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I was given a Respironics Bipap st and have used it for 1.5yr. Since i have had a lot of trouble with my insurance i took my info to another med supply to see if this high $ unit was 100% needed, by looking at my lab results they thought it was the best machine for me but maybe not totaly needed!! I guess if someone knew what all these numbers mean maybe it would give me a better idea what i'm dealing with.

thanks jerry

Hi Jerry,
What numbers specifically are you looking for info on? For instance, AHI is apnea/hypopnea index. The lower the better for this, preferably under 5.
RDI is Respiratory Disturbance index. That's apneas, hypopneas, and anything else that disturbed your breathing and caused arousals (asthma, allergies, etc.)
SO2 is the saturated oxygen level
RLS is restless leg syndrome
Some of these are in the CPAPopedia (on the top of the forum).

If you post specific numbers, or abbreviations you need clarified, I'm sure someone can help you.
Debbie

notbigenuf1 wrote:I was given a Respironics Bipap st

I'm assuming since you're posting here you were put on BiPAP ST as a result of a sleep study that diagnosed sleep apnea and a titration study- not some other neurological breathing disorder. Do you remember your doctor telling you why you were put on BiPAP ST? Sleep doctors usually only use it if you have Central SLeep Apnea (CSA) which is when your body forgets to breath. Obstructive Sleep APnea (OSA) happens because your airway collapses. You may have both- sometimes then it is called Mixed Apnea. I have severe CSA that is only partially controlled with BiPAP ST- its pretty rare and I've only seen a handful of other people post about using in BiPAP ST for CSA in the 1 1/2 years I've been active on the various sleep apnea forums so there are not a lot of people who are familiar with BiPAP ST & why they are used. If it helps to understand a BiPAP ST Spontaneously(S) changes from a higher, inhale (IPAP) pressure and lower, exhale (EPAP) pressure as you breath in and out. If you don't breath for a certain number of seconds (based on your backup rate) the BiPAP ST's switches to Timed (T) mode and attempts to trigger you to breath by switching from IPAP & EPAP which gets most people with CSA breathing. Not all people with CSA need BiPAP ST- some do well with regular BiPAP (BiPAP S) which only Spontaneously switches from IPAP & EPAP with you breathing- nothing happens if you don't breath. Still others with CSA do well with just regular CPAP but they are usually people who have Mixed apnea and the centrals are more a symptom of their OSA.

What you need to look as is the number of obstructive, central, and hyponeas you had per hour during your original sleep study. On the titration study you need to look at how many of each event you had per hour at various pressure combinations and if they improved with regular BiPAP or only with BiPAP ST. It wouldn't be unreasonable to have another sleep study after 1 1/2 years to see what you need now. With the difference in price between BiPAP ST's and regular BiPAPs being several thousand dollars it would save your insurance company money in the long run if you were able to switch. Because BiPAP STs are classified as noninvasive pressure support venilators Medicare (and some other insurances) will rent them for life instead of renting to own due to possible repairs & liability if someone went without one.

Good luck,
Christine

arousal analysis
arousal w/hypo 31
arousal w/resp events 125
arousal w/desaturation 15

resp events related to sleep stages
central 3
mixed o
obstructive 92
hypopnea 31

wake min sa02 88. max 99. ave02 96.2
rem min sa02 93. max 98. ave 96.2
nrem min sa02 87. max 98. ave 95.6
sleep min sa02 87. max98. ave 95.8

dr. appeared to do best on bipap insp 20 exp 16 back-up 14

there is a list that says bipap/cpap cm of water duration ahi

cpap/bipap cm of water duration ahi
4 19 21.2
5 9.8 74.6
6 17.9 80.7
8 37.3 14,8
10 17.9 70,5
12 23.4 19.1
13 53.5 0
14 27.7 0
16 112.9 6.5
17 17.5 0
18/15 30.9 21.7
20/17 6. 69.6
14/10 14.1 64.0
16/12 27.2 18.
18/14 35.9 0
20/16 28.5 0

I don't know if this gives you enough info, but i guess i'm trying to figure out if i need this high $$ machine or can get by with a lesser machine!! This thing has turned into a insurance nightmare. The DR. isn't the one paying for this thing!!!!!

notbigenuf1 wrote:
resp events related to sleep stages
central 3
mixed o
obstructive 92
hypopnea 31

Was this per hour or the entire night?
3 central for an entire night is perfectly normal- even 3 per hour is in the okay range (they usually don't diagnose/treat apnea until they reach 5 per hour). Centrals can happen as we turn over (the hold your breath while I lift a box routine) or when we shift from different sleep stages. A few can be attibuted to just false readings by the monitors- especially the straps around the chest & abdomin that can get loose and give misinformation.

notbigenuf1 wrote: there is a list that says bipap/cpap cm of water duration ahi

cpap/bipap cm of water duration ahi
4 19 21.2
5 9.8 74.6
6 17.9 80.7
8 37.3 14,8
10 17.9 70,5
12 23.4 19.1
13 53.5 0
14 27.7 0
16 112.9 6.5
17 17.5 0
18/15 30.9 21.7
20/17 6. 69.6
14/10 14.1 64.0
16/12 27.2 18.
18/14 35.9 0
20/16 28.5 0

Looking just at your stats it looks like you had 0 events at several different settings (hopefully they come in bold if I highlighted them correctly). You spent 53.5 minutes at a straight CPAP pressure of 13 with no apnea and another 27.7 minutes at pressure of 14. Its kind of hard to tell what exactly the tech was doing or why 20/16 was considered the optimal pressure for you but if it was me I would ask the doctor to explain it better especially since you can purchase the best CPAP with all the bells & whistles for what it cost to rent a BiPAP ST for one month.

The other thing to look at is how your backup rate of 14 was selected. At 14 breaths per minute that means the BiPAP is going to switch to Timed mode if you don't breath for 4.28 seconds which seems a little trigger happy to me. You may want to check how many breaths per minute you take at rest- the average breaths per minute for adults is 10-20 but that includes when you are active and at rest...and when you are asleep it should be even a little lower then when you are awake. There is a possibility that with a backup rate that high that timed switches from IPAP to EPAP could actually be causing you more problems then it helping with especialy if you only have 3 centrals per hour. Just the switch in pressure can cause arousals. Its too bad they didn't break the information down any further on the pressure chart to show which type of events you are having because some people have centrals caused by pressures that are too high. To give you a reference I was started with a Backup Rate of 8 and then moved to 10 with my sleep doctor stating he never puts people any higher then 12.

One thing you haven't mentioned is how have you felt since going on BiPAP. Are you more or less tired during the day, sleeping more or less hours at night, etc. I would really be questioning your perscription if you are not feeling much better. I'd say its time to make an appointment and get some answers from your sleep doctor. You are correct- he is not paying for your equipment- you are, and you are also paying him so get him to do his job. What type of hassles is your insurance company giving you?- is it over xPAP coverage in general or are they questioning the medical necessity of BiPAP ST in particular? I know for Medicare they have a lot of specific requirements for BiPAP ST coverage including proof that it is significantly better then straight CPAP or BiPAP which looks like a lot of other insurance companies also recomend- here are Aetna's requirements which are pretty much word for word what Medicare requires too:


# Central Sleep Apnea (CSA), i.e., apnea not due to airway obstruction:

Prior to initiating therapy, a complete inpatient, attended polysomnogram must be performed documenting the following:

1. The diagnosis of central sleep apnea (CSA), and
2. The exclusion of obstructive sleep apnea (OSA) as a primary cause of sleep-associated hypoventilation, and
3. The ruling out of CPAP as effective therapy if OSA is a component of the sleep-associated hypoventilation, and
4. Oxygen saturation less than or equal to 88% for at least five continuous minutes, done while breathing oxygen at 2 LPM or the member's usual FIO2, whichever is higher, and
5. Significant improvement of the sleep-associated hypoventilation with the use of NPPV device on the settings that will be prescribed for initial use at home, while breathing the member's usual FIO2.

# Obstructive Sleep Apnea (OSA):

1. A complete, inpatient, attended polysomnogram has established the diagnosis of OSA, and
2. Member meets the criteria for CPAP, as set forth in the CPB on Obstructive Sleep Apnea, and
3. CPAP has been tried and proven ineffective.

If all of the above criteria are met, a bilevel PAP device without a backup rate feature will be considered medically necessary for members with OSA. A bilevel PAP device with a backup rate feature is not considered medically necessary if the primary diagnosis is OSA.

I hope this helps some- let me know if you have any other questions~ christine

Most of the rentals through insurance are only rented for several months to a year, then you own it. If you've been renting for 1.5 years already, the machine should be (almost) paid for by now. Do you still have to pay for it or continue renting for a lengthy time?
Debbie

snoozin' wrote:Most of the rentals through insurance are only rented for several months to a year, then you own it. If you've been renting for 1.5 years already, the machine should be (almost) paid for by now.

Debbie- I know with Medicare BiPAP ST are in a different class then other medical equipment including CPAPs so they are rental for life and most insurance companies follow the same general guidelines. It has to do with being a noninvasive pressure support ventilator and that for some people who are dependant on them for other breathing difficulties could potentially die without it. DME's have to be able to provide a loaner when they go out for maintence and there are a lot more things that could go wrong just given the more complexity. Also well a repair on a couple year old CPAP may not be worth the replacement cost it would be on a $4000-6000 BiPAP ST. Monthly rental on BiPAP ST runs $500-700 which would pay for a top of the line autoPAP.

Beautiful analysis, Christine!

I wondered about the same things you noted, Christine. Even if it was 3 centrals per hour, that seemed like a drop in the bucket, compared to the number of obstructives and hypopneas. Looked like not enough centrals to even be worrying about "centrals" when choosing a machine to start treatment for OSA.

notbigenuf, what sleeping position do you normally sleep in at home? On your side? On your back?

What sleeping position were you in most of the time during the titration study when they were changing the pressures?

I agree with Christine about the mystery of exactly what the tech was doing that eventually arrived at "20/16" as being optimal, when you actually slept quite awhile on pressures of 13 and 14 with no apneas noted:

You spent 53.5 minutes at a straight CPAP pressure of 13 with no apnea and another 27.7 minutes at pressure of 14. Its kind of hard to tell what exactly the tech was doing or why 20/16 was considered the optimal pressure for you

I'm not a doctor, but I think if it were me, I'd ask to be given a trial at home with one specific brand of autopap - the Respironics Remstar Auto with C-Flex and a heated humidifier. I'd want the pressure range set at 8 - 18 and C-Flex set at "3".

Every 5 days I'd have a download done to see detailed info for each of the 5 nights. If the download was not done until the end of, say, a two week trial, the detailed info for some of the first nights would be missing even though the overall averages would still be there. I'd want to see the nightly details from every night of an autopap trial at home.

The reason I'd want the autopap trial at home, notbigenuf, is to see if there's any chance I could get good treatment at more moderate pressures than what you are being prescribed now. It's very possible that you don't need such high pressures very often (if at all) during most of the night.

If an autopap does, indeed, turn out to treat you well at lower pressures than what the doctor is recommending, it will be a less expensive machine. But more importantly, lower pressures might be more comfortable treatment for you... in many ways. Especially when it comes to mask issues. In general, Less pressure = less chance of mask leaks.

Good luck!

I feel like a new man!! I feel cheated of some good years now.

Looks like i was switching from side to side
I tend to sleep on my left side at home.

Not sure if they would go for a trial run with auto with cflex when i have a machine already!

$500-700 month rent, no way could i afford that!!!heck now it's 50.00 month + 250.deductible every year and i'm not happy with that!!

As far as my problem with the insurance, the company i work for is based out of ST.Louis so we have BCBS of MO. they have 10 month rent to own so at the end of 10 months(50.00a month) i own the machine GREAT!!This 10 month plan was told to me by APRIA as well when i picked up the bipap!!! still great!! 12 months later i'm still getting billed, odd since this is a 10 month RTO so i get to asking BCBS and my CO whats up come to find out since my location is in Indiana that BCBS of IN. doesn't have 10 month RTO and that it's going to be 50.00a month forever plus a yearly 250.00 deductible!!! SURPRISE!!!!!!SALT to wound, if i would have had ST.Louis fill script 10 month RTO. Trying to get my machine bought by CO/BCBS but APRIA agrees to sell it 10 month RTO this one time but wants us to carry a service contract if we buy it out from them! guess what the yearly service contract cost! 800.00 a year, pretty darn close to what it would be if i just rented it!!
About to tell APRIA they can have there machine i'm going to ST.Louis

not sure if centrals are hourly or all night


Going next FRI. to see the pulm DR. and corner him about this!!!I have a feeling he will say lets do another sleep study since it's been 1.5 yrs to see what he can do! I think if he says that i'm going to another sleep center!!

I'm sure everybody can figure out thats me above not being logged in!!

what makes the auto with cflex different then a normal cpap or bipap st like i have?