A couple of questions about starting on BiPAP

[TNT]

Hi. I posted a few weeks ago that I'd had a titration study done. The DME finally called Friday afternoon and said the insurance company authorized a biPAP and I can get it on Tuesday.

It was too late on Friday to call the doctor or my "health assistant" and I've been searching for information on the internet. I still have a couple of questions, though.

1. Is it common to start sleep apnea treatment with a BiPAP? (How common is it to need biPAP at all?)

2. What are some of the general reasons a person would start on a BiPAP? I'm assuming the test didn't show some serious disorder other than apnea... ethically and legally, the doctor would have to tell me that at the first opportunity.

In an aside, I had my titration study done without a pre-authorization and now insurance won't cover. They tell me the bill isn't my responsibility since the lab scheduled it... and the doctor specifically said, "We don't have time to wait for a pre-auth. Schedule the first available." Has anybody been in a similar situation?

[pbriggs]

Hello TNT

I can try and help with question 1 and 2.

For 1 - I started on BiPAP, as I am sure many other did also

For 2 - in the titration study (polysomnogram study), they typically start with constant pressures for a few steps to see how your breating improves, if not enough improvement then they start looking at BiPAP or Bi-Level pressures. You can ask to see the titration study and they will show it to you. For me I recall them trying 3 or 4 different constant pressures, each time a little higher. Then they switched over to a Bi-Pressure and found a setting where my breathing (sleep apnea is what I refer to here) was good.

Paul

[robysue]

It's a bit unusual, but not unheard of, to start out on BiPAP rather than CPAP or APAP.

The most common reason for starting out directly on BiPAP is somewhat high pressure levels. During the titration study if the pressure setting reaches something like 15cm and there's evidence that the patient is having trouble tolerating it, the tech is allowed to switch to bi-leve (BiPAP) mode to see if that works better.

The advantage of BiPAP is that during the titration, the tech can independently increase the IPAP and EPAP pressures. The lower EPAP pressure usually makes it easier for the patient to exhale. It can also reduce the mean pressure level enough to help prevent issues with aerophagia or pressure=induced central apneas in some people.

[mellabella]

Hi. I posted a few weeks ago that I'd had a titration study done. The DME finally called Friday afternoon and said the insurance company authorized a biPAP and I can get it on Tuesday.

It was too late on Friday to call the doctor or my "health assistant" and I've been searching for information on the internet. I still have a couple of questions, though.

1. Is it common to start sleep apnea treatment with a BiPAP? (How common is it to need biPAP at all?)

2. What are some of the general reasons a person would start on a BiPAP? I'm assuming the test didn't show some serious disorder other than apnea... ethically and legally, the doctor would have to tell me that at the first opportunity.

In an aside, I had my titration study done without a pre-authorization and now insurance won't cover. They tell me the bill isn't my responsibility since the lab scheduled it... and the doctor specifically said, "We don't have time to wait for a pre-auth. Schedule the first available." Has anybody been in a similar situation?

1) It's not that common to start off with a BiPap right away, unless you've been titrated at a high pressure (what pressure did they prescribe for you?) or there are other underlying health issues to consider.

2) Again, it would help if we knew your pressure. I was started on CPAP, but after retitration was recommended BiPap because my titrated pressure got pretty high (double digits), and I also have Upper Airway Resistance Syndrome. A friend with a BiPap ended up with one because he was having compliance problems with just a CPAP because it was uncomfortable. An exception to the rule (that Bipap is not first-line in most cases, except in cases where you end up with an initial high pressure titration) would be if what you're actually getting is a BiPap ASV, for people who do have an unusual respiratory issue along with the sleep apnea diagnosis. This is very different than a plain old bipap.

3) I've had doctors offices that ended up eating fees that my insurance wouldn't cover because it was considered a provider error (i.e. they billed for something they should have known wouldn't be reimbursed)--that doesn't mean your own doctor's office can't go ahead and try to collect for you anyway.

[JDS74]

Not common for a BiPap machine at all.
Most people with sleep apnea are well treated with a single pressure machine.
I'm guessing that percentage is above 80%.

Sometimes patients don't get along at all well with a single pressure and the sleep lab figures it out during the sleep study.
Sometimes the problem is more complicated and effective treatment requires a more sophisticated bi-level machine.
Then, way out there are the folks like me and others who need an ASV type machine of some sort but that number is down below 1% of patients.

I'd guess your doctor and the lab will have a conversation about who pays but it won't be you.

[TNT]

Thanks for all the information.

I don't know of any underlying conditions, and if one was discovered, I'm thinking it would be malpractice not to tell me about it.

However, I recently discovered that my insurance records do list me as having mitral valve disorder and breathing disorder. That's not true, and my doctor and I are working on figuring why that's in there. I had an echocardiogram done a few years ago. My doctor and the cardiologist at the lab where I had it done both said at the time I didn't have any problems. My doctor looked at the test again a few days ago and consulted with a cardiologist... both confirmed the initial results. Not sure if that has anything to do with my situation or not, but I sort of doubt it.

I don't know what the pressures were during the lab titration. I asked the lab tech if he found a good pressure and he said he did. I was pretty certain he did, just based on how I felt when I woke up.

The person I talked to at the DME wasn't sure what BiPAP I'm getting, except that it's a Philips unit and the latest model.

[Julie]

Under the circumstances (of that lab) I'd want a new study and titration! If they can make one mistake, why not more?

[Pugsy]

When you get your machine look on the bottom of the blower unit for a 3 digit number that is the model number.
Likely will have DS or REF in front of the 3 digit number. Once we get that number we can help you get the provider manual for it and we can determine if you can use Sleepyhead software (most likely you can) and if you want Respironics software we can determine which would be best option depending on what operating system is on your computer.. So just let me know.

For some reason you got to skip the cpap/apap models and go straight to bipap...most likely due to pressure needs that were determined during the titration or your response to the pressure.
Not a big deal and if you do have higher pressure needs the bipap will make the adjustment easier for you.

[TNT]

Speaking of software, I don't have an actual computer right now. I have a Chromebook, iPad and android, but no Windows or Mac O/S. It's my understanding that Philips units can provide at least some information through apps... is that true?

[Pugsy]

The Respironics machines have online SleepMapper but what it offers is essentially what you get off the machine's LCD screen.
Not sure if SleepMapper will work though with what you are using for internet and SleepMapper is tied directly to internet.

The 60 series machines offer on the LCD screen.
The usual hours of therapy use plus
1 day AHI (no breakdown into event category) and time spent in large leak (not how big the leak might have been) and % of time spent in periodic breathing (not offered on SleepyMapper that I could see)
and same thing for 7 days and 30 days.
For auto adjusting pressure machines in auto mode will offer 90% pressure...meaning what the pressure was at OR below for 90% of the time which may or may not be all that helpful in determining therapy effectiveness.

SleepMapper doesn't show anything that your machine won't show on the LCD screen. I gave it a try. It's pretty useless IMHO.
You can check it out at SleepMapper.com

As long as your AHI is nice and low and you don't have anytime spent in large leak then we can assume that generally the therapy is acceptable. There are some limitations to that though...like an AHI of maybe 4 which would be acceptable on the surface but a person has several clusters of events and periods of time where nothing at all happens. I had that happen to me because my OSA is worse in REM sleep so I had some nasty clusters in REM sleep. AHI as a whole wasn't all that remarkable because time spent in REM normally amounts to only 20% of the night..and I had not much at all happen in Non REM sleep.. but I was having 15 to 20 events in a short period of time...clusters due to the pressure not quite being optimal.

[TNT]

Thanks, Pugsy, for the info about Sleepmapper.

So much to learn.