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From: aharcus on 27 Oct 2005 17:20
I'm going in for the follow up visit at the sleep clinic, filled with
anxiety. Everyone in my live is assuring me I'll survive, and this will
improve my life. We'll see.

The air blowing against my exhalation drives me loony, and makes me
feel like I'm drowning, even though "rationally" I know it's not so.

I apologize up front, but can someone break down the definitions.
Is bi-pap the same as auto-pap? I'm lost and couldn't find a break down
googling here or anywhere else.

What is the cost difference between the different models. From reading
here auto-pap sounds like the answer. How resistent are HMO's for
popping for this? Anyone familiar with Medica?

Thanks for any help
Andy Minneapolis

*from the news after they rid the planet of fat people and smokers
everything will be perfect, so why are they trying to keep me alive?

From: normc on 27 Oct 2005 18:03
aharcus(a)msn.com wrote:
> I'm going in for the follow up visit at the sleep clinic, filled with
> anxiety. Everyone in my live is assuring me I'll survive, and this will
> improve my life. We'll see.

It takes a lot of determination.... a lot of hit and miss... but the
effort is worth it for many, many people.

>
> The air blowing against my exhalation drives me loony, and makes me
> feel like I'm drowning, even though "rationally" I know it's not so.

Haven't you ever stuck your head out a car window, when it was going
50-60 mph. Or ride a motorcycle without a fairing or helmet (illegal
these days).

Ya, it's a little tough getting used to, but every cpap machine, I know
of, has a ramp feature that starts out low, and lets you fall asleep
before full pressure sets in.

Many, including myself, don't even bother with the ramp after a while.
>
> I apologize up front, but can someone break down the definitions.

CPAP is, as its full name states, one adjustable, continuous positive
air pressure. Bi-pap has two adjustable pressures, a higher one for
when you inhale and a lesser one for when you exhale. Autopap senses
your apneas and adjusts the pressure to meet the need(s).

> Is bi-pap the same as auto-pap?

No. But you can set the inhale and exhale pressures the same, thus
making it a cpap.

> I'm lost and couldn't find a break down
> googling here or anywhere else.
>
> What is the cost difference between the different models.

CPAP costs the least; bipap costs the most; autopap is in the middle.

> From reading
> here auto-pap sounds like the answer.

Several years ago the routine was to prescribe a cpap. If you just
couldn't deal with the continous pressure upon exhaling, they would
prescribe a bipap. But they wouldn't start with a bipap, because of the
cost.

There doesn't seem to be a routine need for an autopap. My certified
sleep doc is part of a big group ( http://www.sleepmedservices.com/ )
and has only prescribed three apaps in his large practice in Los Angeles.

When I asked him why, he said, "Because nothing else worked!"


> How resistent are HMO's for
> popping for this?

Even Medicare won't pop for an autopap, even though it costs less than a
bipap. The reason being that Medicare does not think an autopap is of
value, in most cases.

As for how any health insurance pops, for anything, look at your
policy/agreement, call and talk to them, requesting cites for their
obligations, in the agreement.

HTH

> Anyone familiar with Medica?
>
> Thanks for any help
> Andy Minneapolis
>
> *from the news after they rid the planet of fat people and smokers
> everything will be perfect, so why are they trying to keep me alive?
>

From: Hal S. on 27 Oct 2005 19:15

<aharcus(a)msn.com> wrote in message
news:1130448036.882630.229740(a)g49g2000cwa.googlegroups.com...
> I'm going in for the follow up visit at the sleep clinic, filled with
> anxiety. Everyone in my live is assuring me I'll survive, and this will
> improve my life. We'll see.
>
> The air blowing against my exhalation drives me loony, and makes me
> feel like I'm drowning, even though "rationally" I know it's not so.
>
> I apologize up front, but can someone break down the definitions.
> Is bi-pap the same as auto-pap? I'm lost and couldn't find a break down
> googling here or anywhere else.
>
> What is the cost difference between the different models. From reading
> here auto-pap sounds like the answer. How resistent are HMO's for
> popping for this? Anyone familiar with Medica?
>
> Thanks for any help
> Andy Minneapolis
>
>>----------------------------------------------------------------------------

I'm very familiar with Medica. I've used them for many years, dating back
to when they started out as PHP. They'll supply you with whatever your
doctor prescribes. Mine prescribed VPAP (BiPAP is a trade name) and heated
humidifier.

Hal S.


From: Quick on 27 Oct 2005 20:22
aharcus(a)msn.com wrote:
>
> What is the cost difference between the different models.
> From reading here auto-pap sounds like the answer. How
> resistent are HMO's for popping for this? Anyone familiar
> with Medica?

I've described this a few times here but maybe under different
thread titles.

Most all machines have a "ramp" feature which starts at a
pressure lower than your treatment pressure. The idea is
that you start it at the lower pressure and some minutes
later (adjustable - user settable delay) it ramps up to the
normal operating pressure.

CPAP - Constant
1 pressure all the time. The pressure is set to your Rx and
the machine maintains it.

BiPAP (or VPAP) - Bi-level pressure.
This machine has 2 settable pressures. One for inhale and
one for exhale. The machine senses when you start to inhale
and when you start to exhale. The machine switches between
the low and high pressures almost instantly. The low and high
pressure can be set to be equal to each other making the
machine function as a CPAP. Note that the two pressures
are fixed and the machine switches between them for each
inhale and exhale.

APAP - Automatic
This machine can be set for a maximum and minimum
pressure. The machine will not exceed the maximum pressure
or fall below the minimum pressure. The machine tracks your
breathing and will *gradually* (not each breath) adjust to
provide an adequate treatment pressure. The machines use
an number of sensed factors to adjust the pressure up or down
and how fast to do so. The adjustment occurs over a matter of
seconds/minutes. It provides the same pressure for inhale and
exhale.

CPAPs are the least expensive followed by APAPs with BiPAPs
by far the most expensive. The additional cost of a BiPAP is
primarily due to the blower which must change pressure almost
instantly to stiff tolerances.

BiPAPs are primarily prescribed for people with fairly high
treatment pressures (16 cm, 18 cm, and up) who also have
a hard time tolerating the pressure on exhale.

Each of the machines can provide perfectly adequate treatment.
If you are a normal OSA case there would not necessarily be any
advantage to an APAP over a CPAP. There is nothing to indicate
that getting more pressure than needed to treat your OSA (providing
it doesn't trigger CSA) during the night has any adverse physical
effects.

Look on the web for cost differences www.cpapman.com would
be one place to check. Compare the price of a Remstar Auto
with a Remstar Plus for example. The price between the DME
and your insurance will be a lot more but should be proportional.

I don't know of any insurance companies that will provide an
APAP over a CPAP without a *lot* of resistance. That would be
resistance against your doctor who usually works for them. BiPAPs
are regularly prescribed above some pressure or where otherwise
indicated. Again, for the great majority of patients, there is no
medical advantage to an APAP over a CPAP. Once you are
properly titrated your treatment pressure will not change quickly.
It may change over a few years or if you lose or gain a lot of
weight (in the neighborhood of 30 to 40 lbs).

So. If you are going in for a proper sleep study and titration
don't worry about CPAP vs. APAP. You should make sure
your doctor prescribes a heated humidifier with your machine.
This makes a huge difference in being able to use the machine
for just about everyone (and the integrated ones don't come
cheap).

-Quick


From: Big Bill on 28 Oct 2005 02:47
On Fri, 28 Oct 2005 00:22:03 GMT, "Quick"
<quick7135-news(a)NOSPAMyahoo.com> wrote:

>aharcus(a)msn.com wrote:
>>
>> What is the cost difference between the different models.
>> From reading here auto-pap sounds like the answer. How
>> resistent are HMO's for popping for this? Anyone familiar
>> with Medica?
>
>I've described this a few times here but maybe under different
>thread titles.
>
>Most all machines have a "ramp" feature which starts at a
>pressure lower than your treatment pressure. The idea is
>that you start it at the lower pressure and some minutes
>later (adjustable - user settable delay) it ramps up to the
>normal operating pressure.
>
>CPAP - Constant
>1 pressure all the time. The pressure is set to your Rx and
>the machine maintains it.
>
>BiPAP (or VPAP) - Bi-level pressure.
>This machine has 2 settable pressures. One for inhale and
>one for exhale. The machine senses when you start to inhale
>and when you start to exhale. The machine switches between
>the low and high pressures almost instantly. The low and high
>pressure can be set to be equal to each other making the
>machine function as a CPAP. Note that the two pressures
>are fixed and the machine switches between them for each
>inhale and exhale.
>
>APAP - Automatic
>This machine can be set for a maximum and minimum
>pressure. The machine will not exceed the maximum pressure
>or fall below the minimum pressure. The machine tracks your
>breathing and will *gradually* (not each breath) adjust to
>provide an adequate treatment pressure. The machines use
>an number of sensed factors to adjust the pressure up or down
>and how fast to do so. The adjustment occurs over a matter of
>seconds/minutes. It provides the same pressure for inhale and
>exhale.
>
>CPAPs are the least expensive followed by APAPs with BiPAPs
>by far the most expensive. The additional cost of a BiPAP is
>primarily due to the blower which must change pressure almost
>instantly to stiff tolerances.
>
>BiPAPs are primarily prescribed for people with fairly high
>treatment pressures (16 cm, 18 cm, and up) who also have
>a hard time tolerating the pressure on exhale.
>
>Each of the machines can provide perfectly adequate treatment.
>If you are a normal OSA case there would not necessarily be any
>advantage to an APAP over a CPAP. There is nothing to indicate
>that getting more pressure than needed to treat your OSA (providing
>it doesn't trigger CSA) during the night has any adverse physical
>effects.
>
>Look on the web for cost differences www.cpapman.com would
>be one place to check. Compare the price of a Remstar Auto
>with a Remstar Plus for example. The price between the DME
>and your insurance will be a lot more but should be proportional.
>
>I don't know of any insurance companies that will provide an
>APAP over a CPAP without a *lot* of resistance. That would be
>resistance against your doctor who usually works for them. BiPAPs
>are regularly prescribed above some pressure or where otherwise
>indicated. Again, for the great majority of patients, there is no
>medical advantage to an APAP over a CPAP. Once you are
>properly titrated your treatment pressure will not change quickly.
>It may change over a few years or if you lose or gain a lot of
>weight (in the neighborhood of 30 to 40 lbs).

This seems very likely for me as I've put on that much since quitting
drinking last year. Easy on, easy off, I believe.

>So. If you are going in for a proper sleep study and titration
>don't worry about CPAP vs. APAP. You should make sure
>your doctor prescribes a heated humidifier with your machine.
>This makes a huge difference in being able to use the machine
>for just about everyone (and the integrated ones don't come
>cheap).

I never heard of this humidifier business before. I'm off soonish to
be fitted for a cpap device, just as soon as the local authorities
determine who's going to pay for it.

BB
--
www.kruse.co.uk/ seo(a)kruse.demon.co.uk
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