Throwing in my two cents:
(05-09-2014 08:15 PM)SuperSleeper Wrote: If patients start refusing to accept dumb bricks, or if they stop accepting CPAPs in deference to APAPs, the manufacturers will start making more APAPs in response to the market. Under the current Medicare and insurance reimbursement scheme, patients can be issued any type of CPAP (Auto or fixed pressure) under the same billing code. But the more we have patients willing to "go with the flow" and blindly accept whatever is given to them by a less-than-completely-honest DME, the less control over our own treatment we have, and the more money we end up spending in the long run, as eventually many informed CPAP owners end up spending their own money to get an APAP, which in the majority of OSA cases offers more effective treatment.
It's not that there is an increasing number of patients who are "willing to 'go with the flow'". The problem is that folks like us represent a small minority of OSA patients. Most newly diagnosed patients are totally uninformed about the fact that different kinds of PAP machines exist---they literally have NO idea that some machines record full efficacy data and some only record usage. And they have no idea that an APAP exists and that it has the same billing code as a CPAP.
And in most cases, no one bothers to educate the newly diagnosed OSA patient. Not the doctor, not the sleep tech, not the insurance company and certainly not the DME. Yes, a small percentage of newly diagnosed patients take the initiative and go on line and find a forum like this before
they meet with the DME and get stuck with a brick (that they don't even know is a brick). But most don't.
And as long as the docs and insurance companies do not demand efficacy data
in addition to usage data, the DMEs will continue to set up as many patients with bricks as they can since it's good for their short-term
bottom line. And the manufacturers regard the DMEs as their customers instead of us. So as long as the DMEs want to sell us bricks and keep ordering them from the manufacturers in great numbers, that's what the manufacturers will make.
(05-09-2014 09:06 PM)zonk Wrote: IMO ... No reason why APAP [to be precise, S9 AutoSet (not just any APAP)] is not for everyone
Ok: First, I agree that all newbies ought to be set up with an APAP rather than a CPAP; APAPs are much more versatile and can be set to straight CPAP for people who do better on straight CPAP.
But: The Resmed S9 AutoSet is just not any better than the PR System One Auto CPAP. Most newbies won't be able to feel much of a difference between the way the two machines feel in use. Both machines have well tested and effective
auto algorithms, provided the machine is not left running wide open. Both machines distinguish between OAs and CAs and record full efficacy data.
And there are SOME people who find the System One's Auto algorithm and a choice of A-Flex to be more comfortable than the S9's Auto algorithm with EPR. But yes, there are also SOME people who prefer the way the S9's auto algorithm and EPR feels.
Also add in the fact that the System One runs off of 12volt power, so you don't need an inverter if you're using a battery (flexibility while camping is important to some of us.) And the fact that the System One doesn't overwrite the detailed data on the SD card every seven days, so you don't have to download it at least once a week if you're inclined not too. And the price of the System One Auto is often $100-200 cheaper than the S9 AutoSet if you are forced to buy completely OOP. So for some people, the System One makes a lot of sense.
zonk Wrote:To assume the S9 AutoSet increase pressure at a whim is a fancy idea, the machine can distinguish between types of apneas and prevent apnea by monitoring snoring and flow limitation which typically precede obstructive apnea (not central apnea) and reduces arousals
The problem is: Flow limitations can lead to unnecessary pressure increases. And wake breathing can be misinterpreted as flow limitations, hypopneas, and OAs as well as CAs. And so if you're having a restless night with a lot of tossing and turning (caused by some non-OSA reason), that "sleep/wake/junk" breathing can cause the machine to increase the pressure more than it needs to. (And this is a problem with ALL Auto PAPS, not just the S9 AutoSet.)
For some of us, there's a balancing act that has to be done: Too much pressure triggers other problems---perhaps they're as "simple" as aerophagia or perhaps they're more involved such as triggering centrals. And if you're one of the unlucky people who has a natural "max pressure tolerance" before the PAP starts causing problems, then you really don't want the machine continuing to increase the pressure unnecessarily. Of course, the intelligent thing to do when faced with this need to make some tradeoffs on pressure is to set the max pressure low enough to not cause (too many) problems and high enough to effectively treat the obstructive events.
SnuffySleeper Wrote:I know I am in the minority, but what I have read is that it is much more common than people think.
Seeing as a pressure of 6 or 7 makes me feel like I am not getting enough air, an apap would not do me much good as the only pressure I can do without it causing central apneas is 8 or 9.
(05-09-2014 09:14 PM)retired_guy Wrote: Snuffy, I wonder what would happen if you were to use a system where your exhale pressure was around 9, and your inhale around 12 max? What is being reported as "centrals" might be helped with the lower exhale while your obstructive might be helped with the higher inhale? I don't know for sure actually, but maybe it's something that could be explored with you doc.
Unless Snuffy is having problems keeping the obstructive events under control running at a fixed pressure of 8 or 9, there's nothing to be gained by allowing his inhalation pressure to go all the way up to 12 cm and there's the potential for a whole lot of problems.
That said, I've not gone back and checked all the posts. It could be that at a straight CPAP pressure of 8 or 9 cm, Snuffy's obstructive events are not yet well controlled. And in that case, Snuffy and his doc need to do some real exploring about what might be an appropriate way to handle the situation.