Getting a new machine

[Mask2sleep]

Hi there!

I had an appointment with the sleep doctor who did the BiPAP (11 / 7 pressure) Rx based soley on my study and titration results last Friday. It was the first time I had met him. He suggested doing a second sleep study to find out why the BiPAP wasn't bring my AHI down and combining it with a Multiple Sleep Latency Test (MSLT) the next day. Willing to try anything to get the therapy to start working, I agreed and it was originally scheduled for this past Wednesday night and Thursday.

I got a bad cold and had to cancel the appointment, and boy am I glad I did. To get a second opinion on the apnea and treatment level, I had made an appointment a month ago with an ENT which just happened to be yesterday. He took one look at my results and asked why I was given a BiPAP machine, that those were typically only given to the very old, those with bad lung conditions, or the very obese, none of which I am. He also noted they were the most expensive. My primary care doctor had also asked me before why I got a BiPAP, that it was unusual for someone my age and condition. So, the ENT writes me up a new prescription and calls my medical company, and I now have a shiny new APAP machine coming next Wednesday, pressure range 6- 16. He told me to get rid of the BiPAP and cancel the second sleep studies, because to him it looked like this other doctor/diagnostic company was trying to milk the insurance company. I wanted an APAP machine from the start, so I am really happy. It is only going to be a PR System One REMstar Auto CPAP Machine rather than a Resmed S9, but i'll take it!

I am very hopeful this will fix things and am really looking forward to trying an Auto CPAP rather than the BiPAP.

Does anyone have any Auto machine advice?

Thanks!

[leonardlake]

MaskToSleep,

Do go ahead and get the Encore Viewer software so that you can actually monitor the effectiveness of your APAP. After a while you probably will be able to close in on the optimal pressure range which should be a lot smaller than 6-16. From the software graphs I have determined that my optimum pressure is 9 and I have my APAP range set from 8.5 to 10.0.

Leonard

[jweeks]

Hi,

The stuff that your ENT told you sounds pretty bogus to me. BiPAP machine are prescribed to people who have conditions that need BiPAP, and to make it more comfortable for people with high pressures. Your ENT should not have changed your therapy without understanding why you were prescribed a BiPAP. Given the myths, misconceptions, and stereotypes that your ENT told you, I would be really suspect of anything that he or she told you.

One key thing that your ENT seems ignorant about is how the machines actually work. Your BiPAP auto can be made to do the same thing as an APAP can do by simply turning down the pressure support level. If you set your BiPAP for a low pressure of 6, a high pressure of 16 (or maybe slightly higher), and then set the pressure support as low as it will go (zero or one), you have the same thing as an APAP set at 6 to 16. There is no need to throw away your current machine and spend yet more money on a different machine. It think it is your ENT who is trying to do the milking.

-john-

[Julie]

I agree with Jweekes and think you need to rethink this before you grab at the 'easy' answer from the ENT.

[elena88]

Well hi there!
I have been wondering how you have been doing.. Im sorry your ahi was not going down with the bipap treatment, but I would be confused
as why that would not work, and an apap would? This is a bit of a confusing story, you must be somewhat confounded about the whole situation..

I do think most people dont start on bipap... it might go cpap, apap, bipap.. that is where I ended up, and I have had that machine you
are getting. Its very nice.. but so is a bipap.. gosh, In my dreams I would like to have a bipap. I was so happy when you scored one right off
the bat.. If this sleep study place was running everyone out the door with bipaps, I think they would be getting nailed for that sooner than later.

Ya know, sometimes the first sleep study doesnt tell the whole story, you might want to ponder just a little bit about getting another one, just
in case.. You dont have to pay for it, right? Wow, if I didnt have to pay for another one, I would lickity split have one if I could. My first one
didnt paint the whole picture, that is for sure.. and I have heard that sometimes people have completely different experiences on their second
sleep studies, even testing negative for one or two, and severe on the third.

What did the ENT say about your results? Did he/she give you some definitive reasons why a bipap would not have brought you ahi down
and an apap would? I seems to me they both should do the job, stop your events unless there was something else going on..
I hope you get this all sorted out, and if you end up loving your apap better than the bipap, good... that remstar with A flex has a very
soothing algarithim, but the vpap I borrowed from the hospital was the sweetest thing ever.. like sleeping without a machine..

You have your first sleep study right? Gosh, I would pour over that till I had the thing memorized, and I sure would think about that new sleep study..
sure would think about it.. The situation you are in, you want as much information as you can gather as fast as you can gather it, and having another
sleep study, boy you would be armed to the teeth in figuring out what you really need to do..

[Mask2sleep]

I don't currently have an auto BiPAP, just a normal one that does two pressures.If I had a auto I wouldn't let that sucker go anywhere, so in this case the aPAP could do a lot more than the BiPAP since it can change pressures on is own as it thinks best.

Time is money as they say... the ENT didn't really say anything about my results other than I shouldn't be on a BiPAP. I've got a normal doc appointmen on Wednesday i'll ask her opinion as well.

I postponed but did not cancel the second sleep study and MSLT as the ENT suggested. I may call back and reschedule. I'll see what my primary doc thinks there too.

I'm experience severe fatiigue, exhausted both menal and physical, and I don't know if it is due to these issues or something else.

[Mask2sleep]

I. Just had an idea riding the train to work today. Maybe the reason the BiPAP therapy has not been working is I am a shallow or light breather when asleep. When I first mask up at night I have the two pressures going on. Higher at inhale and lower at exhale. However since day one I have noticed that when I wake up at the middle of the night that I swear I only feel a single pressure, the lower exhale one. Is it possible that I am breathing so softly that the machine is not picking up the inhaling and therefore does not switch pressures as it should? Thoughts? Any suggestions on what to do
I can't exactly change the way I breath when asleep.

Thanks.

[Madalot]

I. Just had an idea riding the train to work today. Maybe the reason the BiPAP therapy has not been working is I am a shallow or light breather when asleep. When I first mask up at night I have the two pressures going on. Higher at inhale and lower at exhale. However since day one I have noticed that when I wake up at the middle of the night that I swear I only feel a single pressure, the lower exhale one. Is it possible that I am breathing so softly that the machine is not picking up the inhaling and therefore does not switch pressures as it should? Thoughts? Any suggestions on what to do
I can't exactly change the way I breath when asleep.

In case you weren't following my story, this is exactly what happened with me. I noticed the same thing you describe -- waking up and feeling like the bipap was not switching pressure (staying at the lower pressure). When I commented on it, I was initially told that people get used to the different pressure and don't always notice it changing. So when I noticed the same thing BEFORE going to sleep (I used to get hooked up and watch TV with the bipap because it made it easier to breathe), I commented again. Again I was told the same thing and was even told that I MUST have been asleep, which I wasn't. I remember it and I was watching Roseanne.

I noticed it more and more often and kept complaining. My DME finally agreed to switch the machine out for a different one, thinking that perhaps the machine was malfunctioning. The other machine was even worse and showed the problem more profoundly. I finally went to the DME and he hooked me up to BOTH machines -- my machine was doing it only intermittantly, but the loaner did it almost constantly -- you could watch the display showing it staying at the exhale pressure almost constantly. After I got through the barrage of accusations -- Are you intentionally breathing shallowly???? Are you holding your breath???? When my husband finally screamed at them -- No, this is how she breathes!!!! The owner of the DME turned white as a sheet when he realized that my weeks of complaints were NOT unfounded. My breathing WAS too shallow to trip the bipap machines.

I tell you all of this because sometimes the "experts" don't want to listen to what you tell them. You may want to try what I did -- hook up and lay there BEFORE going to sleep just to see if you can notice it at that point. If you really feel that the machine is not recognizing your breathing, thus not switching to the inhale pressure, keep complaining and make them really look at it.

I shudder to think what might have happened to me had I not been so insistent about it.

[Mask2sleep]

I did the same thing with the DME on the phone and the tech in person, and sleep doc. The tech turned on the machine and had me breath and it did both pressures, so he said nope, the machine is fine, you must be imaginging it.

the screen has a display where it says what pressure it is currently doing, i'll try and see if I can catch it tonight.

Of course, they would be solved with the aPAP in some ways.

Thanks for the response!

[Madalot]

Of course, they would be solved with the aPAP in some ways.

Not necessarily. My bipap machine WAS on automatic when I first noticed this problem. They turned it off and the problems continued.

[Mask2sleep]

My new machine would be a straight aPAP so it would not be trying to track inhaled and exhaled.

[Mask2sleep]

I tried my experiment last night and it worked... I woke up around 12ish and it seemed like there was only one pressure on. I carefully tried to maintain the same level of breathing that I woke up with and look at the display on the BiPAP, and it was a steady pressure 7, not changing to the 11 when I inhale. If it has been doing that all along, I bet i've found my culprit on why this hasn't been working.

[Breathe Jimbo]

That is a major product defect!

[elena88]

Oh my goodness, the bipap is not tripped by shallow breathing!!!

geez louise, thats incredible.. since a lot of time people need bipaps because they are shallow breathers
and cant handle the exhale pressure..

wow, glad you found that out!

Im sorry, I thought you had an auto bipap... I borrowed one from the hospital, and it was very nice and easy to breath against.


I hope the new apap does the trick for you!

Still, think about that second sleep study.... maybe they will pick up on something they didnt find in the first.. I know you dont want to
be away from the baby, but in the long run, its just one night, and it might pay off..

good luck!

elena