Dr Appt this week. Want a new machine.

Hello everyone. I've been enjoying the info here for a very long time, but have just joined today to get your input.

I've been using my old Respironics BiPAP machine for 7 or so years now. Shorlty after my initial sleep study I had a couple bad experiences with my sleep center, and the DME failed to return my data card years ago. Since then, I've been on my own and doing fine. I had successfully made a few minor pressure adjustments and I was doing pretty well... Or so I thought.

For Thanksgiving last week, I travelled to my parents' and forgot my machine at home. After one miserable night my dad offered for me to use his backup machine, a Resmed S8 Autoset. I slept great for the rest of the week! I had vivid dreams that I hadn't had in years and remembered them all. Most importantly, I woke up each morning because I'd simply had enough rest. It was fantastic! The only downside was the EPR wasn't enabled on his machine, so until I was sleeping, I was fighting to exhale. When we returned home, my wife commented on how she slept so much better with the quieter machine and that my old machine had been making some strange noises at night. I also have noticed that sometimes when I turn it on, the motor doesn't start and I need to cycle power for it to work properly.

Considering all this, and the fact that our new baby has brought us very close to our out-of-pocket max with insurance, I've decided that it's time for a new machine. Doing some research here, on CPAP.com and Resmed's website, I think I'd like to try the S9 VPAP Auto. But here's the catch... My GP knows nothing of my OSA history. I've moved since my first and only sleep study (and my sleep doc has since died). I don't know what my original pressures were and can't really remember anything of importance from my sleep study. I had such a bad experience with the study that I DO NOT want to do another. My GP trusts me and in the past has written prescriptions at my request with no exam, and she has written a 99mo Rx for any CPAP accessories I may need with no questions asked.

I guess my questions are, does she need to specify pressures for this machine? Has anyone had a similar situation? Would it be forward of me to say I want a prescription for that exact machine? I've cleared everything with insurance and the DME. I am eligible for a new machine and actually recommended that I ask that she write the brand and model on the Rx.

Thanks to all!

She probably needs your pressures. In any case you need your pressures to program the new machine. You can check the machine settings and see what the pressure is. By all means tell her what machine to write the script for- she'll probably appreciate your doing the research and the DME can get you what you want.
I have the ResMed S8 AUTO 25 and find it to be a great machine. I'm sure you'll enjoy the S9 Autoset.

Do you really need a VPAP/bilevel, since the S8 Auto worked so well?

Maybe a S9 AutoSet or PRS1 Auto purchased online out of pocket will be cheaper than a bilevel on insurance. Then if you really need a bilevel, you can get it on insurance later. Insurance may want a new sleep study, so be very careful about precertifying.

I'm a firm believer that most people will adapt fairly quickly to no EPR. I turned mine off and find I don't notice the difference after a week or so.

If you want some reasonable pressure settings to have your good doctor put on the Rx just for starters to get another bilevel machine (you can always change the pressure settings later) here's how I'd have the doctor write a very simple Rx for the specific bilevel machine you said you want to get:

ResMed S9 VPAP Auto and heated humidifier, heated tube.
Mode: Spontaneous
EPAP 10 cmH2O
IPAP 15 cmH2O

There are other settings you may want to tweak once you get the machine, but that Rx will "fill" the requirements for what a DME would want to see on the Rx in order to set it up for you.

Even though that machine is capable of auto titrating while working as a bilevel, what I suggested above for the Rx would be for using it purely as a bilevel machine. That would be a simple Rx to have the doctor write and the DME to fill.

"Spontaneous" mode means plain bilevel therapy...not autotitrating at the same time. If you want to do "autotitrating bilevel" with the machine in the future, you can always reset it to VAUTO mode, and set new pressures for "min EPAP" and "max IPAP" and set a "PS" (pressure support) number. You can find out about that, and other settings features, later; but for simplicity's sake for the person setting up the machine, and to get a baseline of simple bilevel data, I'd suggest you start out with it in just bilevel mode -- "Spontaneous" mode.

I think you've picked an excellent machine to get. The S9 VPAP Auto can be set to operate in any of these modes (like having 4 machines in one:)

Plain CPAP
Plain bilevel
Plain autopap
Autotitrating bilevel

Thank you all for the advice.

Rested Gal, I think I'll take your advice. I'll just give the Dr my current pressures and tell her that it's working fine for me, but it's time for a new machine. I think the S9 VPAP Auto has enough features for me to justify her prescribing one, even though the Rx would be for Spontaeous mode. Then I can try the Vauto mode later. I really think the Autoset I borrowed from my dad easily found the right pressure for me, but the fight I had to put up to exhale makes me believe that I really need the BiPAP.

Archangle, I wasn't "pre-certified." I was somehow able to avoid all the automated "enter-your-member-number" systems when I called and just asked questions anonymously. Both with the insurance and the DME. I was really surprised when the DME suggested I have the prescription written for the specific machine I wanted. I'm very close to my OOP max this year, so I couldn't buy any machine cheaper for cash. But thanks for the feedback.