9 Years of APAP and now BPAP is recommended

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Rastaman
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9 Years of APAP and now BPAP is recommended

Post by Rastaman » Wed Oct 22, 2014 6:26 am

I have been using an S8 Autoset Vantage by Resmed for about 9 years now. Originally, I had a Respironics CPAP plus or something like that which had data capabilities. But I got good advice here and had it replaced at my Sleep Doctor's office and have used it ever since. Originally, my 90% pressure was 13. When my original sleep doctor gave me an APAP they set it for 4 to 20 cm's of pressure but I got better advice here and have it set for 10 to 16 currently. Most days I sleep very well. I don't notice the machine waking me up or anything like that.

Well, this Spring I was in the hospital for a little over a month and a sleep doctor shared an office with my pulmonologist and happened to see me in the hospital. I had already met my out of pocket for the year and I hadn't had a sleep study in years now. Also, I hadn't had anything covered by insurance in years. I just used my medical savings card and purchase from cpap.com usually for basic supplies. Well, I had a split night study that turned into two nights. My sleep doctor doesn't have her own sleep lab but she's right across the street from the hospital's facilities here in Austin. After my first night I never got to use the cpap on the first night so they scheduled me to come back a second night. Did that. Results were inconclusive. I take some different medications right now that can affect things but not every night. Not sure how I could've been inconclusive on the 2nd night but I tried a full face mask that night when I normally sleep with a nasal Comfort Gel Original.

Well, my sleep doctor schedules a 3rd night and this time for BPAP. (They used Respironics machines at this sleep lab btw) I don't hear anything back for about 10 days so I call my sleep doctor's office and ask about ordering a new machine that is data capable (been talking about getting a new APAP since I started going there and have already seen her at least twice so far). My Resmed S8 Autoset Vantage doesn't appear to be transmitting data to this office's card reader. And so a new machine would enable her to see this information. And the plan was to order a new machine and use it and then bring in new data for her (She already has 2 nights of CPAP and BPAP to review but that's just 2 nights and not a month's worth or a few week's worth)

Well, I never heard back from a DME. I did get one call back from my sleep doctor's front desk telling me that they were going to look for a local DME that accepted my insurance and have someone contact me but I've never heard anything back. I spoke to them last on last Thursday and now it's Wednesday of the following week. I feel a little odd purchasing a BPAP out of the blue. And when I suggested on that second phone call that I get an Auto-BPAP the front desk girl at my sleep doctor said they usually only get those if there has been a problem auto-titrating you. Never mind the fact that I've used an APAP for 9 years now since 2005.

I know I don't have data to share here. And I have not seen the results of either study. Nor have I gone over the studies with my sleep doctor. I do remember that using the BPAP at the hospital lab (not affiliated with my sleep doctor) was a bit problematic because the lower pressure started before I completed a full breath. I was still taking my longer breath when it would change pressures to the lower pressure, whatever they choose for me. I'm probably going to call my sleep doctor's office and let them know that a DME never got back with me but I'm wondering if I should push harder for an APAP vs. BPAP? In the meantime, I'm writing down my numbers every morning. They disappear by noon on an S8. I also wrote down my weekly, monthly, 6 month and 1 year numbers, which are all on the machine. The card reader "looks" like it works on the machine, it says data transferred. But when I take that card to my sleep doctor's office they can't read it. They said to take it to my DME and they could read it and send over the data. But I don't have a DME. Not yet. I never did. My original sleep doctor provided the sleep study in house and provided all equipment there as well. I never went offsite. And now, it's completely different. And it kind've feels like they've dropped the ball a little by not even contacting me back.

I'm thinking about calling my sleep doctor today and asking for them to email my new prescription to me. Surely, I have one of those after 3 sleep study nights (Split study became two nights, plus BPAP on 3rd night) My sleep doctor is lucky I had already met my out of pocket or else I wouldn't have been able to do a sleep study at all. I have a $5,000 deductible and would've never been able to afford that! So, I'm only going to be able to do a sleep study on years where I've already met the deductible anyway. Usually, I just pay for masks, hoses and filters out of pocket, albeit a medical savings card. (Visa) That is tax free at least.

Should I push for an Auto-BPAP? Or just a regular APAP since I don't normally have issues with my current APAP. My Resmed S8 Autoset Vantage is still alive and kicking. It still has data on it. But it is 9 years old and apparently isn't transmitting data to this office for the doctor to review. I told her I wanted to buy another APAP from the get-go since I already use one for the past 9 years. Why would I need a BPAP over APAP? I don't even have pressure relief now since I don't use the CPAP mode on my APAP. It's just breath by breath and the machine lets me take a full breath each and overtime, unlike the BPAP (non-auto) Respironics model they used at the hospital's sleep lab.

Any suggestions are much appreciated. I don't have much time left because I need to purchase something through insurance before the end of the year since I've already met my deductible for the year. What would you do?

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LSAT
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Re: 9 Years of APAP and now BPAP is recommended

Post by LSAT » Wed Oct 22, 2014 7:23 am

I don't believe that your S8 EVER transmitted data to your doctor. You definitely need to purchase a new machine, but without knowing what the sleep study showed it's hard to make a recommendation. What is your current pressure on the S8 Vantage?

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Re: 9 Years of APAP and now BPAP is recommended

Post by Pugsy » Wed Oct 22, 2014 7:40 am

You need to find out at least 2 main things.
1...what pressures did they come up with for you...bipaps will go to 25...apaps go to 20...maybe your pressure needs have changed.
2...did you have an issue with centrals and that's why they opted for bilevel.
Your S8 never flagged centrals but these new machine do...and bilevel (and there's basic bilevel and high dollar bilevel with a BIG price difference) of some sort is often used when centrals are problematic.

You need to find out what you are dealing with in terms of apnea before worrying about an auto bipap. If centrals are in the mix in numbers enough to be problematic the picture changes.

oh..3rd thing maybe which might help with the auto bilevel argument if centrals aren't an issue ...if you have times where you can use less pressure and only need more pressure like for REM sleep or supine sleeping..that sometimes makes a good argument for bilevel.
So find out from the sleep study (get a copy) what happens to your pressure needs in REM or supine sleeping.

If you don't have issues with centrals...and your doctor will write for Auto bilevel and be specific the DME can be forced to supply the machine but the doctor has to be on your side.
If centrals aren't an issue...and you do need pressures greater than an APAP will do..there is always the option to purchase out of pocket like you did in the past. Those puppies are pricey though.
If centrals are an issue we need to have another discussion but won't cross that bridge unless we come to it as those high end bilevel machines are REALLY pricey.

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Re: 9 Years of APAP and now BPAP is recommended

Post by Rastaman » Wed Oct 22, 2014 7:46 am

LSAT wrote:I don't believe that your S8 EVER transmitted data to your doctor. You definitely need to purchase a new machine, but without knowing what the sleep study showed it's hard to make a recommendation. What is your current pressure on the S8 Vantage?
Well, she advised me to bring in the Res Scan card after sliding it into the machine. It says something when you slide the card in like data transferred or something to that effect. I did this on two different occasions and neither time were they able to get data from the card.

My current pressure range is 10 to 16. And agree without the study it's probably hard. I have not seen either study yet. I will see this Doctor on November 5th.

I just called my sleep doctor's office (My internal medicine doctor just knows I have sleep apnea and I'm compliant but I had it before I got my current internal medicine doctor so he doesn't know any details at all) and they told me that I should've got a call from the DME by now and that they transferred my prescription to them on October 14th, prior to my even calling them in the first place but possibly she got the date wrong. She definitely got the phone number transposed because I called the number given but it's disconnected. And I looked them up by name and the number was just transposed. They open at 9am this morning and I'm going to give them a call about this BPAP. Maybe they have an incorrect phone number for me or something.

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Re: 9 Years of APAP and now BPAP is recommended

Post by Rastaman » Wed Oct 22, 2014 7:56 am

Pugsy wrote:You need to find out at least 2 main things.
1...what pressures did they come up with for you...bipaps will go to 25...apaps go to 20...maybe your pressure needs have changed.
2...did you have an issue with centrals and that's why they opted for bilevel.
Your S8 never flagged centrals but these new machine do...and bilevel (and there's basic bilevel and high dollar bilevel with a BIG price difference) of some sort is often used when centrals are problematic.

You need to find out what you are dealing with in terms of apnea before worrying about an auto bipap. If centrals are in the mix in numbers enough to be problematic the picture changes.

oh..3rd thing maybe which might help with the auto bilevel argument if centrals aren't an issue ...if you have times where you can use less pressure and only need more pressure like for REM sleep or supine sleeping..that sometimes makes a good argument for bilevel.
So find out from the sleep study (get a copy) what happens to your pressure needs in REM or supine sleeping.

If you don't have issues with centrals...and your doctor will write for Auto bilevel and be specific the DME can be forced to supply the machine but the doctor has to be on your side.
If centrals aren't an issue...and you do need pressures greater than an APAP will do..there is always the option to purchase out of pocket like you did in the past. Those puppies are pricey though.
If centrals are an issue we need to have another discussion but won't cross that bridge unless we come to it as those high end bilevel machines are REALLY pricey.
Okay, will find out what those studies say. I won't know for sure until November 5th when I see my Sleep Doctor. My pressure couldn't have been any higher than normal because I use an APAP now and it says my 90% rate is 12.2 lately. Not even the 13 I was prescribed back when I started. My range is 10 to 16 and it's averaging 12.2 but I need to find out about those central apneas. I have read where in some cases an BPAP can be better for some people. But this isn't a case where I was getting up to 20 or 25 cm's of pressure. That would definitely wake me up. And waking up at lower pressure seemed like it might've been an issue based on questions the lab tech asked me during the study. On CPAP (2nd night of split study) I was told I just didn't do that well and the results were "Inconclusive" and so they ordered the BPAP study for night number 3.

I noticed my insurance paid the most for the first night and then less and less for each subsequent study. I think they paid like $3,000 the first night and then half of that the 2nd night and half of THAT the 3rd night ($1,500, $750) I guess those are contracted rates with my insurance company. Btw, good to know about Centrals not being dealt with on S8 but that newer machines will deal with that.

Worst case scenario: I end up with a new BPAP that isn't auto. I still have two more auto's at my house. A PB Goodknight 420E with humidifier and the Resmed S8 Autoset Vantage so I can always auto-tirtrate at ANY time in the future. I'd prefer the auto BPAP of course so I don't have to rely on a 2nd machine for that. But apparently, my doctor's office usually only recommends the Auto's if the sleep studies fail for some reason.

In the long run, it sounds like I might be paying out of pocket on years where I still need to meet my deductible. It's quite high. My goal this year is simply to get a new machine. One would hope that the two new sleep studies would glean some helpful information. Can't wait to find out what the results were!

Thanks for the help!

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Re: 9 Years of APAP and now BPAP is recommended

Post by Pugsy » Wed Oct 22, 2014 8:15 am

Some docs (and people) have this "thing" against auto units and they just dig in their heels and won't do it.
DMEs because they make more money on fixed pressure machines. Docs because of a prejudice I guess...or they are just stuck in the dark ages.

But every "Auto" machine out there has a "fixed" mode available...what's so hard about the doc making the patient happy with the auto for (just in case) and dispensing the machine set to fixed mode...they could do it if they just would.

Oh....if it is a central issue we are dealing with here...and maybe just a small issue...auto adjusting pressures is not normally the way to go...
now if it is a central issue where it's a big issue and that high dollar machine is needed...don't worry it will auto adjust really fast for centrals ..long story there and I haven't had enough coffee to get clear headed enough to tell it.

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Re: 9 Years of APAP and now BPAP is recommended

Post by Rastaman » Wed Oct 29, 2014 4:13 pm

I got my new machine today! It's a PRI System One Bipap Auto w/heater. I'm trying a new mask out but I know the mask that works best for me currently. So, if for any reason I'm not happy with this mask I can return it for 14 days. I'm going to start using the new mask tonight and see how I like it. It's a F&P Eson Nasal Mask (Medium) and came with 2 extra cushions plus filters so that's all good. Funny thing is that he gave me a bacteria filter but said they have the same code as the Bipap but then recommended https://www.cpap.com as a place to buy those very inexpensively. I already shop there and have for about 9 years actually. What was recommended was a Comfort Gel Blue or True Blue. This DME rep said it's an older model. And recommended something newer to try out if I wanted to. Up to me. So, I gave it a whirl.

I currently use a Comfort Gel Original and didn't try the blue until my recent sleep study last month. Looks like my new machine (I would've got a Resmed VPAP with no auto otherwise) seems pretty cool and easy to use and to adjust the settings if need be. My sleep doctor went with 12 cm's with a lower pressure of 7. The ramp is set for 15 minutes as I usually use but is set for 4. I'm going to have to up that because I'm used to 10 to 16 on my S8 APAP currently. I got lucky and got the auto feature by going with Phillips Respironics, which happens to be the same brand they use at my sleep lab exclusively. Sleep mapper was slightly recommended but was said to be a bit gimmicky. Looks like it's available at the Apple Store and Google Play Store.

The main reason I got a new machine, other than my S8 APAP is 9 years old now, is that my sleep doctor couldn't read any data on my machine. We tried twice. It's possible it's just the card. And so she has no other data to go by other than my sleep studies. The DME rep said this Auto Bipap gives more detailed data. Not sure about that. But that sounds fine to me if it's true. This machine does have a card I can take to my sleep doctor so that's good news and going to come in handy in the long run.

Originally, I was titrated at 13 for CPAP and interestingly enough it's dropped back to 12 with a 7 for the lower pressure. Also, Bi-flex is on with a setting of 2. Tonight will be the first night of my trial and error. I'm literally trying out a new mask (which I tried on in the office) and a new machine at the same time. And not in my usual auto-mode. So, this is going to be interesting. I see my sleep doctor on Nov. 5th I believe. Here's pulling the rip cord and jumping out of the plain!

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Re: 9 Years of APAP and now BPAP is recommended

Post by Pugsy » Wed Oct 29, 2014 4:49 pm

There's actually a lot more detailed information gathered on this new machine than was gathered on your old machine.
There's also easy to obtain and use software that you can use yourself if you wish. Don't bother with SleepMapper...it only shows what you would normally see on the LCD screen which isn't much anyway.
Check out my signature line for information on Sleepyhead software that will work just fine with this machine. If you want to try Encore (Respironics software) just send me a private message but Sleepyhead shows the same data and is much faster.

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Re: 9 Years of APAP and now BPAP is recommended

Post by Rastaman » Wed Oct 29, 2014 5:33 pm

Pugsy wrote:There's actually a lot more detailed information gathered on this new machine than was gathered on your old machine.
There's also easy to obtain and use software that you can use yourself if you wish. Don't bother with SleepMapper...it only shows what you would normally see on the LCD screen which isn't much anyway.
Check out my signature line for information on Sleepyhead software that will work just fine with this machine. If you want to try Encore (Respironics software) just send me a private message but Sleepyhead shows the same data and is much faster.
I really appreciate it Pugsy! Thank you for taking the time to comment on my post. Yeah, I'm not surprised that they've improved a bit since 9 years ago! The good thing is that machine is still working fine except exporting data via the Rescan card. I'm thinking about spending $10 to see if I can get a replacement card. It's possible my Doctor's office just can't read an older card like mine but that is hard to imagine. But possible. They actually recommended early on that I take my data card to my DME (Which I didn't have at the time) and have them send over the data to them. I could probably try that today (now that I'm established with the DME) and see if my card is blank or not. If it's not, then I could at least send that data over to my sleep doctor because she's not going to have that much to go by between Oct. 29th and Nov. 5th anyway. It's a thought.

Checking out the Sleepy Head software page as we speak!

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Re: 9 Years of APAP and now BPAP is recommended

Post by Rastaman » Wed Oct 29, 2014 7:19 pm

Got the new system setup and also got Sleepyhead installed. Looks like I just insert a write protected disc which resembles a SDHC memory card for like a digital camera or video camera. (The kind I install and upload from all the time) I got the latest software for Mac OS X. I just upgraded to Yosemite not too long ago. Looks pretty interesting after I installed it. I don't have a previous version yet so I guess I don't need to rename my folder yet because this is a first time install.

I hope this is a fun experience and that I'm able to learn a lot more than I ever did on the S8 Autoset Vantage. I also have a Goodnight 420E APAP by Puritan Bennett and I bought that unit solely for it's data capabilities. (They were just okay and only lasted while I had Windows XP, which was fine back in 2005 - 2007 but had changed very quickly thereafter. Window 7 is the lowest I have nowadays.) Anyway, lost data capabilities then and stopped using the 420E and went back to my Resmed S8 Autoset Vantage until today.

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Re: 9 Years of APAP and now BPAP is recommended

Post by palerider » Wed Oct 29, 2014 7:30 pm

Rastaman wrote:Got the new system setup and also got Sleepyhead installed. Looks like I just insert a write protected disc which resembles a SDHC memory card for like a digital camera or video camera.
they do use a plain sd card, not a disc. it's up at the top of the back of the machine.

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Re: 9 Years of APAP and now BPAP is recommended

Post by Rastaman » Thu Oct 30, 2014 5:46 am

palerider wrote:
Rastaman wrote:Got the new system setup and also got Sleepyhead installed. Looks like I just insert a write protected disc which resembles a SDHC memory card for like a digital camera or video camera.
they do use a plain sd card, not a disc. it's up at the top of the back of the machine.
Yes, I use the term "disk" loosely. I've been using "disks" since the floppy disk days (5 and 1/4 and 3.5 in.) and so anything like these "cards" is kind've a disc to me. Same thing with music. They will always be "albums" to me even if they're all on CD or digital versions.

Thank you for the clarification though.

Apparently, after I got my new machine and slept only 6.5 hours I feel more well rested than I have in quite some time. I plan on going to bed earlier. Maybe I did just need this BPAP after all. Interesting.

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Re: 9 Years of APAP and now BPAP is recommended

Post by Pugsy » Thu Oct 30, 2014 8:35 am

Rastaman wrote: Apparently, after I got my new machine and slept only 6.5 hours I feel more well rested than I have in quite some time. I plan on going to bed earlier. Maybe I did just need this BPAP after all. Interesting.
You know that's the reason I made the switch to bilevel myself. I got a chance to try one out that I bought to go to a friend who used much higher pressures and was struggling so I just had to try it out to make sure it worked....and after the first 5 minutes I said to myself.."I gotta get me one of these" and the next morning when I felt markedly improved from what I had been feeling it was ...."double, I gotta get me one of these"....sent the machine to my friend after using it 3 nights (awesome 3 nights) and told her if you hate it I will gladly take it back. After the first night her response "over my dead body".

I was never able to really put a finger on why I slept better but I did look over past APAP sleep times and after using the bipap for 3 months...and compared sleep times and I was averaging 45 minutes longer on the BiPap than I did on the APAP with no other real changes. For some reason I was sleeping longer and probably a little better so I felt better. I have a couple of theories as to why but they are just theories and it doesn't really matter why. I am just glad to get the slightly better sleep for whatever reason it is.

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Re: 9 Years of APAP and now BPAP is recommended

Post by Rastaman » Thu Oct 30, 2014 4:28 pm

Pugsy wrote:
Rastaman wrote: Apparently, after I got my new machine and slept only 6.5 hours I feel more well rested than I have in quite some time. I plan on going to bed earlier. Maybe I did just need this BPAP after all. Interesting.
You know that's the reason I made the switch to bilevel myself. I got a chance to try one out that I bought to go to a friend who used much higher pressures and was struggling so I just had to try it out to make sure it worked....and after the first 5 minutes I said to myself.."I gotta get me one of these" and the next morning when I felt markedly improved from what I had been feeling it was ...."double, I gotta get me one of these"....sent the machine to my friend after using it 3 nights (awesome 3 nights) and told her if you hate it I will gladly take it back. After the first night her response "over my dead body".

I was never able to really put a finger on why I slept better but I did look over past APAP sleep times and after using the bipap for 3 months...and compared sleep times and I was averaging 45 minutes longer on the BiPap than I did on the APAP with no other real changes. For some reason I was sleeping longer and probably a little better so I felt better. I have a couple of theories as to why but they are just theories and it doesn't really matter why. I am just glad to get the slightly better sleep for whatever reason it is.
That's funny! "Over my dead body". For all I know it's the lower pressure on the exhale or the set pressure vs. varied pressure. Or both. It's also possible that some people respond to certain brands more than other brands but even that seems like a stretch, although it may be true. For each person that actually uses the leading brands and has a good comparison going between them, I would imagine this person has a good grasp of why they like one machine over another. Or one mask over another. That seems all about getting the right fit and a very large part of the battle.

Perhaps the pressure getting too high and waking me up is the reason I got more "rest" last night than the previous several nights. One thing is for certain, I'm trying out a new mask and a new machine at the same time! And so far, it's working out! I still find it interesting that my prescription went down from 13 to 12. And I plan on resetting my Resmed S8 Autoset Vantage and PB Goodnight 420E to the set pressure mode and then turn the flex/EPR/etc. up to 3. I plan on using those machines if I need to take them somewhere over night. It's just easier that way. But that will probably be a ways off because I'm making payments over 10 months for a total of $981.00 My deductible and out of pocket are already met for this year but as of the 4th - 10th payments I will be back to square 1 and need to make those payments myself. For a Auto Bi-Pap, it seems worth it. Wish I tried to buy the thing several months ago though.

I'm not doing the Sleepyhead software thing until I have a few days under my belt to analyze. And I will write-protect it and then un-write-protect it when I put it back in the machine, correct? I want to make sure of that little detail. Thanks a bunch!!

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Re: 9 Years of APAP and now BPAP is recommended

Post by Pugsy » Thu Oct 30, 2014 4:45 pm

Actually the write protect thing is more for the ResMed S9 users as some computer's operating systems add a little file to the SD card and while it doesn't really hurt anything the S9 machines don't want it there and won't accept the card if that file is there.

Respironics machines don't care but it is probably a good idea to get into the habit.

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