Which machine should I request for greatest flexibility?

[reneevanv]

I have already been posting at http://cpaptalk.com/viewtopic/t178617/A ... 85df48cf72 , but I wanted to start a new topic because I have a new specific question that I wanted to make sure didn't get overlooked. I will re-post any personal relevant info further on after I have put forth my query.

I am convinced that I really need to give PAP therapy a try again, in spite of my past failures, as I firmly believe that treating my OSA / UARS is the only way I will get my life back (I am mostly house-bound due to fatigue and continual migraines with many unpleasant associated symptoms including chronic dizziness). I know there are many challenges to adjusting to PAP therapy (masks, etc.), but my first and worst issue that I have to solve is how to even be able to fall asleep at all while breathing against pressure (especially exhalation). This is what stymied my previous attempts in 2008 & 2014, during which I think I tried every type of machine - CPAP, BPAP, and APAP. In my last post I was asking about potential greater tolerability of ASV machines vs. the standard machines. I've moved away from considering ASV based on responses, the greater cost, and the likelihood of difficulty in convincing the doctor to give me a prescription for one since I would not be able to "qualify" for one. ALSO, I am strongly considering whether it might be best to just purchase outright a refurbished machine through one of the online suppliers vs getting a machine through insurance. My reasons are (1) I KNOW this is going to be an uphill battle for me and I can't deal with the stress of being remotely monitored by the DME provider and being bugged about "compliance" and threatened with the possibility that they will want to take the machine back if I am unable to use it within a given timeframe; and (2) I want to be able to "tweak" settings myself at any time based on what I experience. I want the flexibility to take as long as I need (even if I get thoroughly frustrated and have to temporarily "quit" for a week, or two weeks, or a month before trying again) and I want the flexibility to adjust settings without going through multiple phone calls and multiple layers of people and red tape to get changes made.

So, my question is, given my inability to EVER (except for one extremely brief episode I described in my previous topic post) fall asleep with any kind of PAP machine, what is the best machine I should ask my doctor for that will offer me the most flexibility to "play around" with settings to achieve tolerability? I'm thinking a BPAP machine? What brand? What model? Thoughts in general? In my last topic post, one of the respondents mentioned the machine "getting in sync" with their breathing pattern. I think I had an issue with this in the past, as it always seemed the machine lowered the exhalation pressure too late after I was already struggling to exhale and then kept forcing too much pressure of inhalation air when I wasn't ready or was done inhaling. Have there been any changes in the last five years to machines that improve the "syncing" function? Another thing is I always felt as if my chest wall muscles were fatiguing after awhile of struggling to accommodate breathing against pressure. Between that and the aerophagia, I would be unable to breathe easily on my own for quite awhile even after removing the mask and sitting up.

Personal Stats:
Female, 5'5" 118-121 lbs (I always wonder if size makes tolerating CPAP more difficult)

Sleep Study results:
(1) 2008 in-lab study, nearly a failure, only 3.1 hrs of sleep, but AHI of 7.7, 8 central, 4 obstructive, 12 hypopneas
(2) 2013 home study, 8.2 hrs. sleep, AHI of 5.5 but supine AHI of 11.4, 2 central, 42 obstructive, 26 hypopneas
(3) 2014 home study, 7.4 hrs. sleep, AHI of 5.7, 0 central, 28 obstructive, 14 hypopneas
(4) 2019 home study, 9.1 hrs. sleep, AHI of 14.1, 0 central, 70 obstructive, 59 hypopneas

Thanks in advance for any help/advice.

[ChicagoGranny]

Do you have a machine now? If so, which model?

[Goofproof]

If I were you, I wouldn't be too concerned about getting a machine with greatest flexibility, I would get one that meets my needs and get my treatment working. the more "Flexibility", the more complex the function the more complex the problems with the correct settings. K.I.S.S. works best.

The main object should be make XPAP work as best it can, and use it without fail every time you sleep whenever you sleep, doing less is cheating yourself. Jim

[reneevanv]

No, I do not have a machine. That's why I want to ask my doctor about trying it again.

I do not know what machine will "meet my needs." And I can't afford to buy one out of pocket only to find out I can't make it work. That is the reason for my question. e.g. I don't want to be stuck with an autoPAP and then the pressure continually goes us so high I can never get to the place of tolerating it (unless APAP machines have the flexibility to turn them into effective biPAP machines). Hence it seems like BPAP is the way to go (can "set" exhalation and inhalation separately until a tolerable level is discovered that enables me to get used to actually falling asleep with it). I can't use it every time I sleep, unless I can get something with which I finally CAN get to sleep!

[Okie bipap]

I recommend you get the ResMed Air Sense 10 Auto For Her. I doubt if your insurance would authorize a bilevel machine without trying an APAP first. If you can convince your doctor and your insurance company to provide a bilevel machine, then I recommend the ResMed AirCurve 10 VAUTO.

[reneevanv]

Thanks "Okie Bipap"! I was actually just looking at that machine on one of the cpap supply sites.

Question about the autos though: Can you set a limit for the maximum pressure on them? Or are they always auto all the way up to the highest pressure they allow so if the machine thinks you need super high pressure, then you get supper high pressure.

My past failed experience with an auto was the only time I actually did fall asleep with any kind of a PAP machine - during a nap. But I wasn't asleep very long before I was awakened with intolerable pressure that had me so bloated and unable to breathe even after taking the mask off that I had to sit up for a considerable length of time taking short breaths while waiting for the bloating to finally resolve. Hence my question.

If a limit could be set so the max could never go above a certain level, then maybe that would be the way to go.

[zonker]

Question about the autos though: Can you set a limit for the maximum pressure on them? Or are they always auto all the way up to the highest pressure they allow so if the machine thinks you need super high pressure, then you get supper high pressure.

yes.

[reneevanv]

yes.

Yes to which? Yes a limit can be set for the maximum pressure, or yes they are always auto all the way up to the highest pressure?


Edit: I think I just found my answer on another person's post from 2013 - yes you do set minimum and maximum pressures on an autoCPAP!

[Lifeisabeach]

yes.

Yes to which? Yes a limit can be set for the maximum pressure, or yes they are always auto all the way up to the highest pressure?


Clearly I don't know how to add quotes!

The AirCurve VAuto has 3 operating modes: traditional CPAP; S-Mode (a straight bi-level mode with options available like EasyBreathe to make the transition between pressure levels feel more natural); and VAuto mode, which I believe is basically the same as APAP or AutoSet. I think this is the kind of machine you are looking for, though whether or not it’s necessary is another matter. But hey, if your insurance will cover it, so much the better.

[palerider]

And I can't afford to buy one out of pocket only to find out I can't make it work.

buy used, then sell it if it "doesn't work", out little, if any, money.

[chunkyfrog]

So easy to adjust, even a frog can do it.
I set my inhale and exhale pressures a couple of cm either side of my median pressure.
And it feels so natural, I can no longer sleep without it.

[reneevanv]

Thanks everybody!

I have a call in to the pulmonologist's office to see if I can get a prescription. I'm looking at the ResMed Air Sense 10 Auto For Her that "Okie bipap" suggested. I'm looking at used as well as the various new ones offered.

I love frogs! So I should be able to adjust it!

[reneevanv]

SOOO, as of Saturday I now have a machine - ResMed AirSense 10 AutoSet For Her - and a mask. I've put it together and have it set up. But now I need to know what to do next - as in, there is no SD card (can I use any card?); do I need to load the software that has been mentioned in order to have access to ANY data (ResScan? Oscar?)? Of course, my first hurdle is to get used to it and hopefully get to a point where I can actually fall asleep.

[Pugsy]

Any generic SD card will work.
I got one at WalMart...8 GB Sandisk regular SD card...works fine.
2 GB is more than enough storage capacity but those smaller cards are getting harder and harder to find and can end up costing more than one of the larger ones. Don't get one of those massively huge fancy SD cards that are expensive. They aren't needed and in some cases they actually have a problem with available software.

To use any of the software you have available there must be a SD card in the machine if you want more than summary data.

There is some limited summary data available on the machine right now and you don't need the SD card to see it and it will be written to the SD card once you insert the card in the machine. So there is some internal storage of the summary data but for any detailed data you need the SD card.
To see the data on the machine's LCD screen you have to change the setting in the clinical setup menu called "Essenstials" to "Plus"...otherwise it is set to "on" and all you get is hours of use. The get the summary numbers you need it set to "Plus".

[Miss Emerita]

Reneevanv, it’s great you got a machine and are ready to get going with it. I took a look at your previous thread, and I want to suggest that at the beginning, you set your minimum pressure to 7, your maximum pressure to 7, and your EPR to 3. This may be a complete bust as far as treating your apnea goes, but it’s very important that you have a decent experience with returning to PAP therapy.

You might also benefit from using the machine just for a couple of hours during the day for a couple of days. You can set it up outside your bedroom somewhere where you can watch TV or read or do something else sedentary and distracting. This will accelerate your body’s adjustment to the experience.