NOOB questions about treatment selection

[WakingDead]

Hello;

I was given a home sleep study last month and diagnosed with severe OSA.    The doctor prescribed a CPAP trial, I finished the first stage.

I was given an Airsense 10 Autoset for Her, along with a AirFit F20 full face mask, as a previous attempt with a nasal mask failed.

Over the test period I managed over 6 hours average per day, used daily and noticed excellent results.  The whole world seems "brighter".  The provider used the machine to record and review the sleep data, which looked very good.  Down from about 60 events to under 6.   The unit was set to Auto mode, Autoramp, EPR on, etc.

Now entering the second phase, where the provider has programmed the unit for a fixed pressure, no Auto, no ramp, no EPR.  I don't seem to be responding well to these changes, I can't get thru the night without unconsciously removing the mask.  Went from success to failure with a few menu settings.  Basically the provider attempting to determine what model of brick to provide as they said I can't get an Auto CPAP, I would have to pay for it myself.

However, the doctor said if needed I could get a Bipap which may or may not be necessary, and how would they determine that without trying?

So, I have a couple questions. 

What difference does the "for Her" model actually have? I am male.
Would a Bipap also have standard and auto modes?
Should I interrupt the 2nd phase or at least talk to doctor about trying bipap?

I read the wiki and have to agree an auto machine is best for all cases and uses.  I see the prices appear nearly identical all else being equal.

[Mosquitobait]

The For Her model has 3 different modes - straight cpap and two variants of auto mode. Bilevel machines can be straight pressure or auto. I can't really recommend anything else because I don't know what is available in Canada! I hope a Canadian posts soon to help you.

[Gideon]

Download the Clinician manual for how to access ALL the settings.
Make sure you have an SD card installed (left side upper door)
Post your daily charts, they will really help us to help you. Most Doctors prescribe fixed pressure rather than auto. (typically we prefer Auto)

[Sleeprider]

Now entering the second phase, where the provider has programmed the unit for a fixed pressure, no Auto, no ramp, no EPR.  I don't seem to be responding well to these changes, I can't get thru the night without unconsciously removing the mask.  Went from success to failure with a few menu settings.  Basically the provider attempting to determine what model of brick to provide as they said I can't get an Auto CPAP, I would have to pay for it myself.

However, the doctor said if needed I could get a Bipap which may or may not be necessary, and how would they determine that without trying?

So, I have a couple questions. 

What difference does the "for Her" model actually have? I am male.
Would a Bipap also have standard and auto modes?
Should I interrupt the 2nd phase or at least talk to doctor about trying bipap?

I read the wiki and have to agree an auto machine is best for all cases and uses.  I see the prices appear nearly identical all else being equal.

Did it ever occur to anyone that if the provider simply dispensed machines and monitored, there would be no cost difference between auto and fixed? All of this "care management" costs more money.

The For Her manages flow limitation a bit differently. This image is the best explanation:




Bilevels (BiPAP or VPAP) come in both fixed models and auto models.  Fixed bilevel uses a fixed IPAP/EPAP all night, while auto bilevel can vary IPAP/EPAP based on events and sensors.  Resmed uses fixed pressure support on its Vauto, while Respironics uses a variable PS on its BiPAP auto.

I don't know what good it might do to interrupt your titration phase 2, other than to complain you are not comfortable and unable to tolerate the current "feel" of the CPAP. That might do more to move you along to bilevel than anything else.  Keep in mind fixed CPAP can use EPR. You should try to get the data off your machine so if you do get stuck with a brick later, you have at least that reference point in fine-tuning the fixed CPAP.  Also, The Resmed CPAP Elite and the Respironics CPAP Pro both provide full efficacy data.  If you can avoid the lowest version of CPAP (Resmed Airsense 10 CPAP, Dreamstation CPAP) you would at least have data.

[WakingDead]

Thanks for the responses. During the visit when the provider reset the unit to CPAP mode she erased the SD card so I can't retrieve that data.

I did download Sleepyhead and have data from the new settings. I suppose I could format a new SD card and do a test myself for one night to recreate that information.

At the moment I am at a fixed pressure of 19 which seems like being hooked to a Shop Vac in reverse.

[Sleeprider]

A fixed pressure of 19 will probably earn you a bilevel. It is a very difficult pressure to tolerate without EPAP pressure relief. Be sure to whine and complain. If the technician did not erase the machine data you will still have summary data from your auto CPAP with AHI data and pressure. Take a look in Sleepyhead. What will be missing is the detailed flow data. Also go into machine settings and change the Essentials from ON to PLUS. This will give you more detailed on-screen data.

[WakingDead]

UPDATE:

I went for a follow up visit after 30 days of fixed pressure at 19, and basically the results showed I tolerate very badly, around 2-2.5 hours before I subconsciously remove the mask. Only once did I exceed 4 hours of use, whereas with the variable setting previous I never had less than 6 hours.

However, the "vendor" said they don't issue variable machines and there was no indication a Bipap or other alternative was indicated, even before sending the 30-day results to the sleep doctor. She said they could send a letter to the sleep specialist Dr. requesting a prescription change to a lower pressure. I also called the Sleep Dr for an appointment and they declined!

Later, I received a call from the vendor stating they got permission to make changes to my prescription, and I should call for a visit or remote adjustment. I also got a call from the sleep specialist Dr. to call and make an appointment to visit.

At this point, I am unsure of my next move, but my gut feeling is that I am fucking livid that some vendor flunky can call and get approval to have my prescription change, while I was unable to talk to the doctor about it first. IS THIS medically ethical? I have concluded the "technician" wants to attempt to adapt my treatment to their sh**ty fixed pressure CPAP, by altering the treatment I require, as opposed to altering the machine to provide the best treatment.

At this point I would like any suggestions how to proceed, from those who have more experience. Some of the things \I am consider are..

- complaint to Medical review board about doctor modifying prescription without discussing with patient. (which would basically end my ability to see a sleep specialist)
- go all Erin Brockovich on the vendor and request FOI information on what the government pays them for services and equipment to determine whether they are bilking the taxpayer, in addition to finding the diagnostic guidelines used by the Dept. of Health to thereby question the efficacy of their policies.
- Import grey-market APAP machines and sell them for the same price as the local vendor charges for a mask. (I found a stack of NIB Dreamstation Autos for about $275 each)
- go rogue and simply buy my own machine.

Notice how my frustration is getting the better of me, is that a lack of sleep?

[Walla Walla]

Go rogue.

[Sleeprider]

There are vendors in Canada and of course Supplier #2. If I was being treated at fixed 19 cm pressure, I would sure be looking hard at an auto bilevel or at least the Airsense 10 Autoset which can give you variable pressure and 3 cm exhale pressure relief. Do you have any friends in the U.S. that could acquire the Autoset from Amazon, or maybe you can just contact the vendor and inquire about shipping to Canada. The prices are very good, so even if there is a shipping surcharge, you're ahead. About $519 USD for the AirSense S10 For Her with Heated Humidifier. You can use the Amazon "contact us" to inquire about shipping.

[pholynyk]

Walla Walla's suggestion sounds tongue-in-cheek - and it's actually the least trouble and most effective solution for your problem, even if it won't fix The System. Pick your battles after you have had enough sleep.