CPAP versus Bilevel

[Alzwell]

I have been on CPAP since November 27, 2012, and doing well. I also receive 2 liters of oxygen along with the CPAP. Most of my readings have been under the 5 per hour that is considered normal. The Pulmonary doctor ordered a bilevel sleep study for me, but sort of left it up to me to decide whether or not to go ahead with the study.

It is such a hassle to go in for the study to be done, and I have made an appointment finally to go ahead and do it, but I keep wondering if it is necessary. He's the doctor--shouldn't he know whether or not I need this? The only reason I finally made the appointment was because the technician said after my original study that they might want to have me be on bilevel. He said that when we were discussing the fact that my oxygen levels were not quite up to where they want them to be.

I have learned more from this forum than from the doctors, and so I am asking you what you would do in this case. I just need some educated opinions before I go ahead and have this study done. By the way, my husband feels like if it "ain't broke, don't fix it!" Meaning if the CPAP is working, then why bother.

Thanks,
Gloria

[Sleepster]

Did you have trouble exhaling with your CPAP mask on during the sleep study? That's the usual reason for prescribing a bilevel machine.

I would call the offices of both the doctor and the sleep lab and find out just why this test is being ordered. If you can't get a reliable answer from both of them I would visit a different doctor and get a second opinion.

[zonk]

The Pulmonary doctor ordered a bilevel sleep study for me, but sort of left it up to me to decide whether or not to go ahead with the study.

it seem a bit vague to order a sleep study and leave you to decide
he ought to explain why the bilevel so you can make an informed decision

machines with EPR (exhalation pressure relief) feature can for some people make exhaling against pressure easier

for example if EPR set 3, inhale at 11 ... exhale at 8
on bilevel the difference between inhale and exhale pressure can be set higher
F&P Icon don,t have EPR feature. sensawake is not the same thing

Expiratory Pressure Relief (EPR)
http://www.apneaboard.com/wiki/index.php...ure_relief

[vsheline]

The only reason I finally made the appointment was because the technician said after my original study that they might want to have me be on bilevel. He said that when we were discussing the fact that my oxygen levels were not quite up to where they want them to be.

Hi Alzwell, welcome to the forum!

If your oxygen levels were not quite up to where they want them to be, and if in their experience they think Bi-level may be better for you, I suggest it would be a good idea to have the Bi-level titration done.

If you end up being prescribed a new class of machine (bi-level), then your insurance should cover it.

AND, of course, getting a new machine would be a fine opportuniy to ask for one of the machines on Archangle's list of recommended machines.

http://www.apneaboard.com/wiki/index.php...ne_Choices

As Archangle wrote:
"I consider any of the PRS1 or ResMed S9 bilevel machines to be acceptable, because all of them record full data, including airflow data.
"I do not recommend any other brands because they do not record full data, including airflow waveforms"

AHI does not tell the whole story on sleep quality. To fully optimize our treatment, it is also important (at least occasionally, and especially whenever starting a new medication, whether prescription or over-the-counter type) to look at the time waveforms of our sleep data, showing whether the lengths of the apneas were unusually long, whether they were predominantly obstructive or central type, whether there was Periodic Breathing or Cheyne-Stokes Respiration, or anything unusual which our doctor should appreciate being informed of and which he/she may want to have looked at further. Even if we have no unusual issues during a sleep study or now, we may develop one or more in future because of medications we may need to take because of some future change in our health needs.

Take care,
--- Vaughn

[zimlich]

My sleep specialist has always given me choices on how to procede with my treatment. At least the good one does. The bad doc stopped even telling me about changes he was making- he would tell the tech in front of me. I was getting the bums rush out of the office. Often we come to a place where we have to make the decision on how to procede because it's our quality of life. I was never able to get my AHI down to five in any modality- CPAP, AUTO, BiLevel. The good doc explained the ASV machine, told me they were expensive and left it up to me whether to have a sleep study with ASV. I felt ok, I didn't desaturate with an AHI average of 18.6/six months, but I didn't feel great. I was sleeping 10-12 hours a night, still having some daytime sleepiness, and was depressed. Hoping to do better I opted for trying the ASV and have never looked back. If I had settled for feeling ok I never would have know what it felt like to be properly treated. In my case I have mainly hypopneas due to meds I take. I still have a few- AHI 4-8/night over the last six months, but the ASV has cleaned up most of them.
Good luck in your decision.