Titration report received in the mail today

Pugsy wrote:Fixed bilevel pressure machines
PR System One 60 Series Pro BIPap model 660
and the
ResMed VPAP S
function pretty much the same except the model 650 has BiFlex exhale relief.
The S9 VPAPs don't offer any exhale relief. They think that the difference between EPAP and IPAP is sufficient exhale relief.

Sounds like the only way you will talk them out of an auto machine is for the doctor to write the script for a range of pressures and not the 18/22 which is a fixed pressure setting. I warned you this might happen with this RX.
With a range of either EPAP or IPAP written into the RX then that qualifies for an auto machine.

So in the "fixed" BIPAP machine category you rate the Philips Respironics machine to be better than the ResMed S9 VPAP S? Otherwise ask my doctor when I see him next month to list a range of pressures on his script and say "dispense as written" and if he won't write the script that way should I go ahead and take his script then take a copy of my sleep study and go see a pulmonologist? The bottom line is I need to try and get an "auto" BIPAP if I can but with an "auto" BIPAP will I have that exhale relief you're talking about on a ResMed machine or is that only available on the P.R. machine? So does the P.R. 660 not come with exhale relief? Only the P.R. 560? I want some kind of exhale relief like I had on my older machine which came with C-Flex; I especially want exhale relief now that my new pressure is to the moon at 22cm H2O max.


Stevoreno_55
MS Gulf Coast
06/23/14

Stevoreno_55 wrote: So does the P.R. 660 not come with exhale relief?

Incorrect. The 660 has BiFlex exhale relief....similar to your previous CFlex.
http://biflex.respironics.com/

It's the S9 VPAP that doesn't have any extra exhale relief beyond pressure support. To be honest it isn't that big of a deal.

Stevoreno_55 wrote:So in the "fixed" BIPAP machine category you rate the Philips Respironics machine to be better than the ResMed S9 VPAP S?

No, I never said the PR S1 Bipap was "better". I was just pointing out the only real difference between the 660 and the VPAP S. BiFlex exhale relief is the only real difference in terms of the fixed bilevel mode.

There are other minor differences when using auto mode mainly with how the PS is or can be configured.

I have used both brands...the PR S1 BiPap (both the 660 and the 760) and I have used the S9 VPAP Auto (in both the fixed and auto modes) and the BiFlex isn't a make it or break it deal. I think that 4 cm PS (pressure support which is the difference between EPAP and IPAP) will be more than sufficient exhale relief and be quite comfortable.
I happen to prefer or need auto adjusting pressures because sometimes my pressure needs are quite high but not everyone has that need. I actually liked the PR S1 in fixed mode a lot and in fact used it that way for quite some time. It's a toss up as to which I would say is "better". They are both excellent brands...the S9 VPAP and the PR S1 BiPap no matter if in fixed or auto mode.

As to how to get your doctor to help you get the "auto" model. I have no idea what you need to do or say to the doctor. I know that for the DME to be forced into it...there will have to be a range of either EPAP or IPAP to justify auto adjusting machine.
Whether the doctor will come on board with that....I have no idea what he will do or won't do. Some are nice guys and some are hard asses.
The DME is playing hardball. I was afraid they would do that. They could easily supply you with the auto adjusting machine and simply set it to fixed pressure mode but they choose not to do that.

Pugsy wrote:

Stevoreno_55 wrote: So does the P.R. 660 not come with exhale relief?

Incorrect. The 660 has BiFlex exhale relief....similar to your previous CFlex.
http://biflex.respironics.com/

It's the S9 VPAP that doesn't have any extra exhale relief beyond pressure support. To be honest it isn't that big of a deal.

Stevoreno_55 wrote:So in the "fixed" BIPAP machine category you rate the Philips Respironics machine to be better than the ResMed S9 VPAP S?

No, I never said the PR S1 Bipap was "better". I was just pointing out the only real difference between the 660 and the VPAP S. BiFlex exhale relief is the only real difference in terms of the fixed bilevel mode.

There are other minor differences when using auto mode mainly with how the PS is or can be configured.

I have used both brands...the PR S1 BiPap (both the 660 and the 760) and I have used the S9 VPAP Auto (in both the fixed and auto modes) and the BiFlex isn't a make it or break it deal. I think that 4 cm PS (pressure support which is the difference between EPAP and IPAP) will be more than sufficient exhale relief and be quite comfortable.
I happen to prefer or need auto adjusting pressures because sometimes my pressure needs are quite high but not everyone has that need. I actually liked the PR S1 in fixed mode a lot and in fact used it that way for quite some time. It's a toss up as to which I would say is "better". They are both excellent brands...the S9 VPAP and the PR S1 BiPap no matter if in fixed or auto mode.

As to how to get your doctor to help you get the "auto" model. I have no idea what you need to do or say to the doctor. I know that for the DME to be forced into it...there will have to be a range of either EPAP or IPAP to justify auto adjusting machine.
Whether the doctor will come on board with that....I have no idea what he will do or won't do. Some are nice guys and some are hard asses.
The DME is playing hardball. I was afraid they would do that. They could easily supply you with the auto adjusting machine and simply set it to fixed pressure mode but they choose not to do that.

Well the DME hasn't issued me a machine yet and might not. I might just decide to get another CPAP and stay at 18cm which I know I can tolerate rather than try to deal with 22cm. I'm beginning to get tired talking about this mess; I'm going to give it a rest for a few days because I don't know what I'm going to do just yet.



Stevoreno_55
MS Gulf Coast
06/24/14

Stevoreno_55 wrote:Well the DME hasn't issued me a machine yet and might not. I might just decide to get another CPAP and stay at 18cm which I know I can tolerate rather than try to deal with 22cm. I'm beginning to get tired talking about this mess; I'm going to give it a rest for a few days because I don't know what I'm going to do just yet.

Well if you want to cut your nose off to spite your face just because you are having a battle getting an auto unit...I guess you can do that if you want to.

It isn't the end of the world not to have an auto unit....it isn't....especially with your pressure needs...like where is it going to go from 22..anyway..up to 25.
Auto units are nice sure, but it isn't the end of the world if someone doesn't have one and just because a few forum members suggested you get one IF you can doesn't mean that the fixed units are crap machines.
Plus you might not even like auto adjusting pressures after using fixed cpap for so many years.

Finally..to not get a new bilevel machine because you want to use 18 on cpap....hell....the bilevel machine has cpap mode available anyway. If you don't even want to try bilevel because of cutting your nose off to spite your face...then you are really acting childish.
All this because you think you just HAVE TO HAVE an auto machine??? because people here on the forum said it was better??

I am sorry Steve but I don't deal with temper tantrums and cutting your nose off to spite your face very well.

Sit back and take a deep breath and repeat after me "it isn't the end of the world if I can't get an auto unit. The bilevel machine in fixed mode will still be much more comfortable than what I was using and give me better therapy than what I was using" and if you can't do that because of a temper tantrum...then I have wasted countless hours answering your hundreds of questions....and I don't like wasting my time and I will come to your house and put my foot up your butt. Just ask my husband...he knows I am mean enough to do it.

Pugsy wrote:I am sorry Steve but I don't deal with temper tantrums and cutting your nose off to spite your face very well.

Sit back and take a deep breath and repeat after me "it isn't the end of the world if I can't get an auto unit. The bilevel machine in fixed mode will still be much more comfortable than what I was using and give me better therapy than what I was using" and if you can't do that because of a temper tantrum...then I have wasted countless hours answering your hundreds of questions....and I don't like wasting my time and I will come to your house and put my foot up your butt. Just ask my husband...he knows I am mean enough to do it.

well said, and similar feelings felt here.

My thoughts:

Stevoreno,

I'd recommend just getting the fixed bi-level machine. Like Pugsy said, there's not a lot of room on the top for an auto to increase pressure anyway. And since you've used straight CPAP at 18cm for years, you might not even like auto anyway.

There's a reason that you went through the process of getting another sleep study done. And the new sleep study recommend bi-level at IPAP = 22, EPAP = 18.

Some questions for you to consider:

1) How did you feel during the bi-level titration study? Was the machine they titrated you on about the same as your CPAP? Did you ever wake up feeling like there was a hurricane in the mask? If not, then you'll do just fine at home with the bi-level set to IPAP = 22, EPAP = 18 as long as you don't pysch yourself out about it.

2) Why was the titration done in the first place? Is your AHI with CPAP = 18cm no longer low enough? Were the OSA symptoms returning?

3) What is your treated AHI with straight CPAP = 18?

4) What are your current problems with the loaner S9 Elite?

Personally, I'd take the fixed bilevel. And if 22/18 proved to be too hard to tolerate, I'd then switch the thing to straight CPAP mode at 18 and see if that's any better.

To the OP, I see you have made nearly 300 posts here. Is it safe to assume you are competent in monitoring your current therapy?

DeadlySleep wrote:To the OP, I see you have made nearly 300 posts here. Is it safe to assume you are competent in monitoring your current therapy?

Very competent. Now everybody can put their tar buckets and feathers away.


Stevoreno_55
MS Gulf Coast
06/25/14

Very competent. Then you did not need a sleep study to tell you the 18 cm you had been running was not achieving sufficiently good therapy? You had another sleep study because your data was poor or you did not feel well?

My doctor would not agree to write me a Rx for a new CPAP machine when I went to see him several months ago after my old machine quit working. My insurance company also required me to undergo a new sleep study since it had been more than 5 years since my last one before they would agree to pay for a new machine which is why I had the study; it wasn't because I wanted to have the study. According to the new study report which was finished earlier this month my old CPAP pressure of straight 18cm wasn't cutting it; I'm now a candidate for a Bi-Level with a new pressure of 22cmIPAP and 18cmEPAP.


Stevoreno_55
MS Gulf Coast
06/26/14

Let me try again. Did your very competent monitoring of the data from your old machine show that the therapy was satisfactorily effective at 18 cm? Or did it show the therapy was not satisfactorily acceptable? Did you feel healthy using the old machine at 18 cm?

You know these sleep labs are getting a 7-hour snapshot of your sleep/breathing which does not necessarily represent your long-term, at-home situation.

DeadlySleep wrote:Let me try again. Did your very competent monitoring of the data from your old machine show that the therapy was satisfactorily effective at 18 cm? Or did it show the therapy was not satisfactorily acceptable? Did you feel healthy using the old machine at 18 cm?

You know these sleep labs are getting a 7-hour snapshot of your sleep/breathing which does not necessarily represent your long-term, at-home situation.

DeadlySleep:

First of all you can stop with the sarcasistic comments about my competent monitoring of my sleep data. I never monitored my sleep data the 7 years I was on my old CPAP machine at a straight pressure of 18cm because I never got into that stuff. When my old machine quit working in March 2014 I put things into motion then to do what I had to do to get the ball rolling to get a new machine.

I saw my doctor on April 09, 2014; he refused to write me an order for a new CPAP machine which is good since now I'm a candidate for a Bi-Level machine but he did agree to write me an order for a new 2 night sleep study on April 09, 2014. His office then faxed those orders to the lab that was going to test me; the lab received those orders later that same day. The lab then sent my orders to my insurance company for pre-certification on April 10, 2014; my insurance company approved the 2 night study on May 06, 2014.

I reported to the lab on May 21, 2014 for my PSG; I then returned to the lab on June 04, 2014 for my titration. The lab's sleep doctor scored my titration results on June 10, 2014; I received a one page summary of the titration results by email the next day; I contacted the lab and told them I wanted a detailed copy of both tests results; the PSG and the titration which I received in the mail from them on June 14, 2014; all 14 pages.


Stevoreno_55
MS Gulf Coast
06/26/14

Stevoreno,

I don't want to read this whole thread. Have you been without a machine since March? I would be a wreck in a day or two without a machine.

I am a big fan of Auto machines. They allow you to sleep at lower pressures at certain times of the night related to the sleep stage you are in, the body and neck position, amount of congestion and probably a lot of other factors.

Prayers for a quick resolution for you,

CowFish wrote:Stevoreno,

I don't want to read this whole thread. Have you been without a machine since March? I would be a wreck in a day or two without a machine.

He's using a loaner S9 Elite set to 18cm of pressure.

CowFish wrote:Stevoreno,

I don't want to read this whole thread. Have you been without a machine since March? I would be a wreck in a day or two without a machine.

I am a big fan of Auto machines. They allow you to sleep at lower pressures at certain times of the night related to the sleep stage you are in, the body and neck position, amount of congestion and probably a lot of other factors.

Prayers for a quick resolution for you,

My DME has been letting me use a "gently used" ResMed S9 Elite loaner with HH; no heated hose for the last 3 months. I didn't like the machine at first because it was so quiet; quieter than my old P.R. DS400S machine which quit working earlier this year but since I've been using the S9 for the last 3 months I've started to like it. My RT set the loaner to my old CPAP pressure of 18cm straight; no ramp time. I've been on 18cm straight since late 2007 when my pressure increase from 16cm straight to the new 2007 pressure of 18cm straight. The RT was going to recommend a ResMed S9 AutoSet machine if my new pressure remained in CPAP range; 20cm or < but since it didn't and it did increase into Bi-Level range she has recommended a "fixed" Bi-Level; it will not be an "auto" Bi-Level machine.


Stevoreno_55
MS Gulf Coast
06/26/14