Help with upcoming BiLevel selection

[cby1]

Hi All,

I just had a sleep study done, but do not have the results yet - I have requested them, but they'll only mail them out - the Doc-Insurance-DME rodeo is apparently happening now. I have an appt in April to follow up after having the machine for awhile, but I can't easily "swing by" to get the results now, as it's a 45 min drive from here (my sleep doc is co-located with the lab - JFK Neuroscience in NJ). My PCP does not have a copy yet either.

Anyway, I have a history of bad clusters after about 6-7 hours of sleep, and CPAP has not eliminated those, even at 19-20 cm. No idea if they are OA or Centrals, as my machine is too old to differentiate. Background in the thread below if it's helpful:

viewtopic/t103535/Help-with-MyEncore-datacharts.html

This was a "Modified Split" study (one night), unfortunately - did not capture the cluster period, I'm sure of it - since I am aware of it when it's happening, and also they didn't do more than 6 hours with the mask.

My Questions:

1. When the DME comes to me with choices (Ha! if I even get a choice) for a Bi-Level machine, I want to make sure I get one that has maximum data capabilities, and an SD card (as opposed to some proprietary thing coming out of the back of the machine, readable by who knows what). I intend to start using the Sleepyhead SW with it ASAP. So I guess as much as a "what BiLevel machines do you like" question, it's also a "what BiLevel machines should I stay away from?" question.

2. I have insurance, and am trying to figure out (from others' posts) how the whole Insurance/DME thing works (I am in NJ, BTW). I have requested an Auto machine (since I know they won't have seen the clusters during the study) - I have no idea if I'll get prescribed one. I'm sure this varies, but is the typical model that insurance tells the DME they'll pay "x", and then the DME offers a machine that they think will satisfy the prescription? That leaves them plenty of room to screw the patient in the name of profit - how else would it work and have them make max profit?

Thanks in advance. My undertreated apnea is ruining my life - nothing has really changed since that thread a year ago (different job, a little less stressful, so that's good).

Chris

[palerider]

1. When the DME comes to me with choices (Ha! if I even get a choice) for a Bi-Level machine, I want to make sure I get one that has maximum data capabilities, and an SD card (as opposed to some proprietary thing coming out of the back of the machine, readable by who knows what). I intend to start using the Sleepyhead SW with it ASAP. So I guess as much as a "what BiLevel machines do you like" question, it's also a "what BiLevel machines should I stay away from?" question.

all bilevel machines are full data. all use SD cards. auto machines give you more options than non-auto. resmed machines give you more customization options should you ever decide to tinker with them.

I'd suggest a resmed aircurve 10 vauto.

[Cardsfan]

The sleep center should mail you a copy of your test results. Just call them and ask. Get a copy of your prescription also. With the prescription, go to any in network DME and get the machine you want.

[cby1]

Thanks to both of you. It looks like the machine Palerider recommended is what my local DME carries for BiLevel.

Palerider: Are the data from this machine compatible with SleepyHead? I'm assuming so.

Thanks,
Chris

[Okie bipap]

That machine is compatible with sleepy head. I use the same machine and us sleepy head. I would suggest you get a flashier card to use in the machine. That way, you will be able to download the data without taking the card out of the machine.

[OkyDoky]

I really like my Resmed aircurve 10 vauto for home use but I use my Respironics 760 for travel / camping. Respironics are 12 volt machines and are a little easier to use on battery power. Just thought I'd throw that into your decision.

[palerider]

get a flashier card

flashair.

[palerider]

Palerider: Are the data from this machine compatible with SleepyHead? I'm assuming so.

I wouldn't recommend it if it weren't

well, at least mostly compatible, the currently available version of SH came out before the aircurve line was released, so the support isn't 100%, there are a few glitches, but it works well enough to give you the information that you need... the next version of SH will fix those glitches.

[cby1]

Thanks everyone.

So the Flashair card is a wireless "device" you'll see on your network - I assume it has drivers or some kind of application that you install which pulls the data from the card - trying to get my head around how the process actually works.

Guess I'm also a little paranoid about it working with this relatively "new" model (which I don't even know I'm getting yet - haven't been able to confirm) - I guess as far as the Aircurve 10 is concerned, an SD Card is an SD card...

Chris

[palerider]

I guess as far as the Aircurve 10 is concerned, an SD Card is an SD card...

that is correct, it doesn't care whether there's a wifi circuit in the card or not

[cby1]

Well, now I have to change the title of this thread .

The Sleep doc is prescribing an Auto *CPAP* set at 18-20 cm, which is what I already am running right now (the two machines I have are old, however - REMStar Autos from like, 2005). I suspect the algorithms have improved since then.

I have a "squeeze-in" appt Tues. - I will show her my data with the clusters that occur toward morning (again), and see if that changes her mind on the script. Concerned about the clusters in the am, as well as being painted into a corner max pressure-wise. And feeling like crap, of course.

May end up having to go the route many of you have gone - buy and set myself - but I'll see what the Tues. appt yields. Opinions about how to handle/proceed welcome.

Thanks,
Chris

[palerider]

Well, now I have to change the title of this thread .

The Sleep doc is prescribing an Auto *CPAP* set at 18-20 cm, which is what I already am running right now (the two machines I have are old, however - REMStar Autos from like, 2005). I suspect the algorithms have improved since then.

pressures like that warrant a bilevel, which can go to 25.

improved algorithms or not, there's precious little wiggle room between 18 and 20 for an auto cpap.

[OkyDoky]

You are thinking right that you are boxed in with that high pressure. I don't understand why she won't order the bilevel. When I went for my Sleep Study it was a requirement for work and I didn't believe I was going to need a machine. I didn't know anything about machines but when they put the mask on I had difficulty breathing out and told the tech this. I don't know if that comment was what got me the bilevel or not but my pressures at 11 EPAP and 15 IPAP are lower than yours. If you have any difficulty exhaling with these high pressures and told her it is uncomfortable breathing out at these high pressures she might reconsider.

[Sleeprider]

I suggest you describe to the doctor your discomfort and intolerance of the high fixed pressures you are required to use and specifically request to be put on auto bilevel treatment. Your doctor should be in your corner on this, and not affected by insurance guidelines. Insurance and Medicare guidelines for bilevel devices under HCPCS Code E4070 require a demonstration of medical necessity that either CPAP treatment does not meet the goals for treatment (excessive apnea events or other therapeutic measure), or that the patient does not tolerate CPAP.

Your titrated pressure range is a strong indicator the "tolerance" may be an issue. You're going to have to make that case and not accept anything less than bilevel. That could even include a statement that if you don't get a bilevel through insurance you'd be ready to acquire one privately, to make the point that it's that important to you.

Remember, once your doctor prescribes this, he is going to have to defend the medical necessity. You need to give him that information so he can help you. Go sell it!

[cby1]

Thanks.

I suggest you describe to the doctor your discomfort and intolerance of the high fixed pressures you are required to use and specifically request to be put on auto bilevel treatment. Your doctor should be in your corner on this, and not affected by insurance guidelines. Insurance and Medicare guidelines for bilevel devices under HCPCS Code E4070 require a demonstration of medical necessity that either CPAP treatment does not meet the goals for treatment (excessive apnea events or other therapeutic measure), or that the patient does not tolerate CPAP.

Having finally gotten a copy of the study, it looks like it'll need to be latter (tolerance) as the AHI was 2.3 at 17 cm. So what am I whining about, right? Except they only had 209 min of titration time vs. 250 without the mask - so no chance to see my clusters (which appear at hour 6.5-7 of continuous CPAP).

Now maybe what she's thinking is we have to start with CPAP and show that doesn't cut it to justify the BiLevel. I also see the report says "CPAP Tolerance: Good". Not really clear how they assessed that.