Air sense 10 Elite vs Autoset.

[FrankNichols]

I was wondering. It seems that I could manually do what the Autoset does if I am not in a hurry. Meaning, I could slowly adjust the various settings until I find the optimum for the best AHI results. It could takes months but I would think I could attain the same result.

Is there something I am missing?

My doctor is opposed to starting with an APAP saying it is contra-indicated in my particular case. Something to do with my CAs. I am new, so most of what he said went in one ear and out the other. I understand I could run the APAP in CPAP mode, but I would need a prescription for the APAP to get my Insurance to cover it and it also said they typically prefer me to fail with the CPAP before moving to APAP or BiPAP.

I have a Airsense S10 Elite on order (he did write the script for the elite when I said I wanted the additional data) and it should be here shortly. My "plan" is to go with his numbers (10) for a few weeks and then possibly fiddle (during compliance test - argh) if my AHI is not below 5.

Suggestions?

[Mosquitobait]

I'd still give him crap about it. The DME gets paid the SAME AMOUNT whether it's a cpap or apap. In other words, the doctor is trying to give more profit to the DME for a machine YOU are paying for (you pay your premiums, so it's still your dime). You should refuse the machine and ask your doc to change the prescription for an APAP. If you don't have qualifying CAs, then you are stuck with a piece of crap you didn't want.

If you think you can return the machine later for an apap, you are wrong. Won't happen. Take a stand. Chances are he is more annoyed that you are willing to take charge of your therapy than any particular issue about apaps.

[FrankNichols]

Well, I assume you have had a bad experience with a doctor at some point. My doctor and I work well together and I believe in paying experts for their expert advice and then making my own decision based on that advice. In this situation the doctor doesn't profit in any case so he really doesn't care and isn't motivated to recommend which machine I have other than functionality. His advice was based on several things, one being that my particular symptoms do not respond well to auto mode, and two my titration showed the best results in CPAP mode. He originally wrote the script as basically anything that would provide CPAP with pressure of 10.

I then went to my DME (Aprea) which is my ONLY choice with HUMANA. After speaking with them, I was told that they would fill that script with a Airsense 10 CPAP and if I wanted anything else I would have to get the script changed to specify it. After thinking over the doctors recommendations and reviewing my titration study, and asking here if the CPAP would provide the detailed information I needed/wanted (and finding out it would not) I decided on the Elite. I called the doctor and there was no hesitation, he changed the script to specify the Airsense 10 Elite. It was my decision, based on everything, especially considering Aprea's position and reputation, read on for how that entered into my consideration.

I have never purchase a CPAP machine through Humana/Medicare before and I was more concerned with having issues with my local Aprea than whether or not I got a Auto (knowing they preferred to sell me a CPAP).

Also, I do not expect to upgrade to an Auto. The doctor indicated that if I should fail the compliance test with the Elite (ie. the CPAP does not provide the therapy I need, and there is a possibility that will be the case), the doctor felt the next step for me would be to a ASV machine since my main problem was centrals during my initial sleep study. He felt the titration demonstrated that I might not need the ASV and it would be an easier "sell" to the insurance company if I failed the CPAP machine compliance first and then he upgraded me to an ASV.

I would almost rather just buy the Elite - or Autoset from an online store than be stuck dealing with Aprea (considering there is only about $300 difference between the inflated rental price I will pay them and compared to buying it online). However, I want to try to develop a "good" working relationship with my local Aprea DME. I live the country in a very small town, and I hope (probably wrongly) that the local Aprea will be staffed by more helpful people that most. So, I am attempting to "smooth" the path forward if I have to deal with them later, since I will not be able to purchase the ASV (ASV $5000 vs Elite $900) without insurance which means I will have to deal with Aprea. The other option would be to wait a year to be able to change providers from Humana to someone else (open enrollment just ended today - so it will be a year before I can switch insurance companies). However, other than Aprea issue, I am perfectly happy with Humana so far, and would only want to change if Aprea turns out to be as bad as everyone says and I am looking at multiple thousands in expenses for the Apnea treatment.

So, my question is not did I make a good decision and should I go start a war with my doctor or the DME provider - I made what I believe to be the best decision for me in my situation at the time. MY question was, is there something about AutoSet that allows it to "find the right" settings, that would prevent me from achieving the same manually over time using an Elite.

Thank you for replying. I guess I wasn't clear in my first post and I hope this clears up my question.

[OpalRose]

It would have been easier to to find the optimal setting with an APAP, but I would assume you can achieve the same with your machine. It will just take longer.

A plan would be to raise your pressure by .5cm at a time and watch your data for a week or so. Not knowing what type of events you have (meaning, do you have mostly hypopneas, Obstructives?)
If so, raising pressure would be appropriate to bring AHI down.

If you have mostly Centrals, then raising pressure would not be a good idea as it could cause more Centrals.

This is probably why your doctor didn't want you to have an APAP, he is probably worried about the max pressure being too high if you have a lot of Centrals. That kind of reasoning by your doctor doesn't make sense to me....most of us are intelligent enough to figure this out when tweeking our pressure ranges, and he should be able to monitor that with you.

Now, with that said, there is another comment by your doctor that is incorrect.
If he feels you need an ASV, you will not get it by failing Cpap alone. You cannot go from Cpap to ASV.

You will have to go through all the insurance "hoops", by first failing Cpap/APAP, then failing bilevel, before you can be approved for an ASV by insurance. Plus, I believe the Clear Airway events would have to be >5 per hour. If I'm wrong, someone correct me.

[FrankNichols]

It would have been easier to to find the optimal setting with an APAP, but I would assume you can achieve the same with your machine. It will just take longer.

A plan would be to raise your pressure by .5cm at a time and watch your data for a week or so. Not knowing what type of events you have (meaning, do you have mostly hypopneas, Obstructives?)
If so, raising pressure would be appropriate to bring AHI down.

If you have mostly Centrals, then raising pressure would not be a good idea as it could cause more Centrals.

This is probably why your doctor didn't want you to have an APAP, he is probably worried about the max pressure being too high if you have a lot of Centrals. That kind of reasoning by your doctor doesn't make sense to me....most of us are intelligent enough to figure this out when tweeking our pressure ranges, and he should be able to monitor that with you.

Now, with that said, there is another comment by your doctor that is incorrect.
If he feels you need an ASV, you will not get it by failing Cpap alone. You cannot go from Cpap to ASV.

You will have to go through all the insurance "hoops", by first failing Cpap/APAP, then failing bilevel, before you can be approved for an ASV by insurance. Plus, I believe the Clear Airway events would have to be >5 per hour. If I'm wrong, someone correct me.

Thank you very much for the reply, and while you and I and most of the people here, are certainly smart enough to deal with making intelligent decisions, I truly believe most Americans are not. And he has to (for insurance reasons) go with the safe rather than sorry path.

I had a mix of Centrals and Obstructives. During titration there was no significant improvement with BiPAP over CPAP, in fact I struggled to sleep with BiPAP, so his opinion was that I already failed BiPAP and there is no need to repeat it. (It was done in his sleep center.) (He also left that up to me, saying if I disagreed we could try the BiPAP first, but he didn't think I would be happy/comfortable based on the sleep study results.)

Also, he asked me which way I thought would be best - CPAP or ASV. and then we discussed the various rationale between the two approaches. He did not "force" one on me and would have written the ASV scrip if I wanted it, but felt this approach more appropriate in my case. So, I accepted his view. He did say that in either case I would need to do another sleep study with an ASV to determine that ASV in fact works for me before changing (or starting off), if it should come to that.

I don't have my sleep study handy right now, but I think I was at about 20 to 30 on both OA and CA - meaning around 60 mixed. But, it could have been the two mixed were 20 to 30. I will check that when I get my sleep study paper work (I am picking up next week a complete copy of the tests done so far and his notes) We also did a chest X-ray and Pulmonary Function Test (Breathing tests). I also will need to get a complete cardiac work up before switching to ASV to ensure I don't have any heart issues that are contraindicated with ASV. (Left Ventricle Flow reduction?)

[FrankNichols]

Oops, forgot to say, I was thinking of a binary approach to searching for the "optimum" setting. Meaning start low and then next test go very high. If bad, drop down half way between them, repeat. What I am not sure of is just how "dangerous" that could be, would it be a matter of discomfort and or losing sleep, or could there be potential dangers using that approach?

Thanks,

[pholynyk]

I think your binary search technique is unlikely to succeed because xPAP usage is very much subject to adaptation. You are relatively new to xPAP, and jumping to a high pressure is unlikely to be accepted by your body and brain. I think you will get better results by sneaking up on an optimum pressure, perhaps half a cm per week, and monitoring with SleepyHead.

[sdb7802]

There's really a lot of good info in this thread for navigating the doctor-dme-insurance maze and home titration.

Good luck with your machine, Frank.

Thanks,
Steve

[OpalRose]

Oops, forgot to say, I was thinking of a binary approach to searching for the "optimum" setting. Meaning start low and then next test go very high. If bad, drop down half way between them, repeat. What I am not sure of is just how "dangerous" that could be, would it be a matter of discomfort and or losing sleep, or could there be potential dangers using that approach?

Thanks,

I don't know about dangerous....I'm thinking more on the side of uncomfortable.

I'm not sure that's a great idea. Also, you can't just look at one day and choose a setting (and I know I sound like a broken record), but that's the beauty of an APAP.
You can watch your numbers over a period of time, and get an average pressure to work with, then reset to Cpap mode to please your doctor.

[FrankNichols]

I think your binary search technique is unlikely to succeed because xPAP usage is very much subject to adaptation. You are relatively new to xPAP, and jumping to a high pressure is unlikely to be accepted by your body and brain. I think you will get better results by sneaking up on an optimum pressure, perhaps half a cm per week, and monitoring with SleepyHead.

Cool exactly what I was looking for. And yes, I am totally new, and have no idea what I am talking about - which is exactly why I am asking.

Thank you!

---

Oops, forgot to say, I was thinking of a binary approach to searching for the "optimum" setting. Meaning start low and then next test go very high. If bad, drop down half way between them, repeat. What I am not sure of is just how "dangerous" that could be, would it be a matter of discomfort and or losing sleep, or could there be potential dangers using that approach?

Thanks,

I don't know about dangerous....I'm thinking more on the side of uncomfortable.

I'm not sure that's a great idea. Also, you can't just look at one day and choose a setting (and I know I sound like a broken record), but that's the beauty of an APAP.
You can watch your numbers over a period of time, and get an average pressure to work with, then reset to Cpap mode to please your doctor.

Thanks, yes, I understand what you are saying.