Picking a CPAP

[Tinman53]

Especially with Medicare advantage systems....  I have an appointment to meet with the Doctor to schedule my sleep study.  My current CPAP is a brick with no info recording, no auto settings, just a ramp up to my max pressure where it stays all night.
Therefore, I am certain that I will be getting a new machine (and will insist on it).  

I understand that the Doctor provides guidance on type of machine and its capabilities but did you get any input on specific brands or models within his/her specifications?

When I got my first machine, 12-14 years ago, I didn't know anything about it - when to the DMS office and was given a machine, no discussion, no real training, nothing.  

Appreciate you sharing your experiences on the topic.

Michael

[OpalRose]

Tinman53,
Glad to hear you will be scheduling a sleep study.  Your doctor will determine your needs (meaning the type of machine you will need) from the data on your study.

The first thing you should do is call your insurance and find out what coverage you have for your sleep study and machine.  Also, ask for a list of DME's (Durable Medical Equipment providers) that they contract with.  This way, you have a choice of who to use ahead of time.  

Here is a link that may help you understand a little more about the different machines available.  

http://www.apneaboard.com/wiki/index.php...ne_choices

[Walla Walla]

After you read the choices link read the following link about DME's. http://www.apneaboard.com/wiki/index.php...with_a_DME

[Tinman53]

Thanks for the input. I read both the wiki sites.

I must be living right. My initial appointment with the Sleep Doc, new to me (old Sleep Doc did absolutely nothing first time around, as a matter of fact, I never met him) was scheduled for the end of next month. I sent an email to the office and asked them to consider me as a replacement for any cancellations. Got a call today and they changed my appointment to Tuesday! I am hoping that I can get in for the study within the next two weeks and get this process moving.

In dealing with medical services extensively in the past I have learned something very valuable. The medical team you hire works for you, the patient, not the other way around. I fired my PCP a few years ago and it saved my life. I am not afraid to fight for what I believe is right, but I like to have all the information I can obtain before going down that road.

Thanks again.

[OpalRose]

Good for you. It’s important to be armed with information before your visits. Hope you get your study soon.

[Tinman53]

Had my preliminary meeting with my Pulmonary Doctor. Ran some pulmonary function tests and discussed my history. He was amazed that my CPAP has been operating this long (about 12-14 years) and that I have never been contacted about replacing it or being retested.

My Sleep Test has been scheduled for the 18th, but they will contact me if somebody drops out of a scheduled test. He has already indicated that he is certain my settings will have to be increased and that I will be supplied with an AutoPAP or Auto BiPAP, depending on tests results.

Looks like things are moving along. I was very satisfied with our meeting and his willingness to discuss things until all my questions were answered.

Thanks your support and assistance!

FYI: we discussed ASV units, but he said that they are being boycotted right now due to some deaths during testing with cardiac patients.

[Sleeprider]

Tinman, the only reason to consider an ASV machine is if you have central or complex apnea. For most people using CPAP, an appropriate upgrade is the auto CPAP, and the best of those is the Resmed Airsense 10 Autoset. If you had a machine with data, and especially auto-titrating, it is unlikely you would even need another sleep study as you would know exactly your efficacy and range of effective pressure.

If you don't have any complications, just get the Autoset, and keep copies of your sleep studies for future reference. Since 2008, I have never had another sleep study, and don't anticipate I will ever need one.

[Tinman53]

The doctor mentioned different types of PAPs and had not mentioned the ASV machine so I was curious and asked about it. That when he told me that information. He did say that I would need at least an AutoPAP. So, it will be interesting to see what the sleep study shows.

[SarcasticDave94]

I don't agree to a ban of my ASV machine. Second opinion? That doc is a little bit ill informed.

OK seriously, the ASV machine is not the device you need. Being curious and asking questions is perfectly OK though. I will say that the longer I'm here on Apnea Board, the more ASV machine users have cropped up. When I first signed up, I was only aware of a few. And that didn't include myself as I was on BPAP at that time.

For you? APAP should be fine and you'll gain a smart device too with a newer model.

[Sleeprider]

Auto bilevel is a very nice improvement on CPAP for comfort. The Airsense 10 Autoset offers up to 3 cm of exhale pressure relief which functions a lot like bilevel. For higher pressure support you need a true VPAP or BiPAP machine which increases the cost, but offers a lot of flexibility. Many sleep tests do nothing more than judge your needs for CPAP pressure, with no real analysis of your respiratory parameters. Pressure support in bilevel can make a big difference in tidal volume, minute vent and can effectively increase oxygenation and reduce CO2 retention. This won't even be considered unless the doctor is looking for it in the results, or designs the test to evaluate bilevel therapy. We have seen a lot of very poorly evaluated sleep tests on the forum. Keep in mind they are conducted by technicians, then reviewed and signed by doctors. I have personally seen miscalculated AHI and individuals with serious oxygen desaturation where the tests simply ignored SpO2 when AHI was "satisfactory". We have also seen people with moderate and severe complex apnea titrated on CPAP when their symptoms did not appear on the test for the period of a particular pressure. I am very skeptical of the value of many tests and think most people end up better treated when they obtain a machine with full data and auto-adjusting pressure, then become informed of the meaning of those results so they can help their doctors to help solve those problems, or to self-titrate and optimize therapy.