[Equipment] New user - CPAP vs APAP

[janesleeping]

Dx with AHI 48.
I have been on trial with ResMed S9 set at CPAP 8. AHI 8-25
Reset CPAP 10 for 2 weeks, AHI averaging around 12, then to CPAP 11.
Dr wrote Rx for CPAP 11 machine. When I asked for Auto set machine the Sleep store told me that the Dr had not written a script for Auto. Government pays a portion for machine but only according to prescription.
How does the Dr determine whether or not to order a CPAP or an APAP?
It seems from my reading that APAP is easier for compliance and comfort and handles the problem better. When I asked the Dr for a new Rx for an APAP she said that only the CPAP machine was covered but that is not the case. Since the ResMed Auto can be set at CPAP OR APAP I am thinking I should buy the ResMed Auto and pay the difference if needed.
New Rx written for APAP 7-13, but now Sleep Store trying to talk me out of the APAP. Feel like I am getting the run around.
ResMed S9 or S10?
What is the life of a sleep machine?
Comments?

[DariaVader]

Where are you located? Govt Regs and ability to up-select depend on country... IMO, APAP *is* easier and better for 98%, but much of the health industry has not caught up with the latest tech. If you are stuck with straight CPAP at least insist the model that does data (Elite for Resmed)

In Canada, for instance, the pressure needs need to deviate by at least 4 cmh2o positionally, or REM vs non-REM to be considered for an Auto PAP.

Typically you are stuck with your choice for 5 years.

[PsychoMike]

Welcome Janesleeping,

I'd push for the APAP....confirm for the doc that it is covered and voice that it may be easier to adjust to the auto-titrating machine...they want you to have best results, so that will help.

As for the durable medical equipment supplier (a.k.a. DME)....yeah, they want to give you a non-data capable machine that is as cheap as possible for them to get. Insurance pays a fixed amount, so if they can get you into a cheaper model, it means more $$'s in their pocket. Stick to your guns and get what you need to get the best treatment for you.

Manufacturers typically say machine life is 5 years.

[Sleeprider]

You never really did get CPAP pressure to reduce AHI events below 12 per hour. That's not so good. An auto CPAP will continue to try to titrate a correct pressure, and it will also report the kinds of events that make up residual AHI. If you were experiencing central apena as part of that, then positive air pressure alone will not resolve that. However, an APAP will accommodate different sleeping positions and changes in health that may change your pressure needs, without requiring additional sleep studies.

I'm sure the equipment supplier wishes you to take the somewhat less expensive CPAP since they are likely reimbursed the same amount for fixed CPAP or APAP. Both are actually CPAP devices. If you do some research online, you'll find the difference in cost is not much.

[janesleeping]

Thank you Daria
I AM in Canada.
Thank you for enlightening me.
Jane[/b]

Where are you located? Govt Regs and ability to up-select depend on country... IMO, APAP *is* easier and better for 98%, but much of the health industry has not caught up with the latest tech. If you are stuck with straight CPAP at least insist the model that does data (Elite for Resmed)

In Canada, for instance, the pressure needs need to deviate by at least 4 cmh2o positionally, or REM vs non-REM to be considered for an Auto PAP.

Typically you are stuck with your choice for 5 years.

[janesleeping]

Thanks Mike. You have enlightened me and helped with my decision.

Welcome Janesleeping,

I'd push for the APAP....confirm for the doc that it is covered and voice that it may be easier to adjust to the auto-titrating machine...they want you to have best results, so that will help.

As for the durable medical equipment supplier (a.k.a. DME)....yeah, they want to give you a non-data capable machine that is as cheap as possible for them to get. Insurance pays a fixed amount, so if they can get you into a cheaper model, it means more $$'s in their pocket. Stick to your guns and get what you need to get the best treatment for you.

Manufacturers typically say machine life is 5 years.

---

Thanks Sleeprider. I understand better now and will be able to make my decision.

You never really did get CPAP pressure to reduce AHI events below 12 per hour. That's not so good. An auto CPAP will continue to try to titrate a correct pressure, and it will also report the kinds of events that make up residual AHI. If you were experiencing central apena as part of that, then positive air pressure alone will not resolve that. However, an APAP will accommodate different sleeping positions and changes in health that may change your pressure needs, without requiring additional sleep studies.

I'm sure the equipment supplier wishes you to take the somewhat less expensive CPAP since they are likely reimbursed the same amount for fixed CPAP or APAP. Both are actually CPAP devices. If you do some research online, you'll find the difference in cost is not much.

[janesleeping]

Thanks Sleeprider. I understand better now and will be able to make my decision.

You never really did get CPAP pressure to reduce AHI events below 12 per hour. That's not so good. An auto CPAP will continue to try to titrate a correct pressure, and it will also report the kinds of events that make up residual AHI. If you were experiencing central apena as part of that, then positive air pressure alone will not resolve that. However, an APAP will accommodate different sleeping positions and changes in health that may change your pressure needs, without requiring additional sleep studies.

I'm sure the equipment supplier wishes you to take the somewhat less expensive CPAP since they are likely reimbursed the same amount for fixed CPAP or APAP. Both are actually CPAP devices. If you do some research online, you'll find the difference in cost is not much.

[pholynyk]

Jane, each province has different rules for paying for durable medical equipment, so it would be useful to put your province in the location field of your profile. We have members in (at least) BC, Ontario, and Quebec, so the odds are pretty good somebody can help with the health insurance questions.

[trish6hundred]

Hi janesleeping,
WELCOME! to the forum.!
Get an APAP if you can, for the reasons mentioned in the above posts and Much success to you with your CPAP therapy.
Good luck with getting the machine that you really want and that will meet your needs.
Hang in there for more responses to your post.

[GPSMapNut]

In Ontario, 4 cm variance is required to get ADP to pay for 75% of the cost of APAP. That must be documented by the sleep study results. In my case, the doctor ordered specific, APAP oriented study and I just made the cut. If your sleep study was not APAP oriented than, I'm not sure if you can get the funding... maybe, just maybe, that's what the doctor was telling you.
Also, remember that one can get the funding only once every five years. If you accept CPAP now, ADP may not cover APAP before 5 years are up. I'm not sure. You have to check on that.

As for APAP vs CPAP, IMHO it's no brainer. APAP is better - it can treat with normally lower pressure and increase it only when higher is required.
I used to be at 13.4 CPAP. Now, with APAP, 90% of the time I'm at 10.5 or less with similar results.

I looked up - the change is possible.

Quote from: http://www.health.gov.on.ca/en/pro/progr...manual.pdf

505.01 Clients who have received ADP- funded respiratory Devices and continue
to meet the general (see the ADP Manual, Policy 300, Eligibility Criteria
for Program Benefits) and Medical Eligibility Criteria (see Part 3,
Applicant Eligibility Criteria for Respiratory Equipment), are eligible to
re-apply for Funding either during or after the designated minimum funding
period has expired, if there is:
 a documented change in the Client’s medical/respiratory status and
the ADP funded respiratory Device no longer meets the Client’s
basic respiratory needs, as defined by the ADP; or
Respiratory Equipment Policy and Administration Manual
September 2012
27
 damage due to normal use and wear, and the Client confirms that
the respiratory Device is no longer under warranty and the cost of
the repair is more than one third of the original purchase price.