Alaska Sleep Education Center

The Problem with CPAP Machines and Why APAP May Be Better

Posted by Jack Johnson on Apr 9, 2014 6:42:00 AM

apap machineWe are using APAP more and more for our patients at Alaska Sleep Clinic and although APAP is not always the perfect remedy, it does work when applied appropriately. 

When patients are diagnosed with Obstructive Sleep Apnea (OSA), the long-standing treatment has been Continuous Positive Airway Pressure (CPAP).  For patients who could not tolerate CPAP, many were then given an Auto-titrating CPAP, more commonly called Auto Positive Airway Pressure (APAP). 

 The goal of a sleep study with CPAP titration is to reach a final, optimal pressure when the patient is sleeping on their back and in the final Rapid Eye Movement (REM) stage.  When a person sleeps on their back (supine), the tongue and jaw can relax and occlude the airway.  In REM, the muscle tone is very flacid so oftentimes patients have more obstructions in supine REM than in other sleep stages and as gruesome as it sounds, as sleep techs, we want to see the patient at their worst so that we can make sure that the machine delivers enough air pressure to hold the airway open when the patient is most vulnerable. 

The Problem with CPAP Devices

Based on the results of that study, the Health Care Provider (HCP) will write a prescription for CPAP at that optimal pressure and that’s what pressure the machine will provide, all of the time, no matter what.  The problem with that is, normally only 25% of the night is spent in REM, so three-quarters of the night CPAP users may be getting a lot higher pressure than they really need.

Rather than one, continuous pressure say, 12cm H2O, an APAP machine is set at a range of pressures, 5-18cm H2O for example and the machine monitors the breathing and using specific algorithms, will increase or decrease the pressure as needed throughout the night. Most patients find it more comfortable and are therefore more apt to use PAP therapy, not only to begin with, but still be faithful APAP users years down the road.

Changes in Insurance for CPAP and APAP 

It used to be that the patient had to “fail” at CPAP before their insurance company would approve the upgrade to APAP, but over time it has proven to be enough of a game changer in patient compliance that it has been included in the same Durable Medical Equipment (DME) code as CPAP, even though it costs a little more.  Bottom line, if you’ve been diagnosed with OSA and your insurance company approves PAP treatment for you, they don’t care if it’s CPAP or APAP, they just want you to use it.

Increasingly, insurance companies are requiring a Home Sleep Test (HST) first before a much more expensive in-lab study.  If a patient is diagnosed with OSA via a HST, the clinician can then order an APAP and know that the patient will be adequately treated with a range of pressures, versus making a guess at what one, single pressure level will work, most of the time.  

So if you're having troubles with your current CPAP or just want to learn more about APAP and other treatment options available, Alaska Sleep Clinic is always ready to work with you to get the answers you need, so contact us today.

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Topics: children, CPAP

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