Apnea Board Forum - CPAP | Sleep Apnea
Are these flow limits my problem? - Printable Version

+- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums)
+-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area)
+--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum)
+--- Thread: Are these flow limits my problem? (/Thread-Are-these-flow-limits-my-problem)

Pages: 1 2 3 4 5 6 7 8 9

RE: Are these flow limits my problem? - PeaceLoveAndPizza - 12-07-2023

Not sure how Medicare handles it, though I’ll find out in six months…

Five years ago I had a similar challenge with my insurance. I had an APAP and even though my AHI was low my sleep was horrible. I showed the sleep doctor my OSCAR chart showing high flow limitations and arousals, then iced the cake with my Apple Watch data showing frequent wake-ups. He signed off and I got my bilevel. The script he wrote was for any CPAP machine, mask, and accessories, with the script good for 99 years (bonus points!).

What I learned since then is I can buy a gently used bilevel machine for less than my insurance would charge me. If I had known that I would have bought the bloody thing out of pocket at the start.

Maybe someone can chime in on how they managed it with Medicare.

RE: Are these flow limits my problem? - k888 - 12-11-2023

Greetings,
I have an appointment with my sleep doctor tomorrow and plan to ask for a Bipap.  I have relied heavily on the great info and advice in this forum.  I am pasting my basic argument below and would appreciate corrections if you have any.  Also, I am posting last night's chart.  I tested my most satisfactory settings with an EPR of 1 rather than the usual 3.  Flow limitations did get worse.  I did not like the feeling of breathing out, but luckily my nose was not at all stuffed up last night, and I was able to sleep.  Tired today.  Thanks for any advice you can offer, k888

[attachment=57062]
BI-LEVEL PAP MACHINE

I would like a prescription for a ResMed AirCurve 10 VAuto machine.  
My current CPAP machine is a ResMed AirSense 10 Autoset. I have learned to use it, found a workable mask, and overall adjusted to using a CPAP, but I believe I would get better apnea treatment from a machine offering higher pressure support that can be provided by a bi-level machine such as the AirCurve 10 Vauto.

I have mostly brought my AHI down to a good level (still having problems, but much better.)  There are nights where I can breathe in well but have more trouble breathing out, and this makes me feel claustrophobic, which I struggle against, fearing it will interfere with my use of the machine. Also, I am still sleepy during the day.  I pretty much have flow limitations all night, and I am VERY sleepy on the days that those flow numbers are higher (i.e., sleepy shortly after taking a nap or within an hour of getting up in the morning.)

I have tried to reduce flow limitations by increasing pressure, but:
  1. higher pressure has made little difference to flow limitations, and

  2. I can’t seem to move much above a pressure of 13.4 without creating uncomfortable aerophagia and repeated awakening.
By contrast, reducing or eliminating pressure support on my current machine worsens flow limits, but EPR can only go up to 3.  My understanding is that with a bilevel and its capacity to offer higher pressure support, I might 1) be able to tolerate higher pressures or 2) perhaps not even need higher pressures, meaning greater comfort and alertness.  As it stands now, I have to fight to stay focused on my tasks during the day.

I know the bi-level is more expensive, but I believe my insurance will cover it if you will prescribe it.  Medical issues include:
  • I have high blood pressure.

  • In September (2023) an abnormal lexiscan showed “moderate decrease in radioisotope uptake in the distal anterior and apical wall (of heart) that is reversible c/w ischemia,” and

  • I have a history of neck radiation (Hodgkins).  Studies show significant numbers of patients with neck radiation have sleep disordered breathing, both Upper Airway Resistance Syndrome and Obstructive Sleep Apnea.


RE: Are these flow limits my problem? - Sleeprider - 12-11-2023

Your case is set forth in your letter well, and you will certainly benefit from more pressure support, rather than just higher pressure. Be sure to show a closeup of your respiratory wave form to illustrate the extent of inspiratory flow limitation. I'm sure you saw Deborah K's thread where she made a similar request https://www.apneaboard.com/forums/Thread-Flow-Limits-How-to-Upgrade-CPAP-to-Bilevel We cover some of the insurance issues in that discussion.

RE: Are these flow limits my problem? - k888 - 12-11-2023

Thank you Sleeprider.  I will add that closeup view.  And yes, I was relying heavily on Deborah's very helpful thread.  k888

RE: Are these flow limits my problem? - Jay51 - 12-11-2023

Mentioning or showing the 260 tidal volume number in this OSCAR could help also.  This is below normal.  You can find online calculators that calculate normal tidal volume during sleep based on your height to compare it to also.  

Sleeprider knows how to get things done.  He helped Deborah get what she needed.  I hope you get this VAUTO also.

RE: Are these flow limits my problem? - k888 - 12-11-2023

Thank you Jay51.  I looked at my overview, and all the other nights appear to be pretty normal re tidal volume (to my limited knowledge.)  That OSCAR chart was my only night at EPR 1, maybe confirming that less pressure support is a bad thing?  k888

RE: Are these flow limits my problem? - Gideon - 12-11-2023

You asked about Medicare and a BiLevel.
My Story
My original Sleep study showed an AHI of mid-90s. Sorry, but that was a long time ago. I was prescribed a CPAP CPAP Brick at 19cmw. I didn't know it until- 5 years later that it couldn't deliver my prescribed pressure until it started squealing (Bearings going bad) and the DME said I needed to get a new CPAP. I asked for one that had data and they said flat no!!! I said goodbye and purchased an IntelliPAP AutoAdjust CPAP Machine with SmartFlexby DeVilbis from an online supplier. After some time on my own with this machine I found apnea board. Going forward I wasn't happy with my therapy so at the 10-year mark I approached my Sleep Doctor about getting a new machine. I presented therewith about 40 sheet showing mostly over 15 AHI with a lot of flow limitations while at "high" pressures over 15. The pack included 3 "good" nights because I didn't want her to think I was pulling one over on her. She bough it. I was verbal with the ream of charts to backup my words.
I was now eligible for Medicare but still on a good insurance plan. My Sleep doc said I needed a new Sleep Test (Medicare requirement and my last one was over 10 years old, BS but I was moving forward) and she compromised on a Split night study, first Diagnostic then BiLevel. Well THAT was my night from hell. I had, as expected, a very poor nights sleep only to be woken at 6am to go home with the news I didn't get enough sleep and they never got to the BiLevel "Trial". I was so tired I sat in my car trying to wake up enough to drive for three hours. She wanted the BiLevel Sleep Test. Well that I had a reasonable time in the future. The BiLevel test was horrible, It was obviously squarewave therapy and Despite easily handling everything my intellipap could throw at me it was rough. The Tech and the doctor both told me that. I stated that they needed to do the test with a more gradual transition between inhale and exhale and if needed I could learn to tolerate the squarewave therapy. I got my first VAuto and Medicare later covers everything with a "Supplement" Plan "G".

IMHO relate to the doctor WHY your current therapy therapy is not working and back it up with data.

RE: Are these flow limits my problem? - k888 - 12-12-2023

Gideon, you have had a long journey.  I am very fortunate to have found ApneaBoard, which has not only helped me with therapy options, but with the most basic understanding of sleep apnea and even how to change a control on the machine.  If the doc pushes for another sleep study today, I will resist and ask for a way to test at home.  The first sleep study they did went very badly (I hardly slept, created a nose sore), and I seriously doubt that another will be any different.  Wish me luck, k888

RE: Are these flow limits my problem? - k888 - 12-12-2023

Yippee!  I have my bipap prescription.  To my amazement, it turned out to be easy.  The Dr. read my letter, looked at my backup materials, and basically said OK, if it will make you more comfortable, let's try it.  Now we shall see about insurance, and the prescription does not call for a specific machine, so I will have to deal with the DME on that front.  Thank you all for your support, and especially Sleeprider for all the substantial information.  I am most appreciative, k888
Thanks

RE: Are these flow limits my problem? - Gideon - 12-12-2023

I suggest the ResMed VAuto
I suspect an initial Rx ofMode: VAuto, 4-25, PS=4 (4-25 are the min EPAP and max IPAP pressures of the VAuto

This is equivalent to a starting pressure of 8 on a APAP with an EPR=4