[Treatment] Questions about my condition and equipment

[Jioaa1988]

Hello everyone, I am new here so please forgive me if I unintentionally do something wrong. I am a Severe OSA sufferer that is currently without a machine for therapy.

I have Severe OSA, according to a sleep study from last year, and from what I remember the DR said I was her worst case. I was prescribed a Resmed Aircurve 10 Bipap, and sent on my way with periodic follow ups. The doctor I had, in my eyes, was not very good. She was condescending if I ever had questions about my treatment and not sympathetic when I would tell her issues I would encounter using the BiPAP. My IPAP and EPAP settings were set to 15 and 10.

I lost my job last September 2016 and lost my insurance a month after, and for some reason Apria reset the cost of the BiPAP to own when the insurance informed them (it was a rent to own plan) which would have cost me $2500 out of pocket. I couldn't afford this and have gone without it. I have Kaiser Permanente (Southern California) insurance now, but apparently the plan I thought I had selected because it was good coverage, turns out doesn't cover DME expenses at all without a 3rd party (how it was explained to me). So now I am back where I started and have to buy a device out of pocket. To top it off the Kaiser sleep dept won't schedule me an appointment until I get my own device, because I provided the sleep study from last year from the other dr. They won't even meet with me to discuss issues I was having with the BiPAP.  :thinking-about:

That's why I'm here, I've read up on the differences of Bipap, Bipap ST, VPAP, ASV, and I'm even more confused than before! Hoping to get some answers here on an optimal device to purchase. One thing to note is I have unopened bags with replacement parts from my old ResMed AirCurve 10 Bipap, I have Climateline air tube, AirFit f10 mask (without head fitting straps), two replacement hard plastic mask parts (with rubbery outer seal) and some white filters for the Aircurve. Apria took my old mask, straps, and hose tubes when I had to return the old machine. I am leaning towards another AirCurve but I really want to avoid spending $2k+ for a new machine that will last me for the next decade or however long I need it. I am willing to try something from the previous models (S9, etc) if I can save a lot of money. I'm unemployed right now.  :(

First some issues I noticed: I would frequently wake up in the middle of the night or morning with my mask off. For some reason I was taking my mask off at night in my sleep, and my doctor at the time must have thought I was lying because she never told me why. A few times, I have woken up out of sleep and furiously pulled my mask off because I felt like I couldn't breathe, which scared me because I thought using the device was supposed to prevent that! I would pull it off and recover my breath, breathing hard, then reluctantly put the mask back on. I also had difficulty falling asleep using the BiPAP, unless I was very very tired. I could never fully relax because the machine would exhale before I'd naturally finish inhaling, and inhale before I naturally finished exhaling. I also can't yawn with it on, which is a habit I have before falling asleep. Also, almost every single night for the past two years I for some reason wake up sitting up on the edge of my bed (mask off when I had the BiPAP). Family have often seen me this way, woken me up and had me lay back down only to wake up like that again. My doctor again couldn't explain any of this, just saying it is a sign of advanced sleep apnea and often ASKING ME what I thought?! I came to her desperate for answers and always left with more questions. Also, I felt like I never had the quality of good sleep that I did the night of the sleep study, which really confuses me.

So.. Should I buy an older generation BiPAP or a current generation since I have some replacement parts (which I understand are pretty pricey without insurance)? Should I buy a regular BiPAP, a BiPAP ST, or ASV? I am trying to stay with either Respironics or Resmed because Kaiser says they only read info off of those two brands. I want something that will last a long time and if my condition worsens or I somehow develop CSA also, my machine can handle it without having to buy a whole new machine later. I'm leaning toward the BIPAP ST, for the spontaneous timed breaths, because I feel I wasn't getting enough air or maybe forgot to breathe with my old BIPAP? Only thing is I think AirCurve ST is around $2300, way out of my price range unfortunately. 

I am open to all suggestions, sorry for such a long post, I just wanted to include as much detail as possible for the best possible responses. I am still a newbie to all of this.. Thank you everyone and I'm glad I am not alone in all this! :cool:

[justMongo]

Since your sleep study showed obstructive apnea, an ASV machine should not be considered.  They are very expensive.
It's a very good idea to have a copy of your sleep study; and a copy of the prescription for your machine.
If you do not have these, you should make a request for them from your former sleep doctor.
Most legitimate seller's of machines will require a copy of your prescription.

I would suggest an Aircurve VPAP S or an Aircurve VPAP Vauto.
Supplier #2 has the Aircurve VPAP S for $1149.  They have the Aircurve VPAP Vauto for $1349.
Still expensive; but far less that Apria.  They have the AirCurve VPAP ST for $1649.
You'll need your prescription to buy from them.

You could drop back one generation to the ResMed S9. The filters are the same; and the data cards are read by the same software.
Supplier #2 has an S9 VPAP S for $589. Note that some of their machines come with a climateline hose. This machine does not; and they are not interchangeable between the S9 and 10 series.

There is no real evidence that you need a timed backup rate (ST) machine.

It's not uncommon for a person to remove their mask during the night.  Getting accustomed to having a mask on your face can be trying.
As for sleeping while sitting of the edge of the bed -- a guess would be that your apnea is positional.  Sitting up relieves your apnea.

Let's assume you had Aircurve VPAP S.  There is a setting called Timax that is normally set to 2 seconds.  If you try to inhale longer that Timax, the machine will switch pressure from IPAP to EPAP.  Most people don't need 2 seconds to inhale.  You may be a person who breathes slowly.

Your post was very informative; but the question of what machine was prescribed to you; and what your sleep report said leaves one to guess at what you would need now.

There are some gray-market sources for CPAP machines -- like Craigslist.  But, you take a chance on what you are getting.

See if you can get those documents.  BTW -- the life expectancy of a CPAP machine is around 5 years.  But, they can last longer.

Kind Regards,

Mongo

[Jioaa1988]

JustMongo thank you for your reply!! 

Thank you for all of the advice. I did some further reading about differences between BiPAP capabilities and learned that ST machines are the ones that have the set timed inhale and exhale pressures (meaning mine probably needed to be adjusted longer like you said, I do likely breathe slower) I could be wrong but I am thinking my previous machine was the ResMed Aircurve 10 ST, which also matches up with the price Apria was asking for me to pay out of pocket when my insurance ended if I wanted the machine. Apria wanted 2500, I think I've seen that model ST go for 2100+ from what I saw when browsing. 

Question: I have Kaiser and the prescription they gave me only lists a BiPAP. Nothing more than that, aside from IPAP/EPAP settings. It doesn't say BiPAP Auto, or BiPAP ST, just BiPAP. When I was looking at the differences between the current AirCurve models, I can say almost without a doubt that I had the ST. Would the prescription Kaiser gave me keep me from getting an ST machine?

Going to look into those machines you listed. Thank you again JustMongo.

[Jioaa1988]

One last question: Is it better to go with the VAuto vs the standard AirCurve 10 S for example? 

Supplier #2 that you listed is amazing, I did not expect to find a vendor like them. Great prices. Thank you again.

[Jioaa1988]

Sorry JustMongo I just re-read your post. You did provide an example of the TiControl that determines when the machine inhales/exhales. Is this not the same thing as ST? The only reason I keep leaning toward ST was because I had those episodes of waking up and pulling the mask off followed by breathing hard. I was thinking maybe I was forgetting to breathe and the timed breaths could alleviate that. I know I am saying a lot here and I know this isn't the place for a diagnosis but just advice.. Thanks.

[justMongo]

Terminiology.  Generically a BiPAP is Phillips-Respironics tradename for a bilevel machine.
                     VPAP is ResMeds Trade name for a bilevel.
                     and bilevel is a generic name for such machines.

An Rx is is usually written as "bilevel, IPAP 15, EPAP 10".

For an ST, a backup rate is specified.  ST machines switch to IPAP at a timed rate if you do not inhale soon enough.
They are usually only provided to try to treat someone who also has central apnea -- although the ASV machines are the gold standard for mixed or central apnea.

You described a condition where it switched from IPAP to EPAP too soon; and this timing parameter, Timax, is available on the VPAP S and the VPAP Auto.
Timax means Maximum Time at IPAP before forcing a switch to EPAP.

edit: No, the Timax is not the same as an ST. If you truely need an ST, only the ST will force a switch to IPAP at a backup rate.
Although, if you are failing to breathe, the ASV is THE machine. It follows your breathing on a breath by breath basis; and puts in a pressure pulse to ventilate you should you not initiate a breath. The ASVs are really expensive. Insurance companies often require a person to fail therapy on several machines before agreeing to the price of an ASV.
The only way to tell if a 10 series ReesMed machine is an ST is the writing on the lower left of the machine. It would say

AirCurve 10
st



Yes, the Vauto is more flexible.  It can run as a straight CPAP, or a bilevel S mode, or a variable pressure bilevel.

Your Kaiser Rx should be acceptable for the VPAP Auto or VPAP S.

I bought my S9 VPAP Auto from Supplier #2 with a prescription written for a bilevel.  My original DME filled that Rx with an S8 VPAP S.

Given your present RX, if you order the VPAP Auto, they will set it to S mode and set IPAP=15 and EPAP=10.
You can switch to Auto at your discretion.

[trish6hundred]

Hi Jioaa1988,
WELCOME! to the forum.!
Hopefully, you can find the machine you want at a good price.
I wish you good luck and look forward to hearing your progress, hang in there for more responses to your questions.