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Steven B. Ronsen updated their profile
Sep 15, 2018
I have used CPAP. I've heard about APAP, but I'm not sure how that differs. Just now, I read there's a BPAP. Are there any others?!

I've been diagnosed with moderate sleep apnea fairly recently. Admittedly, I am overweight. I'm in the middle of my 57th year of life, and I'm a woman. I had the chance to use the CPAP for two months earlier this year. Then I lost my insurance. We now have a new insurance company. I called and asked if they cover CPAP. Yes, they do. So I called my doctor's office and requested they get the ball rolling for this. Should I be trying an APAP instead of CPAP? Is one preferable? I really didn't see any improvement in my energy level. It was still difficult to get out of bed in the morning. The pressure setting started at 5. After a month it was raised to...I'm trying to remember....it might've been 7 or 7.5. I saw no difference. The pulmonologist who diagnosed my sleep apnea based on the sleep study results is also the same one who I saw for follow-up. After looking at the data from the CPAP, which I used faithfully each night, he said I was having frequent occurrences. (although they were slight) That's when he raised the pressure to a slightly higher setting. At any rate, I only asked my insurance company if they cover the CPAP. Should I ask about APAP or BPAP? I wonder how much my doctor (PCP) knows about these things.

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I would ask your doctor to specifically prescribe an auto-adjusting CPAP with software/download abilities and heated humidification. make sure he writes all that on the prescription --- the insurance company will cover that just as well as a simple, straight CPAP, and it will be a much more advanced machine.

An APAP or auto-adjusting CPAP can run in 2 modes -- as a straight CPAP-- which has a single pressure setting, or as an auto-adjusting machine that has a pressure setting range, of say 7-10, that varies depending on your needs throughout the night. That's why I'd give the APAP the nod. The most important thing is to require a machine that gives full data/efficacy downloadable data, so you can track your progress from night to night between doctor's visits.

Yes, there are BiPAPs -- that operates at 2 pressure settings -- one for exhalation and one for inspiration, but usually you need to go through and fail with an auto adjusting CPAP/APAP first to get that prescribed. Also, there are ASV machines to treat central sleep apneas, but i'm assuming you have obstructive sleep apnea and not central sleep apnea.
Thank you very much for your response, Mike. This information is very useful.

I will tell my doctor's office today that she should include all of those details when prescribing the machine. Hopefully, she will do as I request, but there are no guarantees. I haven't been a long-time patient of this doctor. My previous PCP moved out of the area, so I had to find another one.

Actually, now that I think of it, this sounds like the CPAP machine I had previously -- it had the data card and humidifier. I don't know if it was auto-adjusting, though.
You don't ask your insurance company ANY THING about the TYPE of xPAP. Most do NOT pay for xPAPs by brand or modlel but rather by HCPCS (insurance) code. All CPAPs and APAPs are HCPCS code e0601. What you DO ask them is what local DME suppliers they are contracted with. Hopefully you will have the option of more than one.

You are going to want a local DME supplier who has staff, especially and RRT who is knowledgeable about the various xPAPs they provide, about how to PROPERLY fit a mask and who you feel you will be comfortable working with. You want a local DME supplier w/a lenient mask exchange policy.

AND when the equipment order (script) is written for an APAP for you the pressure range should NOT be set wide open at 4 cms to 20 cms as so many sleep doctors too often do. Ideally the pressure range would be set 1-2 cms below your titrated pressure and 1-2 cms above your titrated pressure. Or at the widest setting 1-2 cms below your titrated pressure and no more than 10 cms above your titrated pressure. Be aware that just because an xPAP has a data card does NOT mean if is fully data capable.

And then it is YOUR RESPONSIBILITY to be as definitive as possible about any and what type of problems you are having w/acclimating to xPAP therapy. And as long as I was having problems I would "bug" my sleep doctor every 30 days, NOT in 3 months or 2 months or 6 months or whenever he schedules an appointment for you (unless less than 30 days). As a matter of fact, that is what I did do. At least until I was seeing SOME improvement, definite improvement even if not totally satisfactory.

Good luck!
Look what I just found. I wrote to you a little while ago to say I couldn't find your message, and here it is!

Mike said:
I would ask your doctor to specifically prescribe an auto-adjusting CPAP with software/download abilities and heated humidification. make sure he writes all that on the prescription --- the insurance company will cover that just as well as a simple, straight CPAP, and it will be a much more advanced machine.

An APAP or auto-adjusting CPAP can run in 2 modes -- as a straight CPAP-- which has a single pressure setting, or as an auto-adjusting machine that has a pressure setting range, of say 7-10, that varies depending on your needs throughout the night. That's why I'd give the APAP the nod. The most important thing is to require a machine that gives full data/efficacy downloadable data, so you can track your progress from night to night between doctor's visits.

Yes, there are BiPAPs -- that operates at 2 pressure settings -- one for exhalation and one for inspiration, but usually you need to go through and fail with an auto adjusting CPAP/APAP first to get that prescribed. Also, there are ASV machines to treat central sleep apneas, but i'm assuming you have obstructive sleep apnea and not central sleep apnea.
I hate to say this, but I just learned today that the doctor (a pulmonologist) is prescribing an APAP with pressure setting with a range of 6 - 18. According to what you said, that's not a good idea. Right? This is Monday night. On Thursday morning, a respiratory therapist is coming to my house with the machine to set me up on it. What should I do? I don't understand that terminology -- titrated pressure. How would I know what that is? This pulmonologist is the same doctor who interpreted my sleep study results. He also did follow up with me when I had CPAP for a couple of months. He must know what my titrated pressure is, right? Why doesn't he have this knowledge about having the settings in relation to the titrated pressure? Where did you learn this, Judy?

Judy said:
You don't ask your insurance company ANY THING about the TYPE of xPAP. Most do NOT pay for xPAPs by brand or modlel but rather by HCPCS (insurance) code. All CPAPs and APAPs are HCPCS code e0601. What you DO ask them is what local DME suppliers they are contracted with. Hopefully you will have the option of more than one.

You are going to want a local DME supplier who has staff, especially and RRT who is knowledgeable about the various xPAPs they provide, about how to PROPERLY fit a mask and who you feel you will be comfortable working with. You want a local DME supplier w/a lenient mask exchange policy.

AND when the equipment order (script) is written for an APAP for you the pressure range should NOT be set wide open at 4 cms to 20 cms as so many sleep doctors too often do. Ideally the pressure range would be set 1-2 cms below your titrated pressure and 1-2 cms above your titrated pressure. Or at the widest setting 1-2 cms below your titrated pressure and no more than 10 cms above your titrated pressure. Be aware that just because an xPAP has a data card does NOT mean if is fully data capable.

And then it is YOUR RESPONSIBILITY to be as definitive as possible about any and what type of problems you are having w/acclimating to xPAP therapy. And as long as I was having problems I would "bug" my sleep doctor every 30 days, NOT in 3 months or 2 months or 6 months or whenever he schedules an appointment for you (unless less than 30 days). As a matter of fact, that is what I did do. At least until I was seeing SOME improvement, definite improvement even if not totally satisfactory.

Good luck!
Find out what your PCP's intentions are. Does he intend to leave you on an APAP? At that range? It is not good to be on a range of that magnitude for very long. Some on here will argue with me, But a think in the long run a straight pressure is better than a revolving one. the fact that your physician is a pulmonologist puts you in good hands. They seem to know there sleep related breathing disorders.
Usually - one has an in-lab sleep evaluation PSG (study) and if OSA is Dx'd (diagnosed) you are then brought back for an in-lab titration PSG (with CPAP) which is when they try out various pressures while you are sleeping to determine the pressure that prevents or eliminates apneas. That pressure is called your titrated pressure.

A pressure range of 6 cms - 18 cms is a good pressure range to start out w/w/an APAP. What your doctor is doing in scripting that APAP at that pressure range is trying to better determine what your pressure need is. We don't sleep the same every night and sometimes data from a fully data capable APAP over a period of several nights can better determine the pressure setting or settings you need. When you think about all that's involved w/an in-lab sleep study it really is quite remarkable and an admirable feat that those RPSGTs find the pressure setting needed so often as they do. My hats off to them!!!

You sound like you are in pretty good hands. I'd go w/the flow for now. The ONLY thing at this point that I would INSIST on is that when this APAP has to be returned and you are to receive a CPAP that that CPAP be a fully data capable CPAP. I would absolutely REFUSE anything less than a fully data capable CPAP. In fact, I've done so and would do so again and again and again until I received a fully data capable CPAP. I'd purchase a fully data capable xPAP out of pocket if I HAD to - and have done so.

I was first provided w/a Respironics pre-M Series Plus w/C-Flex. NOT fully data capable. It was SUPPOSED to have been a Respironics M Series Pro w/C-Flex which IS fully data capable. I returned it immediately and INSISTED on a fully data capable CPAP and received a Resmed S8 Elite w/EPR. Then I got the "APAP bug" from the apnea support forums and self-purchased a brand new Respironics pre-M Series Auto w/C-Flex. But after using a Resmed I really didn't care for the Respironics. I got good therapy w/it - I just didn't like its "features" and method of data access plus the limited data so I self-purchased a lightly used Resmed S8 AutoSet Vantage and sold the Respironics I'd bought.. Then due to my COPD my sleep doctor switched me to a bi-level. I INSISTED on the Resmed VPAP Auto. But by then I was spoiled w/having a second xPAP as a backup and travel xPAP so ..... it took some time, bi-levels are EXPENSIVE, but I finally found a very lightly used Respironics pre-M Series Bi-PAP Auto w/Bi-Flex at a price I could afford. I still don't like the Respironics, even tho I also have the software and cable reader for it plus the freeware to enhance the software data. I get good therapy w/it, there are just incidental features that I don't care for that have nothing to do w/the therapy it provides. I'm just a crusty ole broad set in my ways and likes and dislikes.
Thank you, Jeff. I appreciate your feedback.

j n k said:
You are getting good info.

There are reasons to use an APAP at a wide range at first--to see what pressure it ends up at for much of the night. That may be what your doc/RT has in mind. Running it 6 to 18 isn't a bad idea--at least it's better than 4 to 20. If the pressure they found for you at the sleep study was fairly low, starting at 6 should be fine for now.

You may eventually (with the stress on EVENTUALLY) want to see about changing that range, as Judy mentioned, if you find that 6 is too low after a while. And as Rock mentioned, some end up feeling best, eventually, at a fixed pressure. That can be done with an auto (APAP) too, since, as Mike pointed out, an APAP can be used as a regular CPAP at one straight pressure.

I would like to RE-stress the important point Mike made earlier, and I quote: "The most important thing is to require a machine that gives full data/efficacy downloadable data, so you can track your progress from night to night between doctor's visits."

That is the key. As long as you have a machine that gives you good data, you can make sure things end up going well in the long run. In the meantime, personally speaking, I would suggest that you let your doctor and RT do their thing their way for now, as far as choosing pressure(s).

You have the tools to get more involved in pressure decisions down the road as long as you end up with a full-data machine. So see what the doc and RT come up with first. They may be approaching your situation logically, and now is not the time to argue with them about pressure, it is merely the time to ask questions and learn, from them and from us and from doing research on that.

If you have ever had a PSG, a sleep study, they found a titrated pressure, a pressure you seemed to do well at that night. That it a clue to how to set up a machine for you. But how you do over time is the important thing. If you find that the doc and RT are unsuccessful at making the therapy work for you with the pressures they choose, then, according to how you feel and the data you get yourself from your machine, it will become the time to start trying things, hopefully with the full blessing and cooperation of your doc and RT. If they aren't willing to work with you on that, when that day comes, you can find help here for doing it without them, should that become necessary.

Although I recommend going with their thoughts on pressure for now, I suggest you MAKE SURE you are working with a DME (durable medical equipment company) who will work with you on giving you a machine with efficacy data and letting you try different masks until you find one that works for you. If they aren't willing to do that, find out from insurance what other DME you can work with instead.

That is how I see it, anyway.

jeff
When I first tried CPAP therapy after being diagnosed with sleep apnea, my PCP wrote the script for it. She was aware of my subsequent follow up with a pulmonologist. So when it came time for me to get a machine again (insurance coverage ended before a new insurance began), she said the pulmonologist should be the one to order it now.

Rock Hinkle said:
Find out what your PCP's intentions are. Does he intend to leave you on an APAP? At that range? It is not good to be on a range of that magnitude for very long. Some on here will argue with me, But a think in the long run a straight pressure is better than a revolving one. the fact that your physician is a pulmonologist puts you in good hands. They seem to know there sleep related breathing disorders.
Thank you, Judy. I called the company to ask what kind of machine I'm getting. The only thing I was told is that it's a Resmed SA auto advantage. Do you know anything about that one?

Judy said:
Usually - one has an in-lab sleep evaluation PSG (study) and if OSA is Dx'd (diagnosed) you are then brought back for an in-lab titration PSG (with CPAP) which is when they try out various pressures while you are sleeping to determine the pressure that prevents or eliminates apneas. That pressure is called your titrated pressure.

A pressure range of 6 cms - 18 cms is a good pressure range to start out w/w/an APAP. What your doctor is doing in scripting that APAP at that pressure range is trying to better determine what your pressure need is. We don't sleep the same every night and sometimes data from a fully data capable APAP over a period of several nights can better determine the pressure setting or settings you need. When you think about all that's involved w/an in-lab sleep study it really is quite remarkable and an admirable feat that those RPSGTs find the pressure setting needed so often as they do. My hats off to them!!!

You sound like you are in pretty good hands. I'd go w/the flow for now. The ONLY thing at this point that I would INSIST on is that when this APAP has to be returned and you are to receive a CPAP that that CPAP be a fully data capable CPAP. I would absolutely REFUSE anything less than a fully data capable CPAP. In fact, I've done so and would do so again and again and again until I received a fully data capable CPAP. I'd purchase a fully data capable xPAP out of pocket if I HAD to - and have done so.

I was first provided w/a Respironics pre-M Series Plus w/C-Flex. NOT fully data capable. It was SUPPOSED to have been a Respironics M Series Pro w/C-Flex which IS fully data capable. I returned it immediately and INSISTED on a fully data capable CPAP and received a Resmed S8 Elite w/EPR. Then I got the "APAP bug" from the apnea support forums and self-purchased a brand new Respironics pre-M Series Auto w/C-Flex. But after using a Resmed I really didn't care for the Respironics. I got good therapy w/it - I just didn't like its "features" and method of data access plus the limited data so I self-purchased a lightly used Resmed S8 AutoSet Vantage and sold the Respironics I'd bought.. Then due to my COPD my sleep doctor switched me to a bi-level. I INSISTED on the Resmed VPAP Auto. But by then I was spoiled w/having a second xPAP as a backup and travel xPAP so ..... it took some time, bi-levels are EXPENSIVE, but I finally found a very lightly used Respironics pre-M Series Bi-PAP Auto w/Bi-Flex at a price I could afford. I still don't like the Respironics, even tho I also have the software and cable reader for it plus the freeware to enhance the software data. I get good therapy w/it, there are just incidental features that I don't care for that have nothing to do w/the therapy it provides. I'm just a crusty ole broad set in my ways and likes and dislikes.
I would like to RE-stress the important point Mike made earlier, and I quote: "The most important thing is to require a machine that gives full data/efficacy downloadable data, so you can track your progress from night to night between doctor's visits

j n k said:
You are getting good info.

There are reasons to use an APAP at a wide range at first--to see what pressure it ends up at for much of the night. That may be what your doc/RT has in mind. Running it 6 to 18 isn't a bad idea--at least it's better than 4 to 20. If the pressure they found for you at the sleep study was fairly low, starting at 6 should be fine for now.

You may eventually (with the stress on EVENTUALLY) want to see about changing that range, as Judy mentioned, if you find that 6 is too low after a while. And as Rock mentioned, some end up feeling best, eventually, at a fixed pressure. That can be done with an auto (APAP) too, since, as Mike pointed out, an APAP can be used as a regular CPAP at one straight pressure.

I would like to RE-stress the important point Mike made earlier, and I quote: "The most important thing is to require a machine that gives full data/efficacy downloadable data, so you can track your progress from night to night between doctor's visits."

That is the key. As long as you have a machine that gives you good data, you can make sure things end up going well in the long run. In the meantime, personally speaking, I would suggest that you let your doctor and RT do their thing their way for now, as far as choosing pressure(s).

You have the tools to get more involved in pressure decisions down the road as long as you end up with a full-data machine. So see what the doc and RT come up with first. They may be approaching your situation logically, and now is not the time to argue with them about pressure, it is merely the time to ask questions and learn, from them and from us and from doing research on that.

If you have ever had a PSG, a sleep study, they found a titrated pressure, a pressure you seemed to do well at that night. That it a clue to how to set up a machine for you. But how you do over time is the important thing. If you find that the doc and RT are unsuccessful at making the therapy work for you with the pressures they choose, then, according to how you feel and the data you get yourself from your machine, it will become the time to start trying things, hopefully with the full blessing and cooperation of your doc and RT. If they aren't willing to work with you on that, when that day comes, you can find help here for doing it without them, should that become necessary.

Although I recommend going with their thoughts on pressure for now, I suggest you MAKE SURE you are working with a DME (durable medical equipment company) who will work with you on giving you a machine with efficacy data and letting you try different masks until you find one that works for you. If they aren't willing to do that, find out from insurance what other DME you can work with instead.

That is how I see it, anyway.

jeff
The Resmed S8 AutoSet Vantage is one heck of a GOOD fully data capable APAP. I have one. It sounds then like this will be a loaner APAP for an auto-titration at home for a couple of weeks or a month. If it is to be just a loaner and after they've gotten some data for a couple of weeks are going to exchange it for a straight CPAP then the Resmed S8 Elite II w/EPR would be an excellent choice. It is fully data capable. Of course, if you can keep the Vantage so much the better. I was started on the Resmed S8 Elite w/EPR and it was an excellent device. I actually felt bad when I sold it I had gotten so attached to it! I had self-purchased a slightly used Vantage so I'd have a backup/travel device too. But then I was switched to a bi-level and had liked my Resmeds so much I insisted on the Resmed VPAP Auto that I have now.

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