Uncle Flappy's Journey

[Uncle Flapp]

Finally got a new titration study and have been prescribed a BPAP. DME wants to issue/sell a Respironics BIPAP Pro 660. Rx is for a setting of 10/5.
I have yet to see the study results but look forward to the BPAP as I struggled with the CPAP likely due to centrals.

Can y'all offer any thoughts on the Pro 660? Will that give me the reporting I need to monitor both OSA and central events? With the new year, I am out of pocket until the $5,000 deductable is met; therefore, I want the best bang for the buck.

I apprecaite your help. Hope you all had a nice holiday.

- Flappy

[JDS74]

The Respironics Auto BiPap 760 is a much more capable machine and gives complete data on the SD card,
I believe it has the same reimbursement code as the 660 so your insurance will properly credit the cost against your deductible.

It is possible that you can purchase the machine from an online supplier and get a better price than anything you can get locally given that the local DME will be doing the "insurance cost" shuffle on you. An outright purchase may well be significantly less that even the allowable amount plus co-pay your insurance has negotiated.

Check with your insurance carrier to see if they will credit a direct purchase against your deductible before you commit to anything either on-line or locally.

[cpierc01]

I am new to sleep apnea. I have been doing this since June 2013. I have the BIPAP Pro 660 and it is fully data capable. I never thought I would say this but I love it. So easy to get use to.

[Uncle Flapp]

The Respironics Auto BiPap 760 is a much more capable machine and gives complete data on the SD card,
I believe it has the same reimbursement code as the 660 so your insurance will properly credit the cost against your deductible.

It is possible that you can purchase the machine from an online supplier and get a better price than anything you can get locally given that the local DME will be doing the "insurance cost" shuffle on you. An outright purchase may well be significantly less that even the allowable amount plus co-pay your insurance has negotiated.

Check with your insurance carrier to see if they will credit a direct purchase against your deductible before you commit to anything either on-line or locally.

Good advice, JDS74, thanks. My Rx states a standard BPAP with a setting of 10/5 thus they are steering me toward the 660 Pro. Not sure I can use the existing script for an auto. Pricing on the 660 seems reasonable - $142/mo rent for two months then, with "therapy compliance", sale of the unit for $1,048. Seems comparable to what I see online. In addition, I had such a terrible time with regular CPAP due to centrals (history here), the "try and buy" might be a good way to go. There is still the possibility I will need an ASV long term. Finally, my new insurance carries a $5,000 deductible with no copay.

As a nerd and a control freak, I want to ensure whatever machine I get has full reporting capabilities including the ability to detect the difference between obstructive and central events.

I am new to sleep apnea. I have been doing this since June 2013. I have the BIPAP Pro 660 and it is fully data capable. I never thought I would say this but I love it. So easy to get use to.

Thanks, cpierc01! I have been struggling with CPAP since last November and could not take more than 90 minutes at a time without waking and wanting to rip off the mask. During the titration study, when the tech switch the machine from CPAP to BPAP mode, I got instant relief and slept 3.5 hours - the longest uninterrupted sleep since I started therapy. It was encouraging.

I appreciate all the good feedback.

- Flappy

[Uncle Flapp]

Just picked up my rent-to-own 660PRO from the DME. I also got a copy of the titration study and the results look promising. Good news is that I did not have any OSA events; only some hypopnea and those pesky centrals:

• Untreated, previous study showed AHI 83.4; RHI 84.9
• On CPAP at 4cm, I had 6 centrals, and no hypopneas, TIB 11.5 minutes. AHI 118.4, RDI 118.4
• On CPAP at 5cm, I had 16 centrals and 7 hypopneas, TIB 36 minutes. AHI 110.8, RDI 110.8
• On CPAP at 6cm, I had 5 centrals and 1 hypopnea, TIB 7 minutes. AHI 87.9, RDI 87.9
• On BPAP at 7/5cm, I had 1 RERA, TIB 4.5 minutes. AHI 0, RDI 42.7
• On BPAP at 9/5cm, I had 8 centrals, 36 hypopneas, and 3 RERAs, TIB 90 minutes. AHI 57.1, RDI 61
• On BPAP at 10/5, I had 18 hypopneas, TIB 150 minutes. AHI 11.2, RDI 11.2

While I realize an AHI of 11 is not ideal, it is a big improvement. Going to give this machine a whirl and hope things get better. Sleepy Head loaded on the PC; Sleep Mapper on the iPad. DME RRT and physician will monitor my progress via modem.

- Flappy

[Uncle Flapp]

Wow, what a rough night. I got in 5 hours of treatment but had just as many arousals. I can see in Sleepy Head that most awakenings were triggered by concurrent OSA and/or CSA events. Total AHI 26. HYP 3.48; OSA 15.35; CSA 7.16

Sure hope things are better tonight.

-Flappy

[Lambeau]

Just want to tell you of my history of sleep apnea. I was diagnosed with a sleep study on July 3, 2013 with an AHI of 39. On July 8, 2013 the doctor had my PR system one model 760 BiPap in my hands after a full hour of instructions for use of this machine by the DME (who was located in my physician's clinic).

I have used it faithfully every night for a minimum of 4 hours, but mostly and more recently averaging 8.5 hours a night on the machine.

It took me a long time to get used to it, and at times I felt I was starving for oxygen. Eventually all that went away, and now I am barely aware of the mask being on my face.

Initially, my AHI would be around 7.5 to 10, and rarely did it ever get under 5. That has all change over the past several weeks. Now my AHI is consistently around 2.2, and the typical pressure on the auto machine are running at 11.5/5.0 It took many months before I got to this better AHI number and good uninterrupted sleep for the full night while wearing the device, but it has been well worth the effort.

[Uncle Flapp]

...It took many months before I got to this better AHI number and good uninterrupted sleep for the full night while wearing the device, but it has been well worth the effort.

Thanks for the words of encouragement, Lambeau. I am starting to learn this isn't an exact science and that this will take some time. I'll keep at it...

- Flappy

[Uncle Flapp]

I am exhausted. It is obvious (at least to me) that the current BPAP settings are not effective. While I recognize the therapy is helping, I am still having obstructive events that cause me to wake multiple times per night.

Here is a snippet of last night’s flow chart. It a typical sample of my history thus far – some CAs but multiple & concurrent OAs that likely have my O2 levels low enough to wake me gasping for air.


Question for those more in the know: Should I push for an auto-BPAP or try to be patient as they monkey with the pressure? My current setting is 10/5.

I apprecaite the advice.

- Flappy

[Pugsy]

Could you post the full night detailed report instead of the snippet? Especially the events graph on the upper right?
If the bulk of your AHI and/or events are obstructive in nature you might just simply need a little more EPAP (from your current 5 EPAP).

[Uncle Flapp]

Hi Pugsy! Thanks for chiming-in. I apprecaite your help. Hope you are feeling better.

I got the machine on Friday. Attached are screenshots for Friday and Sunday. No data for Saturday: In an attempt to further get used to the mask, I wore it while watching TV- and feel asleep without the machine turned on.


Friday Data


Sunday Data

[Pugsy]

Are you sleeping with the mask and machine on now?....at least in anything other than 30 minute blocks?
Or are you still having trouble falling asleep and staying asleep?

[Uncle Flapp]

Falling asleep is getting easier but I am still having trouble staying asleep. I am averaging about 90 minutes at a time before something abruptly wakes me up. In looking at the graphs, there are usually multiple OAs with some CAs just before I wake. I suspect my O2 levels get very low and since I am still getting used to the mask, instinct is to get that thing off my face.

[Pugsy]

Are you up for a little pressure tweaking on your own or would you prefer to leave things in the hands of the DME/doctors???

It's pretty much impossible to adequately evaluate therapy pressures when all we get are 60 or 90 minute blocks of sleep.
Sounds like there's a good chance that around the 90 minute mark you probably are getting into REM stage sleep where we often have more chances for collapse of the airway tissues and we often need maybe a little more pressure.
Same thing can be said of supine sleeping but since you mention the 90 minute thing...that sure makes me think REM sleep as primary culprit.

I am personally very familiar with REM Stage sleep and OSA being worse with more pressures being needed.
See this thread
viewtopic.php?f=1&t=88508&st=0&sk=t&sd= ... ster+child

[Uncle Flapp]

Are you up for a little pressure tweaking on your own or would you prefer to leave things in the hands of the DME/doctors???

Normally I would be up for tweaking it myself but the DME has this machine assigned as a two-month rental with purchase on the third month assuming therapy compliance. Since I don't own it (yet) and have the option of swapping it for an auto adjusting machine (with physician approval/convincing) , I thought it would be prudent to get advice on next steps. I wan to be armed with the right knowledge prior to talking with the DME. If you think bumping the EPAP or IPAP is the most reasonable course of action, I will work with the DME. If an auto is warranted because there are too many unknowns, I will go straight to the doc for a new Rx. They have a modem on the current machine and should be able to tweak settings fairly quickly. I am also using Biflex at the highest setting (3). Would that have any impact?

The data is interersting. I am seeing a handful of OAs when first falling asleep and if I make it through that, another group around the 90 minute mark. They do seem to come in clusters. I am a side sleeper and very rarely sleep on my back. Didn't at all during the titration study.

Thanks again for your help.

- Flappy