that I had per hour and my oxygen saturization level during the study. But as far as breaking it down and showing me why one type of unit might work better than another, that didn't occur. No one opened a booklet and asked me which of these 2 or 3 units do you want to pick. NOPE. On my first visit back to the sleep disorder center, it was to "pick-up" my Remstar Plus M Series CPAP. It's a good machine. But it doesn't have any data recording capability. Notta.

Even though I'm a mouth breather the full-face mask made me feel a bit clausterphobic (not very much but a little) and the lab tech opted for the nasal pillows instead. If there is a FF mask that seals relatively well and one where I might breath a little easier, then that's the mask for me. I've never breathed through my nose so much in my life! I've never done it before. And now I am. I have to remember to take two different kinds of allergy meds per day though. One in pill form and one in spray form.

I wouldn't use anything other than an auto. My pressure usually settles in at 7 but there are some nights, I need 11. It seems to depend on my allergies and nasal congestion.

IMO, sleep studies for OSA aren't necessary. A simple home study is fine for diagnosing OSA and then an auto should be RXd and the data analyzed by an MD after a couple weeks of use. If the data from the CPAP shows non-responisve apneas, then a sleep study should be RXd.

My brother was recently diagnosed with OSA. Kaiser Permanente used a simple home study to diagnose him and they are using an auto machine to titrate him. I think they should just give him an APAP permanently since they save all that money by not doing a full blown sleep study but that's insurance companies for you.

Well, I'm making a list of observations for the DME. They didn't ask me which machine I wanted or which mask I wanted. No fitting was done. No real decisions were made. It's like HERE! Take this! You'll feel better. I do. They're right. But what about when I have a few brewski's like on a night like last night? What about when I sleep on my side? And my other side?

Each of my posts, in different threads, contain the "ongoing saga" info. Last night I forgot how to unhook from the machine. That'll teach me to drink! LOL! But I only had a few Amstel Lights. And I felt fine when I got home and even then I got something to eat and then went to bed awhile later. But apparently, I took the mask off AGAIN for the 2nd night in a row. And then I woke my wife up trying to get it off and she couldn't figure out what I wanted to do. I got it together quickly and went back to sleep.

I notice even with daily dish soap washing that my (small) pillow is starting to discolor slighly on part that touches my nose. I assume this is normal. When I first got the unit, to overcome my claustophobia, I had to identify how to 'unhook' the mask from the machine so I can get up in the middle of the night. Fun fun fun. Good times.

But as DME Guy says, your needs change throughout the night. SOME people are 95% what they were presribed at so APAP doesn't really seem necessary for them.

Anyway, the wife and I are getting our ducks in a row and compiling all information related to why I'd like to try the Remstar Pro Auto w/C-flex. It's not much more and it'll deliver exactly what I need. Not too much. Not too little. Just right. That sounds best for me.

Just a quick question. Not that you are wrong at all. But I haven't seen too many posters that use a small swift pillow. Are you doing ok and have no problems with leaks? Maybe you are a guy with very small nares, but consider whether or not you have the right size (all three came with your pack).

Good question. I do have small nares. I didn't know that word until recently. LOL! I started with medium. My nose smarted supreme! So, I switched to small. I don't think I'm leaking. One of my main problems as a mouth breather is that my nasal canal on one side is quite small. Add to that allergies here in Austin, TX (one of the allergy capitals of the world) and I can breath through my nose alot of the time.

Lately, I've been waking up in the middle of the night with the mask off though. It's light. It's snug. It's got a good seal. I really do like it. In the long run, even though I'll probably get a FF Mask I'll probably get one of these again. But I'm going to try a FF Mask next to see how that differs.

On the bright side, I didn't have any air escaping from my mouth last night. But it was happening a couple of nights earlier in the week. At this point I'm thinking about the Resmed Ultra Mirage or the Mirage Activa.