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Roger McWilliams is Sr. Product Manager for AutoSet® and Diagnostic Equipment. Each question is linked to the answer for your easy reference.
1. How does the AutoSet T™ know to adjust pressure?
2. What is the advantage to the AutoSet T?
3. How does the AutoSet T handle hypopnea events?
4. How does the AutoSet T respond to leak?
5. Does AutoSet T wait for an apnea to occur before delivering positive pressure?
6. I have heard that AutoSet T only works with ResMed masks. Is this true?
7.What is an external pressure line?
8. Why does the AutoSet T work with only some masks, why not all masks?
9. I have heard AutoSet T does not work well with nasal pillows.
10. In your answer you talk about a Mirage setting. Are there other settings on the Autoset T?
11. Are patients able to change the "mask" setting? I have patients that like to use different masks for different reasons at different times.
12. Do you plan to make the AutoSet T work with nasal pillows?
13. Does ResMed plan on making its own nasal pillow device?
14. I have been using a non-ResMed mask, one similar to the Ultra Mirage, with my AutoSet T, and I wonder if I should request a different mask from my DME; I am thinking about asking for the Mirage full face mask series 2.
15. Does the AutoSet T work with the IQ mask?
16. I've heard both that the Breeze Nasal Pillow works and doesn't work with the AutoSet T. Which is correct, or does it depend on the pressure? My pressure has been 13.
17. The Tranquility Auto and the 418P are said to work on the same principles as the ResMed AutoSet-T. What features differentiate these machines?
18. The carryon bag for the AutoSet T is not big enough to carry both it and the heated humidifier. The humidifier comes with no bag. Are you planning to perhaps manufacture a big enough to carry both?
19. I recently tried the Sunrise Auto Adjust machine, and it flat out does not work for me. Any little mask leak makes it spike up to top pressure and actually blows my mask off my face! How can I be assured yours will work?
20. Are there negative effects to therapy for "cheating" the autostart setting by indicating a Mirage standard when in fact I am using a full face mask?
21. I hear that autoPAPs only work for people on low to moderate pressures, is this true?
22. Are the pressure settings on AutoSet T and your other flow generators accessible to the patient?
23. Would there be any advantage in having an AutoPAP for someone who has to keep his pressure in a very narrow range, such as: 15 to 18?
24. I am on high-pressure settings and worry that AutoSet T will not keep up with my needs, how high does Autoset T go?
25. Is CO2 rebreathing a concern with AutoSet T or any of your products?
26. I have heard that AutoSet T picks up noise from the bedroom or bed partner and delivers unneeded pressure?
27. With all the advanced programming that the Autoset T has, can a combination be made for changing for daylight saving time. I ended up changing the time and instead of going back an hour, I had to manually go forward 23 hours. Also, if such a change is made, will it be something that those of us that have an Autoset T can get upgraded?
28. Is the data collected by AutoSet T available for the patient to access without the physician so we can monitor our own therapy?
29. What is the benefit of using AutoPAP as opposed to CPAP or bilevel?
30. I saw the AutoSet T at my DME and it seemed bigger and heavier than my current CPAP. Will you be coming out with a new model that is smaller and lighter?
31. Are there any benefits to using a humidifier with an AutoSet T?
32. Are there any charts that list all AutoPAP machines, the principle(s) upon which they work; which ancillary devices are approved, which are tested but not approved, etc. I realize there are problems with liability etc . . . but there is SO MUCH MISINFORMATION out there, that some degree of clarification would be a great help.
33. You have mentioned "validation studies" as reported in peer-reviewed journals. Does your website have a list of the journal articles?
34. How does this new equipment differ from Remstar LX Plus?
35. Is the AutoSet T available as an attachment to CPAP units or is it part of a specific line of CPAPs?
36. If you are an allergy sufferer, will the AutoSet T provide sufficient air filtering?
37. The Goodnight 418P responds to hypopneic events while the AutoSet T only records them, why do you choose not to respond to them?
38. Just started our first client on an AutoSet T. The report features are most helpful. Bed partner is most impressed with low sound level.
39. How is the need for an autoPAP as opposed to CPAP determined?
40. I am looking to purchase an autoPAP. Why should I choose the AutoSet T over any others?
41. If the AutoSet T reacts to an apnea, is it not too late? My understanding is that when an apnea occurs I "wake up." I am new to this (three months with CPAP) and need to know more.
42. If you suffer with hypopneas more than OSA, can the AutoSet T still be of benefit?
43. Is there a more compact version of the AutoSet T in the works, one more compact for travel?
44. Can the clinician download patient info over an Internet connection? If not, how is this done and does it require both parties to be "present"?
45. Is the pressure setting made with the AutoScan software?
46. Is there any difficulty in using non-ResMed heated humidifiers with the AutoSet T?
47. My CPAP is set on 6 cm H2O. Would I benefit from the AutoSet T?
48. Is there a way of having the automatic start feature selected when using the Mirage full face mask?
49. Do you recommend the use of humidity as an integral part of AutoSet treatment to maximize comfort?
50. Does the length of the tubes from the machine to the mask make a difference?
51. What is the difference between an autoPAP and a CPAP?
52. I have found that patients with striking variations in CPAP pressures during a CPAP titration (sleep stage and body position changes) seem to have a greater difficulty with CPAP. Has there been any studies indicating that this pattern of response would lend itself to the AutoSet device?
53. Does the AutoSet T need to be checked on a regular basis to see if it is still giving correct pressure?
54. I believe sleep clinicians should be keenly aware of their patients needs during CPAP titration, in order to assure the best possible result. Such results may require autoPAP devices like the AutoSet T, but where do bilevel devices shine over the AutoSet T?
55. I have an AutoSet T. Can I see AHI etc on the LCD?
56. How fast does AutoSet T evaluate and respond to changes?
57. Will AutoSet T record a nap AND a nights sleep in one 24-hour period?
58. Can you tell me how AutoSet T opens an airway that is closed?
59. I want to take my AutoSet T when I travel, but I'm worried that airport security won't permit me to take it on board the plane. What should I do?
60. I appreciate the openness of your responses. It is accurate information that helps patients decide what products to consider using.
61. I am newly diagnosed with sleep apnea and will be getting my CPAP soon. I asked my doctor about AutoPAP, and he said insurance will probably not pay. Why?
62. My home health care company could not tell me anything about the AutoSet T except that I should not consider it because my insurance would probably not pay for it. I found this insulting. Is this product so new on the market that they have not been educated on it to help us patients?
63. The use of autotitrating devices is, I believe, a much needed instrument in the arsenal to treat OSA. How can we get the Insurers to pay for its use?
64. Given the benefit of using the AutoSet device, why does the insurance industry make it so difficult to get?
65. Can I request that my doctor prescribe an AutoSet T? Will that get my insurance to pay?
66. How do I find out if Medicare will cover an autoPAP for me?
How does the AutoSet T™ know to adjust pressure?
After you fall asleep and your pressure needs begin to vary, the AutoSet T (AutoSet Therapeutic) responds to three separate parameters: inspiratory flow limitation, snore, and apnea. AutoSet T acts preemptively by increasing pressure in response to inspiratory flow limitation and snore, both of which typically precede obstruction. AutoSet T calculates the pressure required based on the severity of the event. This early intervention prevents obstructive apneas and reduces respiratory arousals. If an apnea suddenly occurs without any preceding flow limitation or snore, AutoSet T will increase pressure in order to prevent subsequent apneas. If no further events occur, AutoSet T reduces the pressure back to a minimum level. If an apnea suddenly occurs without any preceding flow limitation or snore (from a change in body position, for instance), AutoSet increases pressure at the termination of the apnea in order to prevent subsequent apneas. The amount of pressure increase is based on the duration of the apnea. When all airway parameters are back to normal, AutoSet T gradually decreases the pressure back to clinician selected minimum pressure setting over 20 minutes. If a mask or mouth leak occurs, AutoSet T increases flow to maintain the desired treatment pressure.
What is the advantage to the AutoSet T?
AutoSet T is an automatic titration system for the treatment of obstructive sleep apnea (OSA). AutoSet T adjusts pressure on a breath-by-breath basis to suit patient needs as they vary throughout the night. As a result, the patient receives the minimum pressure required for effective therapy. The lower mean pressures improve patient comfort, reduce pressure-related side effects, and lead to increased patient tolerance and compliance.
How does the AutoSet T handle hypopnea events?
The AutoSet T responds to obstructive hypopneic events when associated with a concomitant flow limitation or snoring. Hypopneas that are central in origin (related to your central nervous system, not physical obstruction) should not be treated with increased pressure.
How does the AutoSet T respond to leak?
The AutoSet T will deliver up to 200 liters per minute to maintain the desired treatment pressure. With leaks greater than 40 liters per minute lasting 20 seconds, the AutoSet T will sound an optional, audible alarm (our exclusive leak alert function). A message on the AutoSet T display will be shown in the morning if a leak greater than 24 liters per minute occurs for more than 30 percent of the treatment session. The internal memory on the AutoSet T stores information about leak, which can be downloaded, and reviewed with AutoScan software.
Does AutoSet T wait for an apnea to occur before delivering positive pressure?
No, it begins each night's treatment at either a preset pressure or at a physician-selected baseline. Your physician or sleep specialist will decide which setting is best for you.
I have heard that AutoSet T only works with ResMed masks. Is this true?
No, this is not true, but it does raise an important issue. The AutoSet T will work with SOME, BUT NOT ALL, mask systems. When we developed the AutoSet T, we developed it for use with ResMed masks, most notably the Mirage® mask and the modular (or standard) ResMed mask. The later model AutoSet T with the external pressure line is also compatible with the Ultra Mirage™ mask and Mirage full face mask. If you have a mask with the same volume, flow, and tubing characteristics as our Mirage mask, you should be able to select the Mirage setting on the AutoSet T and use your non-ResMed Mirage imitation. Unfortunately, we can't recommend specific mask types for use with the AutoSet T without putting them through frequent validation testing. We have done this with some of our competitors' masks, but we can't do it with all of them. First, there are too many masks for us to test all of them. Second, we don't want to invest in testing masks that won't stay on the market for very long. You may have noticed that some masks come and go quickly.
What is an external pressure line?
It's a 1/8" PVC tube connected to a 22mm male/female adapter on the outlet of the AutoSet T. This pressure line also permits use with a humidifier.
Why does the AutoSet T work with only some masks, why not all masks?
This is a more difficult question to answer. The short answer is that all masks have different physical characteristics and the AutoSet T needs to know the specific characteristics of a mask for optimal performance. The long answer goes something like this: the AutoSet T is a very sensitive, intelligent device that responds to conditions like leak, snore, and inspiratory flow limitation. To properly treat a person with OSA, the AutoSet T needs to know exactly how much of the conditions it detects come from the mask. All masks have some degree of leak to ensure users get fresh air. All masks also have some degree of resistance by virtue of their materials, contours, and leak.
I have heard AutoSet T does not work well with nasal pillows.
This is not true. Our internal testing performed in July 1999 verified that the AutoSet T does work with the Adams circuit nasal pillows (being manufactured at the time of testing) when using the Mirage setting. Our internal testing of the Breeze showed that it does not function acceptably with the AutoSet T as a result of high resistance and should not be used. If either manufacturer has changed the design of these masks, they may function differently with AutoSet T now.
In your answer you talk about a Mirage setting. Are there other settings on the Autoset T?
There is a setting for the Mirage mask, the Ultra Mirage mask, the Mirage full face mask, and the standard/modular ResMed masks.
Are patients able to change the "mask" setting? I have patients that like to use different masks for different reasons at different times.
Yes. Patients are able to change the mask setting with the AutoSet T user menu.
Do you plan to make the AutoSet T work with nasal pillows?
No, we don't plan to create a special setting for nasal pillows. The setting would have to be specific to a particular manufacturer's nasal pillow design, and the setting would be obsolete as soon as the manufacturer changed its design. For that reason, it's a risky investment for us.
Does ResMed plan on making its own nasal pillow device?
I don't know of any plans to create a nasal pillow system, and we have less and less reason to do so. Our innovations in mask technology have been making the need for nasal pillow systems less of a priority. The Mirage family of masks has improved fit and seal to the point that many people who used nasal pillows now use our mask systems.
I have been using a non-ResMed mask, one similar to the Ultra Mirage, with my AutoSet T, and I wonder if I should request a different mask from my DME; I am thinking about asking for the Mirage full face mask series 2.
The Mirage Full Face Mask Series 2 will function ideally with AutoSet Ts manufactured with an external pressure line. Simply select Mirage Full Face Mask on the AutoSet T menu.
Does the AutoSet T work with the IQ mask?
The IQ mask was tested in July 99 and does not function effectively.
I've heard both that the Breeze Nasal Pillow works and doesn't work with the AutoSet T. Which is correct, or does it depend on the pressure? My pressure has been 13.
The AutoSet T does not work with the Breeze, regardless of pressure.
The Tranquility Auto and the 418P are said to work on the same principles as the ResMed AutoSet-T. What features differentiate these machines?
The AutoSet T differentiates itself in its unique ability to monitor, measure, and adjust to a patients pressure requirements in response to three separate parameters: inspiratory flow limitation, snore, and apnea, in contrast to other machines that only respond to one or two of these parameters. To further assist in patient diagnosis, the AutoSet T also provides comprehensive data functionality covering pressure, leak, and AHI flow tracings.
The carryon bag for the AutoSet T is not big enough to carry both it and the heated humidifier. The humidifier comes with no bag. Are you planning to perhaps manufacture a big enough to carry both?
For existing products, additional bags can be purchased from ResMed. You can call our customer service department at 1.800.424.0737 x1. Future product designs will address this requirement. [Since this chat, ResMed has released a new travel bag.]
I recently tried the Sunrise Auto Adjust machine, and it flat out does not work for me. Any little mask leak makes it spike up to top pressure and actually blows my mask off my face! How can I be assured yours will work?
AutoSet T is designed to increase flow to maintain the desired treatment pressure in the face of leaks and not to exceed the desired treatment pressure.
Are there negative effects to therapy for "cheating" the autostart setting by indicating a Mirage standard when in fact I am using a full face mask?
PLEASE DON'T DO THIS! In essence you're telling the AutoSet T to compensate for a situation that doesn't exist. I can't tell you exactly how this will affect your treatment, but it's not a reliable way to address treatment issues.
I hear that autoPAPs only work for people on low to moderate pressures, is this true?
Actually, the opposite is true. According to a recent study, the AutoSet T provides the greatest benefits for people on 10 cm H2O or more.
Are the pressure settings on AutoSet T and your other flow generators accessible to the patient?
No, patients cannot program the pressure setting because it is considered a prescription. With the AutoSet T there really isn't a set pressure because the device adjusts to varying needs. You CAN view the pressure supplied by the AutoSet T at any given moment, but that's not much use when you're asleep. If you have a bed partner, they can look at it while you're sleeping. If you want a good overview of your maximum, minimum, and median pressures, you will have to ask your clinician. Clinicians can download data from the AutoSet T. We actually recommend that clinicians download patient data in the first weeks or months of therapy to verify that treatment is effective. Patients who experience difficulties with treatment may also benefit from a clinician reviewing their treatment data. The AutoSet T records efficacy data that helps the clinician identify problems and fix them.
Would there be any advantage in having an AutoPAP for someone who has to keep his pressure in a very narrow range, such as: 15 to 18?
Yes, there might be an advantage. Let's say that an AutoSet T reduced your CPAP pressure from a constant 18 to an average of 16. If reducing the average pressure by 2 increased comfort, encouraged longer periods of usage, and reduced sinus irritation, then and AutoSet T would be of great benefit. What you and your clinician should consider is if a slightly lower pressure will help you and your treatment. I was talking with a patient the other day. She just changed her treatment pressure from 20 to 18 because of nasal irritation. This slight decrease has helped her, but an AutoSet T might help her even more if it can bring her average pressure down even more.
I am on high-pressure settings and worry that AutoSet T will not keep up with my needs, how high does Autoset T go?
The AutoSet T delivers up to 20 cm H2O.
Is CO2 rebreathing a concern with AutoSet T or any of your products?
All of our products have been designed to minimize CO2 rebreathing, so it shouldn't be a concern. As a rule, CO2 rebreathing is more likely to be a problem at lower pressures and with older mask systems. Today's mask systems are very good in this respect although you may want to check with the manufacturer for details if it's a particular concern for you.
I have heard that AutoSet T picks up noise from the bedroom or bed partner and delivers unneeded pressure?
This is not true. The AutoSet T does not respond to sound. It responds only to pressure changes resulting from snoring, changes in the inspiratory flow-time curve and reduction in air flow that occur during apnea.
With all the advanced programming that the Autoset T has, can a combination be made for changing for daylight saving time. I ended up changing the time and instead of going back an hour, I had to manually go forward 23 hours. Also, if such a change is made, will it be something that those of us that have an Autoset T can get upgraded?
It is presently a one-way menu structure, and there aren't any plans to change this.
Is the data collected by AutoSet T available for the patient to access without the physician so we can monitor our own therapy?
No, unfortunately not. FDA regulations limit the sale of diagnostic software to or on the order of a physician. The software help screen, diskettes, and clinical manual are marked accordingly to indicate this. I don't know of any way for patients to access this info without their clinician's assistance.
What is the benefit of using AutoPAP as opposed to CPAP or bilevel?
The goal of autotitration systems is to deliver only as much pressure as the patient requires at a given moment. The people that benefit the most from this type of treatment are those who have significant fluctuations in their pressure requirements and those that tend to have higher pressure requirements. A study conducted in 1999, by a group of doctors in Chicago, found that patients on 10 cm H2O or greater experienced the greatest benefits. I would like to add that the study I mentioned used our AutoSet T, and the same results should not be expected from other autotitration devices. Not all autotitration systems work the same way, and not all devices provide the same quality therapy. The AutoSet T uses algorithms and sensors not found in other devices, so it provides a very unique type of therapy with proven results.
I saw the AutoSet T at my DME and it seemed bigger and heavier than my current CPAP. Will you be coming out with a new model that is smaller and lighter?
You're right. The AutoSet T weighs 3 or 4 pounds more than our S6 CPAP. However, smaller, lighter devices are inevitable. That is the direction technology and customer preferences are taking industry. ResMed is committed to continuously improving our products so this is a direction in which we are headed. [Since this chat, ResMed has released the AutoSet Spirit™ autotitrating device.]
Are there any benefits to using a humidifier with an AutoSet T?
Humidification benefits are the same as with any other PAP device. But with the AutoSet T the overall lower mean airway pressure typically reduces the need for a humidifier because there is less flow used at these lower average pressures.
Are there any charts that list all AutoPAP machines, the principle(s) upon which they work; which ancillary devices are approved, which are tested but not approved, etc. I realize there are problems with liability etc . . . but there is SO MUCH MISINFORMATION out there, that some degree of clarification would be a great help.
There are a couple clinical articles that compare various devices. Additional studies are forthcoming, based on information we've heard. AutoSet technology has been clinically validated in numerous peer-reviewed journals over the past eleven years. The same is not true for all autoPAPs.
You have mentioned "validation studies" as reported in peer-reviewed journals. Does your website have a list of the journal articles?
Yes. We have a list of the studies that relate to the AutoSet T. Try this link: http://www.resmed.com/us/1005093120200.html#AutoSet
How does this new equipment differ from Remstar LX Plus?
The REMstar LX Plus is a fixed pressure CPAP device, not an autoPAP variable pressure device.
Is the AutoSet T available as an attachment to CPAP units or is it part of a specific line of CPAPs?
It is a separate stand-alone autoPAP device. It is not an adjunct or attachment to existing PAP devices.
If you are an allergy sufferer, will the AutoSet T provide sufficient air filtering?
We do have a hypoallergenic filter. Contact customer service at 1.800.424.0737.
The Goodnight 418P responds to hypopneic events while the AutoSet T only records them, why do you choose not to respond to them?
Obstructive hypopneas are associated with flow limitation and snoring, which the AutoSet T responds to. Responding to central hypopneas with additional pressure stimulates the stretch receptors in the periphery of the lung and can invoke the Hering-Breuer reflex, which sends signals to the respiratory sub-center of the brain and tells the brain that inspiration is complete. This can cause an increase in central hypopneas. Increasing pressure in response to central hypopneas is inappropriate.
Just started our first client on an AutoSet T. The report features are most helpful. Bed partner is most impressed with low sound level.
Thanks for the success story!
How is the need for an autoPAP as opposed to CPAP determined?
If the patient fails standard CPAP therapy, either due to positional apneic events or REM-related apneic events that require a variable pressure range or due to apneic events requiring continuous high pressures, an AutoSet T is indicated. Efficacy is one measure of success, which is indicated by the apnea-hypopnea index (AHI). Poor treatment compliance, the failure to use the device for a minimum of 6 hours per evening, may be construed as another measure of failure. Patients who are noncompliant on standard CPAP, either due to intolerance or failure to prevent the regression of sleep-disordered breathing are considered to have failed standard CPAP. There is also a range of symptoms that indicate possible benefit form AutoSet therapy: pressure-related discomfort, nasal drying, runny nose, abdominal bloating, and flu like symptoms. These symptoms are minimized with an AutoSet T because of the lower overall mean airway pressures utilized.
I am looking to purchase an autoPAP. Why should I choose the AutoSet T over any others?
A: The AutoSet algorithm has been clinically validated in numerous peer-reviewed journals over the past 11 years. It is the only device that monitors the airway and responds as needed on a breath-by-breath basis.
If the AutoSet T reacts to an apnea, is it not too late? My understanding is that when an apnea occurs I "wake up." I am new to this (three months with CPAP) and need to know more.
To some degree, you're right: by the time an apnea occurs it's "too late." That's why the AutoSet T responds to upper airway resistance, snoring, and then apneas when they occur without the usual precursor of inspiratory flow limitation. When an apnea does occur, the AutoSet T waits to respond until the apnea has ended. It waits because the amount of pressure necessary to open an obstructed airway is very high. Once the apnea ends, the AutoSet T increases pressure so that another apnea does not occur.
If you suffer with hypopneas more than OSA, can the AutoSet T still be of benefit?
Absolutely, the AutoSet T is an excellent treatment for hypopneas (upper airway resistance syndrome, commonly referred to as UARS) as long as your hypopneas are obstructive in nature.
Is there a more compact version of the AutoSet T in the works, one more compact for travel?
Our devices have continued to become smaller and lighter, so I think this is inevitable.
Can the clinician download patient info over an Internet connection? If not, how is this done and does it require both parties to be "present"?
Yes, but not really on the Internet. Downloads can be done over a phone line using a modem, but both parties still have to be present because someone will need to connect the device to the line. The only limitation on this capability is modem compatibility.
Is the pressure setting made with the AutoScan software?
The AutoSet T does not require a pressure setting, except in a few circumstances (e.g., clinician selected minimum start pressures). In those circumstances, the clinician enters settings using the interface on the AutoSet T. ResMed's AutoScan software can also be used and so can the ResControl.
Is there any difficulty in using non-ResMed heated humidifiers with the AutoSet T?
We haven't tested the AutoSet T with non-ResMed humidifiers, so I wouldn't recommend using them together.
My CPAP is set on 6 cm H2O. Would I benefit from the AutoSet T?
It might make your overall therapy a little more comfortable, but you're not a prime candidate for an AutoSet T. People with settings of 10 cm H2O or higher are the most common candidates.
Is there a way of having the automatic start feature selected when using the Mirage full face mask?
No, the SmartStart feature automatically turns off when the Mirage full face mask is selected. The Mirage full face masks have an anti-asphyxia valve, which allow you to breathe in case of a power failure. This valve eliminates the pressure changes that signal the AutoSet T to start when someone uses a nasal mask.
Do you recommend the use of humidity as an integral part of AutoSet treatment to maximize comfort?
I believe there is at least one study that reported most patients do better with humidification. However, from a practical standpoint, I would recommend it on an as-needed basis. If you're experiencing nasal irritation, congestion, or a sore throat, you may benefit from a humidification system.
Does the length of the tubes from the machine to the mask make a difference?
Yes. The resistance varies between different tube lengths. AutoSet T utilizes a sophisticated algorithm that takes these differences into account. That is why there is a choice between a 2M and a 3M tube in the menu.
What is the difference between an autoPAP and a CPAP?
A CPAP device provides one continuous airway pressure. AutoSet T adjusts pressure on a breath-by-breath basis to suit patient needs as they vary throughout the night. As a result, the patient receives the minimum pressure required for effective therapy. The lower pressures improve patient comfort, reduce pressure-related side effects, and leads to increased patient tolerance and compliance. When selecting an autoPAP device, keep in mind that all automatic positive airway pressure (autoPAP) devices function differently. AutoPAP is a generic term describing this classification of flow generators. AutoSet T is a registered trademark of ResMed. If you are looking into purchasing an autoPAP device, you should investigate the clinical validation studies for the device.
I have found that patients with striking variations in CPAP pressures during a CPAP titration (sleep stage and body position changes) seem to have a greater difficulty with CPAP. Has there been any studies indicating that this pattern of response would lend itself to the AutoSet device?
I'm not familiar with any studies like this, but they may be out there. It's an interesting observation. My guess is that these types of patients would find an AutoSet T more comfortable than a conventional CPAP.
Does the AutoSet T need to be checked on a regular basis to see if it is still giving correct pressure?
No, it has an internal pressure transducer that maintains calibration and allows patients to use the AutoSet T at varying altitudes without adjusting the pressure.
I believe sleep clinicians should be keenly aware of their patients needs during CPAP titration, in order to assure the best possible result. Such results may require autoPAP devices like the AutoSet T, but where do bilevel devices shine over the AutoSet T?
If a person needs ventilatory assistance, a bilevel will be better. For instance, people with more central apneas or morbid obesity may require ventilatory assistance. An IPAP and an EPAP actually help these people breathe, in addition to helping them maintain an open upper airway.
I have an AutoSet T. Can I see AHI etc on the LCD?
That information is available with the AutoScan software, which is available to clinicians only.
How fast does AutoSet T evaluate and respond to changes?
The AutoSet T evaluates flow limitation on a breath-by-breath basis and adjusts pressure according to a three-breath average.
Will AutoSet T record a nap AND a nights sleep in one 24-hour period?
Yes, it will.
Can you tell me how AutoSet T opens an airway that is closed?
If an airway does close during therapy, the AutoSet T waits for the apnea to end before increasing pressure, so it doesn't actually open the airway. Opening a closed airway takes a significant amount of pressure, which would arouse the user and possibly cause discomfort.
I want to take my AutoSet T when I travel, but I'm worried that airport security won't permit me to take it on board the plane. What should I do?
I suggest you ask your physician for a letter stating the medical need for this device. This should allow you to carry this device on board.
I appreciate the openness of your responses. It is accurate information that helps patients decide what products to consider using.
Thank you!
I am newly diagnosed with sleep apnea and will be getting my CPAP soon. I asked my doctor about AutoPAP, and he said insurance will probably not pay. Why?
Insurance companies tend to pay for the least expensive device that will treat a condition. AutoPAP devices cost more and will usually be prescribed on an as-needed basis only. There isn't any higher reimbursement code for AutoPAP devices at the present time. Autotitrating systems have only been commercially available for a short time compared to the length of time traditional CPAP and bilevel devices have been marketed. Since autotitrating devices are relatively new to the marketplace, a specific HCPCS (HCFA Common Procedural) billing code has not yet been established for these types of systems.
My home health care company could not tell me anything about the AutoSet T except that I should not consider it because my insurance would probably not pay for it. I found this insulting. Is this product so new on the market that they have not been educated on it to help us patients?
The AutoSet T has been available for several years, but it's not considered a standard device. As I stated a minute ago, insurance companies want to pay for the least expensive device that will satisfy your clinical need. So your DME is probably right. Your insurance company won't want to pay for this technology if it's not necessary for your condition. If you're interested in an AutoSet T, you may want to ask your insurance company about how to get an AutoSet T. They may ask you to pay for the upgrade, or they may request your physician document your need before they pay for it.
The use of autotitrating devices is, I believe, a much needed instrument in the arsenal to treat OSA. How can we get the Insurers to pay for its use?
Excellent question. Would you like a job in our marketing dept? Seriously, we feel the same as you, and as the word spreads, maybe the AutoSet T will become the gold standard of care. We are currently working with Blue Cross, CMS, American Academy of Sleep Medicine, and regional reimbursement carriers to increase awareness of the benefits of autoPAP vs CPAP. Patient support in this effort to educate insurance carriers and government agencies is invaluable. Sharing your positive experiences will help patients like you in the future.
Given the benefit of using the AutoSet device, why does the insurance industry make it so difficult to get?
Cost is the primary issue. First they want to know it's effective, and we have the clinical validation to show that the AutoSet T is effective, but next they want to know if it's effective enough to warrant the increased cost.
Can I request that my doctor prescribe an AutoSet T? Will that get my insurance to pay?
Your doctor has the ability to prescribe an AutoSet T, but you will have to ask your insurance company whether or not they will cover it. A letter of medical necessity from your doctor would also improve your chances of getting your insurance to pay for the device.
How do I find out if Medicare will cover an autoPAP for me?
You'll need to work with your homecare provider, but the odds are that Medicare won't cover it. If you have OSA, they will probably cover a CPAP. However, you may be able to pay the difference and upgrade to an AutoSet T if you want. The new Advanced Beneficiary Notice makes this an option. The guidelines for these still have not been published by the Centers for Medicare and Medicaid Services (CMS), but they should be published this year. Ask your DME for details. If you still feel like your clinical needs are not being met, you can and should lobby for changes. If patients don't demand change, I doubt they'll get it.
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