I have the cpap model...not the elite

[tedburnsIII]

Good post #44, kaiasgram!

[zonk]

First of all, Dawn knows the type of data available on her machine, she wrote (post #15) "I can see compliance, mask seal, leak rate, and AHI"

The question is not about whether the machine provide adequate treatment or not, but rather who make most money by dispensing bricks

Insurance does not care about machines data, only about compliance, they pay by billing code 0E601 (brick or top end) same amount for any machine comes under this code. Maybe things have changed since Obama care but I'm not aware of

DME (lousy ones) does care about machines, they pocket extra $$$ if dispensing the lower end machines

So my question to my learned friends, given choice which machine you choose?

49er wrote (post #34) "Since Dawn still has time to exchange the machine, now is the time to do it before it is too late"

I agreed (post #39) "strike while the iron is hot"

Now, back watching "The Voice" and sipping nice glass of Aussie wine

Cheers

[archangle]

Well, let's simplify this.

1) IMHO, you did get screwed. Nothing unusual about this.
2) If your pressure setting is what you need to fix your apnea, the machine will give you good therapy.
3) If your pressure doesn't "cure" your apnea, your machine may give you very limited information (nightly AHI) to indicate this.
4) An Elite or AutoSet machine would give you much better data about how your therapy is working. They will give you or your doctor a lot more info on what's wrong, how severe it is, and how to fix it.
5) The A10 CPAP isn't a total "brick," since it does give nightly AHI data. However, to me, it's inexcusable to dispense such a machine when the Elite model gives much better data.
6) The A10 CPAP will NOT distinguish central from obstructive apnea.
7) The A10 CPAP only gives you a nightly average, not info about whether you have, for instance, a lot of "false" apneas as you're lying awake, or as you fall asleep.
8) The A10 CPAP does not give you airflow waveforms or minute by minute leak graphs.

Insurance and many doctors are stuck in the dark ages on CPAP. There's no excuse to not have a fully data capable machine with airflow waveforms.

To me, the A10 CPAP vs. Elite is like driving your car on a frosty morning with just a patch of your windshield scraped clean vs. cleaning all the windows and mirrors.

[zonk]

To me, the A10 CPAP vs. Elite is like driving your car on a frosty morning with just a patch of your windshield scraped clean vs. cleaning all the windows and mirrors.

and the AutoSet is like a driverless car

Cheers

[vsheline]

Hi mzdawn74,

You asked what to say to the doctor when he points out your AHI is spectacular and clearly you don't need no stinkin' APAP.

The main thing is to be persistent and to emphasize that something is not right because you still feel terrible and cannot sleep.

Although you did not have many RERA events (see below for definition of RERA) during your diagnostic study and maybe not any during your titration (during just a few hours on one night), you could still be having them now, and having a machine which reports RERA events (which the A10 AutoSet For Her does) may be important in your case. Your present machine (and even the A10 Elite) does not report RERA events.

As the therapy pressure is increased, apneas tend to be replaced by hypopneas, and then at higher pressures hypopneas might be prevented but Flow Limitation and RERA could still be happening without you having any way to know. Your present machine does not respond to Flow Limitation (an APAP would) and does not report RERA events. The Clinician Guide for the A10 AutoSet For Her says it reports RERA events whether in Auto mode or CPAP mode, and it says the A10 Elite does not report RERA.

This might be the best reason to give the doctor for why you are asking for the AirSense 10 AutoSet for Her: to give you the best chance of success in finding what the problem is, why, although you are trying to use the machine, you still feel terrible and foggyheaded. You may be having many RERA events disturbing your sleep, and you are asking for a prescription which would allow you to have a machine which is capable of reporting RERA. Good luck!

Background Info:

RERA stands for Respiratory Effort Related Arousal, which is an arousal caused by needing to exert too much effort in breathing, usually caused by Flow Limitation.

Flow Limitation is caused by a partial restriction of the airway which limits the Flow rate of air entering our lungs while we are inhaling, which can make inhalation uncomfortably hard, which may lead to an arousal.

RERA events are arousals which disturb sleep, but because the reduction in respiration was less than 50% (or because some other requirement for being classified as hypopnea was missing) these will not be counted as hypopneas and therefore will not be counted in the AHI. (By definition, an event cannot be counted both as a RERA and as an hypopnea.)

So, conceivably, a person who has lots of RERA but few apneas and hypopneas may have a great AHI but may be unable to sleep well and may feel always fatigued and mentally foggy, etc.

[kaiasgram]

Good post #44, kaiasgram!

Thank you.

To be clear, Ted, I don't share your general orientation to the issue of data and software -- here or on the other forum. I hope Dawn will advocate strongly for a full data machine this week, and I agree completely with Arch and others who argue that there is no excuse for the sale and distribution of brick and half-brick machines today.

Dawn was asking a couple of questions in her OP and in her previous thread -- one was about the availability of efficacy data and the other was about whether the delivery of positive airway pressure (PAP) was functionally inferior because of the lack of full efficacy data. I wanted to tease apart the two issues for her and clarify that her half-brick machine is still treating her apnea, in an effort to reduce some of her stress and anxiety. But in no way do I think that means she should accept the half-brick CPAP model.

I think Dawn understood my point. I hope everything works out this week with the DME and that there's a smooth exchange for her.

[mzdawn74]

Good post #44, kaiasgram!

Thank you.

To be clear, Ted, I don't share your general orientation to the issue of data and software -- here or on the other forum. I hope Dawn will advocate strongly for a full data machine this week, and I agree completely with Arch and others who argue that there is no excuse for the sale and distribution of brick and half-brick machines today.

Dawn was asking a couple of questions in her OP and in her previous thread -- one was about the availability of efficacy data and the other was about whether the delivery of positive airway pressure (PAP) was functionally inferior because of the lack of full efficacy data. I wanted to tease apart the two issues for her and clarify that her half-brick machine is still treating her apnea, in an effort to reduce some of her stress and anxiety. But in no way do I think that means she should accept the half-brick CPAP model.

I think Dawn understood my point. I hope everything works out this week with the DME and that there's a smooth exchange for her.

I did! And thank you for helping me out yet again. I wish you were closer to San Diego, as I would love to work with you personally. I've yet to meet a therapist I actually enjoy talking to and felt comfortable with, until now with you. :grin:

[mzdawn74]

Hi mzdawn74,

You asked what to say to the doctor when he points out your AHI is spectacular and clearly you don't need no stinkin' APAP.

The main thing is to be persistent and to emphasize that something is not right because you still feel terrible and cannot sleep.

Although you did not have many RERA events (see below for definition of RERA) during your diagnostic study and maybe not any during your titration (during just a few hours on one night), you could still be having them now, and having a machine which reports RERA events (which the A10 AutoSet For Her does) may be important in your case. Your present machine (and even the A10 Elite) does not report RERA events.

As the therapy pressure is increased, apneas tend to be replaced by hypopneas, and then at higher pressures hypopneas might be prevented but Flow Limitation and RERA could still be happening without you having any way to know. Your present machine does not respond to Flow Limitation (an APAP would) and does not report RERA events. The Clinician Guide for the A10 AutoSet For Her says it reports RERA events whether in Auto mode or CPAP mode, and it says the A10 Elite does not report RERA.

This might be the best reason to give the doctor for why you are asking for the AirSense 10 AutoSet for Her: to give you the best chance of success in finding what the problem is, why, although you are trying to use the machine, you still feel terrible and foggyheaded. You may be having many RERA events disturbing your sleep, and you are asking for a prescription which would allow you to have a machine which is capable of reporting RERA. Good luck!

Background Info:

RERA stands for Respiratory Effort Related Arousal, which is an arousal caused by needing to exert too much effort in breathing, usually caused by Flow Limitation.

Flow Limitation is caused by a partial restriction of the airway which limits the Flow rate of air entering our lungs while we are inhaling, which can make inhalation uncomfortably hard, which may lead to an arousal.

RERA events are arousals which disturb sleep, but because the reduction in respiration was less than 50% (or because some other requirement for being classified as hypopnea was missing) these will not be counted as hypopneas and therefore will not be counted in the AHI. (By definition, an event cannot be counted both as a RERA and as an hypopnea.)

So, conceivably, a person who has lots of RERA but few apneas and hypopneas may have a great AHI but may be unable to sleep well and may feel always fatigued and mentally foggy, etc.

Thank you for this detailed response. I am going to be using these suggestions as my main argument why a APAP is needed in my case.

Does the APAP treat the RERA's as well as the apnea and hypopneas?

[DariaVader]

One issue that has not been raised is that the AHI is low at least in part because she is not asleep. To get a true picture of the efficacy of the therapy, you first of all need to actually sleep. It would be very helpful to consider what is keeping you from sleep and address those issues.

beyond that - I am a huge advocate for having more data, and I firmly believe that the additional insight into the treatment is crucial to help many people accept the treatment.

[vsheline]

One issue that has not been raised is that the AHI is low at least in part because she is not asleep. To get a true picture of the efficacy of the therapy, you first of all need to actually sleep. It would be very helpful to consider what is keeping you from sleep and address those issues.

Dawn - If you are using the machine 4 hrs a night and are asleep during those four hours, the AHI the machine calculates would be considered valid. The reported AHI would not include any RERA events which might have occurred but the AHI reported would be considered a valid AHI calculation for the average number of apneas plus hypopneas occurring while you are asleep.

Only the data recorded during time you are asleep and at full therapy pressure can be validly used in calculating the AHI. The machine does not know whether you are asleep or awake but assumes you are asleep. If you are awake half the time or all the time you are receiving therapy then the AHI calculated by the machine would be half or totally invalid.

The machine does not count the time or the events during the Ramp time (if the Ramp is used) but assumes you we asleep and uses the events (or lack of events) for all other therapy time in calculating the AHI.