Flow Limits How to Upgrade CPAP to Bilevel

[Nightynite]

Thanks sleeprider! My DR. who is actually a NP will do this I believe with no problem as long as I can tell her exactly what to do. I’m going to tell her what machine I want with the default settings and tell her to fax it over to the DME and go on and say if the DME needs anything else they will call you. I’m sure there’s a paper trail of forms, codes and such and that’s where my new NP will probably have a problem. My last visit she faxed over my yearly note saying that cpap therapy is still working well so I could get some supplies, so I think this is all doable as long as I stay on the phone daily like you did. ( that’s what it takes nowadays) Sorry Deborah, didn’t mean to butt in on your thread.

[Deborah K.]

Nightynite, you are not bothering me any.  I'm glad this thread is helping you!  Sleeprider has been so patient and given so much good advice here that I imagine this thread will also help others who feel they need to upgrade to a bi-level.

[Fixit50]

Hi Deborah K.  I’ve been following your thread since I have a similar situation and will soon have an appointment with a sleep doctor to try and get upgraded to a Bilevel.  I also would like to get a prescription without an additional sleep study.  Like you, my AHI does not reflect the problem I’m having, so I’m concerned that another diagnostic sleep study would not uncover the basis for an upgrade to Bilevel.  Where I live, the doctors seem to be trigger happy on sleep studies so I’m approaching this with some trepidation. 

From you post #45, I see that you convinced you doctor to upgrade you to Bilevel and let you take charge of the needed settings.  I would have thought your doctor would at least order a bilevel-titration study to determine your needed bilevel settings.  May I ask how you persuaded your doctor to permit you to take care of the level adjustment on your own, without a titration study?  Did this come up in your discussion?  My interest in this question is because I will likely need to have the same conversation with whatever doctor I go with. Thanks for your help. 

Also, my specifics can be found here. 

Fixit50

[OpalRose]

The roadblock usually isn't the Doctor. It's the DME (who think they're doctors) or it will be Insurance/Medicare, depending on what coverage you have.

[Deborah K.]

FixIt50, Here's the paper I took to my doctor's visit.  I didn't read it but I referred to it and made sure I included all the information.  I don't think he understood when I talked about pressure support as compared to just using more pressure.  We talked for a good while and I just kept reiterating that I felt sure that I would sleep better and more comfortably with a bi-level and that my present machine was not meeting my needs.  Since he asked, I explained that having an excellent AHI did not always mean that my therapy was optimal.  He saw that I really wanted it and felt sure I would benefit from it, so he wrote me the prescription.  I told him that I had learned that I did not need a new sleep study, so he let that go.  So here's my paper.  You will need to alter it of course to deal with your particular issues, but I hope it helps you determine what you want to say:

"I would like a prescription for a ResMed AirCurve 10 VAuto machine.  My current CPAP machine is a ResMed AirSense 10 Autoset.  It's a good machine for what it does, but I need better apnea treatment from a machine offering higher Pressure Support (PS) that can only be provided by a bi-level machine such as the AirCurve 10 Vauto.

Over the years I have found myself feeling air starved with my machine, so I have been bumping my pressure up until I am now using 14-20 pressure, and am bumping up against the 20, which is the highest my machine will go.  A bilevel goes up to 25, but with more PS I would probably not even need pressure as high as I presently need, resulting in more comfort and fewer air leaks.  I now fight daytime sleepiness and again fight insomnia even though I take Trazodone, and I learned recently that using a machine with higher levels of PS can help with all these issues, and blood pressure as well.  I need to have the quality and comfort of my sleep improved.  I believe it will improve my overall health.

I understand that the air I take in with each inhale (tidal volume) is lower than it should be when I sleep and can be relieved with more PS.  I range from 200 to 220, and it should be more like 300.

I have high flow limits (respiratory flow resistance) which my present machine cannot handle, but the additional PS provided by a bi-level machine should solve that.  A bi-level offers mechanical assistance to overcome airway restriction at the moment it is needed to produce normal airflow. So it's all about needing more pressure support.

The bi-level is more expensive but I believe my insurance will cover it if you will prescribe it."


Go with confidence and stand up for yourself!  I'm praying that you will be successful.  

[Fixit50]

Deborah K: Thanks very for following up with this information. Yes, its very helpful to know what your encounter with the sleep doc was like, so I can prepare for mine. The last time I went to the sleep doc was 6+ years ago. I pulled out some Sleepyhead screen shots showing Flow Rate and the usual other metrics. He looked at it like it was hieroglyphics and didn't understand a word of what I said. I may need to simplify my explanation a few notches for my upcoming meeting! Good thing we have the apneaboard.com! Thanks again for helping!

Opal Rose: Thanks for the heads up on the DME. I already checked with my insurance and they don't require a sleep study as long as they don't see anything wrong with the doctors reasons for the upgrade. I didn't even think the DME would care. Guess I was wrong about that.
Fixit50

[Deborah K.]

MY MACHINE CAME TODAY!!!!  YAY!    I just finished setting it up, so I'll see how it goes for a few days, then let you folks know what is going on.  I used the settings you suggested, Sleeprider.  The other bilevel stuff was set by I don't know who at TI Max 2.0, TI Min 0.3, Trigger Med, and Cycle Med.  I hope those are okay.  If not, I guess we will figure it out later.

My insurance company did not quibble at all.  They just approved it and Breathe Easy sent it.  Breathe Easy was a dream to work with.  I always got a person answering and everyone I dealt with was friendly, kind, and wonderfully easy to work with.  I sent them my very old sleep study, the doctor sent them my prescription and they ordered the machine.  Piece of cake.  

[Crimson Nape]

Deb - Looking at one of your charts, I would increase Ti Max to 3.2. This should allow you enough time to inhale before it will drop to exhale pressure. Otherwise, if you do a long inhale, it will drop after it times out. This makes for an uncomfortable feeling when this happens.

- Red

[UnicornRider]

Please stay handy to walk future forum members through the process. Your experience will encourage others to carry on against all odds.

[Deborah K.]

 Red!  I made the change you suggested.  I so appreciate your advice.    I'm sure it will help me sleep in comfort.

And, Unicorn Rider, I'll be hanging around on this thread.  I might need more help, and I hope I can maybe help someone else too.