Question re:Bi-level machine RX requirements and other things

Years ago (5-ish maybe?) I had a sleep study and it was determined I have sleep apnea

I was given an APAP and have used it since then, and it definitely helped but I never got true relief from symptoms

I've never been able to find a full face mask that fits and works due to the shape of my nose and due to the high pressure level on my machine

So I use nasal pillow airfit only, which is most comfortable and also forces all the pressure into my nostrils which helps me breathe better (stuffy nose and other nasal issues).

However, the high pressure often blows my mouth open and the air comes out, leading to less effective therapy and sore throat etc. I posted about this in the past and tried all the typical suggestions for trying to keep my mouse/lips shut, but none were successful or sustainable for me due to various reasons and complications

About a year ago I did a check-in with my doc. My symptoms and treatment effectiveness were getting worse. My APAP pressure kept rising, now it's basically maxed out at 20 all the time.

Doc suggested I might need a bi-level machine because (a) increased pressure ability and (b) they said the lower exhale pressure might help with some of the other issues. I researched bi-level machines and it sounds like it would be a good fit for me based on what I read.

Doc ordered a titration/special sleep study, but I didn't proceed at that time because I couldn't afford it and because of COVID risks

Got notice of the Philips recall and registered for a replacement unit, but I figure now would be a good time to investigate some other options. (side note, I have been having a lot of unexplained medical symptoms which could possibly be related to the negative effects of the recall issue, but that's neither here nor there regarding my main question)

At this time I am still not comfortable with the idea of doing an in-person sleep study because of COVID (and I have mental health issues which exacerbate my fears/anxiety), and also because even with insurance it's extremely expensive (thousands of $, but of course they don't actually tell you the real price until AFTER you do it).

My question is, if my doctor thinks a bi-level machine would help me, and my APAP isn't helping that well, and if I was NOT going to use insurance for getting new equipment, then is it within the realm of possibility to get an RX for a bi-level machine without doing a titration study? Is there any doctor, anywhere, that would be able to do that by using their own judgment? And if not, why? I can't imagine that trying a bi-level machine could be harmful to me, and at the least it could do just as good a job as my APAP. It seems like a clear call to me, but I am aware we have a lot of stupid rules in our "health care" system. Anyway, I digress, apologies.

Any info and suggestions would be appreciated, particularly toward the goal of trying to get a bi-level machine without a titration study if there is any shred of possibility, no matter how miniscule. Or any other helpful advice on my woes. Thank you, I really appreciate it.

No. Regular Bilevel won't hurt you. Think of it as nothing more than and apap machine that will go to 25 cm instead of 20 cm. Because that's really all they are.

Now there are some very special bilevel models that go above what a "regular bilevel" will do but it doesn't sound like you need anything more than just pressures sometimes over 20.

This machine would suit your needs just fine. I use this model myself.
https://www.cpaptalk.com/viewtopic/t183 ... -sale.html
and you don't just have to have an in lab titration to sort out the pressures.
It's actually fairly easy to figure them out yourself.

to tag on to what pugsy said, that machine she showed? that's a damned good price!

You can buy from a private seller without a prescription. If your doc requires a sleep test first, you're not likely to change his mind no matter what you come up with.

thank you to everyone who replied

more questions and clarification:

- besides the higher pressure capability of a bilevel (relative to an apap), isn't the other difference of a bilevel that it can be set to a lower exhale pressure so it's easier to exhale against a high pressure?

- I want to buy a brand new unit, through something like cpap.com or similar seller, so I will need the rx. My question regarding the lab study was pertaining specifically to whether or not doctors are "required" to do the study before they can prescribe a bilevel machine (vs an apap which I already have). I just don't know the legal rules or whatever that docs have to follow. if it's possible for them to write the rx for bilevel without the test, then I will definitely do a call and try to convince them (and if they say no, I could meet a couple more docs

your insurance may or may not require a new sleep study to justify the higher cost machine. your doctor may or may not know what the insurance requires, do not trust what the dme tells you that you need. machines are sold on this forum with low hours on them. you just have to watch for their posts. remember just like a new car, the minute you get your hands on the new machine it too is used,

wannasmile wrote: ↑

Mon Oct 25, 2021 7:28 pm

thank you to everyone who replied

more questions and clarification:

- besides the higher pressure capability of a bilevel (relative to an apap), isn't the other difference of a bilevel that it can be set to a lower exhale pressure so it's easier to exhale against a high pressure?

lower absolute pressure? no, lower relative pressure, yes, but that's NOT why bilevel machines exist.

The lower pressure is the important one in keeping your airway open, so you *can't* lower the lower pressure too much, or you just get more apneas.

Other sources for CPAP Rx

Who Can Write A CPAP Prescription?

A variety of professionals can write a CPAP prescription including your:

Medical Doctor
Doctor of Osteopathy
Psychiatrist
Physicians Assistant
Nurse Practitioners
Dentist
Naturopathic Physician

Yea but would they do a BiPAP without a study? What would the script say? One BiPAP machine set to user defined levels? (Serious question, not sure how that would work)

GrumpyHere wrote: ↑

Mon Oct 25, 2021 8:39 pm

Other sources for CPAP Rx

Who Can Write A CPAP Prescription?

A variety of professionals can write a CPAP prescription including your:

Medical Doctor
Doctor of Osteopathy
Psychiatrist
Physicians Assistant
Nurse Practitioners
Dentist
Naturopathic Physician

gtstricky wrote: ↑

Mon Oct 25, 2021 9:40 pm

Yea but would they do a BiPAP without a study? What would the script say? One BiPAP machine set to user defined levels? (Serious question, not sure how that would work)

GrumpyHere wrote: ↑

Mon Oct 25, 2021 8:39 pm

Other sources for CPAP Rx

Who Can Write A CPAP Prescription?

A variety of professionals can write a CPAP prescription including your:

Medical Doctor
Doctor of Osteopathy
Psychiatrist
Physicians Assistant
Nurse Practitioners
Dentist
Naturopathic Physician

pick one, call them and ask.

gtstricky wrote: ↑

Mon Oct 25, 2021 9:40 pm

Yea but would they do a BiPAP without a study? What would the script say? One BiPAP machine set to user defined levels? (Serious question, not sure how that would work)

There are reports of doctors who write Rx as matter of long association and giving of favors.

I just specified the EPAP and IPAP myself.

I originally wasted $89 via an online Rx prescriber (where I eventually bought my machines didn’t ask for Rx.)

I had an HST and had tried an AS11 for Her for 2 weeks. I gave them the ApneaLink report and requested a Rx for an APAP.

Tried using that prescription to buy an AirCurve 10 online.

No go obviously. So I went back to the prescriber and got a second $89 RX for a bi-level. I told them I wanted an higher end machine just in case I needed it. They were receptive to that.

I gave them the EPAP and IPAP converted from EPR and minimum pressure from the trial.

One of the two Rx wasn’t wasted because I use it to buy complete mask kits which do require Rx.

GrumpyHere wrote: ↑

Mon Oct 25, 2021 11:25 pm

I originally wasted $89 via an online Rx prescriber

Are you talking about a telehealth doctor appointment?

I used these people.

https://www.healthsqyre.com/product/cpa ... cpap-users

The machine Pugsy posted is an absolute bargain but I can understand you wanting to get something brand new because of Covid. I decided to put myself on BiPAP simply for comfort and it was the best move I ever made. While I don't really need BiPAP it won't hurt me.

When I required an Rx I simply went to my general doctor who wrote a prescription. Most GPs are not au fait with OSA and PAP therapy so I got him to specify the exact machine I wanted in his Rx. The DME simply followed the prescription.

We can help you set up your machine settings when you get it - just keep posting.

Holden4th wrote: ↑

Tue Oct 26, 2021 2:31 am

The machine Pugsy posted is an absolute bargain but I can understand you wanting to get something brand new because of Covid. I decided to put myself on BiPAP simply for comfort and it was the best move I ever made. While I don't really need BiPAP it won't hurt me.

When I required an Rx I simply went to my general doctor who wrote a prescription. Most GPs are not au fait with OSA and PAP therapy so I got him to specify the exact machine I wanted in his Rx. The DME simply followed the prescription.

We can help you set up your machine settings when you get it - just keep posting.

Thank you so much, I appreciate it. This is very encouraging.