Auto Titration & Smart Cards

[levelbest]

Hey All:

Just started my sleep therapy a week ago - and while I am still not feeling great, I think it's starting to make a difference.

After doing some research, I have a few questions.

I have Cigna which uses Apria as their DME. My doctor perscribed at Bi-Pap machine for me and they assigned the Resperonics BiPap Plus. No humidifier just yet. Cigna apparently makes you start with this and then doctor has to request it.

I was looking on cpap.com at the machines and it seems to me that if the purpose of the BiPap is to alleviate this condition we all have, wouldn't treatment make more sense if your sleep was actually monitored? I can't understand why I wouldn't be given the option (even if it was at my expense) of getting a machine that had a smart card reader in it. Otherwise, how do you know if the machine and the pressure assigned in a sleep test (mine was 10/6) is actually working without ongoing data? Why wouldn't this be standard? Seems if keeping me and others healthy, alive and off other medications (blood pressure, anti depressants etc.), then the $300 extra that is the difference between a machine that does monitoring and one that does not seems worth it in the long run.

On another subject, what is everyones experience with the auto titrating machines? It seems to be a logical option (as long as it works well) to deliver only the amout of pressure you actually need at any given time.

Is it worth it for me to pay out of pocket if I have to $1300 to get an auto machine that has a data card port in it?

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, humidifier, cpap.com, DME, auto, Smart Card

[NightHawkeye]

Is it worth it for me to pay out of pocket if I have to $1300 to get an auto machine that has a data card port in it?

Levelbest, only you can answer that question. How much is your health worth to you? Do you believe your treatment is sub-par? Are you one of those who just needs to know?

There may be less expensive options to consider first, though. Are you renting your machine? If so, return it for one more to your liking. People write about doing that here regularly.

Also, don't forget about the software. For Respironics machines that adds another $200 if you get it from CPAP.com.

Regards,
Bill

[levelbest]

Levelbest, only you can answer that question. How much is your health worth to you? Do you believe your treatment is sub-par? Are you one of those who just needs to know?

There may be less expensive options to consider first, though. Are you renting your machine? If so, return it for one more to your liking. People write about doing that here regularly.

Also, don't forget about the software. For Respironics machines that adds another $200 if you get it from CPAP.com.

Hi Bill:

Thanks for answering.

No, I'm not renting. Cigna picks up the complete costs of the machine. This is probably something I should have asked before I brought it home but for some reason I didn't. The machine is ok. I'm not at a super high pressure but believe that an auto titrating machine might be even more comfortable. Need feedback on that.

As far as being "one of those folks who has to know" - I really would like to know that the treatment is working. Or if it's optimally set. I don't see how you can do that without actually seeing data. Am I wrong on that? And then there is the geek side of me - that thinks it would be cool to look at.

[Bonnie Who can't log in]

Levelbest,
I too had Apria for my DME, not a very pleasant experience. After I was diagnosed and found this forum I learned a whole lot in a short period of time including what type of machine would suit my needs. I have the RemStar Auto with Cflex and I had a straight Cpap prior to that one. IMHO an Auto is probably the best for the majority of people. I like the fact that I'm getting the pressure needed rather than a set pressure continuously. I also like the fact that the smart card and reader allows me to monitor readings and tweak as needed.

Because I have the RemStar I was able to download the software free along with the free MyEncore and about $30 for the card reader. Extremely well worth the effort it took to install (with the help of a lot of people here!!!)

Also I believe a heated humidifier is a good thing, and as I found out recently, so is an Aussie heated hose.

What type of mask are you using and are you doing OK with it? That seems to be the biggest complaint that people new to OSA have.

It appears that you are interested in being pro active in your treatment and by having daily read outs (along with how you are feeling) is a great start. Also using this forum will aid in any questions that might come up. A great bunch of people here.

[levelbest]

Right now, I am testing the comfort curve (like how quiet it is) and the mirage swift nasal pillows. Didn't tolerate the full mask at all in the sleep study, nor did I do well on plain cpap. The bipap worked much better for me.

On the proactive side of things... yes, I definately want to monitor what is going on. It's my health and life! So, I want to stay on top of things, and make this thing work best as it can for me...

[ozij]

Because I have the RemStar I was able to download the software free along with the free MyEncore and about $30 for the card reader. Extremely well worth the effort it took to install (with the help of a lot of people here!!!)

Downloading Respirons's Encore Pro for free was possible a few months ago, but no longer is. "My Encore" written by Derek of this forum is free, but needs the data picked up from the machine by "Encore Pro".

As for bi-pap vs. auto: An automatic machine will keep you on "pressure as needed" but will not give you the major exhalation relief you get by using the bi-level. Now, on an automatic machine you might find yourself consistently at lower pressure, with the machine rising up to the maximum only occasionaly, or conversely, you might find the machine hovering around 10 all night, without giving you the exhalation relief you need.

Since you're feeling better, it seems like you've got a machine that's good for you.

The Respironics Bi-Pap Pro 2 (note, the 2) will give you all the details you want, without being an automatic bi-pap. I think it was Nighthawkey who mentioned that the price difference between a regular bi-pap and an automatic one was not that big.

The point is this: you can monitor you own treatment on either an auto, or a Bi-PAP Pro 2. I too wouldn't want treatment without the ability to monitor it. From reading this forum I know some DME's will let you pay price differences out of pocket.

Before you decide which machine to buy, you should make sure you understand why you were prescribed a bi-pap. Maybe they saw you had trouble exhaling against a pressure of 10?

In any case, see if you can get a trial on a auto before you decide.

You'll probably find the DME more cooperative in getting you a self monitoring bi-pap than it getting you an automatic, since the more expensive bi-level has its own reimbursment code, whereas the auto (expensive) and the straight CPAP (cheap) have the same code.

O.

[levelbest]

Ok, so I am a little confused... wouldn't an Auto BiPap provide relief on exhalation - isn't that what the name Bi-Pap implies?

[NightHawkeye]

Ok, so I am a little confused... wouldn't an Auto BiPap provide relief on exhalation - isn't that what the name Bi-Pap implies?

Here's the straight scoop from the CPAP.com site:
# EO601 RR is CPAP rental.
# E0601 NU is CPAP purchase.
# A7034 is CPAP nasal mask, including all nasal masks, Nasal Aire, Breeze, Spiritus.
# A7032 is CPAP nasal mask cushion.
# A7030 is CPAP Full Face mask.
# A7031 is CPAP Full Face mask cushion.
# A7044 is CPAP Full Oral Interface.
# A7046 is CPAP Humidifier Chamber.
# A7037 is CPAP tubing, long and short hoses.
# A7038 is CPAP disposable filter.
# A7039 is CPAP gross particle (foam) filter.
# A7035 is CPAP headgear.
# A7033 is CPAP nasal pillows.
# A7036 is CPAP chinstrap.
# E0561 NU is CPAP Passover Humidifier
# E0562 NU is CPAP Heated Humidifier
# E0470 RR is BiPAP rental.
# E0470 NU is BiPAP purchase.
# E0471 RR is BiPAP-ST rental.
# E0471 NU is BiPAP-ST purchase.

Notice that there is only one code for CPAP purchase. There are two codes for BiPAP purchase, but the BiPAP-ST is a timed device for folks with central apnea.

APAP machines are billed with the CPAP code and the BiPAP-auto is billed with the BiPAP code. DME's don't seem to have a problem charging for the BiPAP-auto using the BiPAP code.

And, yes, the BiPAP-auto operates in auto mode as a BiPAP at two different pressures which are adjusted independently throughout the night. Here is an overnight screenshot which should be self-explanatory:


Regards,
Bill

[sthnreb]

[quote="levelbest"]Ok, so I am a little confused... wouldn't an Auto BiPap provide relief on exhalation - isn't that what the name Bi-Pap implies?
_________________


The Bi-pap does supply relief on exhale. What he is saying is that it may be less than your Rx of 10/6 which is 4 cms constant difference. When you set up the Auto with 6 being low for exhale, it would start out at 8/6 and go up from there. (With 6 as the low setting, it would never go below 6 on exhale) This makes the differential of 2 cm's to begin with which could be a problem for you, but not necessarily. I have a Bi-pap pro 2 and a Bi-pap auto machine. I started with the straight Bi-pap for 3 years and changed to the auto. It did take some getting used to on my part since the pressure was not constant but only as needed. Keep in mind too, the Bi-pap auto can be set for straight Bipap use and not auto titrating. It took some playing around with the auto for me to get it set perfectly to myself. My pressures are 12/8. With the auto, it is closer to 12/9 but runs lower most of the night. At first, I thought I couldn't tolerate the auto starting at a lower pressure and went back to the straight Bipap mode for a week. Big difference. So I decided, I have the Auto function, I like it, so why not use it? I've been using it ever since and prefer it over the straight constant pressure Bipap. Everyone is different but the Bipap Auto fills both functions if you can get one and try it in both modes to see which mode you prefer. You can always go back and forth to see which is best for you. I've been using the Auto now since November of 2005.
With the Auto, you will need the Encore Pro 1.5 software. It was free for a while on the Respironics site. You may can find it now even somewhere or I have it. Some on here feel it is not morally right to give it away since it is sold here, but it was a free download to me and many others. I did purchase the 1.4 from cpap. Derek's My Encore is a free download here too. You can order a card reader online for about $30 from the manufacturer 2factors. http://2factors.com/index.php?sp=&p=6&c ... s=&lang=en
DT3500. Message me if you need to for any questions.