When to go bi-level?

[PaulaO2]

Not that long ago, I was able to shift my max pressure down to 17. Now I hit that as my low and am back up to 20 for max. I don't sit there all night, but long enough in my opinion.

I've had several medication changes, one of which caused me to gain the weight I had lost. Now will be even harder to get it off and keep it that way. Oh well.

But how to justify getting one or if I even need one? Will I need another sleep test (shudder)? I still have Medicare and Medicaid. In a year, I'll be on my fiance's Blue Cross federal.(we had to put our wedding off)

[Sleeprider]

Justifying bilevel therapy is mostly just a matter of establishing discomfort or intolerance to high pressure (above 15 cm) required under CPAP, or some medical necessity (poor efficacy) for bilevel pressure. In your case, pressure is high enough that bilevel can probably be justified if you make the case that comfort is poor. I don't recall your charts, but if you tolerate pressure support, bilevel can be much easier to tolerate than CPAP. Your current machine uses EPR so you have a limited bilevel pressure available to you. With Medicare and Medicaid the medical necessity for CPAP or bilevel is established by your diagnostic sleep study that shows your untreated sleep apnea meets the criteria for therapy.

Nowhere does Medicare stipulate a titration sleep study, rather they require that the benefits of therapy be established by a face to face encounter with your doctor and that you meet minimum use requirement to establish compliance. In theory, you should be able to discuss your comfort and efficacy concerns for using CPAP and make a case for bilevel based on your high requirement for pressure and having your doctor prescribe the bilevel. You know the drill, it will be denied the first time, then approved after your doctor appeals. If you want us to take a look at current therapy charts we're here to help.

[PaulaO2]

My doc would agree to it. But I just got the A10 within the last year or so. I'd have to pay out of pocket.

AHI is still below 5 and nearly all of them below 4. But I'm hitting the 20 max. And we've played around with the idea here that a bilevel would help with the flow limits and my centrals.

I use the EPR at 2. I did an experiment a long time ago to see how I did with it on 1 and 3. I've slept since then and can't remember the results. May try it again. I have no difficulty breathing out, though.

[SarcasticDave94]

I don't know if it helps any, but I'm thinking the BPAP would afford higher Max IPAP up to 25 if that's something deemed necessary.