If bipap/apap cheaper than cpap, would it be first choice?

I think a lot of people get sent off with a cpap as their first machine.. even though it might not be the right one for them....

But what if bipaps and autops were cheaper than cpaps?


Would everyone be walking off with a bipap or an autopap as their first machine?

Would the dme's happily unload these because they were the least expensive?

Would the docs gleefully write prescriptions for autops and bipaps or do you think they would still
start everyone on straight cpap even though and auto can go both ways..

bipaps are easier to breath against, wouldnt everyone get one of those FIRST if they were the cheapest?

Isnt a huge newbie complaint trouble breathing against pressure?

Just wondering what you all think.....

Is cost the main consideration in what machine is chosen for a patient, then what is best for the patient is further down on the list?

I think the first choice is generally whatever therapy is most appropriate for the patient. These various treatment modes have existed alongside each other instead of serving as replacements for previous technology, simply because there is no one true treatment.

Cost is the only consideration! The more options the better you can adjust your treatment. If it can't do it, leave it on the shelf. Jim

On can be turned off, but not there can't be turned on!

Yes is the answer. My experience is that auto machines can be turned into a straight CPAP SO cost is the big factor. One day we will start with autoset machines.

The doctor who diagnosed my apnea appeared to rely on the DME/Sleep Study company to write the prescription - She just signed it. In my case, a CPAP was clearly the wrong decision, but that is what the Rx was for. Fortunately, I had read enough here to tell the DME "forget it" when they handed me a basic CPAP and mask (no fitting effort at all).

I suspect it is pretty common for doctors who do not specialize in sleep medicine to trust the DME to "run the show" in a proper fashion. As the people in between the doc and the DME, we are the ones that know if that trust is being betrayed.

The next time I see my doctor, I plan to tell her about the short-comings of the DME she works with. We'll see if it matters, but she told me they would have an array of masks for me to try out to see what worked best, so I'm betting they misrepresented their thoroughness to my doc.

So my answer is we need to complain to our care providers about the DME if we know they are not performing their duties as well as they should.

breakfast wrote:I think the first choice is generally whatever therapy is most appropriate for the patient. These various treatment modes have existed alongside each other instead of serving as replacements for previous technology, simply because there is no one true treatment.

Thanks breakfast for adding some sanity to the thread. Not that I don't love "yes is the answer" and " cost is the only consideration!" type of answers.
APAP means one of the several available machines which have shown less than perfect correlation with each other in several studies. They respond differently to same kind of SDB stimuli. So when you get an "APAP" machine, you don't know what kind of response you sre getting. Has ANY study shown better outcomes with APAP than CPAP? Have there been ANY long-term studies on APAP comparable to those available for CPAP? There are new APAP machines by new manufacturers with new undisclosed algorithms being churned in the market without validation almost every month. Yes, logic says that beta blockers would be bad in CHF and blood transfusion in anemia is a good thing and such, but studies have shown quite the opposite. That's why human beings, with their limited knowledge of human body, need medical studies to prove what's good or bad for the body rather than assuming that since APAP seems logically better, it should be a better thing.

I totally disagree that patients are prescribed the correct machine their first time out.

IN some instances yes, but money/insurance/ dme profits are priorties..

You cant tell me that anyone would rather struggle to breath against a pressure, then not to have to do that..

If bipaps were cheaper, everyone would have one.. What reason is there to breath against a higher difficult pressure which
is not natural, when it is not necessary.. eveyrone has been doing it because that is how the machines evolved..

and as for straight cpaps, I believe they are dinosaurs..

It is not logical that ONE singe exact pressure is what one patient needs every single night they sleep, too many variables..
sleeping positions, tiredness, alchohol, meds, diet, etc...

My pressure fluctuates two or three notches depending on sleeping positions.. If I had a straight cpap, where would I be?
struggling with the highest pressure?

Had I not found this forum, I would have been stuck with a cheap straight cpap, I would have taken it back, and I would probably have
been dead in a couple years..

What about patient comfort in relation to compliance?

I cant tell you how many people I have run into who were given straight cpaps, and guess what?
They are in the closet, with the umbrellas and winter coats.

People on this board are totally pro apnea treatment, the ones who fell thru the cracks I dont think we will see them here anytime soon..

This is just my opinion, someone who has been on cpap, two different apaps, and a bilevel vpap in six months.. I have "tasted" all of them in
a short amount of time..

elena88 wrote:I totally disagree that patients are prescribed the correct machine their first time out.

IN some instances yes, but money/insurance/ dme profits are priorties..

You cant tell me that anyone would rather struggle to breath against a pressure, then not to have to do that..
.
.
This is just my opinion, someone who has been on cpap, two different apaps, and a bilevel vpap in six months.. I have "tasted" all of them in
a short amount of time..

"money/insurance/ dme profits are priorties.."
Absolutely they are. But what about medical studies... What about them? Of course all investigators are greedy SOBs who have not been able to show an appreciably better adherence to APAP compared to the 'struggle to breath' CPAPs had financial interests. Of course they are paid to show that quality of life in addition to daytime consequences and cardiovascular outcomes improve significantly with the "dinosaurs". One greedy moron could not show even in patients with positional or REM OSA (which might need higher pressures only for a small part of night) that APAP was a better device. That bastard must have got a Rolls Royce from insurance companies to fudge his results against the angelic APAP. A lot of patients with central sleep apnea/ cheyne stokes/ complex osa will get a 'much costlier than APAP' ASV machine as their first machine. But hey, that does not matter. If doctors don't prescribe APAP as the first machine, that is owing to ulterior motives.

sleepydreamers with two posts here,....

It is so obvious to me you have an agenda....

Of course the bottom line is their bottom line. That's just business. The more technology included, the higher the price of the equipment, and it doesn't help skyrocketing medical costs to overprovide across the board. To me that's waste. I personally don't think everyone needs an apap. I did just fine on apap, do fine on cpap. I do think machines that track only compliance should be outlawed. To not gather data just increases costs to patients and their insurances in what could be unnecessary doctor's visits and repeat sleep studies. I do take issue with patients being forced to fail on cpap before going to a bipap when their pressure was titrated in the high teens. To me that's unnecessarily barbaric, and any attempt to save health care dollars on a machine is lost in followup that predictably leads to bipap. I think there's enough blame to go around - from billing rates, reimbursement structure, personal greed... you name it. I would not campaign for everyone to get an autopap. However, I would avidly advocate data capable cpaps being standard issue.

EDIT: Couldn't find the old post, but a study was discussed about 3 years ago (I think) that found apap not to be as effective as cpap, but at issue was if they kept the apaps wide open, which would be a recipe for a skewed or biased result. There would be lots of variables in a comparison like that.

Bi-PAPS and APAPS are better than CPAPS because you have all the options. They can be used or not (turned off). Besides the cost for the units another factor comes in play, no matter what machine you use, if it's set incorrectly for what you need it won't serve you well.

Time after time I see people HERE that got Bi-PAPs mainly because the more money they go for they have to be better idea. Many times they have a harder time getting them to a point where they give them the treatment they need, due to many settings and not knowing what they need. Also they are more complex, and seem to have a higher level of breakdowns. (Real or Imagined) Some are due to not knowing how to set them.

Even APAP's are not bullet proof in setting them up. I started out on CPAP, bought a new APAP out of pocket, had my treatment going well on CPAP. When I went to APAP, my treatment went downhill for the first week, because I was trying to find my Sweet Spot with the APAP, and ended up chasing the wrong conclusions, and I thought I knew what I was doing.

There's a lot to say for the K.I.S.S. theory. Sometimes a little knowledge is a bad thing. Basic rules need to be followed.

1. Control Leaks
2. Use a narrow pressure range, centered on your needed CPAP pressure.
3. Don't jump around changing variables, give it a few nights to settle down.
4. Set up a sleep time, stick to it, nothing to bother you from sleeping. T.V., that's the rule I break every night. But not enough to bother my needed sleep.
5. Have the needed tools so you can see how your treatment is going, guessing is for the birds, and I don't mean the Night Owls. Jim

SleepersDreamers wrote: Thanks breakfast for adding some sanity to the thread.

Lets take a look at the sanity of the studies you refer to.
Please quote the scientific papers in which the minimum pressure for APAP was set to be close to the patients' titrated pressure.

Is there one paper that checked compliance and health effects of the difference between APAP min and 90th percentile titrated pressure?

The papers I've read set the APAP at a minimum of 4 or, regardless of what the patient needs. They were done in an attempt to validate the manufacturers spiel that here comes the magic, money saving machine that will autotitrate.

Even David Rapaport, physician, scientist and inventor of an Auto algorithm that was used commercially admitted that this setting does not work reliably -- he is now working on an algorithm that supposedly distinguishes between sleep and wakefulness, implemented in F&P's auto.

After you've pointed us to APAP studies in which the minimum does not start at an arbitrary number, but is set taking the patients needs into account, please quote the scientific studies in which compliance was tested only after the subjects were adapted to their masks.

If you don't find them, perhaps you can suggest the proper method to run a study that will not confound mask adaptation and machine adaptation.

Thank you.

P.S. You can search for Rapaport's invention, and who owns it, in google patents, and for links to his talk about APAP's in the very forum.

ozij wrote: Lets take a look at the sanity of the studies you refer to.
.....
P.S. You can search for Rapaport's invention, and who owns it, in google patents, and for links to his talk about APAP's in the very forum.

Thanks Ozij.

That's exactly what I am saying. While theoretically there are advantages of fluctuating pressure, there are hardly any good studies validating the cardiovascular and other benefits of APAP. In contrast, cross-sectional and longitudinal, clinic-based and population based, different ages and different races, all studies have validated the benefits of CPAP. If APAP was unarguably better and more reliable than CPAP, multimillion dollar NIH-funded studies like APPLES would have used the former. As I said earlier, logical 'theories' have been proved wrong time and again in Medicine. Many physicians are morbidly afraid of giving beta blockers to patients with COPD and asthma. A recent study actually suggests better outcomes with these drugs in people with lung disease, and with very good rationale. So till APAP has been proven to be a comparable device to CPAP, its use in patients who do not do well on FPAP (fixed) might be acceptable, but it being the first choice at current time in current form is not supported by evidence.

"sleepydreamers with two posts here,....
It is so obvious to me you have an agenda...."
What can I say Elena, it is so obvious to me that you are a genius.

Thanks Ozij.

That's exactly what I am saying. While theoretically there are advantages of fluctuating pressure, there are hardly any good studies validating the cardiovascular and other benefits of APAP. In contrast, cross-sectional and longitudinal, clinic-based and population based, different ages and different races, all studies have validated the benefits of CPAP. If APAP was unarguably better and more reliable than CPAP, multimillion dollar NIH-funded studies like APPLES would have used the former. As I said earlier, logical 'theories' have been proved wrong time and again in Medicine. Many physicians are morbidly afraid of giving beta blockers to patients with COPD and asthma. A recent study actually suggests better outcomes with these drugs in people with lung disease, and with very good rationale. So till APAP has been proven to be a comparable device to CPAP, its use in patients who do not do well on FPAP (fixed) might be acceptable, but it being the first choice at current time in current form is not supported by evidence.

"sleepydreamers with two posts here,....
It is so obvious to me you have an agenda...."
What can I say Elena, it is so obvious to me that you are a genius

You have stated your ideas of apap. I would like your ideas on the bipap.
What if the bipaps were the first generation of cpap, and they were less expensive. Would most everyone had been prescribed one
instead of a straight pressure cpap?
I would also like to know if you have tried cpap, apap, and bipaps? What is your practical experience? Do you have OSA?

SleepersDreamers wrote:

ozij wrote: Lets take a look at the sanity of the studies you refer to.
.....
P.S. You can search for Rapaport's invention, and who owns it, in google patents, and for links to his talk about APAP's in the very forum.

Thanks Ozij.

That's exactly what I am saying. While theoretically there are advantages of fluctuating pressure, there are hardly any good studies validating the cardiovascular and other benefits of APAP.

If there are no good studies of APAP, there is no knowing how a properly set APAP affects anything -- it has never been studied.

In contrast, cross-sectional and longitudinal, clinic-based and population based, different ages and different races, all studies have validated the benefits of CPAP. If APAP was unarguably better and more reliable than CPAP, multimillion dollar NIH-funded studies like APPLES would have used the former.

If APAP was never validated, how could it be used in any study? Which were the APAPs in use when the APPLES proposal was submitted?

https://apples.stanford.edu/history.htm

History of APPLES
November, 1997
American Sleep Disorders Association (ASDA) (now American Academy of Sleep Medicine [AASM]) Board of Directors commissioned a workshop on Clinical Trials in Obstructive Sleep Apnea.

October 15-17, 1998
Workshop on Clinical Trials in OSA at Georgetown University. The consensus was that a clinical trial of the effectiveness of Continuous Positive Airway Pressure (CPAP) on OSA-induced neurocognitive outcomes should be initiated, and that the ASDA and The Sleep Medicine Education and Research Foundation (SMERF) (now American Sleep Medicine Foundation) should solicit and fund competitive proposals to write a National Institutes of Health (NIH) application to conduct such a trial.

December 10, 1998
“A Clinical Trial of CPAP Therapy in Obstructive Sleep Apnea” Request for Proposals (RFP) submitted by fax to AASM membership.

March 15, 1999
Deadline for receipt of proposals.

June 28, 1999
Two clinical centers selected to receive $50,000 ASDA/SMERF funds, out of a field of 7 applicant centers.

October 1, 2000
Apnea Positive Pressure Long-term Efficacy Study (APPLES) / National Heart, Lung, and Blood Institute (NHLBI) application submitted.

So till APAP has been proven to be a comparable device to CPAP, its use in patients who do not do well on FPAP (fixed) might be acceptable, but it being the first choice at current time in current form is not supported by evidence.

You mean, starting therapy in APAP mode is not an empirically supported treatment of choice -- I agree with that.

However, for many people, buying an APAP as first choice makes sense, because they can run it in CPAP mode, and if that fails, they'll run it in APAP mode. If they first buy a CPAP machine, and then fail it, and have to buy an APAP it's a major hassle -- and a greater expense.