dr gave prescription for 1 month trial on BiPAP

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new-to-BiPAP
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dr gave prescription for 1 month trial on BiPAP

Post by new-to-BiPAP » Tue May 27, 2008 8:28 pm

My dr just sent a prescription for a 1 month trial for BiPAP. Apparently I reacted 'erratically' to the titration study but towards the end of the night the tech stabilized my breathing and oxygen so they think they have a the setting and sensitivity right (10/6). I have mild UARS and mild limb movement disorder. But apparently it is enuf to severely fragment my sleep. I called the DME (still waiting for insurance pre-approval) to ask some questions. I have read some of the posts but...I was wondering what I should ask to make sure I get the right supplies for me? It sounded like the dr states a specific mask so I'm not sure I have a choice (one that worked well at the titration study...I tried on 3 and slept with 2) and a specific BiPAP machine, no choice again?. It sounds like the BiPAP will keep track of AHI, leaks etc (although I dunno for sure if it catches UARS, I don't have apneas). I asked about using RO water (the RO is after a carbon filter and softener and after the RO is supposed to take out most of the hardness, salt, chlorine etc). The DME guy said RO water should work but some people have problems with it. The mask I think they will recommend is a nose mask (not the pillow one like my dh received). Can I sleep on my stomach with that? I was not able to sleep on my stomach with the full face mask...I didn't think to try it with the nose one during the study. Is there anything I need to make sure I get other than a ramp up feature & heated humidifier? How do I make sure I can sleep on my stomach (sometimes I really, really need to). The DME said all the BiPAP's keep track of AHI and leaks etc. My dh CPAP only keeps track of compliance. Sorry this is so jumbled. This is all new to me. My dh just got a CPAP and he is getting used to it better than I expected. But I know I have a difficult time getting used to things so I'm kind of worried about this. I really want this to help me because I think it is affecting my health. Any suggesetions? Thanks!!!


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iowamom
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Post by iowamom » Tue May 27, 2008 9:07 pm

This is my experience getting mine: the dr sent a prescription to home health care and when I went to get the machine they had it all ready, the machine etc so I didn't really have much choice in that. (my parents got cpaps in Jan and they each have the same one as me) They gave me the same type of mask as I had used for my sleep study, so you might have a little choice there. I use distilled water, don't know how that compares with RO water.
Stomach sleep: I have had my CPAP for 3 weeks and just in the last few days have slept on my side, before that I had just slept on my back since getting my machine. I was a stomach sleeper before I had kids, had problems since then but still do ocassionally. So it is probly doable.
In my area at least, heated humid is pretty standard and I think most units also have ramp standard. I was SOOOOO sure that I would love the ramp but I don't use it. The first night I had it on 15 min and felt like I was pulling fore every breath, the 2nd night I changed it to 5 min but then just tuned it off after I put the mask on and haven't used it since. I have a pressure of 14 and I put the mask on then turn the machine on and it's good. Everyone is different though.
I thought I would have a hard time too, when my dad got his 6 years ago, he would take it off without knowing about half way through the night and wake up in the morning with it off so I figured I would too, but I haven't had that problem. I feel sooooo much better than I did before, so much more awake. I had my fist download last week and appently I sleep with my mouth open most of the night still, so I got a chin strap and am still having some problems with tolerating the chin strap but I'm working on that and know it will be ok.
Hope this helps a little...

AHI: 110
CPAP 14
FEELING SOOOOO MUCH BETTER!!!!!

cflame1
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Re: dr gave prescription for 1 month trial on BiPAP

Post by cflame1 » Tue May 27, 2008 9:21 pm

new-to-BiPAP wrote:It sounded like the dr states a specific mask so I'm not sure I have a choice (one that worked well at the titration study...I tried on 3 and slept with 2) and a specific BiPAP machine, no choice again?. It sounds like the BiPAP will keep track of AHI, leaks etc (although I dunno for sure if it catches UARS, I don't have apneas).


Not all BiPAP's will keep track of AHI, leaks, etc... the one that you don't want is a BiPAP Plus... all that it tracks is compliance hours.
new-to-BiPAP wrote:I asked about using RO water (the RO is after a carbon filter and softener and after the RO is supposed to take out most of the hardness, salt, chlorine etc). The DME guy said RO water should work but some people have problems with it.


I use RO water without any problems... then again, I buy my RO from a store.
new-to-BiPAP wrote:Is there anything I need to make sure I get other than a ramp up feature & heated humidifier?
Data... Data... Data... get something better than a BiPAP Plus!
new-to-BiPAP wrote:The DME said all the BiPAP's keep track of AHI and leaks etc. My dh CPAP only keeps track of compliance.
The DME doesn't know everything... and I don't profess to know everything either
new-to-BiPAP wrote:Sorry this is so jumbled. This is all new to me. My dh just got a CPAP and he is getting used to it better than I expected. But I know I have a difficult time getting used to things so I'm kind of worried about this. I really want this to help me because I think it is affecting my health. Any suggesetions? Thanks!!!
Just ask away and don't worry about asking... we've all been there at one time or another. Just make up your mind that you can do this... and you will.

Was the DME talking about ResMed or Respironics for your machine? There are slightly different features on each, and it's good to know what you're walking in to.

Is your insurance covering it all or do you have a high deductible? It may be cheaper to check into other sources for the machine if your insurance deductible is high. You may also want to check to see if you can get a better machine (for a better price) if you shop around (if you have DME choices on your insurance). It's better if you know what your insurance says (directly from your insurance) rather than depending on what your DME says that your insurance says.


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dsm
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Post by dsm » Wed May 28, 2008 12:48 am

If you are getting a Bipap try for these ones ....

1) Bipap Auto with BiFlex (possibly the most sophisticated straight BiPap)
- Has very good nightly data incl AHI & ventilation
- Will auto adjust the 2 pressures based on Apnea feedback
- only question re this model is if the 2 CMS gap between ipap & epap is ok,
all most all who use one say it is no problem

2) Bipap Pro II with BiFlex
- Has good nightly data incl AHI info
- Verys simple machine with few dials to mess up

3) Don't accept a Bipap Pro - they are obsolete & you can get 1 of the above.

Do ask for the integrated heated humidifier - your throat will protest without one unless you live in a high altitude area where it may be less of an issue.

Good luck

DSM

PS When you mentioned Bipap I am assuming you are talking Respironics machines. If the DME supplies Resmed then there are a different set of models and recommendations.

xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)

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Slinky
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Post by Slinky » Wed May 28, 2008 6:14 am

You said that this was to be a one month trial of a Bi-PAP. Bi-PAP is a Respironics propriatary name for their bi-levels which is why we are all assuming that a Respironics Bi-PAP (bi-level) is being ordered for you.

You might want to ask your doctor for a copy of the equipment order (script) that he sent to the DME supplier so you KNOW just how explicit the order is. One can not always rely on the "complete truth" from a local DME supplier. They often resort to "sins of omission" - or worse. I would also ask your doctor to clarify his intent regarding a "one month trial".

I would call my insurance company and ask them what local DME CPAP suppliers they are contracted with. Hopefully you will have the option of more than one "just in case". I am assuming since your husband is already on xPAP that you've had prior experience w/this DME supplier but that doesn't necessarily mean that you HAVE to go to this one if you can't get the equipment you want and have other DME options to go with.

I would also be sure to check just how many hours are on the bi-level you are provided with BEFORE you sign any paperwork. If there are hours on it WRITE right on ALL copies the number of hours reported. Since this is to be a one month trial it is quite possible you will be provided w/a used bi-level. Which is fine IF at the end of the one month trial it is determined that you qualify for a bi-level AND are then provided w/a brand-new, unused bii-level.

Most certainly when and if you are to be provided w/a "permanent" bi-level you should have some say in which one you want and receive. Most insurances require that one "fail" CPAP therapy before they will pay for a bi-level except under certain specific conditions and/or health disorders. Bi-levels cost 2-4 times as much as a CPAP.

The other posters are correct: not all bi-levels are fully data capable. What is the brand and model CPAP your husband was provided w/by this local DME supplier? Quite often you will find a local DME supplier has a preference for one particular brand as they get a better bulk price from that company.

And while we are at it, how long has your husband had his not data capable CPAP? If less than 30 days he has a good chance of getting an exchange to a fully data capable CPAP, if less than 60 days he still has a decent chance of exchanging for a fully data capable CPAP. If more than 60 days his chances of exchanging are pretty slim. And if his insurance is contracted w/more than just this one local DME supplier and he has less than 30 days on his CPAP he still has the option of switching to one of the other local DME suppliers his insurance is contracted with.

The thought occurs, and please don't be insulted by this, that perhaps BECAUSE of the two pressure settings mentioned you have assumed it is a bi-level being ordered when in reality it MIGHT be an autoPAP with a set pressure range of 6 cms to 10 cms. Did your doctor specifically SAY Bi-PAP? Given the mention of UARS the bi-level is most likely but ... I just thought I'd mention this.

As far as mask selection, if your doctor didn't specifiy a specific mask then I would take the opportunity to try AT LEAST one of every style of mask (and preferably two or more): full face, nasal cushion, nasal pillows and the "hybrid" type that has both nasal pillows and a mouth piece before taking one of them home. And be sure to ask about how lenient their mask exchange policy is. Explain that you are often a tummy sleeper.


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new-to-BiPAP
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Post by new-to-BiPAP » Wed May 28, 2008 12:29 pm

ok...I didn't realize BiPAP was a specific brand. I got ahold of the dr's office and they want me to get the Bi-level:
Puritan Bennett Goodnight 425 w/ integrated humidifyer

it looks like it had some kind of data it collects but I haven't figure out how much yet...still reading stuff online. I'll try and read up more so I understand this.

Does anyone know much about this machine or have any experience with it?

Thanks!!!!


OK...I looked up some info and have a few questions on features...

I found a few things that this machine doesn't have...I was wondering
-It has an optional portable battery back...but it only lasts 6 hours...is this typical for batteries?!?!?! Makes it kind of difficult to use it for camping. Can you use other battery packs or does it have to be specific to the machine?

-It does not have Bi-Flex but I don't quite understand what this is or if it is important.

-Does not have Timed backup respiratory rate...said something about non invasive mechanical ventilation...but it doesn't have it...does this matter? I had problems feeling like the machine was breathing for me...I wanted a pause at the end of
exhalation but it wanted me to breathe in...would this affect that?

-only a 1 year warranty...most have 2. How long do they normally last...I think the insurance only covers one every 3 years.

-optional ultra fine filter...why doesn't it come with it...is it important?

-There were several comments on another website about the water tank being small. Someone said it only lasted 7-8 hrs and another said at the setting of 2 they needed to refill after 5 hours. I live in the desert so this might be a concern. Has anyone had this problem?!?!

And a general question. This seems to need 2 placed to plug it in (one for the machine and one for the humidifier I think). Can you plus a machine into a power strip and just turn the power strip on and off or will that hurt the machine?
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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, Puritan Bennett


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Slinky
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Post by Slinky » Wed May 28, 2008 1:20 pm

I don't have any personal experience w/the Puritan Bennett GoodKnight 420E but everyone who has one that has commented in the various apnea forums has had nothing but praise for them and love theirs.

I don't think that the PB 420E provides any data via an LCD screen but I've read they really provide some great data and graphs via the Silverlining software. AND they only require the software, they don't require some expensive proprietary cable reader.

AND if you end up w/this PB 420E permanently the software is reasonably priced as CPAP software goes AND easy to obtain.

The PB 420E is not a bi-level, it is an autoPAP - there might well be a 420 5 that I know nothing about. What I CAN tell you is that the PB 420E is a great machine according to all that have them that I've read.


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tony22
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Post by tony22 » Wed May 28, 2008 1:54 pm

I just checked. There is a 425 Bi-level.

http://www.puritanbennett.com/prod/Prod ... S2=&id=277

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dsm
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Post by dsm » Wed May 28, 2008 2:09 pm

PB425E is a very good small lightweight bilevel with an excellent track record.

It is an excellent product. I'd be more than happy with one (I used a PB330 model for 2 years - it was good but didn't collect nightly data like the 425E does)

DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)

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Slinky
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Post by Slinky » Wed May 28, 2008 2:10 pm

Thanks, Tony!!! I'm glad you took the time to find the info on it for New-To-BiPAP. It is appreciated!

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Women are Angels. And when someone breaks our wings, we simply continue to fly.....on a broomstick. We are flexible like that.
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Slinky
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Post by Slinky » Wed May 28, 2008 2:26 pm

Wow! Only 1 1/2 lbs for just the 425 w/o the humidifier!! Impressive. And a range of 3 cms to 25 cms. Quite the gadget! And look at the lovely Information Access button! This 425 sure looks like an impressive bi-level!!

You're gonna have to keep us informed and up to date when you get your 425, New-To-Bi-PAP!!!


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Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2 Software - Contec CMS-50D+ Oximeter - Respironics EverFlo Q Concentrator
Women are Angels. And when someone breaks our wings, we simply continue to fly.....on a broomstick. We are flexible like that.
My computer says I need to upgrade my brain to be compatible with its new software.

new-to-BiPAP
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Post by new-to-BiPAP » Wed May 28, 2008 3:53 pm

I'm assuming the 425E is the same as 425. I dunno if mine is an E but I didn't see 2, 425's either. I called Puritan Bennett and it sounds like they do have a 2 year warranty so that makes me feel a bit better. It sounds like it keeps track of some kinds of events but since I have UARS and not apenas I dunno if it will show those.

Thanks for everyones input and help! I would not have thought of having to buy the mask. They are going to call me back with an estimate so I won't have a heart attack when I go in tomorrow. I was referred to a different DME than my husband. He has had it only a week or 2 so I'll mention the data capable stuff to him.

The dr did specify a mask. I'm not sure exactly what to do about this since I really do have problems falling asleep on my back and it hurts my shoulders to sleep on my side. I'll prolly mention it to the DME guy but I'm not sure if he can do anything. Sounds like I can get a new mask in 3 months thru the insurance...so if I can stand it that long...I could request a different one then.

The more I look at it, it looks like a good machine.

So tomorrow I will be getting my new machine...I'll let you know how it goes!

Thanks again for all the input and help!!!!!!


Oh...I just realized...I read that it could be dangerous to use a nasal mask and chin strap...but that is what my dr ordered. I didn't think about that. I'm not too keen on using a chin strap anyway. Is there any reason why you should use a chin strap?


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Slinky
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Post by Slinky » Wed May 28, 2008 7:14 pm

Ach, there's nothing dangerous about using a chin strap and a nasal cushion mask!

But chin straps ONLY work if your mouth drops open and you try to breathe thru your mouth. Most, or at least a good share, of mouth leaks are due to the mouth gently filling w/air and the air escaping quietly thru the lips, the lip flutters, instead of the mouth actually dropping open or actually trying to breathe thru the mouth. The chin straps can do NOTHING for the lip flutters.

If the DME won't let you try another mask just ask your sleep doctor to re-write his order to read: "full face, nasal cushion or nasal pillows mask OF PATIENT'S CHOICE". Or better yet, "any style mask OF PATIENT'S CHOICE".


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Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2 Software - Contec CMS-50D+ Oximeter - Respironics EverFlo Q Concentrator
Women are Angels. And when someone breaks our wings, we simply continue to fly.....on a broomstick. We are flexible like that.
My computer says I need to upgrade my brain to be compatible with its new software.

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GumbyCT
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Post by GumbyCT » Wed May 28, 2008 9:35 pm

Slinky wrote:I don't think that the PB 420E provides any data via an LCD screen but I've read they really provide some great data and graphs via the Silverlining software. AND they only require the software, they don't require some expensive proprietary cable reader.
I thought that Silverlining software was for Resmeds? Does it also work on PB's? or is that a freudian slip?

I wouldn't mind trying a PB someday. But I need something small that can handle my 18/15 pressure reqs.

On a related note - my sis may end up with a Resmed (I know, I know) - is Silverlining still avail.? if so where & how much?

Thanks,
GumbyCT


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Post by Guest » Wed May 28, 2008 9:52 pm

GumbyCT,

On the Puritan Bennett website for the 425 it says:
"Optional SilverLining® 3 Data Management Software provides compliance information and other patient data in easy-to-format reports." I think cpap.com also sells it...dunno how much it is tho...