New to CPAP/BiPap - living at High Altitude

[forJO]

Sorry for the long first post - a lot of details to cover. I live at 8400' in the Colorado Mountains and will be starting BiPap very soon.

I recently completed a sleep study (at a similar altitude to where I live) and met with a doctor for a follow-up yesterday. I have severe SA and my AHI in the sleep study was 95.9 events per hour. About half-way through the study they connected me to a CPAP. The study showed elevated AHI until they had me on a BiLevel at 25/19, then my AHI was 7.4 per hour. I even got 49 minutes of REM sleep during the CPAP/BiPap part of the study and felt great the next day - I was a "lucky" one that slept great during the study.

The doctor is prescribing me a Respironics System 1 BiPAP Pro with Bi-Flex with datacard, heated humidity and pressure set at 25/19. My concern is this machine and all Phillips machines seem to say max altitude 7500 feet (in their manual). When I met with the doctor I told him my only close DME is Lincare (others would be in Denver an hour+ away) and they told me last week they "only" provide ResMed devices and he said he prefers Respironics and that is what the order will specify. I mentioned what I had seen about the altitude issue - ResMed rates to 8500' and Respironics rates to 7500' and he said he would look into it. Today I asked the doctors office about getting a copy of the order and when I saw it is the Respironics, I emailed back the office about the altitude issue she said the machine will self-adjust.

So I am wondering how big of an issue this is and how far to take this and how to do so. I think I will call Respironics tomorrow and ask them about this issue. I will also talk to Lincare about this tomorrow and see what they say. From there, if this is still an issue, I will try to let Lincare fight back some instead of me being too big of a pain to the doctor and challenging him more (unless that is what is needed).

On a separate but related note should I be looking/pushing to be on a Auto or ASV machine instead of the standard pro? Not sure how important that is now and for my long-term use. I do plan to use Sleepyhead and analyze my results so I was glad he wanted to use a machine with data.

[BleepingBeauty]

Sorry for the long first post - a lot of details to cover. I live at 8400' in the Colorado Mountains and will be starting BiPap very soon.

I recently completed a sleep study (at a similar altitude to where I live) and met with a doctor for a follow-up yesterday. I have severe SA and my AHI in the sleep study was 95.9 events per hour. About half-way through the study they connected me to a CPAP. The study showed elevated AHI until they had me on a BiLevel at 25/19, then my AHI was 7.4 per hour. I even got 49 minutes of REM sleep during the CPAP/BiPap part of the study and felt great the next day - I was a "lucky" one that slept great during the study.

The doctor is prescribing me a Respironics System 1 BiPAP Pro with Bi-Flex with datacard, heated humidity and pressure set at 25/19. My concern is this machine and all Phillips machines seem to say max altitude 7500 feet (in their manual). When I met with the doctor I told him my only close DME is Lincare (others would be in Denver an hour+ away) and they told me last week they "only" provide ResMed devices and he said he prefers Respironics and that is what the order will specify. I mentioned what I had seen about the altitude issue - ResMed rates to 8500' and Respironics rates to 7500' and he said he would look into it. Today I asked the doctors office about getting a copy of the order and when I saw it is the Respironics, I emailed back the office about the altitude issue she said the machine will self-adjust.

So I am wondering how big of an issue this is and how far to take this and how to do so. I think I will call Respironics tomorrow and ask them about this issue. I will also talk to Lincare about this tomorrow and see what they say. From there, if this is still an issue, I will try to let Lincare fight back some instead of me being too big of a pain to the doctor and challenging him more (unless that is what is needed).

On a separate but related note should I be looking/pushing to be on a Auto or ASV machine instead of the standard pro? Not sure how important that is now and for my long-term use. I do plan to use Sleepyhead and analyze my results so I was glad he wanted to use a machine with data.

Hi, and welcome to the forum!

I'm in a similar situation (living at high altitude, although not as high as you). I use an ASV machine, but not because of the altitude; I had a lot of central apnea in my initial sleep studies, and the ASV treats that issue. I also showed a lot of periodic breathing and Cheyne-Stokes Respiration, and my second sleep doc ordered an oxygen concentrator for me due to the altitude issue; been using that with my xPAP for about four years now. I use a Respironics machine, btw, and it treats my complex apnea well (although I live at just under 5,000 feet). I should mention that my initial sleep studies were done in Phoenix, so NOT near the altitude at which I live.

So I would ask if you had a lot of central apnea during your study (which might indicate the need for an ASV) or if your oxygen levels would indicate the need for additional O2 at night. (I had moderate-to-severe O2 desaturations, even at 1,100 feet.)

During my sleep study, the number of centrals increased with increased pressure; that indicated my need for an ASV, but my DME set me up with a PLUS machine, and I used that (unsuccessfully) for about 18 months. I ended up acquiring an ASV on my own, after I joined the forum and got educated about apnea in general (and MY apnea specifically). I'm glad to know you were treated well with BiPAP and are being set up with one from the get-go. Chances are you *don't* need an ASV, considering your AHI was down to 7.4 on the BiPAP. I trust your AHI will be easily manageable (i.e., get lower) with regular use of a BiPAP machine.

I personally wouldn't worry about bringing the altitude concern up again to your doctor or Lincare (or either of the manufacturers, for that matter); both the doc and Lincare work for YOU, not the other way around.

And FWIW, any machine but the bottom of the line (for Respironics, that's any machine with "PLUS" in the name; for ResMed, you'd want to avoid the word "ESCAPE" in the name) will give you detailed data. So no worries about using Sleepyhead with a BiPAP to see what's going on with your therapy.

Good luck!

[Wulfman...]

Sorry for the long first post - a lot of details to cover. I live at 8400' in the Colorado Mountains and will be starting BiPap very soon.

I recently completed a sleep study (at a similar altitude to where I live) and met with a doctor for a follow-up yesterday. I have severe SA and my AHI in the sleep study was 95.9 events per hour. About half-way through the study they connected me to a CPAP. The study showed elevated AHI until they had me on a BiLevel at 25/19, then my AHI was 7.4 per hour. I even got 49 minutes of REM sleep during the CPAP/BiPap part of the study and felt great the next day - I was a "lucky" one that slept great during the study.

The doctor is prescribing me a Respironics System 1 BiPAP Pro with Bi-Flex with datacard, heated humidity and pressure set at 25/19. My concern is this machine and all Phillips machines seem to say max altitude 7500 feet (in their manual). When I met with the doctor I told him my only close DME is Lincare (others would be in Denver an hour+ away) and they told me last week they "only" provide ResMed devices and he said he prefers Respironics and that is what the order will specify. I mentioned what I had seen about the altitude issue - ResMed rates to 8500' and Respironics rates to 7500' and he said he would look into it. Today I asked the doctors office about getting a copy of the order and when I saw it is the Respironics, I emailed back the office about the altitude issue she said the machine will self-adjust.

So I am wondering how big of an issue this is and how far to take this and how to do so. I think I will call Respironics tomorrow and ask them about this issue. I will also talk to Lincare about this tomorrow and see what they say. From there, if this is still an issue, I will try to let Lincare fight back some instead of me being too big of a pain to the doctor and challenging him more (unless that is what is needed).

On a separate but related note should I be looking/pushing to be on a Auto or ASV machine instead of the standard pro? Not sure how important that is now and for my long-term use. I do plan to use Sleepyhead and analyze my results so I was glad he wanted to use a machine with data.

There's a little problem there. The BiPAP PRO is a fixed pressure machine and will NOT auto-adjust. You would need a BiPAP Auto to get adjusting pressures.

It's possible she misinterpreted or misunderstood the terms "auto-adjusting" and "altitude compensation".

But, virtually all of the bilevel machines have an altitude ceiling somewhere in those numbers you mentioned. However, as previously discussed on the forum, adding about 1 cm. of pressure (or so) for each 1000 ft. of additional altitude may compensate for that additional altitude with fixed pressures.

In any event, if it were me, I'd check the output pressures with a manometer for verification.


Den

.

[Pugsy]

Unless you have a lot of centrals for whatever reason the ASV type of bilevel machines isn't likely to be needed.
Otherwise you need bilevel due to higher (than what regular cpap/apap will go) pressure needs.
Your doc has it in his head that he likes Respironics better...why he has that only he can explain his reasoning behind his preference. Perhaps he only has the Respironcis software or likes the way the Respironics machines respond and report the data.

I have used both brands (ResMed bilevel and Respironics bilevel) but I am not at your altitude. How much difference that extra 1,000 feet might make in your therapy is unknown. Was the titration sleep study also done on a Respironics machine?

Between the 2 brands...the ResMed is a tiny bit less noisy...if that matters. All bilevels have an extra bit of machine noise when at those higher pressures. Respironics will have it upon inhale and ResMed tends to have it on exhale. My experience with both...the ResMed exhale noise is a little less than Respironics inhale but unless you are super sensitive to minor difference in noise levels it isn't going to be a make it or break situation.

In terms of needing the auto adjusting pressure version of the bilevel devices...It all depends on if your pressure needs change much during the night.
If you need 25/19 to keep your airway open then getting the auto adjusting pressure machine isn't going to offer you much because the machine can't go higher than 25 anyway. Having auto adjusting would be more beneficial if your pressure needs were lower most of the time and only needed higher some of the time.
If you already need max pressure available...having a machine that will auto adjust isn't going to have anything to auto adjust to. Example...if your pressure needs were maybe 22 on inhale and 17 on exhale for most of the night and maybe a rare time where you needed 25 inhale and 19 exhale...then having auto adjust might help. But with your current RX settings...there's really nothing to auto adjust to.
Now if you think that maybe something might happen to cause you to maybe need less pressure in the future (weight loss planned maybe) then having auto adjust might be beneficial.
But for right now...fighting for the auto adjusting pressure bilevel may not be all that critical at this point with these settings.

[forJO]

Hi, and welcome to the forum!

I'm in a similar situation (living at high altitude, although not as high as you). I use an ASV machine, but not because of the altitude; I had a lot of central apnea in my initial sleep studies, and the ASV treats that issue. I also showed a lot of periodic breathing and Cheyne-Stokes Respiration, and my second sleep doc ordered an oxygen concentrator for me due to the altitude issue; been using that with my xPAP for about four years now. I use a Respironics machine, btw, and it treats my complex apnea well (although I live at just under 5,000 feet). I should mention that my initial sleep studies were done in Phoenix, so NOT near the altitude at which I live.

So I would ask if you had a lot of central apnea during your study (which might indicate the need for an ASV) or if your oxygen levels would indicate the need for additional O2 at night. (I had moderate-to-severe O2 desaturations, even at 1,100 feet.)

During my sleep study, the number of centrals increased with increased pressure; that indicated my need for an ASV, but my DME set me up with a PLUS machine, and I used that (unsuccessfully) for about 18 months. I ended up acquiring an ASV on my own, after I joined the forum and got educated about apnea in general (and MY apnea specifically). I'm glad to know you were treated well with BiPAP and are being set up with one from the get-go. Chances are you *don't* need an ASV, considering your AHI was down to 7.4 on the BiPAP. I trust your AHI will be easily manageable (i.e., get lower) with regular use of a BiPAP machine.

I personally wouldn't worry about bringing the altitude concern up again to your doctor or Lincare (or either of the manufacturers, for that matter); both the doc and Lincare work for YOU, not the other way around.

And FWIW, any machine but the bottom of the line (for Respironics, that's any machine with "PLUS" in the name; for ResMed, you'd want to avoid the word "ESCAPE" in the name) will give you detailed data. So no worries about using Sleepyhead with a BiPAP to see what's going on with your therapy.

Good luck!

Thanks for the information. I will be using additional O2 at night - the sleep study recommended 4L so we will start there. I recently recovered from severe pneumonia requiring surgery so my O2 requirements might change as my lungs continue to heal.

According to my sleep study my events consisted of 0.4 central apneas, 17.7 obstructive apneas, 3.6 mixed apneas, 74.2 hyponpneas per hour. Hopefully that gives you more information about my apneas and specifically centrals.

I have talked to Lincare about the altitude issue and the person in the local office will submit the paperwork to the "Lincare Bipap person" and state the machine needs to be rated for 8500' and then once they specify the machine she will contact the doctor if it doesn't match his specific request. She said they deal with this frequently. So hopefully that will resolve the altitude issue. I feel like I am getting a bill approved by the House (Lincare) and then sending it to the Senate (Doctor) and if we are lucky the President (insurance) will sign it.

[forJO]

Unless you have a lot of centrals for whatever reason the ASV type of bilevel machines isn't likely to be needed.
Otherwise you need bilevel due to higher (than what regular cpap/apap will go) pressure needs.
Your doc has it in his head that he likes Respironics better...why he has that only he can explain his reasoning behind his preference. Perhaps he only has the Respironcis software or likes the way the Respironics machines respond and report the data.

I have used both brands (ResMed bilevel and Respironics bilevel) but I am not at your altitude. How much difference that extra 1,000 feet might make in your therapy is unknown. Was the titration sleep study also done on a Respironics machine?

Between the 2 brands...the ResMed is a tiny bit less noisy...if that matters. All bilevels have an extra bit of machine noise when at those higher pressures. Respironics will have it upon inhale and ResMed tends to have it on exhale. My experience with both...the ResMed exhale noise is a little less than Respironics inhale but unless you are super sensitive to minor difference in noise levels it isn't going to be a make it or break situation.

In terms of needing the auto adjusting pressure version of the bilevel devices...It all depends on if your pressure needs change much during the night.
If you need 25/19 to keep your airway open then getting the auto adjusting pressure machine isn't going to offer you much because the machine can't go higher than 25 anyway. Having auto adjusting would be more beneficial if your pressure needs were lower most of the time and only needed higher some of the time.
If you already need max pressure available...having a machine that will auto adjust isn't going to have anything to auto adjust to. Example...if your pressure needs were maybe 22 on inhale and 17 on exhale for most of the night and maybe a rare time where you needed 25 inhale and 19 exhale...then having auto adjust might help. But with your current RX settings...there's really nothing to auto adjust to.
Now if you think that maybe something might happen to cause you to maybe need less pressure in the future (weight loss planned maybe) then having auto adjust might be beneficial.
But for right now...fighting for the auto adjusting pressure bilevel may not be all that critical at this point with these settings.

As you can see in my post above I didn't have many centrals, it seems the majority of my events could be classified as Hypopneas. Not sure why the doctor prefers Respironics and I would have no issue with his choice if I lived below 7500'. I don't know what brand of machine was used at the sleep study.

Not too worried about the noise levels, I have always slept through any noise. Hopefully that doesn't change with BiPAP.

I was able to get the doctor to rewrite the order (doing that today) and specify an Auto BiPAP. I have to loose weight and they want me to sleep on my side now so hopefully that will result in lower pressure needs and hopefully having an auto machine will help us evaluate that as time goes on.

[BleepingBeauty]

Thanks for the information. I will be using additional O2 at night - the sleep study recommended 4L so we will start there. I recently recovered from severe pneumonia requiring surgery so my O2 requirements might change as my lungs continue to heal.

According to my sleep study my events consisted of 0.4 central apneas, 17.7 obstructive apneas, 3.6 mixed apneas, 74.2 hyponpneas per hour. Hopefully that gives you more information about my apneas and specifically centrals.

I have talked to Lincare about the altitude issue and the person in the local office will submit the paperwork to the "Lincare Bipap person" and state the machine needs to be rated for 8500' and then once they specify the machine she will contact the doctor if it doesn't match his specific request. She said they deal with this frequently. So hopefully that will resolve the altitude issue. I feel like I am getting a bill approved by the House (Lincare) and then sending it to the Senate (Doctor) and if we are lucky the President (insurance) will sign it.

Sounds like you have things covered and that your doc and DME are both being cooperative. (Time to celebrate! )

Needing 4L of O2 at night, you'll get an O2 concentrator rather than a tank. It's a boxy unit, but it makes O2 from the room air, so nothing to refill or worry about re: maintenance (just replacing a filter once a year, for me). The unit, itself, Is easily adjustable (via a dial) re: how much O2 is bled in to your system, so if your needs change down the line as you recover from the pneumonia, it's an easy adjustment to make. It's a good thing you don't mind noise (I don't either), as the concentrator I have makes much more noise than my machine ever does. It's become a "white noise" to me, though (kind of "whoosh-boom" sound), so no problems with it. If the noise were to become a problem, you could keep the concentrator in another room and use a long piece of O2 tubing to feed the O2 into your system. I keep mine about 3' from the bed.

Some FFMs allow you to attach the O2 tubing right to the mask; my mask has those ports on it, but I feed the O2 into the hose at the humidifier end, instead (with an adapter from the DME). That way, if I have to get out of bed during the night and want to unhook my mask from the hose to go to the bathroom or whatever, it's just the one hose I have to detach.

Thanks for the numbers from your sleep study. .4 central events an hour is nothing to worry about; most of us (even people who don't need xPAP treatment at all) experience central events (like when you momentarily subconsciously hold your breath while turning over in bed). So no worries there. I also have more hypopneas than anything these days; low obstructives, low centrals, but always more hypops. I think that's okay, as it just means shallow breathing and not a complete obstruction. I'll take it.

Keep us posted (no pun intended) on how things go from here. As I said, it sounds like you're on a good path with your providers.

[forJO]

Sounds like you have things covered and that your doc and DME are both being cooperative. (Time to celebrate! )

As my Dad always says "It isn't over until the Fat Lady Sings". All good signs but I sure would like to get my hands on the machine and then finally get a good night sleep again - seems like this process takes forever.

Needing 4L of O2 at night, you'll get an O2 concentrator rather than a tank. It's a boxy unit, but it makes O2 from the room air, so nothing to refill or worry about re: maintenance (just replacing a filter once a year, for me). The unit, itself, Is easily adjustable (via a dial) re: how much O2 is bled in to your system, so if your needs change down the line as you recover from the pneumonia, it's an easy adjustment to make. It's a good thing you don't mind noise (I don't either), as the concentrator I have makes much more noise than my machine ever does. It's become a "white noise" to me, though (kind of "whoosh-boom" sound), so no problems with it. If the noise were to become a problem, you could keep the concentrator in another room and use a long piece of O2 tubing to feed the O2 into your system. I keep mine about 3' from the bed.

I have had a concentrator since I got home from the hospital. They were supposed to remove it when my doctor took me off weeks/month ago, but they didn't. When I finished my sleep study the tech (who isn't supposed to say anything) asked if I still had the concentrator and said if I were you I would be sleeping with O2. I actually put the concentrator in our spare bedroom next to ours not so much because of the noise while running but because every time I turn it on it sounds like an alarm clock with the beeping it makes, and I rarely go to sleep before my wife so I feel bad turning it on when she is asleep. If I have it long-term I might figure out how to disconnect the beeper, but then if it fails at night I won't know, but honestly I would rather sleep through the problem and find out in the morning. No problem with finding a long hose to reach to the next room, when I was on it 24/7 I had 50 feet of hose following me around the house - that was a pain, especially when you tripped on it and pulled your face back by your nose.

Some FFMs allow you to attach the O2 tubing right to the mask; my mask has those ports on it, but I feed the O2 into the hose at the humidifier end, instead (with an adapter from the DME). That way, if I have to get out of bed during the night and want to unhook my mask from the hose to go to the bathroom or whatever, it's just the one hose I have to detach.

I will see what machine I get and how it works but having it fed by the BiPAP sounds better than one more tube running to my face.

Thanks for the numbers from your sleep study. .4 central events an hour is nothing to worry about; most of us (even people who don't need xPAP treatment at all) experience central events (like when you momentarily subconsciously hold your breath while turning over in bed). So no worries there. I also have more hypopneas than anything these days; low obstructives, low centrals, but always more hypops. I think that's okay, as it just means shallow breathing and not a complete obstruction. I'll take it.

Keep us posted (no pun intended) on how things go from here. As I said, it sounds like you're on a good path with your providers.

Thanks for looking at the numbers. I wasn't sure what all the hypops meant. Looking forward to getting all those numbers very low once I get a machine.