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Sleep doc's views of APAP machines
#1
Although I'm not sure if there is anything new here, I thought it may prove interesting to share part of the conversation I had today with my sleep doc. He's a pulmonologist and a Diplomate of the American Board of Sleep Medicine--a nice guy who's easy to talk to. He asked me if I liked my new S9 AutoSet, and of course I answered that I do indeed! I arrived with ResScan printouts for him. When we were discussing why more folks don't get (aren't given) APAP machines, he mentioned three things. First, as I recall, was that they are more expensive than a straight CPAP. I said yes, but not much more at all--in the range of about $60. He had the idea that they are more expensive and that, he surmised, might be one reason insurance companies don't want to pay for them. So, extra expense was one thing in his view. Another point he made was his impression (experience?) that patients are disturbed by the changing pressures of an APAP. He asked me if I was bothered by this. I told him no. Although I may be aware of a higher pressure at times when I'm not fully asleep, most of the night I'm not aware since I'm sleeping. The last thing he mentioned about APAP vs CPAP is that the medical literature does not show that there is any particular benefit of an auto machine over a fixed pressure one.
I would find your comments about this conversation interesting.
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#2
From what I've heard, people who require higher pressures like them because they can spend more time at lower pressures than they can with a CPAP.
Sleepster
Apnea Board Moderator
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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#3
I hadn't thought of that, Sleepster, but it's certainly the case.
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#4
I believe he's right on all counts. I haven't explored the differences in the prices which would affect the insurance company. I also do not believe APAP is superior to CPAP in performance or results. Now the older people ( in terms of machine use) on the forums are, I believe, highly educated
in the use of their machine and have a better understanding of how to use their APAP. These are people very involved in their treatment who may like to tweak. I believe so many new people put their machines in the closet or are confused by the settings that the extra expense (or perception of) is not warranted. A quick look at ResMed basic machines shows the difference to be more like $100 without humidifier. I have used CPAP, Bilevel, AUTO and now ASV. The ASV meets my needs, but I prefer a CPAP. You obviously are quite involved in your therapy, educated and have a supportive physician. You probably get optimum results from your AUTO.
Nice thread, it's been gone over before, but we have new people and I believe this is good to talk about.

Good point Sleepster, a bilevel should work for those folks, too, but I don't know price comparisons.
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#5
My doctor automatically prescribes an APAP for patients who need higher pressures. Also, after my diagnostic sleep study, he gave me a choice of an APAP or a titration study. (I had a split study scheduled but I could not stay asleep long enough to titrate my pressure.) I am not bothered by pressure swings.
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#6
the problem to do with US insurance compliance reporting
[my insurance or my doctor don,t give a hoot]
a patient has to use the machine at least 4 hours each night for the machine to paid by insurance

doctors need to know that cpap/apap are billed by the same code E0601 and DME get paid exactly the same amount for a brick or top end machine just they make more money giving out the bricks

some doc have a business connection with suppliers or get kickbacks so they,re really not that fussed whether the patient adequately treated or not .. conflicts of interests

if uninsured ... online price difference is minimal

apap can run on fixed pressure too ... just like cpap

in Norway as a member said ... everyone is given S9 Autoset

incorrectly set machine whether cpap or apap is not good idea but with apap can be easily rectified

as always been said "buyer beware"
just my opinion ... there is right one ... wrong one ... and mine Too-funny








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#7
(10-17-2012, 07:41 PM)zonk Wrote: doctors need to know that cpap/apap are billed by the same code E0601 and DME get paid exactly the same amount for a brick or top end machine just they make more money giving out the bricks

That's likely true for many DME's dealing with US insurance companies and with medicare, but it's not true in all cases in the US.

My insurance company provides a plan where we pay a certain percentage of the cost of the machine. The more the machine costs the more the DME gets paid by the insurance company.
Sleepster
Apnea Board Moderator
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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#8
I think they also have taken a bad rap because a lot of people thought you could just set them to 4-20 auto and forget about it.

While that works for some people, it's much better to set at least the minimum pressure to something where the patient is getting some apnea relief when he first falls asleep. Also, if you fit your mask at 4 cmH2O, but always auto up to 8 cmH2O, you're more likely to have leaks.

Most people may do OK with a wide open maximum pressure, some people will do better with limiting that as well.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#9
(10-17-2012, 08:53 PM)Sleepster Wrote:
(10-17-2012, 07:41 PM)zonk Wrote: doctors need to know that cpap/apap are billed by the same code E0601 and DME get paid exactly the same amount for a brick or top end machine just they make more money giving out the bricks

That's likely true for many DME's dealing with US insurance companies and with medicare, but it's not true in all cases in the US.

My insurance company provides a plan where we pay a certain percentage of the cost of the machine. The more the machine costs the more the DME gets paid by the insurance company.
that could explain why some choose to go online and buy apap out of pockets
anyone looking for a bargain ... PRS1 Auto 50 series - save $$$ and compatible with SleepyHead Thumbs-up-2
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#10
(10-17-2012, 06:50 PM)Sleepster Wrote: From what I've heard, people who require higher pressures like them because they can spend more time at lower pressures than they can with a CPAP.

That's certainly an important reason why I use my machine in AutoSet mode .

Sleepyhead software shows that the pressure on my APAP goes up and down like Alpine peaks throughout the night, which I interpret as meaning that a fixed pressure would be too high at some points and too low at others for what I need.

That said, I do wake up once or twice a night, generally at one of the peaks in pressure., so there does seem to be a trade-off at work, at least in my case.

My average ahi is 0.8 (compared with 35.9 in my sleep study).

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