What brand of BiPap is best?

[mowork]

My husband just got the results of his titrated sleep study today.  We were informed he had both obstructive and central apneas. The doctor said the setting would be 12/5. The doctor prescribed a Bipap but the DME didn't have an appointment untill next Tuesday. We are new to all of this. Neither of us have even seen a Cpap. I have a couple of questions, I saw online that Medicare will pay for a Cpap but will they pay for a BiPap?  What are the best brands?  We know nothing about using, cleaning, etc.  I am sure the people at the DME will answer questions..can you suggest questions we should ask that might not be obvious to newbies?  Any other input would be appreciated. TIA

[Gideon]

With a lot of Centrals there is a decided preference for the ResMed ASV. This comes from users that have used both brands.

BiLevels (the non-brand specific name for a BiPAP) have several different models that target different conditions. If you could post a redacted copy of the sleep study we could give you much more specific advice.

I suspect that you will likely fail at using the biLevel that you may be getting,

[mowork]

Sorry we don't have a copy.. I got a copy of the 1st one but he was rushed today.  May I ask why you think he will fail?? because he hasn't had a Cpap before?  I am concerned about that and compliance but he is just so tired and sleepy all the time.  Stays in bed till 9 or 10..gets up and sits in recliner and is snoring in 15 mintues.  I told his heart dr and he did echo and stress test and those were fine and then heart dr sent him for sleep study.  Thx for your reply.

[DeepBreathing]

An ordinary bilevel machine is not the best for treating central apnea, that's why many patients "fail" with these machines if they have central apnea. (Personally I hate this terminology - it's not the patient who has "failed" it's the sleep doctor who has failed to prescribe the appropriate machine). As Bonjour said above, there are a number of different bilevel models, each optimised for different conditions. That's why it's important to get the study report and see what proportion of his apneas were central. If the central apnea index is over 5.0 then an ASV machine is probably the way to go.

There are two issues with ASV: 1) They can be expensive and your insurance company will make you jump through hoops to get one. 2) If you have severe heart failure the ASV can make things worse. It sounds like your husband's ticker is OK, so cost becomes the issue.

I am sure the people at the DME will answer questions.

I'm sure they will. Now, I'm not an American, so what I'm about to tell you is hearsay from this and other forums: A DME is in business to make money for its shareholders. It does not always make money by doing what is best for its clients. They will often try to palm off the cheapest machine which fits the prescription, even though there may be a more suitable machine available. For this reason you may need to go back to the doctor and get the prescription re-written to get exactly the machine you need.

But before you get to that point you do need to get hold of that sleep study report.

[OpalRose]

Hi mowork,
Before you visit the DME, arm yourself with as much information as possible.

http://www.apneaboard.com/wiki/index.php...re_success

http://www.apneaboard.com/wiki/index.php...with_a_DME

The above members have given you good advice on machine choices.  Talk to your doctor first and be sure the perscription is written for the machine you want.  Also get a copy of not only the sleep study, but the perscription too.

http://www.apneaboard.com/wiki/index.php...ne_Choices

[Gideon]

Sorry. It was not my intention to scare you.
Read this WIKI article I wrote
http://www.apneaboard.com/wiki/index.php...P_Machines
It says, not in these words. To first resolve the obstructive events and fail to resolve the Central apnea then you can get the right machine. That means to fail to treat your apnea.

Unfortunately this process can take about a year.

With the lowest machine that meets the RX is the "S" or spontaneous model. It is intended for patients who have failed CPAP and have obstructive apnea. It is not intended to treat Central apnea. We prefer the VAuto model in the role because it is more versatile.

With the machine that you are getting Central apnea is treated by avoiding it, low pressures and low pressure variance, the opposite of your prescription. This is why we would like to see a detailed copy of your full sleep studies. Charts and all.

The common road to ASV the only BiLevel listed as treating Central Apneas is to
Fail CPAP (you are skipping this step)
Fail BiLevel without backup ( the machine I believe you are getting)
Fail BiLevel with backup
Succeed with ASV

And by fail I do mean fail to adequately resolve your apnea.

[Sleeprider]

Mowork, if you are relying on Medicare to pay part of the cost of CPAP or BiPAP, they will cover 80% of the cost, and if you have supplemental insurance, part of your copay will also be covered by that insurance. There are several different types of machines. CPAP has a single continuous pressure, and this class of machine also includes auto-CPAP. These are coded for insurance coverage as HCCPS code E0601. Fortunately, you are bypassing this first level of machine.
Bilevel (BiPAP or VPAP) include all machines that provide separate pressures for inhale positive air pressure (IPAP) and exhale positive air pressure (EPAP). The difference between IPAP and EPAP is called pressure support (PS), so in your husbands case, at IPAP 12.0 and EPAP 5.0, the PS is 7.0. The thought behind this prescription is that when your husband has a central event, the pressure support may cause him to take a breath. The problem with that theory is that bilevel machines without a backup rate rely on spontaneous respiratory effort to trigger IPAP pressure, and a person having a central apnea makes no spontaneous effort to breathe. This is why your husband will fail at his first bilevel, regardless if it is a fixed pressure (S) or Auto bilevel with automatic adjusting pressures.

Bilevel machines include two major categories. The machine your husband will get is a simple bilevel without a backup rate (HCCPS code E0470). The most sophisticated machines cost more and are bilevel with a backup rate (HCCPS E0471). Insurance and Medicare always requires a patient to fail at E0470 before they they will reimburse for an E0471 machine. There is nothing we can do about this bureaucratic requirement designed to save money and ensure the extra costs are only applied to those with a medical need. That is why the best way to get your first machine is to rent it. That way, when your husband fails to achieve efficacy with the E0470 bilevel, you can return the machine and be issued an E0471, which is the one that will work on complex apnea.

You should immediately request copies of your husband's diagnostic and titration sleep tests. It would be helpful if you would post the test results to the forum with personal information redacted, so that we can help you prepare for what to expect from therapy. I suspect that your husband's best results were at 12/5 pressure, but that the results were probably not very good or that the range of pressures he tolerated during the test was very narrow.

Let me tell you what to expect when you get your first bilevel machine set to 12/5 pressure. Your husband may complain it is hard to breathe. If he manages to get to sleep and use the machine, he will likely record a very high apnea hypopnea rate (AHI). Those symptoms are typical of central apnea which the bilevel can not treat without a backup rate. It is important that he use to machine to demonstrate compliance, however he will need to immediately report his discomfort and AHI to the doctor, and continue to complain until the correct machine is finally issued. This will likely be a difficult period of therapy, but he is not the first one to have to deal with it. Be assured, that a better solution lies ahead, and he will ultimately be fully treated and comfortable once he is issued what we hope is a Resmed Aircurve 10 ASV machine. We have many members that use these, but getting authorized takes some time and effort. It's just best that you understand fully what is happening and why. It is very likely his doctor will anticipate this outcome and support you in moving to the ASV.

[Sleepster]

Hopefully your husband will find that he can tolerate the therapy well. Many people can't or won't use their machine and it ends up in their closet. The medical profession refers to this as a lack of compliance.

On the other hand, I've seen people report here on this forum that they wake up after the first night's use feeling refreshed and better than they have felt in years. One person reported that he came home from work, sat on the edge of his bed, strapped on the mask and turned on the CPAP machine, just to get a feel for how his first night would go. The next thing he could remember was being awakened a few hours later by his wife, asking him if he'd like to take his shoes off or perhaps have dinner!

Most of us are somewhere in between. It took me a few days before I started to notice an improvement on some rare days. But as the days and weeks went by the number of days when I felt better increased.

It's a weird thing to try to sleep with a mask on that's attached to a hose that's blowing air into your face. I had to remind myself over and over that without this therapy I was torturing my body as I slept. In addition to the damage to my cardiovascular system my untreated sleep apnea was impairing my ability to think clearly. It was also causing chronic headaches, anxiety, anger, and sexual dysfunction.

Humans are incredibly good at adapting. CPAP therapy now seems completely comfortable to me. Sure, it's a pain to deal with sometimes, but I just remind myself of how much better I'll sleep and how much better I'll feel, and hopefully how much longer I'll be able to enjoy a higher quality of life.

[mowork]

As I said above I do not have a copy of his sleep study. I will try to get one on Monday.  I am copying and pasting what notes were on his patient portal.  I know they are very limited.  My husband was referred to this sleep doctor by his cardiologist because of tiredness and complaining of little sleep.  His heart doctor did an Echo and stress test and ruled out heart issues before sending him for sleep study.  Any insight is appreciated. I know that I need the actual results and his prescription before we can make an informed decision on what Bipap/Bilevel machine to accept from DME.


"central and obstructive sleep apnea - The patient had undergone a polysomnogram on 3/26/19 and was found to have an apnea hypopnea index 65.2. The patient did have 52% central apneas and 48% obstructive apneas. The patient did return for a CPAP/BiPAP titration study. The patient began the study on CPAP at 4 cm of water and was also studied on CPAP at 5 cm of water. There were no obstructive events but marked central events did persist. The patient was subsequently placed on BiPAP in the spontaneous mode and was studied on BiPAP and 10/5 and 11/5. No obstructive events were noted but central apneas did persist. The patient was subsequently placed on BiPAP with a backup rate at 12/5 and a backup rate of 12 breaths per minute. The apnea-hypopnea index did fall to 7.8. The patient did reach REM sleep and did have 4 obstructive hypopneas. The patient's oxygenation was adequate on the BiPAP therapy. There were no significant arrhythmias or limb movements. The entire study was reviewed in detail with patient and his wife."  I will mention that doctor stated my husband had a long time before he went to sleep and only slept 153 minutes on the titration test. Of course, this was his first experience with a Cpap or BiPap.  On the first sleep test he slept 245 min but he did not have on any device.

[mowork]

As I said above I do not have a copy of his sleep study. I will try to get one on Monday.  I am copying and pasting what notes were on his patient portal.  I know they are very limited.  My husband was referred to this sleep doctor by his cardiologist because of tiredness and complaining of little sleep.  His heart doctor did an Echo and stress test and ruled out heart issues before sending him for sleep study.  Any insight is appreciated. I know that I need the actual results and his prescription before we can make an informed decision on what Bipap/Bilevel machine to accept from DME.


"central and obstructive sleep apnea - The patient had undergone a polysomnogram on 3/26/19 and was found to have an apnea hypopnea index 65.2. The patient did have 52% central apneas and 48% obstructive apneas. The patient did return for a CPAP/BiPAP titration study. The patient began the study on CPAP at 4 cm of water and was also studied on CPAP at 5 cm of water. There were no obstructive events but marked central events did persist. The patient was subsequently placed on BiPAP in the spontaneous mode and was studied on BiPAP and 10/5 and 11/5. No obstructive events were noted but central apneas did persist. The patient was subsequently placed on BiPAP with a backup rate at 12/5 and a backup rate of 12 breaths per minute. The apnea-hypopnea index did fall to 7.8. The patient did reach REM sleep and did have 4 obstructive hypopneas. The patient's oxygenation was adequate on the BiPAP therapy. There were no significant arrhythmias or limb movements. The entire study was reviewed in detail with patient and his wife."  I will mention that doctor stated my husband had a long time before he went to sleep and only slept 153 minutes on the titration test. Of course, this was his first experience with a Cpap or BiPap.  On the first sleep test he slept 245 min but he did not have on any device.