[CPAP] AUTO or not - Is the auto-CPAP machine inherently better than a CPAP?

[SuperSleeper]

[Note: parts of this thread were copied over from our old forum (thread started in December, 2011); some posts have not been included for the sake of brevity]

Since many of us are called upon to make machine recommendations I think we ought to ask a few questions before automatically recommending an AUTO as superior to a CPAP in case at some point we will need to do self tritration. You completely leave the doctor with experience and preferences out of the mix in choosing and prescribing a machine. Many of our friends are not comfortable adjusting their own pressure. I have friends who are perfectly happy with their "brick" machines. They use the machine, feel good and don't care about their numbers. Yon won't find them on any forum. They are doing fine. The argument that by buying the more expensive AUTO to avoid doctors visits for titrations is not a very good one, IMHO. Sometimes there are other problems than just machine pressure needing to be changed. The extra cost for the AUTO is absorbed by all of us when it's asbsorbed by the insurance company.
I think we're giving the impressions- well some are pushing the recommendation (everytime I say I'm happy titrating with my CPAP there is someone telling me I need an AUTO) that AUTO is the only way to go.
If the person is not likely to use the feature, and it often is not necessary to self titrate why lead them to believe nothing else is as good? Why discredit the doc who believes a CPAP is sufficient?

My RT tells me how many of the people he services whose machines end up in the closet. What a waste of money if each of these people had insisted on an AUTO machine. How any people join the forum for advice and we never hear from them again because they're given up on therapy no matter what kind of machine they have.

And, please do not discredit my opinion, you are certainly welcome to yours, but I am tired of being corrected just because I don't agree with you.

[SuperSleeper]

I vote for Auto and data capable. S9 Escape Auto is auto machine but it is not fully data capable, it shows AHI (no breakdown AI,HI,CA) and hours used. No efficacy data on data card, NO Central sleep apnea detection or leak info or mask fit feature.
S9 series specification:
http://www.resmed.com/us/products/s9_ser...nc=dealers

The Benefits of Automatic CPAP Machines:
http://www.apneaboard.com/APAP.htm
http://www.resmed.com/au/clinicians/comp...clinicians

Achieving Compliance
http://www.resmed.com/au/assets/document...july08.pdf

[SuperSleeper]

Many of our friends are not comfortable adjusting their own pressure. I have friends who are perfectly happy with their "brick" machines. They use the machine, feel good and don't care about their numbers. Yon won't find them on any forum. They are doing fine.

Hi Zimlich!

Good thoughts but I wonder though if they're not reading the forums then no one gives them advice here, right? If they're happy and being treated well with their standard CPAP and relying solely on the doctor's advice that is a good thing.

The argument that by buying the more expensive AUTO to avoid doctors visits for titrations is not a very good one,

If they don't have to pay for a doctor visit or avoid causing all our insurance premiums from going up just to do a simple adjustment using an APAP is that bad? Assuming that they know the risks and have followed the precautions we always give around here?

Sometimes there are other problems than just machine pressure needing to be changed.

Like what for instance? I haven't heard anyone say that people should avoid doctor's visits for problems that having nothing to do with CPAP pressure.

The extra cost for the AUTO is absorbed by all of us when it's asbsorbed by the insurance company.

That is not the case. You have some valid points I think but also you're missing something here. Insurance and Medicare generally pays the exact same amount whether or not a patient is given a standard CPAP or an APAP. It's the DME company that makes more money when patients get a standard CPAP and they would like to give everyone a CPAP since they make more money that way. They are remimbursed the same amount of money (usually around $1500) for all CPAPs whether APAP or CPAP. This is the way insurance and Medicare works. So there is absolutely no difference in how much premiums or Medicare cost is payed when it comes to standard CPAP vs. APAP. They only thing you're doing by choosing standard CPAP is making the DME companies richer, you're not saving Medicare payments or insurance premium amounts at all.

Example #1: you get prescribed a CPAP machine by a doctor. The DME gives you a standard CPAP. The DME gets $1500 from insurance/Medicare for that machine, but it cost them only $800. Their profit is $700 if they give you a CPAP machine.

Example #2: you get prescribed a CPAP machine by a doctor. The DME gives you a APAP that can operate in standard CPAP mode (or auto mode). The DME gets $1500 from insurance/Medicare for that machine, but it cost them only $900. Their profit is $600 if they give you an APAP machine.

In either case, no one is paying more for Medicare tax and no one is paying more in premiums. The only difference is the profit level of the DME company.

Actual machine cost: The extra $100 for an APAP is nothing compared to going to the sleep doctor 4-5 times a year and having insurance pay out $100 for each visit in order to get minor adjustments to pressure or consult with a doctor for very simple questions that can be answered within a few minutes in an Internet search or on forums like Apnea Board.

Many people don't have insurance today so it's not taking any money out of anyone else's pocket (not even the DME company) when they choose to pay for an APAP themselves.

I think we're giving the impressions- well some are pushing the recommendation (everytime I say I'm happy titrating with my CPAP there is someone telling me I need an AUTO) that AUTO is the only way to go.

Not sure I've read where anyone said that APAP is the only way to go. People have said it's the best way to go in many cases because there seems to be a lot of opinion that APAPs provide better therapy for most (not all) patients, plus the only one it's hurting financially is the DME company (less profits). They also say it's best because the APAP can also function like a CPAP and still have the option of going with auto mode if need be.

If the person is not likely to use the feature, and it often is not necessary to self titrate why lead them to believe nothing else is as good? Why discredit the doc who believes a CPAP is sufficient?

This is up to the individual patient. Sometimes the doctors can be wrong. Sometimes they can be misinformed. Sometimes they don't have proper training. Sometimes they have no real medical reason for going with straight CPAP other than just "it's what I've done for all my other patients and it seems to work okay". Sometimes they may be "encouraged" by the local DME to prescribe a CPAP rather than APAP so the DME can make more money. Sometimes doctors get kickbacks from the DME to prescribe straight CPAP.

How any people join the forum for advice and we never hear from them again because they're given up on therapy no matter what kind of machine they have.

Probably a lot less than the number who have come here and gotten help from sincere knowledgeable people (like you and others) and have stayed with CPAP because of the help they've received here.

[SuperSleeper]

I am probably going to be buying a new machine out of pocket in the new year. I got the Resmed Escape and I really hate that I get no information or control over my own treatment. I keep going back and forth over what kind to get and it was you, Zimlich, that convinced me that an Auto is good because you can also choose to go straight CPAP.

Right now, I am experiencing a slow rise in blood pressure. Could be several factors but the last time it did this, it was my sleep apnea. We raised the pressure and it went back down. The ONLY "test" I had in relation to OSA at that time was an overnight use with an oximeter. The doc was just guessing, based on what I assume was lower O2 at night. If I had an Auto or at least one that tracked data, I would have known much sooner that it was OSA to blame. Instead, I went through a series of tests including a stress test and a heart cath! (scary test, lemme tell you)

So in January or Feb., I will be getting an Auto that can also go straight CPAP. I will check the data on a regular basis and if something comes up like it is now, I can switch it to Auto and see what happens. I am taking control of my own health, not sitting idly by while we all guess and wonder.

[SuperSleeper]

I just got an S9 Elite and really like it over the S8 I've been using. I didn't want to go with an Auto even though the Dr. would have written the Rx for one, if I wanted one. I would rather have a set pressure that I can change when I decided it might be needed, rather than rely on a micro processor to make a decision for me. I'm not paranoid but I like to have control. Although the main reseason I chose the Elite over the Auto was I would have waited while the Auto was ordered and shipped vs taking home the Elite home last Friday. Instant gratification wins almost every time.

[SuperSleeper]

How often does the Auto PAP make an adjustment to the pressure? Does it change with every breath, or does it stay at one pressure for a day before it changes?

What are the advantages of AutoSet devices?
AutoSet devices adjust pressure on a breath-by-breath basis to suit patient needs as they change throughout the night. As a result, patients receive the minimum pressure required for effective therapy. The lower average pressures improve comfort, reduce pressure-related side effects, and lead to more consistent use of therapy.
How do AutoSet devices know to adjust pressure?
After you fall asleep and your pressure needs begin to vary, your AutoSet device responds to three separate parameters: inspiratory flow limitation, snore, and apnea. AutoSet devices act pre-emptively by increasing pressure in response to inspiratory flow limitation and snore, both of which typically precede obstructive apneas. The AutoSet device calculates the pressure you need based on the severity of the event. This early intervention prevents obstructive apneas and reduces respiratory arousals.
How do the AutoSet devices handle hypopnea events?
AutoSet devices respond to obstructive hypopnea events when they are associated with flow limitation or snoring. Hypopneas that are central in origin (related to your central nervous system, not physical obstruction) should not be treated with increased pressure.
http://www.resmed.com/au/service_and_sup...c=patients

Central Sleep Apnea Detection and the Enhanced AutoSet Algorithm
http://www.resmed.com/au/assets/document...-paper.pdf

[SuperSleeper]

My RT tells me how many of the people he services whose machines end up in the closet.

IMO the RT failed miserably in his duty of care to these people who he suppose to be helping. Here are some examples what doctors can do to help their patients in achieving compliance from ResMed clinical newsletter.
Achieving Compliance
http://www.resmed.com/au/assets/document...july08.pdf

[SuperSleeper]

zonk, that RT was excellent. Just not everybody follows drs orders. Some people are not going to use the machine.
And zonk, woulld you please say in your own words the ideas you post links to. I don't follow the links and it would mean so much more coming from you personally.

[SuperSleeper]

Re: Data capable

Fully data capable is ALWAYS the correct choice. Many patients have different results sleeping at home than in a sleep lab. May patients have an occasional bad night, and might not luck out and have their bad night in the lab when they're hooked up to the equipment. Data from many nights at home is better than data from a single night.

If your doctor isn't looking at data from a fully data capable machine on followup visits, he should learn how to do it. That's like treating a heart attack patient by taking his pulse instead of looking at EKG data.

Re: Auto

Buying an Auto machine is almost always the right answer. Even without insurance, the cost difference is less than the cost of a couple of doctor visits. It's much cheaper than the cost of an additional in lab sleep study. If it helps compliance, it helps prevent wasting the cost of a sleep study and a CPAP machine, and prevents reduce expensive health problems in the future. It can help improve the efficiency of the treatment.

ResMed S9 CPAP AutoSet vs. Elite manual CPAP online is $853 vs. $805 at one online supplier. Philips Respironics is $519 vs. $419. As someone pointed out, insurance companies and insurance patients usually pay the same price.

The Auto machine can be set to do manual CPAP. Even if you start it out on manual CPAP, if the patient has problems, you can set it to do auto for a few nights to see if you can find a pressure that works better. If you're concerned about auto machines "running away" to a high pressure or not supplying enough pressure, you can set it to auto adjust in a narrow range above and below a chosen pressure and see if a slight change works better.

Simply put, the auto machine only costs a little more, and has large potential cost saving benefits. An Auto machine has all the capabilities of a manual CPAP.

I think if a doctor is NOT attempting to get fully data capable auto CPAP machine for all his patients, he needs to look into learning how to use the modern capabilities in order to give better service to his patients.

If the insurance companies were smart, they'd require all prescriptions to be filled with fully data capable Auto machines by a DME who will read the data card at a followup visit. The potential cost savings are so high that it's really a no brainer.

[SuperSleeper]

I think if a doctor is NOT attempting to get fully data capable auto CPAP machine for all his patients, he needs to look into learning how to use the modern capabilities in order to give better service to his patients.

If the insurance companies were smart, they'd require all prescriptions to be filled with fully data capable Auto machines by a DME who will read the data card at a followup visit. The potential cost savings are so high that it's really a no brainer.

Absolutely, 100% TOTALLY AGREE.

Very good points, archangle!