Sleep Apnea and COPD

Just wondering if anyone with COPD/Emphysema or anyone with professional experience have any thoughts on this.
I notice sometimes I feel like if I had lower pressure on exhale it might be beneficial. When I brought this up with my Sleep Dr she said most people want more pressure but we could lower if I wanted. She didn't even mention FLEX or any kind of pressure relief, much less BIPAP. I have the Flex on my Dreamstation at 3 and it seems a little better. I think the Dr. is just clueless about this and like most as long as your AHI is under 5 and you are compliant they are fine..... The odd thing is last year when I was retitrated and pressure raised to 17 she mentioned possibly going to BIPAP. as I do hit the 20 mark sometimes. I.m not due a new machine for a year or 2. Appreciate any comments from peoples personal experience on this.

If it is medically necessary, changing to a bilevel could be done right away.
No need to wait another 2 years--cpap and bipap are not the "same", and the clock resets.

If the doctor writes a new prescription for a bilevel machine, your insurance company will pay for it even if your old machine is less than five years old. The 'five year rule" is used to be the standard for replacing a machine with the same type machine. Most insurance companies require the machine to be broken and cost too much to repair before they will replace the machine. Since the bilevel is a different kind of machine, it should be replaceable under your insurance just as a new medication would be covered.

Okie bipap wrote: ↑

Wed Mar 20, 2019 9:43 am

If the doctor writes a new prescription for a bilevel machine, your insurance company will pay for it even if your old machine is less than five years old. The 'five year rule" is used to be the standard for replacing a machine with the same type machine. Most insurance companies require the machine to be broken and cost too much to repair before they will replace the machine. Since the bilevel is a different kind of machine, it should be replaceable under your insurance just as a new medication would be covered.

She seemed reluctant last year when she brought it up. I didn't ask this time. I'm on Medicare so I'm sure that comes in to play for her. If my Therapy wasn't working I'm sure she would feel different. My AHI is pretty much always under 2. I wonder when a BIPAP is prescribed. Obviousy if I needed pressure over 20 it would be considered.

Bilevel should be an option for people with pressure needs in the upper teens. There's just more exhale relief available and sometimes it's simply needed by some people.

Respironics Flex exhale relief...very limited drop during exhale...and how much of a drop depends on how forcefully the person breathes and the MOST they can get at a setting of 3 is a 2 cm drop and they only get that if they are a strong forceful breather.

Bilevel is more than just for people who need pressures over 20 cm....it's for anyone that maybe needs a little extra exhale relief at any pressures but especially at pressures above 15 cm. I don't know why your doctor is dragging her feet about it...takes very little documentation to get Medicare to pay for a bilevel machine as long as someone isn't wanting one of those high end specialty machines.

Doctor might be contracted with a managed care comoany.
My PCP was in private practice; but a year or so back, they sent out a lettter
indicating they are now in "managed care" --(kind of a "soft" HMO., IMO)
You just need to be persistent--refuse to "wait and see".
The managed care probably postponed my CTR surgery several months-
possibly resulting in prolonging my parasthesia/hyperesthesia fo a couple of months.

A while back I picked up a used Bipap that may have been used not for sleep apnia
but for a copd patient . The data card was still in it and the person had been using
a long ramp setting during which he had an AHI of almost 0 then when he hit full
presure his AHI was 3 and those were usually centrals.


https://www.healthline.com/health/copd/bipap-for-copd

What kind of doctor is this? If they are not one, I suggest seeing a pulmonologist-they should understand COPD, and also the potential need/comfort of bi-level therapy in light of COPD.