Do I need BiPap? Data added

[johnthomasmacdonald]

viking wrote: "
Maybe what I really need is AutoPAP. Seems a lower pressure is ok when not in REM. And then it could adjust up when needed.

But my sleep doctor doesn't believe in them and won't prescibe. "

maybe best would be an auto bipap - they really should make it easy to rent these things for a month or so to see if it really makes a difference - afterall this is for EIGHT HOURS EVERY NIGHT FOR THE REST OF YOUR LIFE - getting it right would seem to be worth the effort on the part of the MDs - even if "right" is just a comfort issue since being able to actually sleep with the thing is crucial

[larry2001]

Don't worry about MAX Leak. I use SmartStart instead pushing button to start and stop.

My leak data is finally under control but notice the clusters of obstructive events (likely during REM sleep). At my sleep study I had ZERO Deep and ZERO REM due to medication. After lots of adjustments I am now having normal sleep patterns but the pressure of my CPAP isn't taking care of my OSA during REM sleep.

Unfortunately, I did not use my pulse oximeter that night so don't know what desats I was have during periods of AHI as high at 15.

Here is the night before.





Maybe what I really need is AutoPAP. Seems a lower pressure is ok when not in REM. And then it could adjust up when needed.

But my sleep doctor doesn't believe in them and won't prescibe.

Where did you get this incredible data print out from ? Your S9 elite ? If so, how did you do it ?

[49er]

Viking Gnome,

For what is worth, if I didn't wear a neck collar with my Quattro FX, I would need a pressure of around 20 to have any chance of getting my AHI below 5. Through trial and error, I have found that a pressure of 5 with the neck collar usually gets me an AHI of 2 or below.

Now, in the name of full disclosure, I have not been able to sleep more than 4 hours consistently on the machine for various non machine related reasons. So one could rightfully claim I am weak on data. But what do you have to lose by trying it except around $7?

By the way, I haven't found any threads or scientific citations that support what I am doing. The only thing I can think if is perhaps due to my facial structures, the full face mask straps are pulling in a way that causes my jaw to be pushed back vs. forward even though I don't wear them tight. This has happened with more than 1 full face mask.

Good luck in sorting everything out.

49er

[Pugsy]

Where did you get this incredible data print out from ? Your S9 elite ? If so, how did you do it ?

That information is available from ResMed's ResScan software and the S9 full data machines...yes the S9 Elite but also from the S9 AutoSet and the S9 VPAP model lines. What machine are you using? If you would add your equipment to your profile we can let you know if your machine has similar software available....other brands offer similar software...so depends on machine brand and model.

[Pugsy]

I notice the Medicare rules state that BiPAP can be prescribed for patients that fail at CPAP. It doesn't say the BiPAP wouldn't be covered if CPAP already bought. How else would you prove that CPAP was a failrure? Does it have to be in first 61 days of CPAP?

It sure sounds like a bilevel pressure machine would be of benefit to you. I made the change to bilevel on my own on a lark and I was totally amazed at how much better I felt and my AHI was always well below 5.0 so I technically didn't "need" it. If you are bored you might read my story. Just skip the parts about the Hybernite heated hose. viewtopic/t71442/viewtopic.php?f=1&t=71 ... te#p656179

Medicare will pay for a different type of machine provided the criteria is met. It happens all the time and there is no set time limit for the "failure". Might be 30 days, 3 months or 3 years or whatever. People go from CPAP to even high dollar ASV machines and have Medicare pay.
Proving failure by their criteria might be a challenge though. You will need for your doctor to be on board for sure.

It might be that you could get by with APAP model that would allow up to 20 cm (I used to see 18 and 19 cm fairly routinely when I was on APAP) but with your Elite you have no way to know if allowing up to 20 cm would reduce your AHI to more acceptable levels and even if it would...if you would feel much better. Given your pressure needs (16 to 17 cpap) if it were me I would be lobbying for auto adjusting bilevel machine if it were me. You could reduce EPR maybe but personally....bilevel would be hugely more comfortable for you to use.

[purple]

What you need is a new Sleep Study to do a Titration. Just make sure you lobby for the beginning pressure is high enough so you do not suffer half the night from a lack of air.

Be careful as to what you say when you leave a sleep study. I did a sleep study where they started the pressure way too low. By morning when I was leaving I was asked how I felt, and I said, "I feel a lot better, referring to the last two hours as opposed to the first five, where I really suffered." Now that statement can be used to prevent me from getting a Bi Level machine.

Not sure if I understand the exact nature of the machine, and how it works, but there are some PR Bi-Pap machines which are not really much more costly than APAP's. I think I would still consider a Resmed S9 VPAP auto though.

If your insurance is being impossible, there is http://www.secondwindcpap.com/

[SnorkelPuss]

Would someone with low ahi and high compliance but no improvements in how she felt maybe have a better result on bipap?

[Pugsy]

Would someone with low ahi and high compliance but no improvements in how she felt maybe have a better result on bipap?

While I can't say I had no improvements on APAP (I did have initial cessation of the killer morning headaches and nocturia) prior to my bilevel pressure trial ...see my previous post and link to my story....I had really low AHI and great compliance since June of 2009 and the first time I used the bipap I felt a difference in how I felt the next day. Totally amazing how much better I felt and that is why I changed. I don't know why...I only know there was a marked improvement in general compared to all the days with using the APAP and getting great numbers and sleeping quite decently (I thought). I talked about it in my thread above.
Would it help you? Don't know. I still don't know why it worked for me. On paper (the reports) are essentially unchanged EXCEPT I have noticed that with the bilevel machine I am getting 30 to 60 minutes MORE sleep when left to wake up on my own.

[avi123]

Ten months ago I had similar Flow Limitation as your and also at max pressure of 17 cm, but on APAP






I did the following changes to improve the situation:

=> Used Saline nose spray and if necessary took Claritin. Nostrils must be clear of any junk by using lots of paper towels (Bounty).
=> Changed from FF mask to the present mask and chinstrap
=> Did a sleep study to double check the optimal pressure (on CPAP) which was 13 cm
=> Got an Rx for a BiPAP but gave up on it b/c setting the 13 cm as max on the APAP with EPR =3, Full time, was no problem to exhale into
=> Fine tuned the min and max pressures limits on the APAP

The results:

30 days ResScan Stats report:




6 months Stats report:



Pressure and Events graphs:

(Data for APAP= AutoCPAP mode is shown)



It took me time to set-up the pressures. I started with the first set- up by using the optimal CPAP pressure from my latest sleep study of 13 cm on CPAP. But later, I fine tuned the setup, by changing the limit pressures gradually as to confine the pressure graph only to "kiss" the two limit lines of max and min pressures. See the graph above. The idea was to set the limits so that the machine should not 1) Waste time responding to events, and 2) Run the pressure up, suddenly, and cause new Emergent Central Apneas and also cause the ingested air to rise.

Leak and Snore graphs:



Flow and Flow Limitation graphs:

(the Flow graph will be needed to show detailed graphs in the double panels)

No more flow limitation.

[VikingGnome]

Where did you get this incredible data print out from ? Your S9 elite ? If so, how did you do it ?

I just used the ResScan software with data downloaded from my S9 Elite. Displayed the graphs on my monitor and then used Windows SNIPPING tool to capture what I wanted. Uploaded to Photobucket and then pasted the image URL from photobucket my forum message.

[VikingGnome]

Medicare will pay for a different type of machine provided the criteria is met. It happens all the time and there is no set time limit for the "failure". Might be 30 days, 3 months or 3 years or whatever. People go from CPAP to even high dollar ASV machines and have Medicare pay. Proving failure by their criteria might be a challenge though. You will need for your doctor to be on board for sure.

I think I can easily meet all criteria. My AHI during first half of sleep study was 66. I've been compliant 95% of the time for almost 12 months (Occasionally I stay up all night on computer and don't go to bed). I have hypertension and my EKG shows t-wave changes consistent with cardiac ischemia. Obviously the CPAP is not controlling my severe OSA. I have an appointment to see sleep doc on January 9 so want to be totally ready to have a serious discussion with her about my treatment.

I really hope they don't need to do a new titration study. If they do, it is their fault. They didn't do a complete study the first time around. They quit at 6 AM at pressure 15 and admitted they ran out of time to complete the study. They just "guessed" on prescription with pressure 16. A month later they moved it up to 17. I've been on 17 for 10 months. Struggled big time to deal with mouth leaks. I'd wake up with air just blowing out my mouth. FF mask in extra small still too big. Finally solved it with nasal mask, sports beanie and chip strap but have to pull it real tight. Some mornings I have dried saliva on the side of my face.

I have worried that the tight chin strap may actually be obstructing my airway because it pushes my jaw back. Anatomically, I have a VERY NARROW airway and very short neck. Also deviated septum with one nostril almost completely blocked due to nasal fracture as a child. Having surgery to correct that might help but Medicare won't pay for that to treat OSA.

I certainly don't fit the criteria for UARS. I'm almost 60, I'm obese but have lost 40 pounds since last January. I have snored loudly since childhood. I have elevated blood pressure. That is all opposite of UARS patients.

[avi123]

viking wrote: "
Maybe what I really need is AutoPAP. Seems a lower pressure is ok when not in REM. And then it could adjust up when needed.

But my sleep doctor doesn't believe in them and won't prescibe. "

maybe best would be an auto bipap - they really should make it easy to rent these things for a month or so to see if it really makes a difference - afterall this is for EIGHT HOURS EVERY NIGHT FOR THE REST OF YOUR LIFE - getting it right would seem to be worth the effort on the part of the MDs - even if "right" is just a comfort issue since being able to actually sleep with the thing is crucial

Reply,

Many Docs don't like to subscribe APAPS because of the following reasons:

1) APAPs are not included in the AASM guidelines for titrations, so the Docs don't want to take responsibility

2) In many countries APAPs are used for titration instead of letting Sleep Clinics do it, or there are no Sleep Clinics there

3) The Docs don't understand the value of APAPs

In my case, I was prescribed a CPAP and got an S9 Elite, 2.5 years ago, on Medicare rental. But the CPAP gave me a poor treatment. I had to ask my Doc to give me
an Rx for S9 Autoset. After I told him that I'll pay cash for it he agreed.