CPAPtalk.com

Thanks Sleepmba,

BiPAP never came up in my sleep reports from the Pulmonologist, I have both copies of the original and the titration study. My friend who is on CPAP and O2 had 3 sleep studies, at least at one point from his description they tried a BiPAP but apparently he didn't tolerate it well during the study and they ended up switching to a CPAP with supplemental O2 and that is what was prescribed for him. He went to a different sleep center then I did but has had no follow up with a Doctor or DME in over 2 years. He says that he feels pretty good so he doesn't see a need for a follow up. I had to tell him that he probably should get a new mask and tubing and that the insurance would cover it. He happened to be with me when I was picking up my machine during a lunch break and took my advice and got a new mask from the DME. He isn't interested at all in his therapy as long as he feels fine, I guess that is as good as a barometer as any.

Anyway as far as the APAP goes if my lowest pressure is set to my best titrated pressure then it is acting much like a CPAP would with the option of increasing pressure if necessary.

There may be other reasons to use a BiPAP but I thought it was mainly for people who needed pressures above 18 and needed bi-levels to make it easier to exhale or for those with Central Apneas. Since I didn't show central apneas during my PSG's, perhaps that is why a BiPAP wasn't prescribed? A CPAP was prescribed and I requested an APAP since I wanted something that was smart enough to self adjust, in light of the PSG titration report which was a bit ambivalent about finding a single pressure that was ideal and because I wanted to monitor my own therapy. I'm sure there is more to the BiPAP issue since I know for specific pulmonary conditions it is a better fit.

Anyway thanks for the information I'm finding it quite interesting even though I've been wishing that the APAP would have solved all of my problems.

regards
John

John, be aware that most insurances, including Medicare, require that you "fail" CPAP (that would include APAP) therapy before they will pay for a bi-level except under very specific conditions. Just having COPD as I do is not enough to meet those conditions. It is "easier" for the sleep doctor to just script a CPAP, collect enough data to "prove" you are "failing" CPAP, then bring you back in for an in-lab bi-level titration and if the data warrants THEN script a bi-level.

That is what happened w/me. I was started on CPAP Oct 06. It was definitely an improvement but not satisfactory. Still we went thru several pressure changes and an APAP trial before I finally complained enough that I was brought in for another in-lab sleep evaluation and then a bi-level titration and was scripted a bi-level Mar 08.

Each pressure change, each PAP change, brought an improvement but not entirely satisfactory. That data bore this out as did the in-lab PSGs.

My wife is on O2 at 2%. She has the PR1 Auto running in CPAP mode. The only time she needs it is when she goes into REM sleep, her O2 level goes down into the lower 80's upper 70's.

Slinky wrote:John, be aware that most insurances, including Medicare, require that you "fail" CPAP (that would include APAP) therapy before they will pay for a bi-level except under very specific conditions. Just having COPD as I do is not enough to meet those conditions. It is "easier" for the sleep doctor to just script a CPAP, collect enough data to "prove" you are "failing" CPAP, then bring you back in for an in-lab bi-level titration and if the data warrants THEN script a bi-level.

That is what happened w/me. I was started on CPAP Oct 06. It was definitely an improvement but not satisfactory. Still we went thru several pressure changes and an APAP trial before I finally complained enough that I was brought in for another in-lab sleep evaluation and then a bi-level titration and was scripted a bi-level Mar 08.

Each pressure change, each PAP change, brought an improvement but not entirely satisfactory. That data bore this out as did the in-lab PSGs.

Thanks for the information Slinky, I really appreciate it. I will be very interested in what the Sleep Dr. has to say about the Oximetery.

regards
John

REF wrote:My wife is on O2 at 2%. She has the PR1 Auto running in CPAP mode. The only time she needs it is when she goes into REM sleep, her O2 level goes down into the lower 80's upper 70's.

Thanks REF, I had a lot more apneas during REM so I may have a similar problem. Thanks for posting the information I appreciate it.

regards
John

Your leak rates for that mask look OK, as do your numbers, except for the low time spent on the machine. Hope you use it all the time you sleep. The O2 destats don't look too bad maybe the Dr's test will show something else. I run 93 while awake, I was at 90 when he put me on O2 for 8 months, when he took me off O2 I was still at 90, go figure....

I do believe in a narrower APAP range 3 cm, I'd drop you high setting to 11 cm but you don't seem to be having problems with it running away. I use the Comfort Gel nasal mask, your mask seems to have less venting, I'd like that, may have to try one. Don't know if the straps would hold up over time being undone every time (no snaps0. Jim

Hey, GoofProof. I used my original Respironics Simplicity simple nasal cushion for a good 9 months. It didn't have any snaps, etc. either. Just velcro. That velcro never wore out all the while I used it. I used to release only the bottom left strap to take it off and put it back on and the velcro never gave up the ghost. It always gripped great.

Slinky wrote:Hey, GoofProof. I used my original Respironics Simplicity simple nasal cushion for a good 9 months. It didn't have any snaps, etc. either. Just velcro. That velcro never wore out all the while I used it. I used to release only the bottom left strap to take it off and put it back on and the velcro never gave up the ghost. It always gripped great.

Good to know, I've had shoes that the velcro straps fussed and gave up. I don't mess with the mask straps much, even less now that Comfort Gel has made the clip holder stronger. Jim

I got so used to using the Simplicity's velcro that I really don't like the clips and have trouble w/the various styles of clips when I try a new mask. I know and can tell by feel just where to place the velcro on that one lower strap to get the right fit every time.