i went in today to pick of my Auto PAP. i have it for one month only. i ran into my friendly DME person while i was there. this is the guy who has listened to me whine and complain for months. he asked if i was there to pick up the Auto PAP and i said yes. i stated that i believe it would save medicare govt insurance and any insurance company a bunch of money if they would only allow me to buy it rather then rent it for one month at $200.00 per month.  
that's when he spoke something that i had never heard before. better then 75% of all people on cpap/ or BIpap have to be retitrated every 2 years or less to have their OSA under control.
that is AMAZING to me!!!!  why not save us people with OSA a bunch of money by giving the Auto PAP to start with rather then spending the extra money to be retitrated every 2 years or so.
has anybody else ever heard of this ?
janey

Yes I know.. why do we have to be re-titrated all the time?

An APAP machine costs about $750, while a regular CPAP costs about $300.
That's a difference of $450.

A titration test at most, cost $200. Therefore there is an incentive for insurance companies to have you titrated
in hopes of saving the $250 !! It's absurd but true, anyway they can save costs at the expense of consumers,
they will do it. The biggest problem is that our employers fortify their actions because the insurance companies
are saving our employers money.

Does that explain it ?

I'm not sure where Lionel is getting the information about a titration test costing $200 at most. The ball park figure is around $1000. That $200 won't even pay the sleep techs wages for the night, let alone overhead, doctors wages, facilities and the list goes on. You may be lucky to get one done at around $500 but good luck finding that one.

Well, the place where I had my test done, Sleepmed, gave me an auto machine and 2 masks and told me to return it 3 days later.

I really can't explain the use titration test, DVL, like Janey I am baffled as to why they don't give the APAP to begin with.

I think there is a confusion about the definition of a titration test.  It is traditionally done as part of an overnight sleep study in which a CPAP is used and the pressure "titered" up to a point where the majority of apneas are eliminated.  If done during a sleep study, then all of the parameters measured are recorded as pressure is increased.

Vicki


_________________
That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Yes Vicki that was my understanding of what Lionel was saying. Those titration studies cost a lot of money to do. Now in regards to using an APAP to just get a pressure level over a period of nights, then yes Lionel is right in the amount of money to do that from what I understand.

In regards to getting titrated every 2 years, in Ontario the doctor usually follows up after 1 year. If you don't have a serious problem such as oxygen desaturation, stats such as weight have remained the same and have been using an APAP you may be able to show the doctor your most recent readings. At that point it is up to him to make a decision on whether or not to retitrate you.

Janey, if you want the APAP then demand one in a nice way. List out your reasons and they may be as simple as you respond better to an APAP, are more compliant and feel that it is the right treatment for you. It is your money and your treatment.

Good luck .

DVL wrote:

Yes Vicki that was my understanding of what Lionel was saying. Those titration studies cost a lot of money to do. Now in regards to using an APAP to just get a pressure level over a period of nights, then yes Lionel is right in the amount of money to do that from what I understand.

In regards to getting titrated every 2 years, in Ontario the doctor usually follows up after 1 year. If you don't have a serious problem such as oxygen desaturation, stats such as weight have remained the same and have been using an APAP you may be able to show the doctor your most recent readings. At that point it is up to him to make a decision on whether or not to retitrate you.

Janey, if you want the APAP then demand one in a nice way. List out your reasons and they may be as simple as you respond better to an APAP, are more compliant and feel that it is the right treatment for you. It is your money and your treatment.

Good luck .

APAP is not a bad thing, but if someone is on BIPAP and wants to be on APAP because of what they read on a message board, they should be careful.  There are specific conditions that are often treated with BIPAP, not APAP.  Unfortunately in OSA therapy there is not a one size fits all.  I don't want this to seem to come across as against APAP, I myself use one, but to be fair and balanced, we have to look at the entire OSA population so we need to qualify our statements...

Quote:

APAP is not a bad thing, but if someone is on BIPAP and wants to be on APAP because of what they read on a message board, they should be careful. There are specific conditions that are often treated with BIPAP, not APAP. Unfortunately in OSA therapy there is not a one size fits all. I don't want this to seem to come across as against APAP, I myself use one, but to be fair and balanced, we have to look at the entire OSA population so we need to qualify our statements...

I agree with you Mike but just try getting an APAP if the prescription reads BiPAP. Even if you were to buy online, they would not substitute an APAP for a BiPAP. By the way there is an Auto BiPAP available now by Respironics which would be fine for someone requiring BiPAP treatment. I suspect though that it would be just as hard to get one of these units as it is to get an APAP in place of a CPAP.

Well what I have seen happen is that because it is stated as a matter of fact on some forums that APAP is the BEST therapy, folks that are not on APAP will find a way to switch.  (I.E. get their GP to write an RX)  And that might not be in their best interest.  For some it seems that it is very difficult to get an APAP, and others have no problem at all.  

I did a topic on APAP in late night to address this issue...


Here

Quote:

Well what I have seen happen is that because it is stated as a matter of fact on some forums that APAP is the BEST therapy, folks that are not on APAP will find a way to switch. (I.E. get their GP to write an RX) And that might not be in their best interest. For some it seems that it is very difficult to get an APAP, and others have no problem at all.

Mike, I post on 3 sleep apnea forums out of the 4 that I know of and have yet to see anybody and I mean anybody state in writing that an APAP is better than a BiPAP.   I would love to see a thread that does.   Maybe that statement appeared on the forum I won't visit, hence a good reason not to log in there if indeed it did happen.

Anybody that knows anything about this treatment knows that a BiPAP is the Mercedes of treatment devices and the APAP is the Caddy. If they don't know this, the vast price difference between them will undoubtedly quash any question of this. Of course they serve to remedy different problems and is why a sleep doctor will script one rather than the other, no question. A GP who over rules a sleep doctors script, due to insistence by the patient, by prescribing an APAP in place of a BiPAP is not only foolish, risking his license to practice medicine should something seriously go wrong, but would be inline for a hefty lawsuit. I am not saying this hasn't happened but I would be very surprised at the least if this did happen. Now for a GP to script an APAP over a CPAP, I would have no problem with. The only thing that would change would be the APAP to replace the CPAP. Now if the DME couldn't figure out that the single pressure setting meant putting the APAP unit into CPAP mode, then it would be time for that particular person to go finish high school, don't you think.

Compare an APAP to a CPAP and yes the APAP wins in all categories hands down.   Why? Well you know. First an APAP can easily be setup to operate just like a CPAP and you have data at your fingertips to boot. Nobody says you have to monitor or even bother with the data but should you want to at some time it is there for you. Wouldn't it be nice for someone to go to his/her sleep doctor and say hey, I'm having a problem, here is my data card. Can you take a look at the data and help me out. Sleep doctor does and says, I think we need to get your unit in for an increase/decrease in pressure but otherwise things are looking good. Or maybe the scenario is changed so the doctor says we need to do another sleep study because of what this data is telling me. This data, although it may not be perfect, is definitely well within the realm of the ballpark so to speak. Can you imagine an APAP working properly but the data is not even close. I don't think so! Anytime something is measured, the act of measuring it introduces error, no matter what it is but that error is so small that it becomes irrelevant in the major scheme of things.

You can use the APAP in APAP mode and manage your own treatment if you feel so inclined to, something that more and more people are rushing to in all aspects of health care today simply because your best advocate for your own health is you. All APAP users know that the only time a CPAP comes out on top is if money is a factor and then only if you buy from a online reputable vendor. DME's go ahead and sell you a CPAP that is typically low in price (not quality) but jack that price up to double or even triple so that the difference between an APAP and this CPAP is only a few hundred dollars or less. Yes this still may be a factor for some but if it is they should be looking for that reputable internet vendor who can sell them the APAP for the same or less than the DME is selling the straight CPAP for. I had a straight CPAP from the DME that was going to cost my insurance company $798. That same unit on the internet cost $399. Now I could have bought an Auto for $515 from the internet or buy the Auto that I did for $760. But now we digress into the DME situation which from many posts and peoples experiences has it's own inherent problems, some benefits but for the most part problems that need rectifying.

For you CPAP users, am I bashing you for getting a CPAP Not really. I understand that some people respond better to a straight pressure (which you can do with an APAP). I also understand that some people are just not interested in or have the time and energy to monitor their own treatment and would like to leave it up to their doctor(s). That's okay as well. There is also the DME factor which is abundantly clear from posts on this and other forums. But be aware that this taking control of your own treatment is going to become more and more of a normal thing. All you have to do is look at what diabetics are doing today. We know that diabetes is far, far more deadly when compared to OSA yet diabetics are not only expected to look after themselves, it is demanded of them. They get the medical devices needed to monitor their own treatment and follow up with a doctor when necessary. Twenty to 30 years ago this was frowned on and the world was going to end if this happened, or so they cried out. The medical community had no choice as they just couldn't keep up with the amount of people coming down with this disease. Well diabetics are managing just fine with the equipment available, thankyou very much. You are seeing this same trend in the amount of people being diagnosed with OSA. Long waits to get a sleep study and even longer waits to get equipment. Governments, insurance companies and the medical community are going to demand a similar approach to this as the numbers ever increase. Sorry for the long post but if you think I'm wrong, think again, think about the diabetics out there and tell me that OSA isn't headed in the same direction.

[quote="DVL"]

Quote:

[b]

Anybody that knows anything about this treatment knows that a BiPAP is the Mercedes of treatment devices and the APAP is the Caddy.

Actually they are different devices.  That analogy is flawed.  It is like saying a dumptruck is the same as a 4 door sedan.  APAP has its place and BIPAP has its place, and yes there is some overlap, but there are also ailments that one would be prescribed BIPAP for that APAP would not be suitable.  As to not finding it on other forums, dig a little deeper.  

I am not sure what you mean about the DME aspect, as the ASAA does not support a particular vendor or manufacturer.  

It is quite clear that you think that anyone with a CPAP should have an APAP, and that is fine, but at least you realize that not everyone in that group wants, or needs one.  

I have no problems with people getting an APAP for whatever reasons that are behind it, but they do need to be aware that it is not a magical machine that works perfectly for everyone.  There are people that the algorithms don't work, and those who have a pressure requirement that is low and would not really see any benefit from an APAP.  

As to the diabetic analogy, I doubt that you would suggest a diabetic use the wrong type of insulin for their diabetes would you?

Mercedes, Cadillac? Wow, from someone who is more than happy to keep driving my well maintained 94 Chevy Caprice,(pad for) I would like to say, that it gets me every where I need to go comfortably and dependably! (Even to the bank to deposit my check into savings account)
  Most people frequenting these boards have insurance which will only pay for a cpap, which will treat their apnea very very well.  I have seen NO studies that show their apnea would be any better treated by apap, than straight cpap.  Even for those paying out of pocket, the cpap will cost half what the apap does, not to mention the price of the software!!  I, like many, was "brainwashed" that the apap was SOOO much better, and, tight as I am, shelled out my own money for one, complete with software.  In the beginning, I downloaded often, the charts are pretty and interesting...now, several years later, I seldom download more than every two or three months (generally to check the leak rate on a new mask I'm trialing)
  As for taking the printouts to a physician, I did that once when I was having extreme EDS.  He wasn't the least interested in it, said the information ONLY told him what pressures the machine was running at, nothing of my aruousals or O2 sats, and the wealth of other information a good sleep study shows.  He scheduled me and my autopap for a sleep study, and directed them to do the first half of my study with the apap.  His reason, many people have arousals due to the constant pressure changes, and the apap doesn't always find the best pressure for many people to control apneas and hypopneas!  We know every brand has it's own program of what to respond to, and it is kinda the luck of the draw, if you bought the brand that will work best for you!!  He has done studies comparing various brands of autopaps in the sleep lab, and it is his opinion that most people have better sleep on a straight cpap.  So I was surpirsed the next day, when he reported my particular machine "worked beautifully" in responding to my apneas.  I also slept equally as well on straight pressure during the later half of the study.  
  You also use the diabetes analogy, my husband is diabetic.  He does use a glucometer daily, mostly to determine how well his DIET is doing.  The glucometer lets him adjust his eating, but he still has regular blood work done by the physician, who prescribes his medication.  He can't go into the pharmacy and ask to change his medications based on his home glucometer readings, nor would the physician change, without confirming bloodwork.   I also would not change my apnea treatment, based on my own interpretation of my downloads!
  I am concerned that the constant touting of "treat yourself with autopap" will encourage people to spend private money buying an autopap, doing downloads, and possibly missing important information regarding their sleep health that a trip to the sleep physician might have diagnosed and treated.  Their money would probably be better spent on finding the mask that is as comfortable as possible, and keeping their cpap in great condition (hoses, filters, etc).  With the cpap, you don't have to worry about things like run-a-way pressures from line condensation, or whether the algorithym is a good match for your unique condition.
   I say, keep driving the 94 chevy, using the cpap...just be compliant....and put the money you saved into your IRA...cause if you are compliant, your probably gonna live longer and need more retirement nestegg!!!

Thanks for the responses. Mike I did get your PM and have responded. In reference to my Mercedes/Caddy remark I did qualify it a sentence or two down,

Quote:

Of course they serve to remedy different problems and is why a sleep doctor will script one rather than the other, no question.

In regards to the DME aspect (I called it a factor), we all know that a DME makes much more money selling a straight CPAP unit vs a data recording CPAP or an APAP. Why would they even consider either of these 2 if they get more money for a CPAP How many people have been offered top of the line masks and CPAP units when they go in to get equipment None in what I have been through, seen and read about. The lower quality masks are always pushed first unless you are knowledgeable and partake in forums like this one. Same for the machines. For example F&P put out a straight CPAP unit with a heated hose to help reduce rainout. No one I know has been able to get this machine from the DME without demanding it. Why Again it is a profit thing.

Now in your last statement about the diabetic analogy you say,

Quote:

I doubt that you would suggest a diabetic use the wrong type of insulin for their diabetes would you?

Not really the same type of issue. I would definitely recommend a blood glucose monitoring machine if I had a preference. That would be what I would consider being more inline with what I am suggesting.

In response to you, Okie, I understand you are a moderator and have to, well, be moderate.

Quote:

from someone who is more than happy to keep driving my well maintained 94 Chevy Caprice,(pad for) I would like to say, that it gets me every where I need to go comfortably and dependably!

Are you encouraging old technology and by this are you saying that CPAPs from 12 years ago are just as good as the ones made today Have to disagree here. That vehicle of yours is much more likely to get you severely injured or even killed in an accident as compared to today's vehicles. In treatment of OSA todays machines are much better and more advanced than those of the yester year you speak of.

No there are no studies that I know of that would say an APAP is better for OSA over a CPAP or vice versa but that could be because I haven't found the study yet. However, compliance is the big factor and from all that I have read and seen, it is less than 50% with numbers down as low as 30%. From my own experience I fine APAP to be easier to accommodate to as well as others that have gone that route. Would an APAP get the compliancy percentages up Maybe. My first unit was an F&P 233 straight CPAP. I had it for just over a month and it was terrible for me. The REMstar I have now is a dream compared to that.

Quote:

Even for those paying out of pocket, the cpap will cost half what the apap does, not to mention the price of the software!!

Did you even look at my personal example I guess you are comparing the lowest priced CPAP to an APAP. However, put that low cost CPAP into the hands of a DME and see just how expensive it becomes. CPAP's are not any where near as versatile as an APAP. The software is not that pricy. In fact a lot of us REMstar APAP users got our software free from Respironics. Obviously that isn't always the case though.

Funny you say

Quote:

I, like many, was "brainwashed" that the apap was SOOO much better,

yet you still have one. Can anyone with a CPAP do what you can with your APAP Don't like the APAP, hey you can put it into straight CPAP mode and still get data from it. I highly suspect that you run it in APAP mode and like all of us do, we initial set it up for our best sleep and have the data to prove it. Then as you say every so often we check our data to see that we are still getting that good sleep. Can't do that with a CPAP can we!!!

Your doctor according to you says,

Quote:

many people have arousals due to the constant pressure changes, and the apap doesn't always find the best pressure for many people to control apneas and hypopneas!

This is typical of a doctor who doesn't follow the technology. An APAP adjusts pressure up by one half to one cm at a time and not the huge jump your doctor likely thinks is happening. This small increase happens over time and if you wake up to that then even CPAP is not going to work for you. You would be too sensitive to pressure. Surprise to him that you actually responded great to your APAP, something all APAP users already know.

As much as I would like to argue diabetic treatments, most people who know a diabetic know they take care of themselves through self treatment and only see their doctor when needed.

Thanks for the great discussion and even though you, Okie, and Mike both use an APAP, like me, I agree that for some people a CPAP is fine to use and for the reasons you both stated. But for those interested in taking a more proactive response in their own treatment I have to say a data recording CPAP, APAP or if the situation calls for it an Auto BiPAP is the route to go.

So would someone explain to me, who is going to be scripted a BiPAP type machine, is the ResMed S8Elite a bi-level or not? It says it is a CPAP but then says it includes new EPR (expiratory pressure relief) mode which drops pressure on exhalation. What about the ResMed S8 AutoSet Vantage which also has the EPR mode can that be used as a bi-level? I am assuming that bi-level is the same thing as BiPAP except that BiPAP is a brand name and the BiPAP company is touchy about the use of its name for a generic.

Quote:

Crohnie posts - EPR the same as bi-level???
So would someone explain to me, who is going to be scripted a BiPAP type machine, is the ResMed S8Elite a bi-level or not? It says it is a CPAP but then says it includes new EPR (expiratory pressure relief) mode which drops pressure on exhalation. What about the ResMed S8 AutoSet Vantage which also has the EPR mode can that be used as a bi-level? I am assuming that bi-level is the same thing as BiPAP except that BiPAP is a brand name and the BiPAP company is touchy about the use of its name for a generic.

Typically people who have a high pressure level (say around 15cm H2O) prescribed to them and find it hard breathing against the pressure are prescribed BiPAPs. People who are prone to central apneas, have lung disease, heart problems are prescribed BiPAPs if their doctor feels it is required. Of course he makes his decision based on a sleep study. The ResMed S8Elite and S8 AutoSet Vantage machines are not bi-level machines although they do function somewhat similar to one. In those cases both machines have a reduced pressure at exhalation to help with your breathing out against the pressure. The pressure can be set from 1 to 3 cmH2O lower than your set pressure. The S8 Auto does not have pressure relief in the Auto mode, only in the straight CPAP mode.

BiPAPs on the other hand have pressure relief at exhale that is at minimum 4cm H2O lower from the inhale setting. There are more settings with BiPAPs that work at reading your breathing characteristics. Respironics even has an Auto BiPAP out now. ResMed's version of a BiPAP is the VPAP III. Some BiPAPs (maybe all) have a spontaneous trigger where they will try to get you to breath again should you be having a central apnea. Yes BiPAP is a registered trademark of Respironics as is C-flex. EPR is a trademark of ResMed.

You cannot get a BiPAP without a prescription for one same as you cannot get a CPAP/APAP without a prescription. A CPAP prescription is valid in most cases for an APAP but not for a BiPAP machine. Similarly, you cannot get a CPAP/APAP with a BiPAP prescription. Hope that clarifies things for you   .