Do I need BiPap? Data added

AHI has been moving up every night since I solved my mask leaks and mouth breathing. Night before last it was at 7.9. So I went ahead and upped my pressure from 17 to 18. Last night my AHI was back down to 3.2. I'm getting very close to the pressure limits of my S9 Elite (20). Do I need BiPap?

What happens under Medicare if I need an Rx change. I own this machine in one more month's rental. But if it isn't giving me proper therapy and I need a different machine, do I have to start all over with 13 months rental. Or will Medicare even allow me to get a BiPap if prescribed by my sleep doctor?

i can't comment on "need" but i know that cpap only became tolerable for me when i switched over to bipap -to me it was the difference between having a hurricane blowing down my nose which i had to continuously struggle to exhale against to something that is more comfortable than breathing room air - with non bilevel apap i dreaded facing sleep now i look forward to it again

johnthomasmacdonald wrote:i can't comment on "need" but i know that cpap only became tolerable for me when i switched over to bipap -to me it was the difference between having a hurricane blowing down my nose which i had to continuously struggle to exhale against to something that is more comfortable than breathing room air - with non bilevel apap i dreaded facing sleep now i look forward to it again

JTM, what are your pressure settings now?

The AASM (American Assoc of Sleep Medicine) has specific guidelines for titration procedures in sleep study clinics on CPAP, whereby the Techs suppose to check with the patients who undergo a titration study for CPAPs. If the pressure is raised above 15 cm then the Tech "suppose" to ask a patient if it is "inconvenient" for the patient to exhale into the higher pressure. If the reply is YES then a BiPAP procedure should replace the CPAP procedure.

What happens under Medicare if I need an Rx change. I own this machine in one more month's rental. But if it isn't giving me proper therapy and I need a different machine, do I have to start all over with 13 months rental. Or will Medicare even allow me to get a BiPap if prescribed by my sleep doctor?

See my post below.

Yea, the sleep tech screwed up my titration study. I told him I had been on CPAP for 12 years at pressure of 10. I had a split study because my OSA was so bad (AHI=66 and that doesn't count RERAs). So the idiot tech started my titration at 4 totally disregarding that pressure of 10 wasn't doing the job. Time ran out for the titration study when he got to 15 (it was morning). My sleep doc wrote the prescription for pressure of 16 since 15 still didn't stop all obstructive events. I think I should have been prescribed a BiPap instead of CPAP.

I notice the Medicare rules state that BiPAP can be prescribed for patients that fail at CPAP. It doesn't say the BiPAP wouldn't be covered if CPAP already bought. How else would you prove that CPAP was a failrure? Does it have to be in first 61 days of CPAP?

If CPAP machine cannot provide sufficient pressure to keep my airway open, that is definately a failure. The BiPaP can go as high as 30 while CPAP stops at 20.

IMO, you could benefit by showing here a log of changing the the pressure on your S9Elite from 12 cm to 16 cm, gradually, by raising or lowering the pressure 1 cm at a time, and changing the EPR thru the on or off.
(I used FF masks at that time which leaked a lot)

kaiasgram wrote: johnthomasmacdonald wrote:
i can't comment on "need" but i know that cpap only became tolerable for me when i switched over to bipap -to me it was the difference between having a hurricane blowing down my nose which i had to continuously struggle to exhale against to something that is more comfortable than breathing room air - with non bilevel apap i dreaded facing sleep now i look forward to it again

JTM, what are your pressure settings now? "


On nights i use the dental appliance, i use 8 and 6 and my ahi is always between 1 and 2 and almost entirely centrals

When I don't use the appliance, I use 12 and 8 and my ahi is much more irregular ranging from 2 -7 with the average being 3 something. Over half are still centrals but there are a lot more of all types.

I prefer not to use the appliance since I've read that they do long term damage to dental work and i have a fortune invested in implants and caps in my mouth, but i can't seem to get the apnea under control without it

I've picked up a resmed vpap asv adapt enhanced ( resmed's older asv model) to see if this will work for me without the appliance but i need to figure out how to program it and get it to work properly - i've got the clinical manual but it isn't very clear

VikingGnome wrote:AHI has been moving up every night since I solved my mask leaks and mouth breathing. Night before last it was at 7.9. So I went ahead and upped my pressure from 17 to 18. Last night my AHI was back down to 3.2. I'm getting very close to the pressure limits of my S9 Elite (20). Do I need BiPap?

What happens under Medicare if I need an Rx change. I own this machine in one more month's rental. But if it isn't giving me proper therapy and I need a different machine, do I have to start all over with 13 months rental. Or will Medicare even allow me to get a BiPap if prescribed by my sleep doctor?

My guess, and its only a guess - is that if you need BiPap, its going to depend on the cooperation of the DME. If a DME wants to be really helpful, they could bill a BiPap next, after your S9 Elite is paid for AND if Medicare will pay for BiPap. I think medicare will if billed properly. You may need yet another sleep study to PROVE that you need BiPap, that your need is above the current machines limits. IMHO you will need the joint cooperation of your dr & DME to accomplish getting the machine & probably will have to do another 13 month rental.

If you don't get any cooperation, you will then have to purchase your new machine out of pocket. As you probably know, seconwindcpap.com has some lower cost units, or instead of buying from local DME (too costly - their costs are outrageous), and if you want new, price it as cpap.com.

If I were in your situation I would approach DME with confidence that medicare would pay, until they tell you otherwise. I'm generaly an optimist, and find a positive attitude helps in a variety of situations.

Good luck,
Jen

ps - please excuse my typos, I got a set of nails for xmas & they need shortening, guess you could say I need my claws sharpened

Bipaps are way easier to breathe with than cpap. Is there some advantage to using cpap over bipap that may not be obvious? Otherwise, why wouldn't they put you on something that you would easily get used to. Is it a money scam or is there medical reasoning that makes since to start out with cpap? I have wondered if the pressure fluctuation of bipap would create arousals and kick you out of deep sleep. I get problems of not getting good restful sleep. I sleep fairly good but I don't think I am getting the restful sleep that keep you from falling asleep from time to time. Anyone have any problems from using bipap?

Money.

johnthomasmacdonald wrote: On nights i use the dental appliance, i use 8 and 6 and my ahi is always between 1 and 2 and almost entirely centrals

Thanks John -- I pick up a bipap machine from my doctor's office this Wednesday for a one-week trial. I'm praying it makes a difference in my quality of sleep. Like you I sleep through the night most nights but I'm definitely not getting restorative sleep. So I've been wondering, even if I don't need a higher pressure, could the rhythm and sensitivity of bipap be more conducive to better, deeper sleep with easier breathing. Fingers crossed and thanks again for your reply.

Kalasgram wrote: "Thanks John -- I pick up a bipap machine from my doctor's office this Wednesday for a one-week trial. I'm praying it makes a difference in my quality of sleep. Like you I sleep through the night most nights but I'm definitely not getting restorative sleep. So I've been wondering, even if I don't need a higher pressure, could the rhythm and sensitivity of bipap be more conducive to better, deeper sleep with easier breathing. Fingers crossed and thanks again for your reply. "

I definitely think that the rhythm of the bipap on its own will improve your sleep. The bipap machine was a huge improvement right from the first night and if you remember my early posts I LOATHED using cpap when i first started with the system one apap machine - my sleep was horrible, I dreaded going to sleep and i was becoming phobic about sleep , I started calling surgeons since i knew that there was no way I could adjust to this - Now i have to say - I LOVE IT , I REALLY LOVE IT, I can't wait to go to sleep, i actually enjoy waking up ( less and less each night but i think mainly because of the severe hip arthritis pain i've got) because I have this great feeling of being REALLY sleepy and knowing that i will just turn over and go back to sleep and that i've got more of the night in front of me - I LOVE IT ( did i mention that yet?)

I do SO hope that it works the same for you - if it does I actually think that starting with the bad machine is actually an advantage in the long run since the bipap probably is unpleasant relative to no machine but I'm now comparing it to the apap machine and by comparison it is heaven

I doubt that there is much that i can tell you to help but if there is please don't hesitate to contact me

johnthomasmacdonald wrote:Kalasgram wrote: "Thanks John -- I pick up a bipap machine from my doctor's office this Wednesday for a one-week trial. I'm praying it makes a difference in my quality of sleep. Like you I sleep through the night most nights but I'm definitely not getting restorative sleep. So I've been wondering, even if I don't need a higher pressure, could the rhythm and sensitivity of bipap be more conducive to better, deeper sleep with easier breathing. Fingers crossed and thanks again for your reply. "

I definitely think that the rhythm of the bipap on its own will improve your sleep. The bipap machine was a huge improvement right from the first night and if you remember my early posts I LOATHED using cpap when i first started with the system one apap machine - my sleep was horrible, I dreaded going to sleep and i was becoming phobic about sleep , I started calling surgeons since i knew that there was no way I could adjust to this - Now i have to say - I LOVE IT , I REALLY LOVE IT, I can't wait to go to sleep, i actually enjoy waking up ( less and less each night but i think mainly because of the severe hip arthritis pain i've got) because I have this great feeling of being REALLY sleepy and knowing that i will just turn over and go back to sleep and that i've got more of the night in front of me - I LOVE IT ( did i mention that yet?)

I do SO hope that it works the same for you - if it does I actually think that starting with the bad machine is actually an advantage in the long run since the bipap probably is unpleasant relative to no machine but I'm now comparing it to the apap machine and by comparison it is heaven

I doubt that there is much that i can tell you to help but if there is please don't hesitate to contact me

Well you're a little too far away for me to buy you a cup of coffee to say thanks for caring and for helping me stay hopeful -- so I'll just say thanks. I do remember some of your earlier posts so it does give me hope that you feel so positive about bipap vs. cpap. I'll post or contact you about how it goes.

Don't worry about MAX Leak. I use SmartStart instead pushing button to start and stop.

My leak data is finally under control but notice the clusters of obstructive events (likely during REM sleep). At my sleep study I had ZERO Deep and ZERO REM due to medication. After lots of adjustments I am now having normal sleep patterns but the pressure of my CPAP isn't taking care of my OSA during REM sleep.

Unfortunately, I did not use my pulse oximeter that night so don't know what desats I was have during periods of AHI as high at 15.

Here is the night before.





Maybe what I really need is AutoPAP. Seems a lower pressure is ok when not in REM. And then it could adjust up when needed.

But my sleep doctor doesn't believe in them and won't prescibe.

VG, looks like some significant flow limitation to my admittedly untrained eye. FL is one of the most mysterious parts of the software report to me, I see the graphs but I don't know how much is significant in terms of affecting our sleep. I understand from what I've read that the fix for flow limitation issues is usually higher pressure -- which I guess would bring you back to your question about whether your stats indicate the need for a bilevel machine. I hope some of our 'seniors' will comment on your FL graph.

Sorry about your doctor's rigid stance on APAP -- silly since it makes sense that pressure needs can vary a lot for some people depending on sleep position and stage of sleep. On the other hand, a lot of people on APAP ultimately find it's more comfortable to have a steady pressure and end up switching to straight CPAP mode. But why not give the patient the option to find out?