An introduction

[KingSnore]

Hi, I'm new around these parts, been reading the forums for maybe a month or 6 weeks. But I've been using CPAP since July 2015. I've always been a champion snorer, but my apnea diagnosis wasn't until I had major surgery that spring, and while in hospital they were sufficiently spooked by my sleep issues to recommend I get a study done.

I live in the St Louis area suburbs, just turned 38, and the reason I started coming here and doing a bunch of other research was to be ready before I get a replacement device. My insurance covers replacements every 5 years, but I've wanted to wait for new devices.

I have a PR System One 60 series, and have used several styles of masks, always full face because I'm a mouth breather. The AirFit F20 (and its predecessor), and I've also tried the AirTouch F20. I'd have to try AirTouch with the large cushion because medium leaked too much for my liking, and currently, for the past month or 6 weeks or so I've been using the F30i. It's really nice to be able to use full light-blocking eye masks with this F30i.

I started at a pressure of 10, which was within months raised to 13 where it stayed until early 2020. Moved to 15, and with my most recent visit about 12 days ago, was instructed to get a new machine with APAP capability (trying desperately to wait until the Air11 though). I'm using the 30-day titration function on my machine now and it's almost hitting 20 cm most nights though it seems to average around 16-17.

OSCAR information tells me that my starting AHI was nearly 65, took a few months for acclimation and dropped about in half, and within about 6 months settled in about the 7-12 range. When I moved cross country and spent a few weeks in a hotel room, my AHI spent those weeks around 25-30cm while my home usage was 1/4th those numbers. OSCAR says the average AHI for the last year is 12. However, the 30-day average is 2.94. As far as problems with the therapy and what really feels like room for improvement is, I'll sometimes tend to wake earlier than I would prefer and have difficulty going back to sleep. Means I spend the early hours of the day quite tired, then nap in the early afternoon for an hour or so.

Anyway. I'd love to help encourage newcomers to therapy because I relate to the issue of only wanting to wear it a few hours a night in the early going and feeling super frustrated with those new sensations. It's definitely worth the learning curve.

[Miss Emerita]

Hello! So far, we haven’t seen clear evidence that the new ResMed machine will be different from the AirSense 10 Autoset in core functionality. But I understand wanting to wait.

Could you post a typical Oscar chart from the past month? I’m curious what’s going on.

[SleepGeek]

Welcome to the zoo...

Sounds like you are over due for an auto and in fact most likely over due for a BiPap.

Hopefully you already have a backup but if not I think it would be prudent to buy a used bipap from Craigslist while you wait for technology improvements.

[KingSnore]

Okay, hopefully I've captured what you need with this one, this is probably right in the middle of the range for the month (3.9 AHI), I had some days where the AHI is around 0.7, others where it's 9.5, 11.5 etc

But I think the main reason it's lower this month compared to the past 12 mos, in general, is probably the new mask. I don't know what other things I've changed.



Thanks so much to both of you. Sounds like next time I see my doctor I should discuss a BIPAP with him.

[SleepGeek]

Sounds like next time I see my doctor I should discuss a BIPAP with him.

The doc will likely want another sleep study for that. If you don't want to do that then you need to buy a used one and then show the doc the results. You should be able to reduce your AHI and feel much better if things work out.

[Miss Emerita]

Thanks for posting a chart. The left panel contains useful information. Could you repost with the left panel showing? Be sure to turn off the calendar and pie chart if they are showing.

[KingSnore]

Thanks for posting a chart. The left panel contains useful information. Could you repost with the left panel showing? Be sure to turn off the calendar and pie chart if they are showing.

Really appreciate when people who know what to look for volunteer to check out my data. Thank you.

Apnea 1.png (889.74 KiB) Viewed 1420 times

Apnea 2.png (862.86 KiB) Viewed 1420 times

[KingSnore]

I realized I may have misunderstood what you were asking for, so here's another bit of data. Apologies if it's unnecessary.

[Miss Emerita]

That last post is indeed the left-hand panel with lots of good information. Even with the pressure increases over time, you could use a higher minimum to deal with various kinds of obstruction: obstructive apneas, flow limitations, hypopneas, and snores. You could try 15 or 16 to see what happens.

The machine you have is an APAP machine; it adjusts the pressure automatically during the night depending on input from you and the algorithm in the machine. But Philips Respironics machines have very conservative algorithms and "want" to raise pressure as little as possible. You'd probably do better with a ResMed machine, as these are generally more nimble and responsive.

There are several reasons why you might benefit from a ResMed Aircurve VAuto machine. (This is called a bi-level machine.) One reason is that it can give you a greater differential between inhalation and exhalation pressures than e.g. a ResMed Airsense 10 Autoset, and that might help with the flow limitations. The other is that the maximum pressure is 25 rather than 20. (I pretty sure the new 11 machine will not have these features.)

Your doctor and/or insurance company may balk at the idea of a VAuto, since your recent 30-day average is below 5. But I hope you can make the case. You might even consider asking for the prescription and then buying the machine yourself.

I'm curious: over time, has something relevant changed? Weight gain? Sleep position?

[KingSnore]

That last post is indeed the left-hand panel with lots of good information. Even with the pressure increases over time, you could use a higher minimum to deal with various kinds of obstruction: obstructive apneas, flow limitations, hypopneas, and snores. You could try 15 or 16 to see what happens.

The machine you have is an APAP machine; it adjusts the pressure automatically during the night depending on input from you and the algorithm in the machine. But Philips Respironics machines have very conservative algorithms and "want" to raise pressure as little as possible. You'd probably do better with a ResMed machine, as these are generally more nimble and responsive.

There are several reasons why you might benefit from a ResMed Aircurve VAuto machine. (This is called a bi-level machine.) One reason is that it can give you a greater differential between inhalation and exhalation pressures than e.g. a ResMed Airsense 10 Autoset, and that might help with the flow limitations. The other is that the maximum pressure is 25 rather than 20. (I pretty sure the new 11 machine will not have these features.)

Your doctor and/or insurance company may balk at the idea of a VAuto, since your recent 30-day average is below 5. But I hope you can make the case. You might even consider asking for the prescription and then buying the machine yourself.

I'm curious: over time, has something relevant changed? Weight gain? Sleep position?

Thanks! I scheduled a video meeting with my doctor for tomorrow morning (general practice, not specifically the sleep specialist I see) noting that the reason for the appointment is interest in scheduling a sleep study to see if BIPAP would be beneficial for me. I'll update the thread with the results of that appointment....

I know I'm not sleeping any better than usual despite the AHI decrease....nightly CPAP hours is nowhere near where I would like, most of the time. Not uncommon for it to be under 6 hours despite my best efforts, or barely above 7, and on top of that I think they say if you average 10 events an hour or more you could qualify for BIPAP. I don't sleep without the therapy, no taking the mask off at all or even napping without it, so if it says 5.5 hours of therapy that's all the sleep I got that night.

For most of my life I'd only be able to sleep on my side, or stomach when I was younger and less overweight, but I received a pillow as a gift (Purple Pillow) that made sleeping on my back feel more comfortable so I've been doing that for about a year. And then in the process of my recent sleep research I've found that sleeping on the back is not ideal for apnea patients. I've since gone back to my other preferred pillow for side sleeping, and for the times when I do want to sleep on my back I bought a wedge pillow to keep elevated. I've also started using a PAP-CAP chinstrap. If these could be reasons for the AHI decrease...it's a lot of effort and comfort sacrifices and if I could forego them and just rely on the BIPAP I would be happier

[KingSnore]

They are going to call in the AM, they said. Finally got the doc's script. I'm hopeful it will be generic and I can tell them to get me the VAUTO you were talking about, but I don't know how much of a say I'm going to really have here, or how much I should be prepared to argue for it. I know bi-levels are traditionally for central apneas, and my data shows I might have one or two of those a night, if at all.

I think they're gonna probably try and push a Dreamstation on me and I'll probably accept it. Last time I was in the office they mentioned my doctor's place seems to have an affinity for Philips.

[Miss Emerita]

Bi-levels are not for central apneas; you're thinking of ASVs (adaptive servo ventilation machines). As I say, the value you would get would be the capacity for higher pressure (over 20) and for higher pressure support (difference between inhale and exhale pressures).

Please don't settle for a PR machine. The doctor's place having an "affinity" is no kind of reason at all for you to accept a particular machine. Sometimes the "affinity" is just a business deal between the practice and the manufacturer. At the very least, insist on knowing the patient-centered reasons they have for why you should accept a PR machine over a RM machine.

[KingSnore]

Bi-levels are not for central apneas; you're thinking of ASVs (adaptive servo ventilation machines). As I say, the value you would get would be the capacity for higher pressure (over 20) and for higher pressure support (difference between inhale and exhale pressures).

Please don't settle for a PR machine. The doctor's place having an "affinity" is no kind of reason at all for you to accept a particular machine. Sometimes the "affinity" is just a business deal between the practice and the manufacturer. At the very least, insist on knowing the patient-centered reasons they have for why you should accept a PR machine over a RM machine.

Grateful for all this, it's going to be nice to have as a reference for when I'm doing this. When they finally called today apparently the insurance denied the claim ("It's been less than five years!", which OSCAR evidence easily refutes.)

But I'm assuming eventually the doctor's office will sort this out and I'm going to have your posts here to thank for getting the best possible device. Just might take a little more hoop jumping.

Anyone know if the DME supplier would typically let you pay to "upgrade" to a higher tier machine than what the insurance is willing to pay? I would gladly pay the difference myself for the expected comfort benefits moving from the AirSense to the AirCurve.

[Miss Emerita]

Anyone know if the DME supplier would typically let you pay to "upgrade" to a higher tier machine than what the insurance is willing to pay? I would gladly pay the difference myself for the expected comfort benefits moving from the AirSense to the AirCurve.

The question about costs would be a question for your insurance company rather than the DME, I think. If you had a prescription for, say, a VAuto but your insurance wouldn't cover it, you could buy one yourself. There's a market in lightly used machines, which are less expensive. (I got my lightly used machine from forum member LSAT, for example, and there are places out there like Second Wind.)

[SAG]

I have no interest in getting in the which brand is better contest IMO they are both decent cpaps tho Resmed seems to charge more for things like the DC power cord and making sure theirs will require 24V to operate. I've been to seminars where the REsmed sales people are outright arrogant and that has turned me off.

If your doc is pushing you one way or the other I would find another doc, if not today or for this cpap certainly for the next. And if things don't go the way you want you simply don't have to accept the equipment when they do call.

When they finally called today apparently the insurance denied the claim ("It's been less than five years!", which OSCAR evidence easily refutes.)

As mentioned I would contact your insurance directly. It sounds like your DME may be feeding you some BS and that is not uncommon. Speak directly to them not thru your doc or DME.

Anyone know if the DME supplier would typically let you pay to "upgrade" to a higher tier machine than what the insurance is willing to pay? I would gladly pay the difference myself for the expected comfort benefits moving from the AirSense to the AirCurve.

Don't get caught in that with your DME. They get paid by billing code from your insurance. Your doc is the one who can order the Aircurve. If the DME is willing to take an upgrade fee they are crooked and are likely to screw you too. That would be like the pharmacy accepting a payment from you to provide a 100mg drug in place of the 50mg the doc ordered. Or giving you 14 day supply when the doc ordered 7 days.

If you want to try an Aircurve buy a used one either on this forum or Craigslist. Craigslist often will have new or barely used cpaps. Also but don't pay the insurance price for it, compare to the price shown on cpap.com