Need some advice

Okay so I am 30 days into CPAP, apnea's are under control, but I wake up 2-6 times a night and have to get out of be for 15 mins to 2 hours because I just need to get off the machine. It's not the mask and I have adjusted the heck out of the settings. I end up forcing myself to get back into bed with the mask on. My compliance is great, but only because of brute force. I know I HAVE to us CPAP.

I know that I am very sensitive to exhale pressure and have the EPR set to 3 on my Airsense. I talked with my Doctor yesterday and he said BiPAP might help, BUT I am in compliance without it and I would have to do another sleep study. To get this study he would have to say that CPAP was not working for me and insurance would want the machine back. If the study does not show that I need BiPAP and we have said that CPAP does not work for me, he is concerned that I would end up without a machine paid for by insurance.

I know this is kind of complicated and that is why it sounds exactly like something insurance would do.

Advice/questions

Refresh my memory please....are you the one whose starting pressure is around 5.6 cm?
If so, are you aware that your EPR of 3 isn't giving you full 3 cm exhale relief? The machine won't/can't go below 4 cm so unless your starting pressure is 7 cm you aren't getting full 3 cm relief.
EPR at 3 feels like a bilevel machine feels when there is a 3 cm difference between inhale and exhale...now of course bilevel machines can offer higher than 3 cm differences...but to get that difference you would need more inhale pressure.

So what pressure settings are you currently using right now? I am sorry but I forget exactly.
And how high does it go during the night...like what is the pressure around the time you might wake up and want to remove the mask?

I have ramp turned on auto. my pre-ramp pressure is 5.6
normal pressure is 8-14
The doctor said that on the airsense A10 the EPR is an average function and will start at full pressure and step down over time, always trying to return back to higher pressure. Which means that some of my exhale will always be at full pressure even when EPR is set to 3.
I think that over time I am just getting fatigued by exhaling into pressure and need a break from it.

When setting the pre-ramp pressure 5 was okay, but a little on the low side. 6 was getting uncomfortable.

looking at last nights sleepyhead data:
1. I took the mask off 3 times
2. AHI 3.06, sleep of 9.4 hours, 23 CA's, 5 hypopnea's, 2 OA's
3. first mask off was after 1:15 and had zero events with no pressure adjustments, no large leaks noted
4. 2nd was after1:45 and had many events, max pressure around 8.3 with several adjustments, no LL noted, no events within 30 mins of waking
5. 3rd was after 3 hours, many events, some LL at the end, max P just under 10, no events within 15 mins of waking
6. the last was after 2 hours, with 5 events, 15 min LL noted, max P of 9 right before waking
7. resp rate about 17.5 ish, peak of 35
8. tidal volume 587 ish, peak 1762
snored for 10 mins, once

My breathing looks like a saw tooth, with a slow ramp up (80%) and rapid exhale (20%). insp time 2-4, exp time 0.9-2

if exhale is the problem go for the bipap titration they need to find a pressure for you
the bipap is so much easier to exhale
its not the insurance who wants the machine back its the dme
your doc could order the machine and have the titration done at home
remind the doc to try that he could order that before giving up the cpap

This is true, I could get a BiPAP machine now if I didn't want insurance to pay for it and the DME would want the machine back because insurance would no longer be paying for it. Now if I was wealthy, but alas this is not the case.

PoolQ wrote:This is true, I could get a BiPAP machine now if I didn't want insurance to pay for it and the DME would want the machine back because insurance would no longer be paying for it. Now if I was wealthy, but alas this is not the case.

alas if you doc knows what he is doing the insurance will indeedy pay for it.

Guest 2... are you kidding. I can't tell you how many times my doctor has ordered something, and the insurance said NO.

Poole: your situation is similar to mine. I was due a new machine, and I had my EPR maxed out, but my chest was sore. Me and my doc (and I think Pugsy helped out) decided I needed more EPR help than my S9 would offer. I got the bipap, increased the exhale relief. I got better after a week. I have had only one more bout...and the result was the same. I prefer the cpap mode, so I have this fancy machine in cpap mode! It is comforting to know the bipap mode is availiable if I need it.

Sheriff

My doctor "failed" me on cpap after 1 month and the ins. co. did an outright purchase. They turned around and did another outright purchase of a BiPap machine. The doctor has to use the right lingo in order to get the ins. co. to pay. BTW, a year later, I "failed" BiPap and the ins. co. bought me my ASV!

To get a BiPAP I need to have another sleep test, so I have to "fail" the sleep test. I think I can do that.

Interesting note about all this. I got a new mask today, the Amara View at the suggestion of my Doctor and while there I talked up the tech. She said changing to the P10 was the wrong move for problems with exhaling into pressure. She thinks what is going on is that when my inhale pressure increases (as it should) the EPR causes my exhale pressure to track that increase and she thinks this increase in exhale pressure is what is waking me up. She says I need BiPAP.

Well here's hoping I can get one.

Why can't your doctor just "fail" you? The only time I had to go back to the sleep lab was for ASV titration. Your doctor should have access to any necessary documentation to support your need for BiPap. After all, I can't believe that the ins. co. would want to spring for another sleep test unnecessarily. You might call them and ask.

just called BCBS and yes I need another study. One study-one prescription. Now I just have to be sure I know how to fail the regular CPAP part of the study so I can get a BPAP. I end up taking the mask off and getting up every 1 1/2 -2 hours every night at home, but am not sure that is a fail if my AHI is below 5

Poole: a bipap can be prescribed for medical reasons (centrals, higher pressures, ect...). If you need "more" exhale relief than an autoset can deliver, as in my case, it is more a comfort issue. Yes, a hurting chest is a medical issue, but it is a condion that will not show up on a sleep test. Keep us updated.

Sheriff