Do I need another sleep study?

I have checked into getting a different machine, due to the fact that the pressure on exhalation has kept me from sleeping. The technician said I might need a new sleep study if I wanted to try a machine with EPR technology. Is that correct? I highly doubt my insurance will pay for another one. I just had one 3 weeks ago.
Thanks for your help.

I'd check with my doctor and insurance company. The technician may be biased or misinformed. How long have you been on your machine? What are your pressures?

chopper06 wrote:I have checked into getting a different machine, due to the fact that the pressure on exhalation has kept me from sleeping. The technician said I might need a new sleep study if I wanted to try a machine with EPR technology. Is that correct? I highly doubt my insurance will pay for another one. I just had one 3 weeks ago.
Thanks for your help.

Do you have to purchase a new CPAP with your own money or is this just an exchange (i.e. you are still renting?). I only ask as EPR isn't that great of a feature in my opinion.

Do you have the heated hose with your ICON? I consider having a heated hose/higher humidification setting more important for comfort (again IMHO) than EPR. The technician is somewhat right as using EPR can increase apneas as the machines might not go back up to pressure in time. I know that using EPR on my S9 autoset increases my AHI by 2-4 points (from <1 to 3-5). Whether this is significant is another matter. But EPR can result in minor changes. I don't think you'd need a sleep study though as the onboard data should let you know if it is working or not.

If you are bent on getting a new machine, what about an APAP? If you are paying out of pocket the price difference isn't that much/however if you have to fight with the insurance it might not be worth it. It might be better tolerated as you can get by with a lower initial setting.

Also do you have the Ramp turned on on your current machine. If your problem is only falling asleep that might also work.

Finally masks matter a ton. What types have you tried?

I will just be exchanging the machine. How does the APAP work? I feel so uninformed. I have done lots of reading, but it is very confusing. I am thankful for this board.....everyone is so knowledgable and willing to share info. When I went for my follow-up they gave me the F & P and sent me on my way. They never mentioned ramping. I do have a heated hose, and that has helped a little. I need to feel like I don't have to "blow" out to breathe. My pressure is set at 8. That is the only number I am aware of.
Is EPR something you can turn on and off? Can you notice the difference at all? I feel like I just need a little pressure relief on the exhale.
I am very happy with the mask I am using...it is comfortable and seems to seal well.
I have been on the machine for almost 3 weeks........

Thanks for your help!

chopper06 wrote:I will just be exchanging the machine. How does the APAP work? I feel so uninformed. I have done lots of reading, but it is very confusing. I am thankful for this board.....everyone is so knowledgable and willing to share info. When I went for my follow-up they gave me the F & P and sent me on my way. They never mentioned ramping. I do have a heated hose, and that has helped a little. I need to feel like I don't have to "blow" out to breathe. My pressure is set at 8. That is the only number I am aware of.
Is EPR something you can turn on and off? Can you notice the difference at all? I feel like I just need a little pressure relief on the exhale.
I am very happy with the mask I am using...it is comfortable and seems to seal well.
I have been on the machine for almost 3 weeks........

Thanks for your help!

Here is a video describing the ramp on your CPAP (same guy has many other videos for CPAP on his youtube page). You can have it at a very low pressure for up to 45 minutes to let you fall asleep:
http://www.youtube.com/watch?v=9HceMMka-0c

An APAP is basically a "smart" CPAP that can adjust its pressure automatically. Since you have a titrated pressure of 8 you could have an APAP that starts at a pressure of say 5 or 6 and then will only go up to 8 (or higher) if needed (and when you are asleep); Otherwise it'll stay at the lower pressure. While early APAP's weren't the best at detecting obstructuve apneas (they could get confused by normal slow breathing and ramp up the pressures really high) most of the new ones (Resmed S9, etc.) are immune to this and work very well. I have an APAP with a starting pressure of 8 that'll ramp up to about 11.5 when my sleep apnea is at its worse (which is generally during REM sleep).

I actually have the EPR turned off on my APAP as it was raising my AHI. Many people have reported this as the pressure doesn't always come back as fast as it needs to. I can definitely tell the difference using the EPR, but don't miss not using it. I actually found the highest level (3) annoying, especially with nasal pillows, as it caused them to "move" a bit due to the sudden changes in pressure.

Unfortunately Fisher and Paykel doesn't have any machines with EPR. You'll have to switch to either Resmed, Devilbiss or Respironics machine to get that.

In terms of getting an APAP they actually aren't that much more expensive (a couple hundred bucks at most) but it still might be a fight to get insurance to pay for it. More than likely you'll have to have your doctor write new prescription for it stating its necessity.

Should add.. if the insurance will spring for it go with a Resmed S9 series Elite (CPAP) or Resmed S9 autoset (APAP) as these have every feature you would want.
Have a doctor write a prescription for one of these exact machines (preferably the APAP if the insurance will spring for it) as Resmed also makes cheaper versions of the S9 CPAP's and APAP's that do not allow you to log any data to see how well the machine is actually working/use software such as sleepy head (and some less than scrupulous equipment dealers will substitute these to make even larger profits). The cheaper version both have "escape" in their name, which is kind of funny when you think about it (it's as if they warn you to runaway from them).

So if you do go with ResMed get:

CPAP: S9 elite
APAP: S9 Autoset

Avoid:
Anything with "escape" in its name (i.e. s9 escape or s9 escape auto).


I'm sure other people can offer advise about which Respironics or Devilbiss machines to get if you want to go with those brands.

thanks so much for your help.....i appreciate it.