Cpap AUTO vs BI PAP AUTO - Help

[chriscummings83]

Ok, I have been on AUTO CPAP for 5 years. The DME got me in and setup on a S9 AUTO CPAP, 8 days later the new S10 AUTO CPAP came out. My insurance deductible renews Jan 1. So if I am paying for my machine I want the newest version (Sorry I like the latest model).

The insurance company said to return the S9 AUTOCPAP and I will stop having to pay for it because its listed as a rental currently. I confirmed with the DME that it is listed and that I can return it and the billing will stop.

At the same time I am having a lot of Central Apneas about 3- 5 AHI. I have 0 OSA and 0 H. Doctor thought it might have been the CPAP and sent me for a BI Pap study. The BI PAP study came back with an AHI of a lot higher. He wrote me a script for the AUTO Bi Pap, but said to turn it in when ever I want, because my AUTO CPAP has lower AHI.

My Question is, Is a AUTO BI PAP, better than a AUTO CPAP. Meaning I always Run it in AUTO mode. It would just fix my inhale, and exhale (AUTO BI PAP) where as the AUTO CPAP only fixes my INHALE Pressure, and 1-3 relief based on inhale number. My theory is that the AUTO BI PAP would be better because A) It does more (auto inhale and exhale), B) If I need an ASV machine to fix the CA's, then they will want to see me using a BI PAP first.

Let me know if my thinking is wrong or if AUTO BIPAP would cause more problems, But don't see how it could. Same machine just autos inhale/exhale.

Thanks you. Please help I have 5 days to decide..

My pressure is 95% 10. with an EPR of 3.

[Sleeprider]

You are using the S9 with an EPR of 3 which is effectively a bi-level mode when you are at 95% pressure. (EPR does not function at pressures under 7 cmH2O). Your 95% pressure is quite low at 10, and we don't know what your average or minimum is. Finally, you report that AHI is higher with a BiPAP machine. Given the relatively low inhalation pressure, and better results using CPAP auto with EPR, I don't see the reason to jump into a machine that will be double the cost. What am I missing?

[chriscummings83]

I completely understand.

What your missing

1. My deductible is $750, so the cost isn't an issue if it goes above or twice the price.
2. What if my cpap gets worse or they want to see data on a bi pap before doing the ASV study.
3. My CA are 15 - 20 seconds long and sometimes back to back.
4. I have a bad back, so sleeping with 90 wires on my body, and a uncomfortable bed probably cause more AHI, also they were hunting and pecking for the correct AHI, where the machine does it pretty fast.

[Wulfman...]

At the pressure(s) you're at, I hardly see how a Bi-Level machine would be any benefit. Even though they can be set to CPAP (straight pressure) mode, they're more expensive and you could buy multiple CPAP machines for what they cost.


Den

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[chriscummings83]

I with you guys. But I'm tired of waking up and feeling just ok. Sluggish even on 8 hour non stop sleep. 3-5 ahi.
I'm sometimes having CA back to back with no air for 20-35 seconds. Dropping 02 to below 87% some.

I am with you and believe that cpap is doing the best it can. But I might need ASV

[Greg Riddle]

If the ins co will pay for it and it don't cost you anything more, I say do it. Even if you might not need it. you'll have it available if you do need it

[chriscummings83]

Can it run in auto cpap mode?

Or auto bi level and straight cpap

[Wulfman...]

I with you guys. But I'm tired of waking up and feeling just ok. Sluggish even on 8 hour non stop sleep. 3-5 ahi.
I'm sometimes having CA back to back with no air for 20-35 seconds. Dropping 02 to below 87% some.

I am with you and believe that cpap is doing the best it can. But I might need ASV

My pressure is 95% 10. with an EPR of 3.

Are you running your machine in a range of pressures?

If so, that may be your problem. When you enter different sleep stages, your breathing often changes and that may signal the machine to increase pressures. When that happens, you may be bumped out of the needed sleep stage and into a lighter one. That can leave you feeling unrested.
I'd suggest setting your machine to CPAP mode at a pressure of 10 cm. Experiment with the EPR settings......including turning it off.


Den

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[mike1953]

research the machines here http://www.resmed.com/us/en/consumer/pr ... vices.html

[Greg Riddle]

If you set the the pressure support at 1,2 or 3 it will work like a apap with exhale pressure relief

[palerider]

Can it run in auto cpap mode?

Or auto bi level and straight cpap

the vpap auto machines (resmeds's bi-level, the s9 or ac10 verisons) can all directly be set for cpap mode, fixed pressure bi-level, or auto bi-level, and by setting the pressure support to zero, will act like an autoset.

[cnaumann]

In my non-medical, very-much-new-to-all-of-this opinion, BiPAP is often ineffective for treating CA. This is especially true if the CA due to something other than high blood CO2 levels (hypercapnea), though it does seem to help in some of these cases. It is not always clear if CA even should be treated unless it is causing or suspected of causing problems. If the CAs are short and are not causing significant drops in spO2 and are not causing arousals, you might be better off just ignoring them. Talk to your doctor.

Auto BiPAP is not "better" than Auto CPAP. It is just different. If Auto CPAP is working well for you, stick with it. If BiPAP works better for you, go with that. From the sleep study, it does not appear that BiPAP is going to help.

It is possible that you would benefit from S/T or ASV therapy or something even more exotic like EERS (which you should never try at home). The benefit to more advanced therapy really depends on how much trouble the CAs are causing, and that cannot really be answered with just an AHI number.

Many insurance companies require that you 'fail' a BiPAP trial before they will cover the cost of an S/T or ASV machine. Failure can be different things, it can be an AHI > 5 in a sleep study or the failure of BiPAP to resolve symptoms such as daytime sleepiness.

http://emedicine.medscape.com/article/304967-treatment

[chriscummings83]

I have switched to Cpap straight @ 10 epr 3. First night around the same ahi. Tonight half an ambien and will check it tomorrow.

Back to the point. If I can get a auto bi level under insurance for free and v10 model. I will be able to test straight Cpap auto Cpap and bi level and auto bi level. And if none of that helps. They will send me for an ASV study.

Does that make sense?