Which biPAP?

[HalfAsleep]

The sleep tech says I need a biPAP. He mentioned a lot of transitional centrals.

Do y'all have a preference for which biPAP to ask the doc to prescribe? I would assume Resmed, but there's a new Aircurve 11. Advantages over Aircurve 10? Likes and dislikes?

[Sleeprider]

For central apnea, the Resmed Aircurve 10 ASV is the best treatment, but if you're being prescribed  spontaneous bilevel therapy, the best choice is the Resmed Aircurve 10 Vauto.  It has the same "feel" as your Airsense 10 with EPR  because it uses the EasyBreathe algorithm, and it is the only one I know that has a trigger sensitivity setting that allows us to increase the sensitivity for triggering IPAP with less spontaneous inspiratory flow.  Many people with sleep onset centrals are still breathing, but very low flow. That low flow is detected by the Vauto with high or very-high trigger sensitivity and the device will trigger the IPAP pressure. This stimulates a spontaneous breath where a CA might otherwise be flagged.  We have treated many forum members with this feature, and it is very successful in mild to moderate CA and therapy onset CA.  It is not a substitute for ASV in cases of moderate to severe central apnea.  

We called for you to switch to ASV a long time ago, so if you can get the script for the Aircurve 10/11 ASV we can ensure you will resolve the central apnea and periodic breathing you have experienced, and will better tolerate more pressure support. https://www.apneaboard.com/forums/Thread...#pid236020 Your December 2017 sleep study shows significant central apnea, and you were uncomfortable on spontaneous BiPAP in a titration test at 12/8 pressure.
https://www.apneaboard.com/forums/Thread...#pid237711
https://www.apneaboard.com/forums/Thread...#pid238815

Your titration study shows that with BiPAP, you continue to have transitional central apnea, so that is NOT a solution. Also, your BiPAP titraiton was a mess and resulted in non-linear results making the efficacy questionable, even for the periods with no events.





I have no experience with the Aircurve 11 Vauto, but I assume the features and therapy are unchanged from the 10 series.  The pros and cons of the 11 series Autosets would be the same for the Aircurve. After reviewing your previous results and thread on the BPAP Titration Study, you need ASV, not the Vauto.

[SarcasticDave94]

ResMed 11 vs 10, only advantage I've heard of is a smaller machine. Disadvantages include based on smaller blower from the travel unit, more noise, possible less humidifier tub capacity.

I would still choose the 10 series if me.

As for the Central component, best answer is find out what it is. Is there a report to post? If there's a majority of CA in some idiopathic (unknown medical cause) form, then ASV is the CA machine of choice. It will eliminate CA and treat the rest.

If you're still on AutoSet for her, maybe getting the VAuto with timing controls is enough. It all comes down to the info involving the centrals, how many, where do they show.

[HalfAsleep]

So, I had a new sleep study last night. I don't yet have a report. The tech (way better than the last one I had a few years ago) did a diagnostic and then titrated CPAP and biPAP. (yep, all those in one night). He said the biPAP gave the best results.

However, he's not my (new) sleep doctor, so I have no formal input.... also, however, I trust his titration skill, and almost certainly his observation about the centrals will make it to my doc.

I'm not sure I could qualify for an ASV unless I "fail" biPAP, but, yes, we did conclude back in the day that I need an ASV.

So, partly I'm awaiting info, partly not expecting a rainbow just yet.

Also.... @sleeprider, the biPAP titration from a few years ago was mostly done while I was AWAKE.

[Sleeprider]

It showed abnormal responses so I almost would have guessed awake. Did they just fake the sleep stages? Anyway it makes sense to see the results ahead of your appointment. He shouldn’t just spring it on you for your appointment. You need to be prepared to discuss this intelligently. Too many times you have accepted solutions that don’t work. Be involved this time and let’s talk about the new study after you have results and before your appointment. You really need to insist on getting results beforehand so you can have a discussion, not a dictation.

[HalfAsleep]

Yes, @sleeprider, that's exactly my plan. I plan to see the actual sleep study, and then my pals at Apneaboard can go over it with a fine tooth comb.

In 2017 when I had the biPAP titration while I was awake, I had all your input to verify that what I noticed on the sleep report, was exactly correct.

They didn't fake the sleep stages. If you look at the chart ^^^, they did the titration with 2 out of 4 measurements while awake (0 at non-REM and REM). I wasn't barely awake, but in fact, WIDE awake, since they told me they were changing the pressure while I was talking to them). Titration #3 was at 20 minutes of sleep while I'm barely asleep (note lack of events) and got up to use the restroom, and #4 sometime later. Anyway, the 2017 titrated sleep study's end result showed EXACTLY the same data as the 2017 diagnostic study, same AHI, same distribution of event types, same 90-second hypopneas....all. As we pretty much agreed here, this was analogous to a null experiment.

I am at a different sleep center now, with a better reputation, new doc (in my 2017 situation I never in fact met with any M.D. sleep person, just a nurse for mask fitting), more on-the-ball tech. I feel more encouraged that I have a good sleep team. I feel okay with them prescribing a biPAP, arm myself with data from our discussions here, and then meeting with them for follow up and significant consultation. But, yes, I'd require the actual sleep study soon: I'm fairly confident I can get it from the doc. They might even be mandated to give it to me.

Right before the sleep study last night, the tech mentioned that I had to meet Medicare qualifications first (takes at least 2 hours of sleep). If I didn't meet those, they'd just let me sleep the rest of the night. If I met those, as I did, he could proceed with the CPAP titration. If he couldn't refine treatment using CPAP adjustments, then he could move to biPAP. I felt this was a very sensible process, and accelerated me through several steps that would otherwise have required 2 more sleep studies and a wait time to demonstrate need.

[Sleeprider]

Something you need to understand. You have more control over this process than you know. Authorization of bilevel therapy does not require a titration test...only the determination of your "treating physician" that CPAP is not tolerated or ineffective, and that bilevel therapy is "medically necessary". Your treating physician can be your primary health care provider, and a sleep specialist is only required to sign off on diagnostic sleep tests. No where in Medicare is a titration test required or even mentioned. You only have to demonstrate compliance and a therapy benefit as determined by your treating physician within 90 days of starting the therapy. All this nonsense you're going through can be avoided with a cooperative doctor. I discuss this in the "Dealing With A DME" wiki and you can get a real-life view of how this got another member bilevel therapy with no tests in Deborah K's thread here. It's a good read. https://www.apneaboard.com/forums/Thread...to-Bilevel

[HalfAsleep]

Thanks @sleeprider. I was actually required to take a sleep test because my last one was over 5 years ago with non-compliance since, so I wouldn't qualify for any equipment at this time via Medicare. My new doc asked me a hundred questions towards "medically necessary", and wrote them into my chart, so she has them at the ready. Documentation! She was already leaning to biPAP after looking at the old info. I am really okay with her requiring me to take a sleep test and a titration study, because I've never had a test that wasn't fraught (I had to be woken and moved in the middle of the night to a second bed during my diagnostic test.). I think it will be helpful to start anew with data numbers the sleep doc can build a case from to write her prescription. I just had nose surgery, too, so that's a factor in here.
But, no worries. I will feel no compunction at all about making adjustments after I get my hands on a new machine.

[Sleeprider]

Whatever you end up with will give us more options than the CPAP. To summarize all this, it seems ASV would be best followed by the Aircurve Vauto or ST. I'm not fond of the ST because of its square wave pressure deliver, but it has a backup rate.

[HalfAsleep]

Thanks @sleeprider. I'll post the findings.