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+--- Thread: [CPAP] AUTO or not - Is the auto-CPAP machine inherently better than a CPAP? (/Thread-CPAP-AUTO-or-not-Is-the-auto-CPAP-machine-inherently-better-than-a-CPAP)
RE: AUTO or not - Is the auto-CPAP machine inherently better than a CPAP? [copied] - SuperSleeper - 02-25-2012
zonk Wrote:Quote:Can you list what those downsides are? Are these professionally-researched downsides or simply personal opinion?The only thing i read is APAP is not recommended for people with heart problems but now my brain too fogy to find the link, too much booze.
Yes, I have read peer-reviewed journal articles that raised concern with APAP for some patients.
RE: AUTO or not - Is the auto-CPAP machine inherently better than a CPAP? [copied] - SuperSleeper - 02-25-2012
Sleepster Wrote:Ltmedic66,(time=1324780010) Wrote:Of course, I think the whole system is out of whack. I, like most people, had no clue what I was doing when I picked up my CPAP. Luckily, I got one that I liked, but is was really a crap shoot. The "system" was not set up to make me successful.I agree, a lot of it is out of whack. But consider the possibility that it wasn't just luck. Some doctors know about the sysem being out of whack and try to serve their patients. They rely on a good DME. In my case, at least to some extent, that's what happened in my case, and maybe in yours.
I just went with the DME my doctor chose, and went with the machine they delivered. It was a fully data capable CPAP, but I was offered the option of a dumb CPAP for $100 less. After that I was upgraded to a BiPAP. I still don't understand why I wasn't given a APAP.
RE: AUTO or not - Is the auto-CPAP machine inherently better than a CPAP? [copied] - SuperSleeper - 02-25-2012
Sleepster Wrote:Ltmedic66,(time=1324783274) Wrote:I'm just wondering why ANY business would reduce their profit unless forced to do so. The incentive for any business is to sell you the product that costs them the least, and charge you the most they can get away with. That's true for cars, soup, cereal, and CPAPs.In many cases profits can be increased by lowering the per unit profit. A DME may make a bigger profit per patient by providing cheap CPAP's, but find that he could make a larger profit by selling more expensive xPAP's to a larger number of patients.
RE: AUTO or not - Is the auto-CPAP machine inherently better than a CPAP? [copied] - SuperSleeper - 02-25-2012
Cutter Wrote:That is interesting that APAPs aren't recommended for people with heart conditions. My Dr's Assistant was willing to prescribe an APAP for me if I wanted one. I declined. I've had two heart attacks and bypass surgery. They have my complete medical history. Was that an oops on their part or do I have the wrong heart problems to be concern with in relation to APAPs? Maybe the brain cells can get together tomorrow and remember some details. Meanwhile enjoy the buzz.
RE: AUTO or not - Is the auto-CPAP machine inherently better than a CPAP? [copied] - SuperSleeper - 02-25-2012
zonk Wrote:zonk,(time=1324784998) Wrote:Just had a nap with pap and pot of fresh brewed coffee suddenly the grey cells working again. Here is the link mentioned, read about the reason and the rest of it:Quote:Can you list what those downsides are? Are these professionally-researched downsides or simply personal opinion?The only thing i read is APAP is not recommended for people with heart problems but now my brain too fogy to find the link, too much booze.
Yes, I have read peer-reviewed journal articles that raised concern with APAP for some patients.
It is for this reason that APAP devices are generally not recommended for patients known to have conditions, such as congestive heart failure, that predispose to central apneas.
http://www.resmed.com/au/assets/documents/product/s9_series/1013916_s9-autoset_white-paper.pdf
RE: AUTO or not - Is the auto-CPAP machine inherently better than a CPAP? [copied] - SuperSleeper - 02-25-2012
zonk,(time=1324793569) Wrote:It is for this reason that APAP devices are generally not recommended for patients known to have conditions, such as congestive heart failure, that predispose to central apneas.Thanks for the link, Zonk.
http://www.resmed.com/au/assets/documents/product/s9_series/1013916_s9-autoset_white-paper.pdf
I think we have to read the full white paper in context.
They are not saying that S9 AutoSets should not be used by people with congestive heart failure.
The first part of the article gives a history of problems that occurred with older Autos. (it is within this history section where the recommendation against Autos for congestive heart failure patients is acknowledged)
What they are saying is that with the older algorithms used in pre-S9 machines, those older Autos are not recommended for people with congestive heart failure because of the "runaway pressure" issue that would cause increased central apnea events (this issue no longer exists in the S9 AutoSet machines).
ResMed improved the algorithm in the S9 AutoSets to address this issue. From the article: "The algorithm has not changed for 10 years, but has recently been enhanced to increase sensitivity to flow limitation, decrease reliance on snore and introduce central sleep apnea detection (CSAD)."
Also from the article: "Conclusion - The enhanced AutoSet algorithm on the S9 AutoSet now includes CSAD for the classification of apneas using the FOT. CSAD was extensively tested using patient simulators, normals simulating obstructive and central apneas and clinical trials. CSAD correctly identified and the enhanced AutoSet correctly treated obstructive, central and unknown apneas with a very high degree of accuracy. The enhanced AutoSet and CSAD algorithms have been shown to treat
patients appropriately, including those with predominantly central apneas, and without causing disturbance to sleep."
From reading this white paper, I drew two conclusions:
1. Not recommended to use older pre-S9 Auto-CPAPs when you have congestive heart failure.
2. Is safe now to use the S9 AutoSet for congestive heart failure patients and the improved AutoSet algorithm along with the new CSAD algorithm have been shown to treat both obstructive and central events appropriately.
Of course, since this white paper is specific to ResMed machines, we're not sure if the information also applies to the algorithms used in newer machines from other manufacturers (like the PR System One Auto).
RE: AUTO or not - Is the auto-CPAP machine inherently better than a CPAP? [copied] - SuperSleeper - 02-25-2012
Ltmedic66 Wrote:HeadGear,(time=1324788211) Wrote:If there is good medical reason to differentiate between CPAP an APAP, I would accept that. However, any justification is irrelevant because the APAP can be set either mode and the patient can be advise as to what modality is prescribed and why. As others have pointed out, there are ulterior motives and conflicts of interest involved, namely profit. Many sleep physicians are also owners, partners or investors in DMEs and/or sleep labs.I respectfully disagree. I believe that there are some people who either cannot, should not, or do not want to use APAP. So, there are examples of people for which APAP is not really a useful option. This is not irrelevant. Again, that's just like saying a VPAP can be set to VPAP, APAP, or CPAP modes, so we should just get everyone a VPAP and use it in the mode that they need.
I do agree that the monetary relationships between docs that have a financial interest in a DME are concerning. This happens all throughout medicine-surgeons who own surgical centers, docs who have an interest in drug manufacturing, pharmacutical companies that "bribe" doctors with trips, dinners, and other financial incentives to use their medications. Again, welcome to for-profit, market-based health care.
RE: AUTO or not - Is the auto-CPAP machine inherently better than a CPAP? [copied] - SuperSleeper - 02-25-2012
Ltmedic66,(time=1324832803) Wrote:Again, welcome to for-profit, market-based health care.Our current health care system in the U.S. is not a market-based system.
The real answer to these issues is informed, educated consumers who are free to make their own economic choices. We should not be expanding the size of government with more costly, complicated health care legislation and regulations that make health care more costly and restrictive for both doctors and patients.
In the U.S., it is the current government-controlled Medicare system (and the insurance industry which must abide by Medicare rules) that is responsible for giving $1500 of our taxpayer-funded Medicare money or insurance policy-holder premium money to a DME who then gives us a non-data capable standard CPAP (which cost them $700, allowing them to pocket the remaining $800). Yeah, that government-controlled system is working real good... (for the DMEs) :annoyed:
Welcome to our government-controlled, anti-free market current health care system-- because that is what we currently have. It's socialism at the core, unless you choose to play word games and re-define the definition of "socialism".
Get the stupid government out of my way, please. We don't need government to protect us from ourselves... that kind of nanny-state socialism ends up turning into fascism politically. It make things much more expensive for all of us and with it, less freedom of choice. I'm biased because I'm an American, maybe. This country was not founded upon socialism... it was founded on free-market capitalism... and no, we don't have free-market capitalism today, we have a blend of corporatism & socialism.
The answer again is informed and educated patients, not more complicated laws and industry rules. The more complicated the rules and regulations for health care become, the easier it makes it for unscrupulous health care providers to find a way to skirt that law (un-noticed) and screw their customers. If the customers are informed, they can learn how to avoid doing business with a scumbag DME and go to the DME that provides the best service & products for the best price.
What is the answer? Forget additional government regulations. We've tried that and it just does not work. Patients need to come together and help educate one another as we go through this whole Sleep Apnea thing together.... maybe even a place on the web that could provide an independent, non-commercial, non-governmental forum for Sleep Apnea patients to help one another... hmm... that sounds familiar.
Again, all just my opinion...
RE: AUTO or not - Is the auto-CPAP machine inherently better than a CPAP? [copied] - SuperSleeper - 02-25-2012
Ltmedic66 Wrote:zonk,(time=1324837215) Wrote:zonk, not sure where you are getting your facts, but I can find brand new CPAPs for around 300-400 all day long. An S9 with humidifier is around $1100-1200. Seems a little more than $50 to me.Ltmedic66,(time=1324832803) Wrote:Again, that's just like saying a VPAP can be set to VPAP, APAP, or CPAP modes, so we should just get everyone a VPAP and use it in the mode that they need.Even with Boxing day hangover i can figure this one out by myself, it is exaggeration of the facts the price of VPAP is more than double of APAP while APAP is only $50 more CPAP.
Can i have another mince pie please :lick-lips:
Sure, if you take a really expensive CPAP and compare it to an average APAP, the price difference is probablly modest...but that's kind of rigging the comparision, no?
RE: AUTO or not - Is the auto-CPAP machine inherently better than a CPAP? [copied] - SuperSleeper - 02-25-2012
Ltmedic66 Wrote:SuperSleeper,
I'll try to bring this back to CPAP. Sure, a free market works great with informed consumers who have easily accessible choices between suppliers. However, this simply will not ever be the case with CPAP, or most medical care, for that case. The average consumer will most often lack the time or the ability to become an expert on CPAP and the choices and options that are out there. Therefore, the most basic requirements of free market forces could never be brought to bear in the CPAP market.
So, in a truly unregulated, wild-west CPAP market, what would take the free market's place? Disinformation and profiteering. Suppliers who do whatever it takes to maximize their profits. CPAP suppliers would be more like used car salesmen (many are already close...).
Because CPAP patients run the range of society- from the highly informed to the totally uninformed, there is no way to have "informed, educated consumers" as a major influence on the CPAP market. Sure, some have the abilty and time to become informed and they'll probablly make out OK in such a market. Many (I'd say most) cannot, so they'd just be at the mercy of the industry. I think we already know, through experience, that there are plenty of business folks out there who would make medically unsound decisions if they could make a few bucks doing it.
I don't have the time or expertise to make sure that my CPAP manufacturer used sound practices, built the machine with safe materials, or followed appropriate treatment parameters. That's what government regulations are there to provide, and I'd just a soon keep them in place for such things.
However, we're straying from the original concept of "is APAP always the best choice", and are running the risk of getting off topic here.