New bipap presciption

[Shamus54]

Well I turned 65 a few months back and went on Medicare... My sleep doctor/ent told me that he had to order another sleep study so that medicare would cover my DME and supplies. The sleep study was horrible but naturally confirmed my apnea problem, and my doctor prescibed bipap with settings of 21/15. I have never thought I had a problem with exhaling before, (and really still don't think so), and seem to sleep good using my cpap set at 17. My question is should I question getting a bipap, or just go with what was ordered for me? I have TFL as a secondary insurance, so I don't think I'm going to be billed a copay for anything...

[Sleeprider]

Shamus, your new bilevel machine can produce straight CPAP pressure, but most of us find the bilevel pressure more comfortable than straight CPAP when pressures get relatively high. In your case, the prescription is 21/15 which is a difference of 6 cm H2O pressure between IPAP and EPAP. This is a relatively high pressure support, and I can only speculate that your study showed that you needed an EPAP pressure of 15 to prevent obstructive apnea, but that the IPAP pressure of 21 showed greater effectiveness in reducing hypopnea, flow limitation and snoring.

The best way to know the rationale is to request a copy of your sleep study so you (or we) can see the results, and it is not unreasonable to ask your doctor why he thinks bilevel is your current solution. While a bilevel machine is more expensive, it is much more capable of treatment at higher pressure and targeting events other than obstructive apnea. In addition, it is generally more comfortable to have a higher inspiratory pressure and lower exhale pressure. I think you scored a good sleep study, but let us know if we can help you understand this better. Get a copy of the report.

[Shamus54]

I had to have my leaking mask tightened several times during the titration study, and I think that may be why an increased pressure was called for? I left a message for a call back from my doctor to find out, but haven't heard back yet...  I'll post when I see my study results!

[Shamus54]

My sleep doctor called me back this morning and explained the results of my new sleep study. The increase in pressure requirement may have been due to the environment I was in at the hospital, but he still thinks the bipap would be the right choice for a new machine because of the increased options and versatility... He told me that I can call him anytime I'm concerned about my needs and he would order any changes to my settings. So for now I'm gonna go with the 21/15 initial recommendation. We'll see what happens when I get the new bipap machine? Thanks for the input!

[Gideon]

I would specifically request the ResMed AirCurve 10 VAuto because of it's versatility despite the fact that he is requesting Manual mode.

CPAP choice to treat OSA, CA, obstructive or pulmonary restriction[edit]
The Auto CPAP such as the AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea
Just to clarify The VAUTO, ASV, S, and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between them to treat a single condition.
They should be chosen to treat the specific condition that the user has, Here are the various CPAP machines and what they are designed/intended to treat
This info is from the ResMed Sleep Lab Titration Guide

• CPAP (continuous positive airway pressure) Fixed pressure delivered with optional expiratory pressure relief (EPR). It Treats OSA
  

• AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA
  

• AutoSet for Her/APAP Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas along with an increased sensitivity to each flow-limited breath, providing a more comfortable therapy for women. Increases sensitivity to each flow-limited breath, providing a more comfortable therapy for women (OK for men too). It Treats OSA
  

• VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA
  

• S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD
  

• ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• PAC (Pressure Assist Control, also known as Pressure Control) The inspiration time is preset in the PAC mode; there is no spontaneous/flow cycling. Inspiration can be triggered by the patient when respiratory rate is above a preset value, or delivered at a set time at the backup rate. It Treats Neuromuscular disease (NMD), pediatric patients
  

[Shamus54]

Picked up my aircurve 10 Vauto yesterday from my DME supplier... After struggling a little to adjust my mask correctly, I settled into a decent nights sleep. Machine showed all smiles this morning... 

[Shamus54]

Five nights so far on my new Aircurve bipap, and it seems that my apneas are getting worse? Using myAir for the past two nights and my AHI went from a 2.8 to 18.0? I did notice more leakage last night which woke me several times... I'm thinking that I preferred my old S9 autoset instead of the bipap?

[ardenum]

It doesn't matter because the vauto can be settup exactly as your old s9, you just need to post what your setting were and a report from your 18 ahi night using OSCAR software, check Bonjour's signature for the necessary links and how to organise the charts, without data charts we can't help.

[Shamus54]

It doesn't matter because the vauto can be settup exactly as your old s9, you just need to post what your setting were and a report from your 18 ahi night using OSCAR software, check Bonjour's signature for the necessary links and how to organise the charts, without data charts we can't help.

Yeah I understand I can use the cpap mode, (but then why would I?) The aircurve costs 3 times that an airsense right? What I was saying is that I'm not even convinced that I needed a bipap in the first place...  LOL

[OpalRose]

Shamus54,
Give the good folks here a chance to help.

Download the OSCAR software, then follow the tutorials in mine or bonjour’s signature to post a chart here.

There are many knowledgeable folk here, especially when it comes to setting up bipaps that will look at your data and advise.