Sleep apnea is a significant cause of morbidity and mortality and affects up to 14% of the population, yet it often remains underdiagnosed. In my primary care practice, sleep medicine specialists are frequently booked months in advance, so I've transitioned to diagnosing and managing sleep apnea care directly. This blog shares practical tips for ordering a Continuous Positive Airway Pressure (CPAP) machine.
Recommended Device
I recommend the automatic CPAP or APAP (Automatic Positive Airway Pressure) device for its ability to adjust pressure levels automatically. This is generally suitable for mild to moderate OSA (Obstructive Sleep Apnea) cases. Before ordering, discuss mask options with patients, such as full-face masks, nasal pillows, nasal masks, or hockey masks. Showing them pictures online can be helpful. The prescription will include the maximum pressure, typically 14 cmH2O, while the device adjusts as needed. Ensure patients receive proper training from the durable medical equipment (DME) supplier on how to use the CPAP machine and achieve a comfortable fit.
Follow-Up and Compliance
Most insurance companies require a follow-up appointment within 90 days of receiving the CPAP device to verify compliance (this can be a telemedicine visit). Patients should use the device at least 4 hours per night, 5 nights a week. Utilize electronic monitoring systems if available, or have patients provide device usage data from their apps (I find a screenshot through the patient portal is sufficient). Coordinate with your DME company for ongoing supply needs and ensure annual documentation of device use and compliance.
Documentation
For insurance compliance, appropriate documentation in the patient’s chart is essential. An assessment/plan note may look something like this:
Initial visit: I prescribed an Auto CPAP at 6-14 cmH20 with heated humidification and compliance monitoring, with a mask of the patient’s preference through the DME company. Once the CPAP is received, the patient should use it nightly for the duration of each sleep period, including naps. We have discussed compliance requirements, common side effects, and strategies for successful acclimation to CPAP. Follow up in two months for compliance.
Follow-up visit: The patient continues to use CPAP consistently with good compliance and is receiving benefit from treatment. I recommend continued replacement of supplies and routine cleaning of the machine per the manufacturer’s instructions. Continue using each night for the entire duration of sleep, as well as naps. I will check back remotely in three months to follow up on the CPAP report. The patient is encouraged to reach out with any concerns prior to the next visit. Follow up in one year.
Tips & Tricks for Successfully Ordering a CPAP
- Get familiar with local DME companies: Establish a relationship with a local DME company and get comfortable with their ordering system. Many companies offer online ordering, which can simplify the process. Meet with the DME representative if you have questions, they are full of knowledge!
- Understand Insurance Documentation: Set clear expectations with patients regarding the required insurance documentation and the steps involved in obtaining a CPAP device. Make sure that they understand the compliance requirements for use and that they schedule their follow-up appointments in order to maintain insurance coverage.
- Troubleshooting: If patients encounter issues with their masks or devices, work with the DME company to find solutions, such as trying different mask types or adjusting pressure settings. Humidification can also help alleviate some side effects.
- Know When to Refer: If you’re unsure or the patient’s case is complex, don’t hesitate to refer to a sleep specialist. Ensuring your patients get the right care is paramount.
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