Flow Limits How to Upgrade CPAP to Bilevel

[Sleeprider]

I can't speak for others. A leak is a problem when it is disruptive to sleep or therapy. I see a lot of misunderstanding on the forum where reasonable leak rates are very alarming to some members. I don't see it that way, especially if events are in a reasonable range or if the night of higher leaks is what we call an outlier. Even people with good mask fit and air control have a bad leak night. It happens to me from time to time, and it's probably time to clean or change the mask cushion.

I don't interpret or speculate on a persons health based on what I see in Oscar charts. If you want answers about your pulmonary health, ask your doctor for a pulmonary function test (PFT). this is an easily performed procedure at any health exam using a spirometer, and usually done by the nurse. A PFT is most useful to establish a baseline and track changes. Everyone should have a baseline metric so the impact of any illness or injury, or just aging can be compared.

[robbob2112]

In my case just about any visible spike in leak rate no matter how small results in CA events for the next 10 minutes or so.  Maybe it is just me, maybe it is the ASV and the complex apnea.

[Lucky7]

I can't speak for others. A leak is a problem when it is disruptive to sleep or therapy.  I see a lot of misunderstanding on the forum where reasonable leak rates are very alarming to some members.  I don't see it that way, especially if events are in a reasonable range or if the night of higher leaks is what we call an outlier.  Even people with good mask fit and air control have a bad leak night.  It happens to me from time to time, and it's probably time to clean or change the mask cushion.

I don't interpret or speculate on a persons health based on what I see in Oscar charts. If you want answers about your pulmonary health, ask your doctor for a pulmonary function test (PFT). this is an easily performed procedure at any health exam using a spirometer, and usually done by the nurse.  A PFT is most useful to establish a baseline and track changes.  Everyone should have a baseline metric so the impact of any illness or injury, or just aging can be compared.

I really like the PFT idea, thanks!

In regards to speaking to doctors, is there any good literature to use to make the argument that Bi-Level is better? I know some docs personally that I've won over by showing them published papers.

[Deborah K.]

Sleeprider,  I made notes about what to talk to my doctor about.  What do you think?

REASONS I NEED A BI-LEVEL PAP MACHINE

I have high flow limits, higher than my CPAP can handle.  Only a Bi-Level pap machine can provide sufficient Pressure Support to overcome the flow limits, which cause high levels of respiratory effort.  I need the Pressure Support during inhalation so that I don't need to work hard to get more air, and can let the machine do some of the work.  This is why respiratory effort arousals (RERA) happen, and even short arousals are disruptive to sleep.  A Bi-Level machine offers mechanical assistance to overcome airway restriction at the moment it is needed to produce normal flow.  A CPAP cannot do this nearly as well.

I also have annoying physical symptoms that seem to be getting worse.  I fight daytime sleepiness more often than I ever have.  I still have my ever-present depression.  I understand that Bi-Level use can help with mood problems like this.  I still fight insomnia some nights even with the Trazodone, and I find myself considerably more forgetful, so anything that helps me sleep better would be very welcome.  Also, Bi-Level use can help with problems due to high blood pressure.  I never realized that all these health issues could be improved by getting better sleep.

[Deborah K.]

I also need a Bi-Level to help raise the Tidal Volume, the amount of air I take in every time I inhale.  Mine ranges from 200 - 240, lately mostly 220.  These numbers are too low.

[Sleeprider]

Good arguments, however I think keeping the emphasis on your lack of comfort and continuing fatigue with CPAP therapy will be the most important in your doctor's decision. You are very involved in your therapy, understand it and know how it will likely improve. From what you've said in the past, you have a supportive patient/doctor relationship. I think your appointment will go well and you will come away with a Rx. The real challenge is insurance.

[Deborah K.]

Would my insurance look at my sleep study and decide it's not for a bilevel and refuse?  If they did, I know my doctor would appeal.  We went through this in September with a 14-day supply of pills for $2500 (can you believe it?) that he wanted me to try.  They denied, he appealed and I got the medicine for $120.  I don't know if it would work for the bilevel, but it's close to the same price, and if I get it it will be free, as that is how my coverage works.  Everything except prescriptions is free.

[Sleeprider]

In the end, it is not up to your insurance. They may appeal a bilevel, but if your doctor prescribes it, and says it is medically necessary the game is over. I'm mo different from you. I have the same AHI on bilevel as CPAP, but there is a significant difference in how I feel. While you can see the difference in the data, it's mostly the fact my doctor supports what I want. I'm not sure how to explain it other than to point out you have used CPAP for many years and have not achieved restful sleep. Bilevel can and does change that, but the path to covered bilevel therapy is via your supportive doctor. Sleep studies and "proof" of need are just inventions of the insurance system to avoid paying more than the minimum. It's a game, and you need to play to win. A test costs more than a bilevel machine.

[Deborah K.]

Thanks!  I plan to see my doctor as soon as he is available, and hopefully get this show on the road.  You have been more than kind and helpful and I am very grateful for your support.  I would never even have considered that I would benefit from, and might be able to obtain a bilevel without your suggestions and help.

[Sleeprider]

Good luck! You will really love it. Don't be discouraged by an initial insurance denial. You have to stick to your needs and probably deal with the process.