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CPAP titration study -- CPAP vs. APAP (very long!)

Posted by Bill in TX on January 31, 2002 at 13:29:55:

I've been lurking here for a couple of weeks gathering information. I wanted to thank all of you for your spirit of support and sharing.

I had a sleep study done a couple of weeks ago, after suffering (and inflicting on my wife) progressively worse snoring. The worst part was waking up in the night gasping for air. It got to the point where I was having a recurring dream of being under water and being unable to get to the surface for air.

The sleep doctor still hasn't gotten the results back to my family physician, but the technician told me I had moderate sleep apnea which would definitely need CPAP treatment. The clinic called yesterday to arrange for a CPAP titration next Tuesday. I talked to the head technician about the equipment they use (Respironics Quartet with Maestro remote and gold seal mask), and how they would be doing the titration.

I have been scrambling to educate myself as much as possible -- especially before I have to make a decision on equipment. My insurance will pay at 90% for anything that's prescribed, but there were only a handful of DME's in the Central Texas area for me to choose from. I called all of them, and the only one that seemed really interested in helping put me through to their respiratory therapist, who answered all my questions and told me they sell only ResMed equipment. All the other DME's in the area stock only Respironics. Incidentally, this RT was the only person I talked to who recommended the heated-air humidifier; some of the others told me that the humid air in this part of the country does away with the need for a humidifier... which to me sounds just plain dumb when you have a mask on your face and a machine that's pumping dry air down your throat.

After poring through the forums for info on the various machines, I see a very strong bias toward APAP machines by those who seem to have a lot of experience with both CPAP and APAP. I am also a techie and like the idea of being able to download all the data from the machine and be really involved in my treatment.

My big question is how to make sure that the sleep clinic will recommend the APAP if that is the right way to go. Will they do this as a matter of course, or will I have to push for them to try APAP as well as CPAP? I don't want to just take a prescription for a standard CPAP if ultimately I'm not going to be happy with it.

The tech at the clinic told me that their Quartet machine works in 4 modes: CPAP, APAP, BiPAP and split night (APAP) sleep study. I'm assuming that during the course of the night I have the titration they will try to find which of the 3 basic modes works best for me... is that assuming too much? The tech made the comment that APAP might be more suitable than CPAP if they find I have apneas in different sleeping positions, as different amounts of flow might be suitable to prevent them. Is that true? Are there clinical reasons for using an APAP rather than CPAP, other than not tolerating the generally higher air flow necessary with CPAP?

Then, supposing that APAP was the best mode, how does that mode work on the lab's Respironics Quartet -- like the Respironics Virtuoso? Which I now know functions off tone and not flow limitation like the ResMed AutoSet T that I could get from the DME that I want to work with locally (and which my insurance will pay for).

One last comment is that I don't really want to get into a position where I'm self-diagnosing in terms of what equipment I need, but reading the terrible tales posted on the forums I realize that one has to take the initiative/offensive to make sure that one gets quality treatment. I know that's true of health care in general, but it seems particularly applicable to sleep apnea at this point in time.

Thanks in advance to anyone who can help me muddle through this.

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