They now say I need a BIPAP (somewhat long)

Insurance changed about 9 months ago so I had to start the whole process over so that I would get my supplies covered by insurance. I have been on APAP since February 2010. most of that time the pressure has been set to 7-12 auto. recently I changed it to 8-12 which reduced my AHI per the machine display and sleepyhead. The only time I have had an AHI above 5 while on the machine for more than a few minutes was just before I upped the pressure.

The lab that does the studies of the new insurance does many things that I would consider incompetence.

First study on this new insurance in July said I needed only about 5 CM at most but probably did not need CPAP. The doctors did not look at the study in detail and prescribed a new machine with no pressure settings on the script. I bought one and set it up for 7-12 anyway. This study got me an appointment to see a pulmonologist. He referred me for a titration study with an Ambien so I could sleep better and hopefully get some REM sleep. All lab studies I had done prior to the most recent had a grand total of about 2 1/2 minutes of REM sleep between them. This current pulmonologist does not seem to believe in looking at machine data.

Most recent study was on December 7th. I took the ambien as requested. The mask they insisted I wear did not fit well. AIr leaked out the sides if I did not lay perfectly still and cranked it as tight as I could stand. They would not let me put on a mask that i had brought from home that did fit. I do remember waking up at least once and probably twice having trouble breathing which never happens here at home.

They lost or sent the study to the wrong place. After some phone calls they sent it to the pulmonologist. The doctors office called me this morning to tell me I needed a BiPAP machine set 13/7. I have an appointment to see him Friday afternoon.

I know that I need a machine of some sort, if for no other reason that it lets my wife sleep. I do have a problem with sleep schedules so I don't see the sleep quality improvement that some see when starting CPAP. I don't have problems getting to sleep or staying asleep as long as it is about 2 AM or later.

Does this make sense? Could I have needed a BiPAP this long and not known it? Or could it have just been the Ambien which I have never taken before.

Hopefully the sleep lab, DME and doctor are not the same group. I don't understand how a doctor "does not believe in looking at machine data". Does he use a Crystal ball?

jacobsbd wrote: Does this make sense?

Not a whole lot to me.

jacobsbd wrote:Could I have needed a BiPAP this long and not known it?

Not likely unless you were having problems at the previous settings like aerophagia or something.
Plain BiPap is really nothing more than cpap/apap with 2 distinct pressure settings.
Now if they are talking BiPap (Respironics calls them BiPaps and ResMed calls them VPAPs but both are bilevel) that is in the ASV type of machine then that's a different situation entirely.

If you never had problems exhaling with your cpap/apap machine at your prior pressures then I don't see how they justify bilevel unless maybe the sleep study showed a marked reduction in arousals or something. Maybe something showed up during the titration sleep study that would warrant the change.

Wait and see what your appointment with the doctor tells you. Get a copy of the titration results and make sure the doctor explains his reasoning behind his recommendation for the machine change. It's possible he as some valid reasons that we don't know about.

I am skeptical that I need the change. I did change my a-flex setting this morning from 2 up to 3 to see if I can detect the change. I don't think my pulmonologist has seen it yet, I think the reading was done by someone on the staff of the sleep center. That is how it was done the last time.

From your description, you have pretty good treatment with APAP. I wonder how much you'll be dinged for the new machine. It would be best if you got a copy of the study, including detailed wave form data that shows your response to various CPAP and bilevel therapy pressures.

A couple possibilities are that the study results were affected by the poor-fitting mask that required over tightening. This could have caused your jaw to move back causing airway occlusions. The use of Ambien is not normally a problem, but could have caused some CA (lack of respiratory effort). As Pugsy says, bilevel is not necessarily the solution for that problem either.

I THINK .... just like every one should get a data capable machine !
Every one should get at least a Bilevel machine .... they can be set as a cpap or auto if needed and the other setting are there if you need or want them.

Next time you are out on the road dirving see if you can find a two door car (or pickup truck) .... the are generaly cheaper ... why not buy one ... because you may want to use the back seat ... sometime.

If he had gotten a bilevel machine when he started it would not cost him or the insurance company anything now .

grayghost4 wrote:If he had gotten a bilevel machine when he started it would not cost him or the insurance company anything now .

Yeah but the doctor wouldn't have got his new car payment from interpreting the sleep study results and if he is in cahoots with the lab or equipment supplier then he wouldn't have got the second car payment or been able to upgrade his car or boat.
The devil in me says that the doctors who don't trust the cpap/apap/bipap machine data simply want an excuse to get an in lab study so they can ding for more money. Now of course sometimes there is a legit reason for the repeat sleep study but I think most of the time the reason is $$.

I know of several DR.'s that also own the sleep lab .... so yes I think you are correct.

none of the studies I have seen so far were well done. Most suggested more studies. When you were working second shift and they only let you start as late as 10:30 that is just wrong. They wind up waking you up and kicking you out about three hours after you normally go to bed. Then they say you have bad sleep hygiene.

A new study made some sense in that they had less than three minutes of REM sleep. This place is not organized enough to give a kickback to the doctors. I was with a person who was being referred for a study at this place (different doctors office) They apologized for having to send her there based on insurance requirements. I think it is more likely they just massively underbid everyone.

I think the issue with the Dr is that he just does not have the training to read the data or was told 15 years ago that the data from the machines is bogus.

I have seen doctors who ask you to get old X-rays and either only look at the summary from the radiologist or complain bitterly when the summary is not included.