CPAP/APAP

[Pugsy]

Is there a way that the inhale could be lowered by the DME?

Better yet there is a way you can lower the inhale and it's easy to do.

You need to get the provider/clinical manual anyway for this machine.
Go here and request it.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

Scroll down about 2/3 way down the page and you can see directions for requesting the manual via email.
There is a short version that explains just how to get to the clinical menu to make changes here
http://www.apneaboard.com/resmed-airsen ... setup-info

But do take the time to get the manual and read it so you will understand your machine better and what the settings mean.

I suggest this....start with EPAP minimum pressure of 4....Set PS to 2 (PS is pressure support) and set maximum IPAP to 9.
When you start the night you will experience 4 cm on exhale and 6 on and the machine won't change from that unless it needs to but it won't ever go past 9 on inhale.
Right now the PS is at 4 and that is what is causing inhale to be 8. You can change it...you can even set PS to 0 if you wish and the machine will just do one single pressure.
See if 4 exhale and 6 inhale is comfortable enough for you. It should feel like the cpap felt.

Ramp won't/can't really kick in with the exhale pressure at 4 but you can turn ramp off, if it is on, in the setup menu area if you wish.
Easy to do.

[Pugsy]

Alternately ...you could switch to cpap mode and have it function and feel exactly like your AirSense 10 CPAP felt..but you have full data.

[Sleepqueen]

The Bipap machine I have is just a trial so I only have it for a week or two. I didn't want to change anything myself. I called and spoke with someone at the DME and she said there needs to be a minimum of 4 between the inhale and exhale pressures and it was set at the lowest it could be. They said likely bipap might not be an option for me.

[Pugsy]

she said there needs to be a minimum of 4 between the inhale and exhale pressures

That's simply not true and if they don't know the equipment any better than that then I wouldn't trust them on anything.
This stuff isn't rocket science.
I have owned the prior ResMed S9 version of this machine..they didn't change the setting options with the new model.
What they told you....simply not true. Either an outright lie or they are so ignorant of what these machines will do that it's scary how stupid they are.

They said likely bipap might not be an option for me.

Giving up so quick when there are viable options...setting you up for failure. They are doing zero to help you and everything to make you fail.

I didn't want to change anything myself.

Your choice of course but since it is a loaner...what do you have to lose by actually trying something else?
What I suggested will work...or change it over to cpap mode and set it like your other machine and at least see the data that your other machine won't show you.
They won't be putting you in jail for messing with the settings. There's no law that says a patient can't change his settings despite what the DME might say...there simply isn't any such law. Your insurance certainly won't care. All they care about is if you use the machine the minimum number of hours each night.

[silversleeper]

I use the aircurve 10 vauto and it is great. The machine will sense when you are ready to exhale or inhale, its called their easy breath algorithm. Truthfully, I could have probably used an APAP, however the Aircurve is soooo comfortable. Once you get used to it, you will not realize that you are on a machine and will look forward to putting the mask on. It is a more expensive option than an APAP but if you are going to use for five to seven years it is easy to rationalize the expense amortized over the life of the machine. If you have a high pressure requirement some people just cannot exhale. Good Luck!!

========

mine never did that

XXYZX, if you had put as much effort in trying to stick it out with your bipap as you have diligently working the sleep apnea forums......I think that you would have been well on your way in solving your apnea problems and treatment. I realize that you have central apneas, but your stand fast position has left you worse off than when you started. I have control issues as well, however they seem to be my shortcomings!! Sometimes you just can't fight the world and win.

[Sleepqueen]

So I was able to get the Bipap trial machine adjusted (spoke to someone else at the SAME) so I can tolerate it now. I actually prefer this over the CPAP. I am sleeping better than I did on the CPAP for sure. Starting to have dreams again and achieve deeper sleep but energy is not much better. I have been on the bipap trial for over a week now and still have not slept as well as I did on the auto machine I had tried for a week (when they were trying to determine my pressure at home). Question: do they use auto machines for at home titration? I keep thinking maybe I had some special machine that is not really the APAP and that's why they won't give it to me. However, it looked identical to my CPAP and I believe it said auto?

[Julie]

Yes, it's done all the time.

[zoocrewphoto]

just because it says auto does not mean it IS auto

they can set the auto to act like a one size fits nobody fixed cpap

If it says auto on the machine, it *IS* and auto. It can be set in straight cpap mode. All you have to do is go into the clinician manual and change the mode.

I realize that you didn't have the clinician manual when they gave you an auto, and they may have lied and said it could not be changed. But it really was an auto machine. Other people have used the same machine in auto mode with no problems.

[zoocrewphoto]

just because it says auto does not mean it IS auto

they can set the auto to act like a one size fits nobody fixed cpap

If it says auto on the machine, it *IS* and auto. It can be set in straight cpap mode. All you have to do is go into the clinician manual and change the mode.

I realize that you didn't have the clinician manual when they gave you an auto, and they may have lied and said it could not be changed. But it really was an auto machine. Other people have used the same machine in auto mode with no problems.

======

i believe you

but i am trusting and used to believe what people told me
although i am starting to see that fake news has infected people with the lying bug
especially when their profits are at stake

otoh some of them are simply brain dead stupid and cant think at all but that has the same result

I've been on this forum for about 5 years now, and there have been hundreds of stories of DMEs lying to people. Some of it is ignorance. Untrained people handing out machines an dnot really knowing much about them. But a lot of it is classic greed. They fit the stereotype of used car salesman more than used car salesmen.

When I first started, I realized my headgear was too big. My mask comes with a standard size headgear, but there is a smaller version available. I tried to order it from the DME. They said it did not exist. I emailed them the link to cpap.com showing the product and the number as well as an email from Resmed. They said they couldn't order it. Basically, it was a low profit item, so they don't bother. I never went back.

One of the topics we really push here is to NOT trust what the DME says. So many people get lied to, and then they give up and quit. ANd their long term health is hurt, all because these people are too ignorant and too unethical to help people correctly.

[Sleepqueen]

I'

I've been on this forum for about 5 years now, and there have been hundreds of stories of DMEs lying to people. Some of it is ignorance. Untrained people handing out machines an dnot really knowing much about them. But a lot of it is classic greed. They fit the stereotype of used car salesman more than used car salesmen.

When I first started, I realized my headgear was too big. My mask comes with a standard size headgear, but there is a smaller version available. I tried to order it from the DME. They said it did not exist. I emailed them the link to cpap.com showing the product and the number as well as an email from Resmed. They said they couldn't order it. Basically, it was a low profit item, so they don't bother. I never went back.

One of the topics we really push here is to NOT trust what the DME says. So many people get lied to, and then they give up and quit. ANd their long term health is hurt, all because these people are too ignorant and too unethical to help people correctly.

I have been watching this forum since the day they told me I had sleep apnea. I have read a lot of great things here! I have also seen the comments about DMEs. Mine has been great up until this situation with the APAP. I have been told there's no insurance code for it. Also, Both the RT (also the DME) and the sleep MD are telling me the APAP is not the best way to treat apnea. Which is funny because I have mild.apnea and was told I didn't need to treat it unless I felt tired. Which I am exhausted. When they gave me the APAP to home titrate me I slept like a baby and had more energy than I did in years. But when they tell me it's not the best treatment and recommended this bipap I thought id try because I am not a medical professional and at least I can say I tried. I am a week and a half in with the Bipap and while I am sleeping better I am not feeling as great as I did with the APAP. That was what prompted my post before. Am I confusing the machine they used to titrate me? Am I wrong for pushing for this? Why should I need to push for this if I had such immediate relief with it? I'm exhausted both from my apnea and this whole situation!

[Pugsy]

situation with the APAP. I have been told there's no insurance code for it

Simply not true. The HCPCS billing code for the APAP capable machine is the same as the CPAP machine E0601 because the apap is a cpap machine but with the additional mode where it can be set to auto adjust pressures that we call APAP.

[Pugsy]

your bibpap is cheaper and mine was just a cpap with exhale relief not auto

you need an auto device

The AirCurve 10 VAuto IS and auto bilevel device and can actually be set up to function just like an apap capable cpap machine.
It most definitely is NOT "cheaper".

[Pugsy]

cant believe they gave him a more expensive machine when the cheaper one was working better

somebody made more money somehow on insurance
maybe their profit was actually bigger on the one insurance pays more for

I can believe they did it.
Let's see...insurance pays the same for the ResMed AirSense 10 CPAP (half assed brick), theA10 Elite, the A10 AutoSet and the A10 AutoSet for Her...because all those machines fall under the E0601 billing code.
So they already got X amount of dollars for the half assed brick she was originally given.
They can't/won't give her the APAP she wants because that has the same E0601 billing code and insurance won't fall for that and pay a second time. So they tell her there is no billing code for an APAP which is an outright blatant bold faced lie and they would be fired on the spot for that if I was their patient.

So how to make more money...duh...let's tell her insurance that she needs a different machine...a bilevel machine...the E0470 bilevel because it doesn't have a back up rate (and no way insurance is going to approve a machine with a back up rate anyway)....
So the get X amount of dollars for the E0470 bilevel....so they got money for the half assed brick and now the E0470 bilevel...they are just hauling in money because they can get away with it. Lying SOBs IMHO. I would be finding a new supplier if it were me.

Here again are the billing codes for various xpap machines. Pretty plain and simple and not rocket science figuring it out.

The AirCurve 10 VAuto (and the S model) are E0470 machines.
One has to step up to the high dollar machines with back up rates to get the E0471 machines....machines like the ASV model or the ST model or one of the other specialty high end models.

She's getting screwed by her DME. Her copay (assuming she has one) is also higher on the bilevel E0470 machine.

[Pugsy]

but doesnt it depend on insurance

It's fairly easy to justify moving up from cpap/apap to bilevel (the plain bilevel with no back up rates and not the ones with the back up rates).
Pretty much just takes the DME and the doctor saying the patient isn't tolerating cpap/apap well.
The plain bilevel, with no back up rate, is really nothing more than a glorified cpap/apap with higher maximum pressures and higher exhale relief (that PS) hence the PS set to 4 on the AirCurve she was given....higher PS than is available on the half assed brick using EPR which is limited to 3.
EPR and PS is pretty much the same thing...that's why we call the ResMed machines with EPR the "poor man's bilevel".
I have tested EPR at 3 and PS at 3 and they are pretty much going to look, act like and feel the same.

She could (the DME could do it too) set the AirCurve 10 in auto mode using PS of 0 and the machine will function just like the apap she trialed and liked.
Pretty simple. But they don't want to do that....which boggles my mind that they don't know their equipment...for whatever reason and instead are setting her up for failure and that's pretty sad when the fix is so easily available.

Hell, I don't really care if they make more money or not...they just won't do what she needs or wants and what she needs and wants isn't unreasonable at all. Might be different if she were being unreasonable but she's not. I don't know if they are just stupid or greedy or both...but being lied to is something I will not tolerate. I fired my first DME for that very reason.

But apparently they have her believing their lies and I can't force her to believe what I say...and I have used the very same type of bilevel she is using...I have owned 2 of them in the S9 model line and the features I am talking about did NOT change with the move to the AirCurve bilevel models.
It will do what I say it will do...because I have done it.

[Sleepqueen]

but doesnt it depend on insurance

It's fairly easy to justify moving up from cpap/apap to bilevel (the plain bilevel with no back up rates and not the ones with the back up rates).
Pretty much just takes the DME and the doctor saying the patient isn't tolerating cpap/apap well.
The plain bilevel, with no back up rate, is really nothing more than a glorified cpap/apap with higher maximum pressures and higher exhale relief (that PS) hence the PS set to 4 on the AirCurve she was given....higher PS than is available on the half assed brick using EPR which is limited to 3.
EPR and PS is pretty much the same thing...that's why we call the ResMed machines with EPR the "poor man's bilevel".
I have tested EPR at 3 and PS at 3 and they are pretty much going to look, act like and feel the same.

She could (the DME could do it too) set the AirCurve 10 in auto mode using PS of 0 and the machine will function just like the apap she trialed and liked.
Pretty simple. But they don't want to do that....which boggles my mind that they don't know their equipment...for whatever reason and instead are setting her up for failure and that's pretty sad when the fix is so easily available.

Hell, I don't really care if they make more money or not...they just won't do what she needs or wants and what she needs and wants isn't unreasonable at all. Might be different if she were being unreasonable but she's not. I don't know if they are just stupid or greedy or both...but being lied to is something I will not tolerate. I fired my first DME for that very reason.

But apparently they have her believing their lies and I can't force her to believe what I say...and I have used the very same type of bileve she is using...I have owned 2 of them in the S9 model line and the features I am talking about did NOT change with the move to the AirCurve bilevel models.
It will do what I say it will do...because I have done it.

I am appreciative of your input (and everyone else's) and that's why I came here. DME said we can discuss the APAP but I will need to pay an extra $160 for the machine. I have no problem paying this if I get the proper treatment but does this sound correct?