Future BiPAP user.. Which machine to ask for?

[Herb]

Hello everyone!

Just starting my journey and now I'm waiting to hear from my DME for Medicare approval of a BiPAP S/T machine.

The sleep study took two nights , and the first night revealed I have moderate central sleep apnia with Cheyne-Stokes respirations and AHI of 35 events per hour. Lowest oxygen saturation was 82 with 16.9% of sleep time under 90.

The second night whern I was put on a machine reduced my AHI to 7.3 an hour at a pressure of 11/6.

The sleep study doc recommended BiPAP 11/6 with back up rate of 10.


My question centers around my choices of machines.

From what I have been able to glean from reading various manufacturers' web sites, and the helpful forums I've found, there are only a few machines from the two manufacturers I prefer (Phillips Respironics and Resmed) that offer spontaneous timed functions (S/T) to regulate my breaths per minute.

The machines I've found are:
Respironics: Dreamstation BiPAP AVAPS, BiPAP AVAPS, and BiPAP S/T.
Resmed: AirCurve 10 ST, and S9 VPAP ST.

Since I plan to carefully monitor my progress using the machine's reports and a recording pulse oximeter, I would like to know which of the machines will offer the best reporting?

From what I've read on the SleepyHead forum, the Phillips Respironics BiPAP AVPS Model 1160P does not provide Flow Waveform reports. This might apply to their Dreamstation BiPAP AVAPS also, I can't seem to find accurate information.

At this point, I don't even know if Flow Waveform reports matter much, so I'm asking for a little guidance.

Should I just ask for an older model like the S9 VPAP ST to get the reports? (I'm assuming it provides Flow Waveform reports based on the absence of comments to the contrary)

Is AVAPS an advantage over regular S/T?

Anyone have experience with these machines... which of these machines do you think I should push my DME for?

Thank you!

[Sleeprider]

First of all, you omitted the most effective machine of all of them for your central/complex apnea, the Resmed Aircurve 10 ASV. The results we have seen among forum members don't lie. That machine beats the Philips Respironics BiPAP SV Advanced nearly every time. As far as S/T and AVAPS, the are not suited to your condition as described.

[Herb]

Thank You for your help!

Yes, I was wondering about ASV. They seem to work well for my condition.
I am going to contact my sleep study lab and ask why they didn't recommend ASV.

[Sleeprider]

Herb, for central apnea, the current state-of-the art for efficacy is a bilevel machine that is capable of the following:
1. variable EPAP: This feature works automatically in a set range to resolve obstructive apnea.
2. variable pressure support: People with central apnea will normally have many more apnea when fixed bilevel pressure like all the ST machines impose. Modern ASV allows for zero PS when spontaneous breathing is detected and up to 20 cm pressure support to cause a breath when a central apnea occurs. Normally 8-10 cm is needed to do the work of respiration. This variable PS assists in breathing enough to overcome hypopnea and periodic breathing as well as apnea.
3. automatic breath timing that uses your respiration rate for the last 30 minutes to determine a backup breath is needed, rather than using a breaths per minute timer.

I could go on, but I'll ask you to read this and come back with any questions http://www.resmed.com/us/dam/documents/p...er_eng.pdf

All of the machine you listed try to make you breathe by brute force. They use no variable pressures or pressure support. If you don't take a breath in the time it is set to deliver one, you get full IPAP pressure. When you spontaneously breath, you still get full IPAP pressure. This induces centrals and you will have uncountable hypopnea, apnea and discomfort. Find a doctor that actually understands the science and technology of complex apnea. AVAPS machines are intended for patients with restrictive lung disease and obesity related hypoventilation. All bad choices for you. I'm very concerned about the direction things are heading for you.

[Herb]

I agree with your recommendation.

I've been reading about ASV and it seems like a much more precise solution, not to mention the success stories here.

I'll go through the information you linked to (if I haven't already, I've been reading different studies for hours) and report my progress.

So far, I have been trying to talk to the sleep study doctor, but keep getting the run around.

I should try and make an appointment, but it seems pointless since he appears to be comfortable with dated technology. 

I won't be committing to the wrong machine once the Medicare approval arrives.
 

My next move is to wrest the sleep study waveform data from center somehow.
They refuse to provide it to me, so I asked my primary care doctor's office to request a disk.

Hopefully, I can upload it for you to take a look at.


Finally, I need a good sleep doctor in my area, Southern California.


Again, I am SO thankful for your help steering me through this medical labyrinth.

[DeepBreathing]

My next move is to wrest the sleep study waveform data from center somehow.
They refuse to provide it to me, so I asked my primary care doctor's office to request a disk.

Know your rights under the law:  https://www.hhs.gov/sites/default/files/...anguage=es

[Gideon]

The best advice here is to follow SleepRiders advice.
And when you get your BiPAP
To post your data here.

[Herb]

SleepRider,

What medical term should I use to request the raw waveform data that was produced during my two overnight sleep studies?

I noticed the center used a Resmed machine in the studies. 
 
If they eventually supply me with the raw data, what would I need (software) to read it, or could I request a basic reader be added to the disk? (I've had xrays with reader programs installed on the disk.)


I live in California, and the laws here make it easier to require the provider to supply medical records.
It's 5 days after the request to see the records, and 15 to provide copies instead of 30.



While I'm waiting, one source of data I do have is my recording pulse oximeter charts. At least that shows my SpO2 and pulse rate.

Would that reveal much?

[Herb]

The best advice here is to follow SleepRiders advice.
And when you get your BiPAP
To post your data here.

Oh, believe me, I intend to.

My problem right now is getting Medicare to provide an ASV machine instead of a BiPAP ST that was recommended on the sleep study paperwork.


Monday, I'm going to talk to the DME coordinator at the sleep center and see if I can request a ASV machine, or if they can talk the sleep doctor into changing the order. I don't know if he is familiar with ASV enough to specify the settings.

I'm not holding much hope though, they seemed to have trouble discerning the differences between CPAP and BiPAP recommending airsense instead of aircurve when I discussed BiPAP ST options.

[OpalRose]

Herb,
Unfortunately, it's unlikely you will get an ASV machine, unless your doctor can pull some strings.    

Insurance/Medicare usually require you to try and fail at bipap first before approving an ASV.  

I know that doesn't make sense, but that's usually the procedure.