Sleep doc only wants CPAP, not APAP

[REMfan62]

I have seen alot of praise for APAP on this board, so I asked my sleep doc about enabling it on my machine. She didn't want to because she wanted it at 14 CPAP to achieve the best oxygen level. I suggested we set it for a range that did not fall below 14. She wasn't interested. Do you veterans agree with her approach?

[retired_guy]

Well Rem, the proof, or lack of it, will be in the pudding.

I'm not a fan of using a perfectly capable auto in straight cpap mode, but lots of docs like to do that. I think it gives them the feeling of total control they might not have if the patients are using a range of pressures.

But see how you do. Use the Sleepyhead software to monitor the actuals. Are your events, for the most part, eliminated? Are you comfortable with the pressure? (14 seems a little high to me, but some need it) No/minimum mask leaks?

Yes, I would rather see a nice tight range such as perhaps 11 to 15. Then you could make better decisions as to what pressure you actually need, and adjust up and down accordingly. But for now, dance with whom brought you, and report back how you are actually doing at a fixed 14.

As to the O2 thing? I'm not sure a fixed pressure makes any particular sense when it comes to O2 level. That's more a function of if your events are controlled properly. Unless you're on supplemental O2? I don't personally think it's relevant to tell you a fixed 14 is done to control O2.

[GWild]

I always try to remember that doctors are practicing medicine... makes me feel a touch better when I hear something that sounds a bit whacko. Also enables me to change doctors when they do something like that near me.

In this case, information is your friend. My APAP was set at 5-20; and it occasionally hit 17. Over time I have been able to tolerate a higher starting pressure. I am now at 8-20, and the machine now only hits 13 to 14. Not entirely sure what that means, but I believe the higher starting pressure somehow makes the apnea events I have not as severe.

The thing you can go back to the doctor with is that an APAP allows continuous monitoring of your condition. You can visualize what your mean required pressure is over a real set of life conditions (a sleep study is NOT a real life situation). For example, my average pressure is hovering just below 9, and a setting of 8 means the machine only needs to pitch up a bit to cover my typical event and blow my airway clear before I really suck it in to where I am in serious need of air. With a fixed CPAP - you lose the opportunity to understand how you are behaving in treatment - and thus can't explore alternative settings that may significantly improve treatment, compliance, or comfort.

[zonk]

I have seen alot of praise for APAP on this board, so I asked my sleep doc about enabling it on my machine. She didn't want to because she wanted it at 14 CPAP to achieve the best oxygen level. I suggested we set it for a range that did not fall below 14. She wasn't interested. Do you veterans agree with her approach?

Actually 14 is not some sort of magic number fit for all occasion, might be needed only for some time during the night, not all night long

Here is the beauty of well adjusted APAP (not left at default setting 4-20 and hope for a miracle), APAP adjust pressure to suit your breathing needs throughout the night. So you receive the lower pressure required for your therapy and improve comfort, PAP therapy is all about comfort

Remind the doctor APAP can deliver constant pressure all night long just like CPAP and in addition can be used as APAP if desired, basically like having two machines in one ... common sense prevail.

As far as insurance concerned, they pay for the machine by a billing code, E0601 is the billing code for both CPAP and APAP

[me50]

tell her that you don't mind her having it in CPAP mode (you can make adjustments yourself) but that a CPAP costs the same as an APAP and that you would like to have the option of an APAP JUST IN CASE it is ever needed to see if a lower or higher pressure is needed. IF she won't do it, ask your primary doc to write the script for you and put the exact machine you want and make sure the script says dispense as written. Include mask of patient's choice and heated hose. All other necessary supplies. You should be good to go.

[OpalRose]

I have seen alot of praise for APAP on this board, so I asked my sleep doc about enabling it on my machine. She didn't want to because she wanted it at 14 CPAP to achieve the best oxygen level. I suggested we set it for a range that did not fall below 14. She wasn't interested. Do you veterans agree with her approach?

Well, I don't consider myself a veteran yet , but I believe the only way to go is an Auto Adjusting machine.

I'm not sure why any Doctor leans toward a straight CPAP setting based on an overnight study, because it is only one night. Your docs reasoning is to achieve the best oxygen level? Makes no sense to me, because an auto CPAP will adjust to your needs. I really believe that some doctors just don't know enough about the auto machines and what they can do for you, or they simply are afraid of losing control.

You are the patient! Tell her you want a fully data capable Auto CPAP machine, then tell her she can set it to CPAP mode with a straight setting instead of Auto. You can always change it yourself. :grin: Remind her that an APAP can be used as a straight CPAP, but a CPAP can only offer you that straight setting. You don't know what your future needs will be.
Good luck!

[trish6hundred]

Hi REMfan62,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you with your CPAP therapy.

[Mich]

I have seen alot of praise for APAP on this board, so I asked my sleep doc about enabling it on my machine. She didn't want to because she wanted it at 14 CPAP to achieve the best oxygen level. I suggested we set it for a range that did not fall below 14. She wasn't interested. Do you veterans agree with her approach?

If you are using it as she recommends and having issues with high AHI, download the manual for your machine and set it up yourself as auto, then monitor your progress on Sleepyhead software and see what works best for you. You will definitely know when you hit the "Sweet" spot when you can sleep all 7-8 hours straight without events and waking up feeling wonderful!

Good luck!

[Mich]

I have seen alot of praise for APAP on this board, so I asked my sleep doc about enabling it on my machine. She didn't want to because she wanted it at 14 CPAP to achieve the best oxygen level. I suggested we set it for a range that did not fall below 14. She wasn't interested. Do you veterans agree with her approach?

Well, I don't consider myself a veteran yet , but I believe the only way to go is an Auto Adjusting machine.

I'm not sure why any Doctor leans toward a straight CPAP setting based on an overnight study, because it is only one night. Your docs reasoning is to achieve the best oxygen level? Makes no sense to me, because an auto CPAP will adjust to your needs. I really believe that some doctors just don't know enough about the auto machines and what they can do for you, or they simply are afraid of losing control.

You are the patient! Tell her you want a fully data capable Auto CPAP machine, then tell her she can set it to CPAP mode with a straight setting instead of Auto. You can always change it yourself. :grin: Remind her that an APAP can be used as a straight CPAP, but a CPAP can only offer you that straight setting. You don't know what your future needs will be.
Good luck!

TOTALLY AGREE!

[PaytonA]

Blood oxygen levels are not only a function of minimizing apneas but, as DocWils pointed out in a different thread, are also a function of the pressure differential across the alveoli in the lungs. I do not know how much difference a few cm/H2O might make in blood oxygen level but it should make some difference (might not be detectable).

The real question in my mind is, how is your doc going to know what your blood oxygen level is doing while you are asleep. Has she given or prescribed a pulseox instrument???

Best Regards,

PaytonA