CPAP Equipment

One of the most difficult parts of practicing sleep medicine is getting PAP equipment for patients.  As deductibles and copays increase, the majority of the cost for PAP falls back to the patient.  Patient responsibility can be thousands of dollars.  Many people cannot or do not want to afford it.  I can't say I enjoy spending money on PAP equipment.  There are several ways to save money on PAP equipment. Shopping around is a must.  
Shopping online can be a daunting task for first time PAP users.  There are dozens of machines with different abbreviations and descriptions - CPAP, APAP, BIPAP, ASV, AVAPS, auto-titrating - the list goes on.  Nasal mask , nasal pillows, full face mask, or hybrid?  How do you decide?  Here are my suggestions...
Straight forward sleep apnea is treated with CPAP.  CPAP can be either fixed pressure - where you set the machine at one pressure and it stays there for the entire night - or auto-titrating(APAP).  APAP machines adjust pressure depending on estimates of airway resistance.  You set a pressure range on APAP machines - often 5 to 20.  The software decides on the pressure to keep your airway open.
I highly recommend getting an APAP versus a CPAP.  The cost difference is minimal - $100 or so.  You never have to worry about being on the "right" pressure. Most APAPs can be set on a fixed pressure mode if desired.  I have never regretted using an APAP machine.  Changing pressure on a fixed pressure machine requires an in lab titration.  I only prescribe APAP.
BIPAP, ASV, and AVAPS are usually used in patients that have some other cardiopulmonary disease in addition to sleep apnea.  These modes can provide various levels of ventilation.  In other words they can actually do some of the work of breathing for you.
You can get an excellent APAP machine online for $500-600.  This will not include a mask - which is usually another $100 - or a modem.  I don't recommend on buying your first mask online.  Buying a mask without trying it on first is not a good idea.
So for straight forward sleep apnea you can get all the equipment you need to treat it for around $700.  Don't expect to be quoted this price if you walk into a DME company and ask to buy APAP.  They will probably quote you a price of $1500 or more.  You will notice your insurance company will also pay more that $700 for a good APAP.  The reasons for this are beyond the scope of this article.  I will be glad to direct you to a specific website to buy.  Remember - if you buy a PAP online it will not likely go to your deductible.  For people that don't usually hit their deductible it is not an issue.  If you do usually meet your deductible - you are better off to go through insurance even if it is a bit pricier.
Next time I will give you my thoughts on masks!