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One thing about upright in a chair.....make sure her head doesn't tilt forward, say, putting her chin on her chest as this could narrow her airway.

BrianRT wrote:One thing about upright in a chair.....make sure her head doesn't tilt forward, say, putting her chin on her chest as this could narrow her airway.

Thanks! Maybe we'll tilt the chair back just a little bit to help ensure this doesn't happen.

Anonymous wrote:Apparently he doesn't think one night's going to be too big a deal, and keeping in mind that she's probably been this way for a very long time, the body's probably used to it, to some extent. I know it's very bad, but the doc probably figures one more night is very unlikely to cause a horrible outcome.

I have to wonder, however, if one called and raised the question of malpractice by not immediately offering therapy whether the response might not change.

Regards,
Bill

NightHawkeye wrote:

Anonymous wrote:Apparently he doesn't think one night's going to be too big a deal, and keeping in mind that she's probably been this way for a very long time, the body's probably used to it, to some extent. I know it's very bad, but the doc probably figures one more night is very unlikely to cause a horrible outcome.

I have to wonder, however, if one called and raised the question of malpractice by not immediately offering therapy whether the response might not change.

Regards,
Bill

Yeah, I wondered that too... but this guy has a good reputation and is probably going to end up being the guy she sees from here on out, for her sleep-related treatment. Threatening malpractice and lawsuits isn't exactly the best way to stay on his good side.

Thanks for the thought, though... all opinions are welcome. You guys are great.

Anonymous wrote:Threatening malpractice and lawsuits isn't exactly the best way to stay on his good side.

It was merely a thought. To be clear, I never said threaten. You might want to ask yourself though, if your relative doesn't survive the night, or suffers a stroke or heart attack, then what will your opinion be.

Ya gotta do what you think is right, but raising an issue as an immediate concern needing to be addressed should not get you relegated to anyone's bad side. If it does, then that's a useful piece of information as well. Just my opinion, of course.

Regards,
Bill

I got to 53% and was woken up for oxygen also during my study. Whilst that isn't as low as your relative it must have worried both the technician and my doctor as I had oxygen delivered the morning after my study

Hey guys.

My relative slept upright in a chair last night, slightly tilted back to minimize the chance of her head tipping forward and closing the airway. It went fine, and today she went to the sleep doc for her results from her titration.

Doc prescribed BiPAP at IPAP 19 and EPAP 14 with Bi-Flex of 3. I didn't get her AHI; I'll have to ask her later. He said she was at at 93% O2 sat with treatment during the titration, which he wasn't thrilled about, but he said it was acceptable and that it may improve over time. Mask is going to be the F&P HC431 full-face.

She gets her gear today. I'm going to help her as much as I can. I use the 431 myself, so I'm familiar with it. My only concern is that at 19 cm, that 431 is going to need to be adjusted to be very, very tight.

Other than that, she should do fine. She didn't get creeped out initially (as some folks do) from having the mask on her face during her titration, so she's probably not going to have any claustrophobia issues or the like.

Thanks to everyone who responded!

Good! I was hoping you'd provide an update. Good to hear that things are going well.

Regards,
Bill

Hey Guys. The Doc ordered her a Respironics BiPAP Plus M Series with Bi-Flex.

This seems like a good machine, EXCEPT that, based on what I found at Respironics' website, it does NOT seem to have detailed data recording to smartcard. It looks like it records compliance (hours of usage) data only:

Specs page:
bipapplusmseries.respironics.com/Specifications.asp

I have an M-Series Pro CPAP, which does the detailed data recording (apneas, hypopneas, flow limitations, etc.) and I would really like her to have the same capability... otherwise she's flying blind, right?

But, it appears only the BiPAP Auto has detailed data recording, and her doc prescribed a 19/14 pressure, not automatic titration.

Do you think she can convince the DME to take back the Plus and give her an Auto?

It seems, unlike CPAP, Respironics has no non-Auto BiPAP that does detailed data recording. Am I wrong? I'm new to BiPAPs, can someone please enlighten me ASAP?

Thanks guys! I want to make sure she gets the right machine, not a basic one with no detailed data.

I don't recall anyone reporting that their DME fought them over providing a BiPAP-auto. Apparently, the DME's get well enough compensated for BiPAPs that they don't usually quibble over providing the BiPAP-auto. Ya might want to discuss this with them today though, while the one they provided is still a new machine.

Regards,
Bill

I would suggest fighting for the Bi-PAP Auto. She may not use all the features, but at least they're there......especially the data recording.....which isn't on the Plus model.

Den

Thanks a ton, everyone! I just called her and told her to call the DME and ask for/demand an Auto, for the detailed data to track her therapy. I gave her several defenses to their possible questions:

Challenge: "What do you need the detailed data for? You're a simple-minded patient" (or nice words to that effect) or "You don't need detailed data, that's for doctors."

Answer: I want to be proactive in monitoring my therapy and its effectiveness. Furthermore, with detailed data I can observe how I perform the night after I exercise hard, exercise moderately, drink, don't drink, eat certain foods, etc.... all of which will allow me to home in on the optimal lifestyle choices I should make. Without detailed data, I can do none of that.

Challenge: "Your doc prescribed straight 14/19, he didn't prescribe auto-titration"

Answer: simply configure the Auto in regular (non-auto) mode at 14/19, then, and it'll be exactly what he ordered.

Sound good? That's all I could think of off the top of my head. She's gonna call now, while the Plus is still brand new and unused, as one of you suggested.

Thanks a ton! This is invaluable help!

My nice DME guy just today told me that the auto bipap and the plain bipap from Respironics cost the same to him, so all he buys is the auto. That is what he would give anyone who had any prescription for the bipap.

Check with other DMEs in your area to see if they do the same.

Maybe another DME would give you what you want without the hassle.

Catnapper

The DME said they can only give her what the Doc ordered, and he didn't write "Auto" on the script. Furthermore, the DME said that Autos are usually only given for people waiting for a sleep study, not for people who've already had one. Lastly, they said that because of this typical usage of an Auto, her insurance will only pay for an Auto for one month, no longer.

Thus, I told her to use this machine for now (she has no choice) but to contact her doc and explain her reasoning for wanting an Auto set up in non-Auto mode (see my above post, she wants the detailed data, not the Auto functionality), and see if he agrees to write a new script for an Auto. If he does, she then has to see if her insurance will cover it fully, rather than just for one month. I think if the doc orders it right on the script, they might have to pay for it fully. But, I'm not sure.

If the doc says no, I suppose she's stuck, aside from shelling out $1340 to CPAP.com for an auto with heated humidifier.

Thanks again guys. Any other ideas are welcome!

Catnapper wrote:My nice DME guy just today told me that the auto bipap and the plain bipap from Respironics cost the same to him, so all he buys is the auto. That is what he would give anyone who had any prescription for the bipap.

Check with other DMEs in your area to see if they do the same.

Maybe another DME would give you what you want without the hassle.

Very interesting! And, what you say is backed up by cpap.com, which shows both the Plus and Auto costing exactly the same amount.

I'll have her call other DME's tomorrow... maybe she can find one who does what yours does (only stocks Autos).

The fact that there are DME's that only stock Autos tells me that this DME is lying to her... she's on Medicare, and you can bet that if Medicare only paid for 1 month of Auto, ALL DME's would carry the Plus, too.

Then again, DME's lying is reportedly fairly routine....

Thanks again!