CPAP, BIPAP and APAP; Which Therapy Should You Use

  You have been diagnosed with obstructive sleep apnea or OSA and then they hit you with a bunch of words you have never heard before.  They start talking about machines and mask and humidity.  You are told this is long term therapy.  What they do not explain is what the machine does, what types of therapy are you eligible for and what will be the best type of therapy for you. 

• CPAP stands for continuous positive airway pressure.  It is the most common therapy used for the treatment of OSA.  It is one continuous pressure that supports the airway.  This pressure was determined during the second sleep study, called the titration study.  On some occasions the titration is able to be done on the same night as the diagnostic study.  During the titration the technician will slowly increase the pressure until the breathing issues, snoring and airway resistance is eliminated or reduced to within normal levels.  In order for the insurance company to pay for the machine you must have at least 5 respiratory events an hour with some type of co-morbitity such as hypertension, or excessive daytime sleepiness.  Once the respiratory events increases to 15 events or higher a co-morbidity is no longer needed.
• Bilevel or BIPAP therapy is similar to CPAP however, instead of one continuous pressure there are two pressures.  The lower pressure is the EPAP or expiratory pressure is increased to eliminate obstructions.  The higher pressure called IPAP or inspiratory pressure is adjusted to eliminate snoring, upper airway resistance and partial closing of the airway.  This therapy is also used to help people who can not tolerate CPAP therapy.  Patients who can not tolerate the pressure they need or who need high pressures this can allow the use of a more comfortable lower pressure.  The change in pressure also assists some people to feel more comfortable or natural.  In order for insurance to pay for this therapy the technician or the doctor must document that CPAP was used unsuccessfully and that Bilevel therapy is the best alternative.
• APAP or AutoPAP is a self titrating therapy that is used for people who may need higher pressures part of the night such as when they are in REM, the stage of sleep where they dream or when they sleep on their back.  This allows the pressure to remain low until the higher pressure is needed.  This therapy is also used when the patient does not wish to come back for the second sleep study.  Many insurance companies do not wish to pay for Autopap because it is more expensive and it is not set to specific settings.
• ASV, AutoSV, or BIPAP ST all of these are similar.  They have an inspiratory pressure and an expiratory pressure the difference is they have a rate as well.  This particular therapy was designed for people with central apnea.  Central apnea is when the brain does not tell the body to breathe.  The Bilevel therapy allows the machine to give a breath and the back up rate allows the machine to give the breaths when it does not sense a breath after a certain period of time.  These machines are only ordered when there are more central apneas then obstructive apnea.  Insurances pay differently for this therapy since it needs closer follow up by the doctor and the durable medical equipment company that sets it up. 
• Oxygen can be ordered for some patients.  It can be added to the therapies described above or be given alone.  Oxygen is prescribed when the level of oxygen in the blood is lower then 89% for a minimum of 5 minutes without an associated respiratory event.  This means that there is not an obstructive apnea or hypopnea causing the decrease in oxygen.
  

Therapy for breathing disorders can be complicated.  It is best to talk to your doctor and your technicians.  The more information you have about the therapy and the options available the more likely that you will be successful.  It is also important to understand your insurance policy’s durable medical equipment reimbursement as this can have a high initial cost.  If you work with your team you should have a successful experience and start to feel better rested and healthier in no time.

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