Type of sleep test needed to be prescribed a APAP machine versus CPAP?

I recently had a home sleep test and was diagnosed with sleep apnea. The doctor said I had 30 AHI and my lowest O2 level was 70%. The doctor said I need to do a sleep test at the hospital and I'm trying schedule that now. I've been reading this board for a few weeks and it sounds like a APAP machine would be a lot more comfortable than a cpap machine. I called my insurance provider and they said I could have whatever the doctor prescribed. So I recently spoke with one of the the doctor's staff and asked if the doctor would prescribe me a APAP instead of a CPAP machine. The staff member said that the doctor ordered a titration study and I would likely be prescribed a cpap machine. So I was wondering what type of sleep study do I need to get a apap machine instead?

Welcome to the forum.

There is no special titration sleep study for apap vs cpap. They don't do anything any different.

Some doctors always prescribe an auto machine. Some always prescribe a straight cpap machine. (Perhaps they don't like APAPs or understand them).

The doctors who prescribe either one based on the titration results usually prescribe an APAP when the person's pressure needs vary by position or sleep cycle. For example, many people need more pressure when they sleep on their back or during REM, or both.

If you aren't using insurance, you can purchase online, and the prescription for cpap will let you get an apap. The problem is if you need to use insurance, AND your doctor doesn't want to prescribe an apap. In that case, you will need to convince your doctor to prescribe the apap, or take the cpap prescription and convince a different doctor to write a script for the cpap. Any doctor can write it, but you need one who will do it. You might have a primary doctor who will look at your script (obviously you need a machine) and will write the script for the auto.

Just in case, I would do some searching online and find some medical websites that explain why an auto machine is better, and also how an APAP can be used as a CPAP, but a CPAP cannot be used as an APAP. Then be prepared to argue your case if the doctor is one who doesn't like APAPs.

You guys are all too nice. Knowing what I know now I would walk into the doctors office tell him he either writes me a prescription for an apap or I am not getting pap. After he picks his jaw up off the floor, if he tries to convince me cpap is better, I walk out the door tell him he is fired and find a new doctor.

I have had it up to my ears with ignorant doctors and I will no longer put up with their crap.

My neurologist office told me I couldn't switch to the office that was closer to my house because it was against policy. I said ok give me a copy of my medical records I will go find someone who wants my business. She tells me I can't do that, I said why ? She said I will have to get my boss. I then told her boss that their policy was ignorant and that I wasn't driving an extra 30 min because of their stupid rules. She also tried to tell me I couldn't do that. I said watch me. You're fired. I called up a different doctors office and had a new appointment within a week.

Doctors are not gods! They provide a service and if I am unhappy with the service, I will find someplace else.

Let us know what you end up getting. Welcome to the forum.

Roger

babydinosnoreless wrote: ↑

Fri Oct 04, 2019 7:42 pm

You guys are all too nice. Knowing what I know now I would walk into the doctors office tell him he either writes me a prescription for an apap or I am not getting pap. After he picks his jaw up off the floor, if he tries to convince me cpap is better, I walk out the door tell him he is fired and find a new doctor.

I have had it up to my ears with ignorant doctors and I will no longer put up with their crap.

My neurologist office told me I couldn't switch to the office that was closer to my house because it was against policy. I said ok give me a copy of my medical records I will go find someone who wants my business. She tells me I can't do that, I said why ? She said I will have to get my boss. I then told her boss that their policy was ignorant and that I wasn't driving an extra 30 min because of their stupid rules. She also tried to tell me I couldn't do that. I said watch me. You're fired. I called up a different doctors office and had a new appointment within a week.

Doctors are not gods! They provide a service and if I am unhappy with the service, I will find someplace else.

This is very good advice!

The first dealer I went to rented me a dumb CPAP machine without humidifier. It felt like knives were being pushed into my nose after 1 hour. Gave up on CPAP for some time then heard about this physiotherapist who immediately started my treatment with an APAP with humidifier (for HALF the price) and I could sleep the whole night on my first try. Makes a world of difference!

Thank you all for the replies. I'm beginning to think this doctor just prescribes cpap. Several of my co-workers went to the same doctor and the doctor prescribed them all with the Resmed Air Sense 10 CPAP which I've read doesn't give a lot of info to the user or vary the air pressure.

I'm going to try to get the sleep doctor to prescribe me an APAP but if they refuse, I think I'm going tell them to send my records to my primary care doctor. He is very agreeable about things and hopefully would see the logic and value of me getting the more versatile machine. I'm also going to make another appointment with a different sleep specialist just to be safe incase my primary care doctor won't do it.

My insurance company will only pay for one machine every few years so I will be stuck with this one for years. I don't know why it would be an issue for the sleep specialist since a apap can operate exactly like a cpap but from the way her assistant spoke I get the feeling she just prescribes cpap.

But I have been feeling awful for years now and have been feeling much worse since I got diagnosed. I guess its psychological now that I know I have it because since the diagnosis my sleep has gotten much worse. But I think I've had it for at least 10 years so I guess a few more weeks or months without treatment won't kill me. Thanks again for all of the information.

Definitely a good plan. You don't want to waste insurance money on a machine that won't give you data or the ability to run in auto if you need it. And sleeping at home is easily different than a sleep study. Even if you decide you prefer a straight pressure, it is good to have the ability to put it into auto and review the data.

Success with cpap is a lot easier to attain with a full data machine.

tarheelalum wrote: ↑

Fri Oct 04, 2019 10:45 pm

Thank you all for the replies. I'm beginning to think this doctor just prescribes cpap. Several of my co-workers went to the same doctor and the doctor prescribed them all with the Resmed Air Sense 10 CPAP which I've read doesn't give a lot of info to the user or vary the air pressure.

I'm going to try to get the sleep doctor to prescribe me an APAP but if they refuse, I think I'm going tell them to send my records to my primary care doctor. He is very agreeable about things and hopefully would see the logic and value of me getting the more versatile machine. I'm also going to make another appointment with a different sleep specialist just to be safe in case my primary care doctor won't do it.

This is the only course of action. When I first started I rented and asked the rental company (read DME) for an auto machine. They refused, said it wasn't on my prescription. I then went and saw my GP, explained what I wanted and he wrote me a script for an auto machine of my choice. I must admit that most of the script was drafted by me but he saw the sense in doing that. When I went back to the DME she initially said 'no' so I asked her why she wasn't following prescription requirements and who should I report this to. She grudgingly gave me the new machine and I made clear my dissatisfaction with her attitude.

In other words, not a sleep test, but one that measures DETERMINATION.

babydinosnoreless wrote: ↑

Fri Oct 04, 2019 7:42 pm

After he picks his jaw up off the floor, if he tries to convince me cpap is better, I walk out the door tell him he is fired and find a new doctor.

I have had it up to my ears with ignorant doctors and I will no longer put up with their crap.

<snip>

Doctors are not gods! They provide a service and if I am unhappy with the service, I will find someplace else.

Truth!

I took a normal split study(2 night) sleep test at a hospital. I did horrible a AHI of 69. I was prescribed a bipap. It took my apneas down but not all of the way. The Dr then changed the prescription to a bipap st with noninvasive ventilation if I don't breath. I have a combination apnea. Both obstructive and central. No special test was needed.

Some specialists do not agree that APAP is best and they want everyone on a fixed pressure, others disagree. Some doctors don't want you questioning their word or their G-d-given titrated pressure that they have decided is the best for you regardless of real life. I'd run far from any doctor like that.

But the real obstacle to an APAP is the DME. APAP and CPAP have the same billing code, but there's a little higher profit margin on the CPAP. So some DME's refuse to supply an APAP unless the prescription specifies a pressure setting range.

Insurers don't care--they pay the same amount for the same billing code, whether you get APAP or CPAP. Most (not all) doctors don't care. It's the DME's you're going to have to fight over this (assuming your doctor doesn't specify a particular CPAP machine in the prescription).

Get ready, DME's lie like snakes: Insurance won't cover it (not true), your test didn't show the need for it (doesn't matter) we don't carry that (order it), etc.

Your idea of asking to have your primary care doctor take over is a good one. Ask him to write the script specifically for what you want.

Janknitz wrote: ↑

Mon Oct 07, 2019 2:53 pm

Get ready, DME's lie like snakes: Insurance won't cover it (not true), your test didn't show the need for it (doesn't matter) we don't carry that (order it), etc.

Your idea of asking to have your primary care doctor take over is a good one. Ask him to write the script specifically for what you want.

Lie like snakes is so true! When I got the call from the first DME, I was told, "Everyone get the same machine." and that they would not give me the one my doctor had prescribed (that I had researched and asked for. I politely replied that my Rx SPECIFIED the other machine, but she said too bad, everyone gets the SAME machine! I said, no thank you, I will call my doctor. His office found another DME who is VERY accommodating to exactly what I want!

P.S. I actually did not end up with the machine I originally wanted, but I also did not end up with the machine the first DME wanted to give me either!

Lie like snakes is so true! When I got the call from the first DME, I was told, "Everyone get the same machine." and that they would not give me the one my doctor had prescribed (that I had researched and asked for. I politely replied that my Rx SPECIFIED the other machine, but she said too bad, everyone gets the SAME machine! I said, no thank you, I will call my doctor. His office found another DME who is VERY accommodating to exactly what I want!

P.S. I actually did not end up with the machine I originally wanted, but I also did not end up with the machine the first DME wanted to give me either!

Good job!!!