Respironics M series BiPAP Plus question from a newbie

I am new here and have tried searching around for my answer in past posts but haven't found anything definitive. I was diagnosed with OSA back in May of this year following my first sleep study (O2 level dropped down to 81% and had over 300+ stop breathing events over the course of the study). My second study was to set my levels and I ended up with BiPAP with a setting of 12/8.

Now after about 2-3 months struggling to make sure the copies of my sleep study reports and got to the right people and getting a script for a BiPAP machine I am now dealing with the DME that my insurance (Aetna) would like me to deal with (Apria... I know, but they seem to be the only choice for Bi-Level, if I had be prescribed CPAP I would have had more choices).

I contacted the local Apria office and they stated that they had no BiPAP machines on hand in stock and would have to special order (which will take about a week it sounds). The model they told me they were ordering based on my doctors orders is a Respironics M series BiPAP Plus w/ heated humidifier. From what I have found on different sites this machine does not have a smart card and I don't believe it allows me to track in any way things like leak data or to see what sort of breathing events I may be having despite the current pressure settings.

I called my doctors office and left a message for my doctor asking if this machine would be capable of giving him a report he can use to recommend setting changes but I haven't heard anything back yet.

I wanted to know if anyone has experience with this particular machine and if it is "fully data capable". My gut tells me that without the smart card that this machine probably isn't tracking much more than compliance data (how many hours I am wearing the mask with the machine on). From what I have read so far it seems that I would be much better off with the Respironics M series BiPAP Auto but I don't know how to convince the DME and my doctor that is what I need. Any ideas?

there is a Plain Jane CPAP machine called the Remstar Plus AND
there is a Plain Jane BIPAP machine called the Remstar Bipap Plus.

top one is CPAP, bottom one is BIPAP/BILEVEL. When dealing with Apria, they will always give you the cheapest possible model. That is what you are looking at above.

It does you really no good to argue the point, if you want a better machine or one that gives you data from the LCD you have to pay for that yourself. Most of the time it is simply easier to just purchase the machine outright and get what you want.

I'm surprised Aetna allowed you to go straight to a Bipap without first trying CPAP, unless you have a history of heart disease or stroke or COPD.

Thanks for your response.

Well, them letting me go straight to Bi-Level sort of surprised me as well (even more after I found out about the cost differences). In my second sleep study when they got me hooked up and the machine turned on I noticed that it was much harder for me to exhale. I mentioned this to the sleep tech and she just said that she would switch it to BiPAP. I wasn't even really complaining that I couldn't tolerate the constant pressure on exhale but I am not going to look a gift horse in the mouth. I definitely had a much better time sleeping in the second sleep study despite all of the other discomfort (how they expect you to sleep being completely wired up I will never know).

As for the difference in machines, it is definitely the M series BiPAP Plus (not the Auto) they mentioned over the phone. I know that the Plus doesn't have a card reader, I just wanted to know if anyone had experience with this specific machine and if anyone knew what sort of data that the machine collected (even if I can't get to it myself without getting into the clinical menu).

I really don't think that I will be able to purchase my own machine anytime soon so I will at least be stuck with whatever they give me. However, if I can convince my doctor to change the prescription I might have a chance of getting the Auto (which from my understanding does have the smart card). I am worried that my doctor won't be able to get any useful feedback from the current machine they have on order, I am not even sure without a smart card how Apria will be able to generate reports to send to my doctor/sleep center.

So again, does anyone have experience with this particular model?

nacks--you should definitely go explain that to your doctor...I don't think s/he would care either way about prescribing you an Auto vs. Plus. The Auto can be set at fixed IPAP/EPAP pressures anyway.

here's the manual global.respironics.com/UserGuides/BiPAPAutoMUserMan.pdf

(silly thing wouldn't let me post a link)

Thanks for the reply and link to the manuals. I had found the manuals before but the PDF is so large the machine I have here has issues displaying the file.

The other thing that has me puzzled is that what cpap.com has listed for price for the Plus M vs. the Auto M BiPAP is like a difference of $40. I know that the DME is likely to charge a lot more (since you are also paying for support of the RT) but that little of a price difference I would be willing to pay if it gets me a better machine.

I am still waiting to hear back from my doctor today, hopefully he gets back to me in time so I can stop the current machine order and see if they will get me the Auto.

If your Apria office is like mine, don't expect much in the way of support from the RT. I've met 2 different ones here, had to show both of them how to assemble the mask! I did call a couple of times with questions, never got called back.

Brenda

Sigh... just got a call back from my doctor's office and they are fine with the Plus series and don't want to change the Rx. I guess I will just have to wait and see. Should be getting a call from Apria early next week to make an appointment to pick up the BiPAP Plus M and get fitted for a mask/headgear.

The good news is that I can go to a different DME (my doctor likes Respira Medical) for when I need new accessories later.

Hopefully if this works for me I can convince my doctor to change my Rx at a later date so I can go and get the machine I would prefer myself online and then will just use the machine I am going to get from Apria as a backup.

Thanks all for the comments/answers.

Who does the Dr. work for, mine works for me. If I don't have a say in my health care, I get a better Dr., one that works with me, in my best interest, not the DME's. Jim

And did you talk this over with the Dr themselves, and not just with the office staff?

Just an update and thanks for the responses. I picked up my BiPAP machine on last Friday (8/31). I was surprised when the model that Apria gave me was actually a BiPAP Auto M series machine rather than the Plus that they quoted over the phone. So far things have been ok. I had a pretty good night the first night with about 7.5 hours of sleep and I kept the mask on the entire time. The next couple of nights I woke up sometime in the night and for various reasons took the mask off for some period of time. I am averaging around 6 hours at a time however.

I did notice several times that there have been drops in pressure being put out by the machine (as some other posts have mentioned). I haven't tried to see what pressure the machine thinks it is putting out on inhale but it definitely seems to be a lot lower than I expect. I haven't made use of the ramp feature so far as I actually feel I get to sleep more quickly at full pressure. I don't think ramp is being turned on (at least I don't remember hitting any buttons) but it sure feels like ramp is somehow kicking in. As far as I know the machine is set in standard BiPAP mode and not set to Auto. I have the Auto off feature turned off (I remember seeing that recommended elsewhere) and the mask off/leak alarm is set to on (though if the mask really is off the sound of the air rushing through the mask is much louder than the alarm). In any case the drop in pressure has me worried. I plan to bring this up with Apria when I speak with them next. I haven't attempted to look at the lcd when I feel that the pressure has dropped as this is almost always in the dead of the night and since the screen isn't backlit I would have to turn on the light to tell what pressure it thinks it is using.

I haven't attempted to get into the clinical menu to check any of the data that might have been captured there and I don't have the software or card reader (yet, still not sure where to get the software and I may just bug Apria or another DME that I have access to to generate reports for me on a regular basis). Without getting into the clinical menus it seems the only data available is runtime hours (sessions, number of hours the blower has been running, number of hours that it believes it has been used with me breathing and useless compliance numbers). Does anyone have suggestions on how to get any more useful info (without a card reader and software that is on my own)?

I am having some issues with the mask I was given (the RT did have several masks to try but I wasn't really able to tell any difference there at the office in the setting she had me try them on). I have a Flexifit HC405 nasal mask and it tends to leak when there is any external pressure (like if I attempt to sleep on my stomach and my head rests on the side of the pillow). The leaking will wake me up (and probably my wife as well) so, I have only had success so far sleeping on my side with my head facing upwards away from the pillow.
I had a followup with my doctor and asked if he would refer me to the local sleep center which has a cpap clinic where they will allow you to try a variety of masks and may have some suggestions on what I am doing wrong or possibly a different/better mask for me to use.

thanks again to everyone for your responses/suggestions.

nacks, you are one lucky guy! First you got switched to a bi-pap titration so easily. And then received a BiPAP Auto instead of the BiPAP Plus they were talking about!

You're right that the Plus would have recorded only "compliance" -- hours of use. No useful data at all.

You are lucky, lucky.

I don't think I'd call the DME to question anything about the machine right at this point. Your luck might change and they might whisk the machine away and present you with a Plus after all.

I'd look at the present machine's settings first. I would definitely not call the DME quite yet.

Check your Private Messages -- button at far upper right of this webpage.

Just a thought... for many people pressure that seems like a lot when any machine first starts up can feel like almost no pressure later on during the night if you wake up. It's amazing the way the body adjusts to the "feel" of cpap pressure as the night goes on. That might be the sensation you're getting of a lot less pressure later on in the night.

If you like to sleep on your stomach, the mask I'd recommend above all others for sleeping in any position, including on the tummy, is EvoMedical's "Headrest". That mask has been through several name changes -- Aura, Twilight NP, Headrest -- but it's still the same excellent nasal pillows mask. Of course, just because I like it so well doesn't mean it will suit you. But I'd sure want to give it a try if I wanted to sleep on my stomach.

Make SURE you don't take the machine back to the DME or allow them to come by your house, they will snatch that sucker up and give you the cheaper plain-jane Plus model and give that Auto to the next newbie and the process continues.

So if they ask you to bring the machine back so they can read the data, just take the card in only, don't take the machine. Make sure they give you the card back before you leave or it won't record data.

It is the bait-n-switch trick, machine looks the same but now you have the cheaper Plus version.

If you are like most, the first 30 days on the Auto is to confirm your pressure.

Oh, for reports I wasn't planning on taking the machine to them, I know about the smart card.

I have been having other issues sleeping as of late. I have a select comfort sleep number bed and my air chamber seems to have started leaking (funny how it seems to happen right when I get this machine). So now I am waking up several times a night just to put air back into my bed so I am not sleeping on the frame in the morning.

Last night went much better, I did wake up again feeling like the pressure was too low but breathing normally for a few seconds seemed to get myself adjusted to it again. I think I may try playing with the Bi-flex settings, right now it is set on 3 (what the DME set as the default). I am wondering if that might be causing some of the low pressure feelings that I have been experiencing.

Overall however I have been sleeping better and I have felt more rested so far.

thanks again to everyone for your suggestions. I have an appointment with the sleep center next Thursday to their non-dme-affilated cpap clinic so hopefully then I will have a better idea of what mask will work for me.