Top 10 Reasons Why Sleep Centers Allow APAP's vs CPAP's

Okay, I'm just curious (shamelessly ofcourse) what the top 10 reasons that DME's, doctors, insurance companies, etc. allow you to get an APAP vs CPAP?

I'm thinking about upgrading my CPAP to an APAP. I have my reasons. I have good reasons (I think) why I NEED to APAP vs. the CPAP. There's nothing wrong with CPAP. But I'm interested in something that keeps track of my needs in all different sleeping positions. I don't like the idea of "too much" to fix all. I like the idea of "just right". I use a setting of 13 but do I really need a 13 ALL NIGHT? I doubt it.

I know for one that apneas are worse on your back. I'm on my back about half the night. The other part I'm on either side. Probably more often my left side. I don't want any DME second guessing my decisions. If she accepts them and accomidates me, then fine. No problemo. If she wants to say "Oh no, you don't need that." then I want to hear logically why and not a "Yes" man's answer either. I can tell the difference because one involves actually looking at my sleep study results.

And even then it was just one night where I wasn't at MY house and I had stuff all hooked up to me. How normal of a night of sleep could I possibly get? I probably never turned over on my side the whole night so they think 13 is "just right".

What are the legitimate reasons that a person would REQUIRE or atleast give an APAP a try for?

Okay, let me throw my best reason out there for fun.

Before CPAP I NEVER woke up during the night except to go to the bathroom. I feel asleep like a log. Now, with CPAP I wake up a few times during the night all freaked out. I go to sleep ok at FULL BLAST (13). But I wake up and feel like the pressure is too strong. The DME said that within a month I wouldn't even be able to tell I had it on.

My guess is there is some fluctuation when I turn on my sides from my back. During the sleep study I slept on my back the whole time because I really couldn't turn over on my side with all the stuff on. Or so I thought. And it seemed to be true.

Now, I might get a APAP and later realize I was completely wrong but I doubt it. If the DME is correct I shouldn't notice the pressure during the night. I should just wake up in the morning as per usual. But that's not happening. And the mask itself is the smallest they make. I can't imagine it being any more comfortable.

your best bet is just to wait til the end of the month for the M series autopap to come out and purchase your M series autopap outright from cpap.com.

You can then use your same humidifier with it and use the autopap to fine tune the pressure on the cpap. If you don't have a copy of your prescription, then get it from your doctor. By law, your entitled to the original or a copy of it (not just faxing it to your DME). You'll need it to buy your own machine, you can use the cpap script to buy the autopap from cpap.com.

It is an uphill battle to getting your DME to switch you to an autopap and then get insurance to pay for it.

If pressure is a problem with your current setup, set it up with wider range if your pressure is 13cm, then set it to like 6cm low, 13cm high and set the ramp timer longer to 45-minutes. If your not asleep, hit the ramp button again. Use a Cflex setting of 2.

If you had the autopap, you would set it to the same pressure range (6cm low, 13cm high). But the machine would always try and settle back to the low pressure setting.

Rastaman wrote: Now, I might get a APAP and later realize I was completely wrong but I doubt it.

If that's happens to be the case, the just set your APAP to CPAP mode & you're no worse off than you were.

I have very slight apnea (actually, more hypopneas). The sleep Dr started me out at a pressure of 4 then raised it to 6. I had some problems with the Dr (he had the "I'm the DR. Why do you question me?" kind of attitude) so I decided to get an APAP instead of the CPAP that I had and see if I couldn't work it out for myself. I got the prescription for an APAP from my Internist (the sleep Dr also didn't like APAPs) & I had to pay an additional $100 out of pocket to get it, but I've never been sorry. Set that puppy up in Auto with a pressure range of 6 to 13. Found out I average 10.8 most of the time.

Since that APAP & the CPAP have the same insurance code & I had a script for the APAP, I just worked it out with the DME to switch. Was not a problem

Lyn

Rastaman wrote:...My guess is there is some fluctuation when I turn on my sides from my back. During the sleep study I slept on my back the whole time because I really couldn't turn over on my side with all the stuff on.

You have touched on the TOP reason on MY list to own an APAP:

PRESSURE REQUIREMENTS VARY WIDELY FROM NIGHT TO NIGHT, AND EVEN FROM HOUR-TO-HOUR FOR A GIVEN INDIVIDUAL ON A GIVEN NIGHT.

OK, sorry for yelling. But it's a message that is difficult to convey. The working assumption is that "for all but a few minor exceptions, the pressure requirements are steady as Gibraltar and do not vary, hour by hour, night by night, UNTIL PROVEN OTHERWISE". And there is usually no effort by sleep labs to prove it otherwise. The number of labs that routinely follow up a sleep study titration by sending the patient home with an APAP to measure or estimate the VARIABILITY of a patient's pressure requirements are, according to my count, very very close to ZERO. I would be happy to learn of a sleep lab that, as a standard of practice, followed up their titration data with a multi-night auto-ranging titration study to learn what the actual pressure requirements are and how they vary, what is the range, what is a more carefully determined estimate of the all-important 90% titration pressure, and having done all that asking "What is the most appropriate equipment for this particular individual?"

In my opinion, there should be a minimum 7-day recording of pressures to get a statistically meaningful measure of a patient's pressure requirements and an estimate of the individual's VARIABILITY. Does that ever happen? YES! It usually happens when people buy their own APAP equipment and know how to use the data and get meaningful and reliable information that profoundly affects their therapy and compliance and outcome and level of comfort and overall satisfaction. Why seven days? Because we sleep on weekends too, and sometimes we party hearty, and there are a lot of things that can affect our "pressure requirements" and the VARIABILITY.

The standard of practice remains 1) get a sleep study that includes a titration over a period of a few hours, 2) provide the patient with a straight CPAP set to the titrated value, 3) wonder why the therapy isn't working, 4) encourage the patient to keep trying if for a few months while "your body adapts", 5) randomly adjust the pressure up or down and see how badly the patient complains, 6) wonder why the attrition rate is horrendous (estimated >50%), 7) accept full payment no matter what the outcome.

Unfortunately the system is structured to favor mediocrity, and not optimal patient care. The physician gets paid for hearing your complaint and making a referral. If the therapy isn't working for you, he will see you again and make another referral. The sleep lab honestly does a really good job of studying you for one night, I have no doubt about that. To send you home with an APAP or other monitoring device for an extended period of days would require an additional investment, and nobody is doing that, and doctors aren't ordering it. If it's so terribly bad, you might need another sleep study. The DME is happy to sell you a cheapo CPAP for the same outrageously inflated price they would get reimbursed for a state-of-the-art APAP. Simply put, they will do ANYTHING to keep you from owning an APAP. And if the pressure seems goofy, they make even MORE $$$ for tweaking the pressures up and down endlessly until the system runs out of money or the patient throws the machine in the trash compactor, (or sells it on eBay). The insurance providers and third-party payors are all too happy to make sure you get the bottom-of-the-line technology and equipment, and NOTHING more. And since they are mostly staffed by accountants, clerks, actuaries and other fiduciary types, there is no point in explaining to them that if you get the right therapy this might preempt other major health issues (and expenses) like hypertension, heart disease, and on and on and on.... (You need a HUMIDIFIER? did you mistake us for Home Depot? You have a mask? why do you need HEADGEAR?)

So which of the above players REALLY TRULY wants you to own an APAP? Only you.

I think you need only ONE good reason to own an APAP. But if "the system" INSISTS you should have a CPAP, you should INSIST they have the data to prove a CPAP will do the job. A single titration will not answer that question.

OKAY As you can see below I can't change the settings on my CPAP because it's a cpap But this is good information if I get the APAP. Dang, some get the APAP easily and some don't. I'm at a disadvantage here because my insurance will pay for ANYTHING. I have no limit on DME. They pay 100% of everything. I also don't have the cash set aside for this CPAP.com thing. Or, I would buy one there in an instant. We contacted my insurance through myinsurance.com and found out that they will pay full price for DME ONLY from out of network DME's or websites. My understanding is that CPAP.com doesn't accept insurance. Correct me if I'm wrong.

So, that leaves me with only two options as far as we've been able to see. I can either go through my DME at the sleep disorder center and they can work with me and all that jazz. Or we can return this unit and request my prescription and go elsewhere to someone who DOES accept my (very nice) insurance. Bottom line: I want to be involved in this decision. So far, I have not been. I'm not an idiot. I realize some people have zero clues about what to pick and all of that. They're not idiots either. But they probably respond better to just being given something without any explanation. An APAP has dual functionality. It can account for many things and still can run as a CPAP if needed. With ALL this in mind, it's easily the next level up and CAN provide as good or better therapy IMHO.

Maybe I'm a simple needs kind of Joe. MAYBE, I only need the CPAP. They would've done well to send me home with an APAP on CPAP mode or on Auto mode to really determine what I need. This sleep disorder center is HIGHLY recommended by my doctor and is supposed to be the very first doctor who brought OSA sleep studies to Texas. Ofcourse, I'm not really working with the doctor. I'm working with those lower on the totem pole.

Wow, sounds like an almost impossible battle then. But guess what? I've already learned enough. I'm already schooled by you guys. I'm sure you can guess what happens next? I'm the kind of guy who asks for the manager when one is needed. I'm going to tell the DME (what I call the lady in charge of equipment at the sleep lab) and tell her I've been experiencing some changes depending on which side I sleep on and waking up in the middle of the night with the pressure being too much at times. If she balks at all, I'll tell her I've already contacted my insurance and I can buy the unit through ANY vendor and if she doesn't want to upgrade me, I'll be dropping off my CPAP machine that very day. If they prefer NOT to ever sell APAP's to patients with insurance, it leaves me wondering when they actually DO sell them. And I'm not playing any games here. I'm quite aggressive when I want to be. And I'm not going to argue or fight. I'm going to take my business elsewhere

What do you think?

Excellent post, Ric!!

You're thinking right, Rastaman.

btw, when you say you contacted myinsurance.com, did you mean "billmyinsurance.com"? billmyinsurance.com is the subsidiary of cpap.com.

I did mean that, thank you. I'm not super familiar with cpap.com I didn't think cpap.com worked with insurance. Am I wrong?

You're not wrong...you're right that cpap.com does not work with insurance. But the folks who own cpap.com also own another company called "billmyinsurance.com" which does work with insurance...some insurance companies, anyway.

The prices for equipment at billmyinsurance.com are a little higher (reflecting the extra paperwork they have to do, to deal with insurance) than at cpap.com, but still probably a lot less expensive than from the local DME's.

And there's not the hassle of the seller telling you what they will or will not "let you have". With billmyinsurance, you pick out what you want. Big difference in THAT from the way most local DME's try to make you accept only what they want to give you.

Another subsidiary company owned by the cpap.com people is cpapforseniors.com, which deals with Medicare reiumbursements for cpap equipment.

Rastaman wrote:Okay, I'm just curious (shamelessly ofcourse) what the top 10 reasons that DME's, doctors, insurance companies, etc. allow you to get an APAP vs CPAP?

I see one.

Still waiting for the other nine.

-G

rested gal wrote:You're not wrong...you're right that cpap.com does not work with insurance. But the folks who own cpap.com also own another company called "billmyinsurance.com" which does work with insurance...some insurance companies, anyway.

The prices for equipment at billmyinsurance.com are a little higher (reflecting the extra paperwork they have to do, to deal with insurance) than at cpap.com, but still probably a lot less expensive than from the local DME's.

And there's not the hassle of the seller telling you what they will or will not "let you have". With billmyinsurance, you pick out what you want. Big difference in THAT from the way most local DME's try to make you accept only what they want to give you.

Another subsidiary company owned by the cpap.com people is cpapforseniors.com, which deals with Medicare reiumbursements for cpap equipment.

Billmyinsurance called me and said that they couldn't help me right now since I had already "started the process" with my current DME/Sleep Center. Interesting. For some reason my wife didn't have me listen to this message first. I might've deleted it by accident thinking it was one of my friends that calls alot. Well, I guess that means I need to terminate "the process" completely with my sleep center in order to go through Billmysinsurance.com ???? No? Last resort I guess. My DME is the same office that is my sleep center. They must expect this part of the time. And it MUST occur during the first month of initial treatment of the CPAP machine, otherwise, their hands MIGHT become tied.

I can't say my DME has denied me in any way. What I can say is that I've noticed that when I'm NOT sleeping on my back a setting of 13 seems a little bit much and wakes me up defeating the purpose in some ways. I can see where the APAP would be different. Maybe they'll let me try out an APAP instead for 30 days. Maybe that's necessary just like trying out the CPAP for 30 days is. Maybe?

WAIT ! ! ! ! ! ! ! ! ! ! ! !

here's another.....

Bookbear wrote:This is only with 2 weeks of experience, but when I changed to apap mode instead of cpap mode, my mouth breathing went away.

(thanks Bookbear!)

-Ric

Rastaman wrote:
Billmyinsurance called me and said that they couldn't help me right now since I had already "started the process" with my current DME/Sleep Center. Interesting. For some reason my wife didn't have me listen to this message first. I might've deleted it by accident thinking it was one of my friends that calls alot. Well, I guess that means I need to terminate "the process" completely with my sleep center in order to go through Billmysinsurance.com ???? No? Last resort I guess.

Unfortunately, my experience with billmyinsurance.com is that even if you completely terminate your service with your current DME they won't talk to you. According to the rep and supervisor that I talked to, the first DME to bill has "priority" (their words not mine). So, they can continue to bill and will still be paid. Also, you might want to check with your insurance. For many/most insurance companies, even though they pay at 100%, if they have paid rental to one DME, they will reduce any benefits to a second provider by the amount paid to the first. YMMV.

Interesting. Well, my DME did give me an exchange. She took my Remstar Plus M Series and gave me a Resmed S8 Autoset Vantage. And so far things are going very well after a week on the new machine.

I did have to pay for the "water chamber" (humidifier tray), which she charged me $35 for but that was a drop in the bucket for the right machine, IMHO. I asked about any cost increase other than that and she told me "Don't worry about it." So, I'm not.

It doesn't appear my sleep doc collects the data though. That's there for MY benefit. There is a data card and a mailer but my Sleep Doc/DME didn't say anything about mailing it in later or even using it.

One difference I noticed between the two units is the Remstar used less water in the humidifier tray. I actually forgot to remove the water chamber on my s8 last night and it STILL had water in it after 2 nights of use. I don't plan on repeating that but I don't seem to need to fill it up to the fill line.

Also, I've been having some nasal pain with my Swift Mirage Nasal Pillow system and I started with Mediums and made the mistake of going to the smalls, which took care of the problem for 2 days but it came back. So, now I'm using the larges with no problems after 2 days.


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