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Any advice on talking my Dr into the Auto machine?
#11
(06-18-2012, 12:06 PM)andersgeorgsson Wrote: I am about to get mine today - I cited the fact that I have a lot of allergies and frequently get colds,
my doctor had written the RX for 9-10cmH2O so they will give me the auto machine locked into CPAP
mode and then change it if the doctor agrees to auto mode.. (or if I try it on my own <evil laughter>)

Have a great week! Smile

My machine usually generates 11-12 cmH2O of pressure, except when I'm congested, which happens frequently and has been a lifelong problem. Then, the pressure shoots up to 15 or 16. I don't think I'd do well with a fixed pressure.
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#12
(06-18-2012, 07:27 AM)zimlich Wrote: I think "AUTO is the way to go" is not the best way to go. Some people respond better to straight CPAP, or bilevel.
Although since most AUTO machines can be used in CPAP mode that is almost a moot point. But, AUTO is not an inherently better mode of treatment. If it were that's all doctor's would prescribe.

(06-18-2012, 12:03 PM)SuperSleeper Wrote: Although an APAP (Auto-CPAP) is not ideal for everyone... I will say that I wholeheartedly believe that it is the best option for the vast majority of OSA patients.

I agree with SS here, and with your last paragraph, Zimlich. As APAP machines can be set to fixed CPAP, I can't logically see any case at all for supplying anything other then an APAP to the end user. It only makes sense to do so just to have that flexibility to future proof their therapy.

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#13
(06-18-2012, 01:14 PM)CHanlon Wrote:
(06-18-2012, 07:27 AM)zimlich Wrote: I think "AUTO is the way to go" is not the best way to go. Some people respond better to straight CPAP, or bilevel.
Although since most AUTO machines can be used in CPAP mode that is almost a moot point. But, AUTO is not an inherently better mode of treatment. If it were that's all doctor's would prescribe.

(06-18-2012, 12:03 PM)SuperSleeper Wrote: Although an APAP (Auto-CPAP) is not ideal for everyone... I will say that I wholeheartedly believe that it is the best option for the vast majority of OSA patients.

I agree with SS here, and with your last paragraph, Zimlich.

I don't agree with the logic in Zimlich's last paragraph. I don't believe that all doctors would prescribe APAP's instead of CPAP's if APAP's were inherently better. Some doctors don't know enough to prescribe an APAP. They don't even know enough to prescribe a data-capable machine! Many of them don't specify anything except the pressure that they copy from the sleep study titration.

As an example, let's apply that logic to data-capable machines. They aren't inherently better than bricks, because if they were that's all doctors would prescribe?

The fact is, data-capable CPAP's offer advantages over bricks, and APAP's offer advantages over CPAP's. Those advantages come at an extra cost. The advantages versus the costs have to weighed to decide which, if any, of those options is best for you.

If they were all available at the same price from the same manufacturer's product line, you'd be a fool to choose the brick or the data-capable CPAP over a fully data-capable APAP.
Sleepster
Apnea Board Moderator
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#14
The Dr shot me down on the Auto - said I don't need one.
I tried using congestion and the fact that I want to lose weight to no avail.
At least the machine will have a SD card.
He did say it will be for BiPAP pressure 10 - 4, said my AHI was 30 and that my lowest recorded O2 during my initial study was 84%.
I forgot to ask how long a period that was.
I have the set up appt. Wed. Then I guess the "fun" will begin.
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#15
I got a prescription for my S9 Autoset, after I had tried a conventional no data CPAP machine. When I was diagnosed with OSA, there wasn't time for the titration study, since I only slept for the last 2 hours of the night. I was given the CPAP machine and told to use it for a month and then return to the sleep lab. The machine was set for a pressure of 7.0 cm. After 2 weeks of using the machine and seeing no improvement, I called my sleep doctor. I dreaded going back to the sleep lab and not sleeping. I asked her for an Autoset based on the fact the CPAP wasn't working and the fear that they would never get a proper titration study done. Furthermore, I argued that given all my trouble sleeping, how could the results of a one night titration study be depended upon. The sleep lab, after all, wasn't my home. Well, I got the machine I wanted and as a result the sleep that I wanted.


Having said all this, I would try the BiPAP machine and see how it works for you. It could work as well or better for you than an Autoset.
A friend of mine has a System ONE BiPAP and feels fantastic since getting his. He doesn't know the first thing about the inner workings of his machine or the software available for it. When I showed him how to get into the clinical menu of his machine, it was no surprise that his AHI average for the past 30 days was 0.5. I told him not to bother with SleepyHead or touching any clinical setting on his machine. He doesn't need to do either.
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#16
(06-18-2012, 03:04 PM)johns019 Wrote: The Dr shot me down on the Auto - said I don't need one.
I tried using congestion and the fact that I want to lose weight to no avail.
At least the machine will have a SD card.

Not everyone's pressure increases when congested like mine does. I think it's more common to develop a mouth leak, which I have never had a problem with. Others on the board have reported that they switch to a full-face mask when they have a cold.
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#17
(06-18-2012, 03:04 PM)johns019 Wrote: The Dr shot me down on the Auto - said I don't need one.

Unless he has good reasons for this statement, I would go to another doctor. For instance, you might have a high level of Central events and he's afraid that setting an auto BPAP machine too high might induce centrals.

But I certainly wouldn't just leave it as him saying, "you don't need one" without asking "why is that, doc?" His answer or refusal to answer could be very revealing to your future therapy.

If he cops and attitude and says, "just trust me, I'm the professional here, not you", (refusing to explain it to you) then RUN from that doctor.

If he gives a well-reasoned, logical reason that makes sense to you, then you probably want to go by his advice, but ask him to prescribe an auto-BPAP, which can be set like a normal Bi-level with a specific IPAP and EPAP (inspiration and exhale pressure) with no automatic variations. That way, if you need the auto function at a later date, you can use the same machine without laying out additional expense.

There is really no reason not to obtain an auto-CPAP or auto-BPAP (aka BPAP or VPAP) machine these days, if you're able to. They can be set for standard CPAP or standard Bi-level modes (by turning the auto-functions off).

Many doctors don't realize this, which is unfortunate. Even with BPAP, the patients pressure needs DO vary throughout the night, as conditions change such as weight loss/gain, diet changes, exercise changes, drug changes, etc., etc. To assume that a patient will never need an Auto machine is an unfortunate assumption.

By refusing to issue an auto machine, if your needs ever do change during the 5 year useful life of life a CPAP or BPAP machine, you'll have to pay for an auto out of your own pocket, because Medicare and insurance companies usually only cover a new machine every 5 years, unless there's an absolute medical necessity.



SuperSleeper
Apnea Board Administrator
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.



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#18
BabyDoc's experience at the sleep lab side by side with mine suggests that a sleep lab mess up may be one of the easiest routes to getting an Autoset. Unlike BabyDoc, I slept long enough when wired up in the lab, but kept snoring and struggling with apneas afterward using the new titration pressure. That gave me an opening to suggest to the sleep doc that I try an Autoset on loan. Not having any other good ideas, other than doing another sleep study, which I shot down due to cost and the poor results of the one I just had, he agreed. Of course, the autoset loaner got my AHI down dramatically using higher pressures than the false titration indicated during the recent sleep study. Taking the loaner's ResScan printouts back to the doc was all that was needed for him to agree to write for an autoset of my own in trade for the still-new S9 Elite. That sleep lab mess up producing an inaccurate titration pressure was the best thing that happened in my CPAP career to date.
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#19
(06-18-2012, 07:57 PM)Dawei Wrote: That sleep lab mess up producing an inaccurate titration pressure was the best thing that happened in my CPAP career to date.

Sometimes Murphy's Law works out in your favor. Congrats
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.



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#20
I hadn't thought about that, SuperSleeper. Murphy isn't always a pain in the rear afterall!
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