Should I push Doc to order a Bipap machine?

[Greg.Ca]

The main reason I hate my current Auto Cpap Phillips respironics dream station was that I had a difficult time exhaling. The provider company that I got this from (Apria health care) just mailed all this stuff out in a box to my front door and it was only recently that I figured out how to get into the clinician settings to enable the Flex setting. Enabling this 'flex' feature made the machine more tolerable. Nobody in Apria health care was helpful at all. They barely spoke English and have refused to help.  I have the Cflex setting set to 3 which is the most relief so I can exhale easier. I was told that by enabling the AFlex setting would help even further?

Should I push my physician to order a true Bipap machine for me. Would I even enjoy it better? How much more relief would I get if I indeed get a true BiPap machine? Would there even be somebody to set it up? It appears that the Dream Station AutoBiPap is about 3-4 times more money. Is it worth it?  Thanks --Greg--

[Walla Walla]

Welcome to Apnea Board. Someone should be along to help you shortly.

[SarcasticDave94]

Welcome,

IMO the true BPAP can assist with further reduction on exhale pressure. The catch is with a setting you have listed as 12 likely would not be approved via your insurance as required. I think the pressure threshold is typically over 15 for consideration.

You may want to post Sleepyhead charts so knowledgeable guys n gals could suggest some optimized settings. That is all free.



PS I thought the same as you, it was hard to breathe out when I first started. My first CPAP was set to straight 18, no EPR etc. I failed it's compliance due to that in part, and in part because it was later revealed I have mixed apnea.

[Sleeprider]

With a CPAP pressure of 12 you don't fall into the kinds of pressure that would normally require a bilevel device. They are more expensive and the insurance is going to fight you to ensure it is "medically necessary" Making the patient cannot tolerate CPAP pressure argument is going to be really hard, and it's the only one you have since there is no qualifying medical condition.

My recommendation is to look into swapping your Philips Dreamstation Auto CPAP for a Resmed Airsense 10 Autoset. The Resmed is much more like a bilevel, although it is limited to 3-cm of pressure relief. The expiratory pressure relief (EPR) on the Resmed is a true bilevel implementation taht trigger inhale pressure and cycles exhale pressure based on your respiratory effort. The Philips only offers up to 2-cm of pressure relief and it triggers and cycles on a predictive algorithm that is flow-based. In other words the pressure relief is based on the expiratory flow rate you create, while the Resmed consistently provides the set amount of pressure relief.

You can try to get the bilevel, but it is a difficult matter to qualify for insurance. Read and understand Table 1 requirements for qualifying for an E0470 Bilevel device on page 4 of this link. https://www.cms.gov/Outreach-and-Educati...905064.pdf This is the criteria most insurance uses for obtaining a bilevel device.

[jaswilliams]

Maybe putting your machine into auto mode will help with a starting pressure of 8 that will make your initial pressure much lower and the machine will only go to the higher pressures when needed

[Mosquitobait]

You have an auto-machine and have a choice of using straight pressure (12) or auto pressure (say 6-13). If you want to continue with the 12, my suggestion is to use the ramp. If you normally fall asleep in 15 minutes, set it for 25-30. Another option is to set your pressure at 9 and get used to that, then up it to 9.5 after a few days, on up to 12.