How do I get a relative an upgrade to a BiPap through Medicare?

[palerider]

I did notice a definite increase in centrals with raising the Flex settings though, so it's hard to know if bilevel will be better without running a few experiments.

Flex is a pressure difference between inhale and exhale, .... that's the entire point of bilevel... if she doesn't do well with any flex at all, then a bilevel is a waste of money.

[palerider]

You know, it's funny you mention that. Her husband uses a ResMed auto pap, but she was given a dreamstation auto pap. He's very dialed in and simple (10.5 no flex).

Are you saying he's got an autoset in cpap mode?

Are you suggesting the EPR on his ResMed may work better than the Cflex/Cflex+ on her dreamstation? I can give that a shot if so. Or no flex/epr at all and just stick with the Auto-mode with no EPR on the ResMed machine for her?

She's saying that the auto mode on Resmed works better than on Dreamstation.

https://www.youtube.com/watch?v=lzCCgNLya_g

[Sleepygal1]

Sorry, I didn't mean to confuse everyone. I understand now what Pugsy and Palerider meant as far as the auto working differently/better on the Resmed vs Respironics.

If anyone is interested on an update, I found out the Resmed APAP has a "soft" mode which is very similar to the "for her" APAP mode.

I switched him to the Dreamstation and her to the Resmed both with 0 pressure relief, and he claims the pressure is higher even though the pressure settings match between both machines, but she is doing a ton better. AHI down from 8+ to 3-5, so "Soft" mode Resmed APAP made all the difference. Very few RERAs and a few centrals, so thanks for all the help!

I'm now trying to get him dialed back in. On his Resmed machine, he was able to set ramp to where it starts lower and then builds up just by putting on the mask, but I am not finding that feature on the Dreamstation. I found something called "SmartRamp" and it may be similar, so I'm trying that. I told him to press the ramp button when it goes on but he's mad he has to do one more step besides just sticking on his mask and going to bed.

He still claims the pressure is higher at 10.5 than on the Resmed, but I'm moving him to APAP mode instead and just starting a bit lower so it's closer to the slow ramping he's used to.

Thanks again everyone for your help!

[zonker]

If anyone is interested on an update, I found out the Resmed APAP has a "soft" mode which is very similar to the "for her" APAP mode.

yes! i want to testify (sorry, just replied to the "are you addicted thread!) that the "soft" mode saved me. i was having all kinds of trouble breathing against pressure, even with epr, until i found this feature. worked at once, no need to get used to it. previously, i could only have a min pressure of 9.6. any higher would trigger aerophagia. now i can easily handle a min of 11.6!!

[Sleepygal1]

If anyone is interested on an update, I found out the Resmed APAP has a "soft" mode which is very similar to the "for her" APAP mode.

yes! i want to testify (sorry, just replied to the "are you addicted thread!) that the "soft" mode saved me. i was having all kinds of trouble breathing against pressure, even with epr, until i found this feature. worked at once, no need to get used to it. previously, i could only have a min pressure of 9.6. any higher would trigger aerophagia. now i can easily handle a min of 11.6!!

That's really interesting and surprising. As far as I can tell, it just changes how quickly it raises and lowers the single pressure. I would have thought EPR would have more of an influence on aerophagia than soft mode, but that's interesting to know! I'll keep that in mind if that becomes a problem with others I know and suggest that mode.

[zonker]

That's really interesting and surprising. As far as I can tell, it just changes how quickly it raises and lowers the single pressure. I would have thought EPR would have more of an influence on aerophagia than soft mode, but that's interesting to know! I'll keep that in mind if that becomes a problem with others I know and suggest that mode.

i know! it defies convention and practical wisdom, but FOR ME, it works. it just confirms in my mind what i've said before. we are all of us different and what works for me may not work for thee.

the advice wasn't even aimed at me:i read it posted to someone else and thought i'd try it. now, i can't remember who posted it so i can thank them.

[palerider]

If anyone is interested on an update, I found out the Resmed APAP has a "soft" mode which is very similar to the "for her" APAP mode.

No, it's not. Read the manual, the 'for her' mode is this:

• Reduced rate of pressure increments designed to help prevent arousals.
• Slower pressure decays.
• Treats apneas up to 12 cm H 2 O and continues to respond to flow limitation and snore up to 20 cm H 2 O.
• Minimum pressure (Min. Pressure) that adjusts according to the frequency of apneas: If two apneas occur within a minute, the pressure reached in response to the second apnea will become the new minimum treatment pressure until the next treatment session.

so "Soft" mode Resmed APAP made all the difference.

No, "Resmed APAP" made all the difference, "soft mode" may or may not have helped, it may have made the machine less effective.

I'm now trying to get him dialed back in. On his Resmed machine, he was able to set ramp to where it starts lower and then builds up just by putting on the mask,

Are you confusing the soft start Resmeds use where they build up to pressure over the span of a few seconds with a settable feature? There isn't one. It's just how they start. Respironics just whack on at the full treatment pressure immediately, it's startling to someone used to the gentle start of the Resmeds.

but I am not finding that feature on the Dreamstation. I found something called "SmartRamp" and it may be similar, so I'm trying that.

No, it's not at all the same. Don't you read the manuals to see what these features do? There's half a page of description in the clinical manual.

I told him to press the ramp button when it goes on but he's mad he has to do one more step besides just sticking on his mask and going to bed.

I'd be hopping mad too if someone took away my Resmed and stuck me with a Respironics machine!!!!

He still claims the pressure is higher at 10.5 than on the Resmed,

Resmed, with it's EasyBreathe pressure delivery often feels more comfortable to people, especially when they're used to it, and then get stuck with something rougher.

Give him back his machine. Get hers switched out.

[palerider]

That's really interesting and surprising. As far as I can tell, it just changes how quickly it raises and lowers the single pressure. I would have thought EPR would have more of an influence on aerophagia than soft mode, but that's interesting to know! I'll keep that in mind if that becomes a problem with others I know and suggest that mode.

i know! it defies convention and practical wisdom, but FOR ME, it works. it just confirms in my mind what i've said before. we are all of us different and what works for me may not work for thee.

The placebo affect is real...

Here, take this pill, it'll make you feel better!

Hey! I DO feel better!

I knew you would!

[Sleepygal1]

As far as what I said about the "For her" being similar to the "Soft" mode, I could have sworn I read it here. I'll have to do more searching to see where I read that. Perhaps I'm just reciting someone else who was wrong. I'll try to pay more attention to manuals and less to just forum posts.

Give him back his machine. Get hers switched out.

Yes, i really think this is the key. I'll have her tell the doc to see if he can get her switched over. A resmed "for her" would probably be the best option, but at worst case, another ResMed full data capable APAP would probably be adequate.

Now of course I want one too just to compare. But I'm pretty well controlled at a 1-2AHI or so on my Dreamstation. Everyone I know in the past few months has received Dreamstations from various DMEs. Maybe its the sleeker white boxes or just a better deal on the DME's part?

[Pugsy]

As far as what I said about the "For her" being similar to the "Soft" mode, I could have sworn I read it here. I'll have to do more searching to see where I read that. Perhaps I'm just reciting someone else who was wrong. I'll try to pay more attention to manuals and less to just forum posts.

I have read it also and it's been someone's "opinion" but not based on real fact and they don't really understand soft mode...and actually ResMed doesn't really go into much detail about it either. They don't go into a lot of detail how they go about doing things...they just hit the high spots. The real nuts and bolts are under national secret restrictions probably to prevent others from copying stuff.

Just because someone says something here...don't assume it is the gospel....we get wild incorrect assumptions being made here all the time. And not always from newbies who we don't expect them to know much about anything. Some of the veterans don't know what they are talking about either.

My AirSense machine doesn't offer it....that "soft" thing was an add on after some of the first machines were released so not everyone will have that option.
I would like to try it myself just to see if I could isolate how it works but I can't until I can get a hold of a machine that has it.

It is NOT a way to make the regular auto adjusting algorithm function like the for her mode algorithm though..
My thoughts about it if it is available and it feels good and seems to help....use it no matter what it does and don't worry about it.

[palerider]

As far as what I said about the "For her" being similar to the "Soft" mode, I could have sworn I read it here. I'll have to do more searching to see where I read that. Perhaps I'm just reciting someone else who was wrong.

You might have read it here, someone that doesn't know what it does may have said that... doesn't make it right, though

I'll try to pay more attention to manuals and less to just forum posts.

I think that's a very good plan.
Typically, when someone posts a theory here that's wrong, someone else will promptly correct them. but that doesn't always happen, and sometimes, on things like soft mode, the definitive info is a bit vague... (now, over on apneaboard, wrong things like that can linger for quite a while... don't want to hurt anybodies feelings by telling them that they're wrong) ... But what 'for her' mode is, (I have to trust) is documented clearly.

Read the clinical manuals, they're the best reference for what the machines do, and how they're going to behave, and what the settings mean.

Also, reading the titration manuals can be quite informative. Just google "Resmed titration guide" (I also found a copy of the respironics one there, but Respironics manuals tend to have less information in them compared to Resmed, it seems to me. I've got a couple different Resmed titration guides, if you can't dig both up (S9 and air10) shoot me a PM and I'll get whichever one you couldn't find over to you, they've got different stuff in them, and I think it's worth looking at both.

Give him back his machine. Get hers switched out.

Yes, i really think this is the key. I'll have her tell the doc to see if he can get her switched over. A resmed "for her" would probably be the best option, but at worst case, another ResMed full data capable APAP would probably be adequate.

It's "Resmed Airsense 10 Autoset for her" or "Resmed Airsense 10 Autoset". There's no price difference between the two, I always recommend the 'for her' because of the extra treatment mode, it *may* help, it *may not*... but it doesn't hurt anything to have the option.

Now of course I want one too just to compare. But I'm pretty well controlled at a 1-2AHI or so on my Dreamstation. Everyone I know in the past few months has received Dreamstations from various DMEs. Maybe its the sleeker white boxes or just a better deal on the DME's part?

Respironics are cheaper. The DME has a financial incentive to push them, because (typically) they get paid the same for insurance whether you get a junk "Dreamstation CPAP" (cheapest brick) or a "Resmed AS10 Autoset For Her" so, the cheaper the machine they can foist off on someone, the more they make.

For me, the decision is clear. The Resmeds are quieter, they're more comfortable to use (that soft start when first turned on, for example), they're more responsive to changing needs throughout the night. the auto start works *WAY* better than on respironics.. (just try it, they usually auto start on the first breath after putting the mask on, every Respironics I've had took a lot of heavy breathing to get it to wake up, then it'd blow for a minute after taking the mask off... Resmeds shut down in a few seconds.) and more.

[Dog Slobber]

My AirSense machine doesn't offer it....that "soft" thing was an add on after some of the first machines were released so not everyone will have that option.
I would like to try it myself just to see if I could isolate how it works but I can't until I can get a hold of a machine that has it.

What mode is your device set to?
AutoSet or
AutoSet for Her

When my device is set to AutoSet mode, the Response option is available and the first option under the comfort settings.

When I set my device to AutoSet for Her mode, the Response option disappears and is no longer available.

I don't know what the relationship is between Soft Response and for Her mode is, but it's availability is dependant on what mode you're in.

[Pugsy]

What mode is your device set to?
AutoSet or
AutoSet for Her

When my device is set to AutoSet mode, the Response option is available and the first option under the comfort settings.

When I set my device to AutoSet for Her mode, the Response option disappears and is no longer available.

I don't know what the relationship is between Soft Response and for Her mode is, but it's availability is dependant on what mode you're in.

Right now set to the for Her auto mode but I also have used it in regular autoset mode and I still don't get the any choices in Comfort section.
In fact just to make sure I hadn't missed it somehow....just went in and tried all modes and in the comfort section I simply have zero choices for anything...it's black and pushing on it does nothing.

The soft mode was an addition later to more newer models.
I don't know if it is something that could be added with a software update or not.
ResMed doesn't do much forced updating over the air...and I got my machine second hand...so even though it was low hours it didn't have the soft option available. It was an older machine that someone bailed on using. No telling how long it set in the closet.
If I think about it I will take it to my DME and see if I can get it updated....they are selling ResMed machines now and maybe they know how to get it added...if they can.

[Dog Slobber]

Right now set to the for Her auto mode but I also have used it in regular autoset mode and I still don't get the any choices in Comfort section.
In fact just to make sure I hadn't missed it somehow....just went in and tried all modes and in the comfort section I simply have zero choices for anything...it's black and pushing on it does nothing.

The soft mode was an addition later to more newer models.
I don't know if it is something that could be added with a software update or not.
ResMed doesn't do much forced updating over the air...and I got my machine second hand...so even though it was low hours it didn't have the soft option available. It was an older machine that someone bailed on using. No telling how long it set in the closet.
If I think about it I will take it to my DME and see if I can get it updated....they are selling ResMed machines now and maybe they know how to get it added...if they can.

Agreed.

Attached are pics of my backup AS 10 AS for Her, it's a pretty new unit, bought it three months ago and it had 100 hours on it.

On the left you can see it's in Mode: AutoSet and Response: Soft, In the middle Mode: AutoSet for Her and the Response option is gone.

On the right is my Software version, SX567-0306, I'm guessing your version is earlier.

R_FH_Version.jpg

[zonker]

That's really interesting and surprising. As far as I can tell, it just changes how quickly it raises and lowers the single pressure. I would have thought EPR would have more of an influence on aerophagia than soft mode, but that's interesting to know! I'll keep that in mind if that becomes a problem with others I know and suggest that mode.

i wanted to come back in and make a bit of an add on here. i was going through my menu settings , checking something pugsy had said about adjusting temperatures on my machine. i hadn't noticed before, but while i AM using soft mode, i also have epr set at one. didn't realize that before and just thought i'd mention it here.

apparently, the soft mode allows me to tolerate the epr, at least at level one.