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[CPAP] Start with APAP or go directly to BIPAP?
Start with APAP or go directly to BIPAP?
Hi everyone Smile,

Need your advice with something. I suspect I have sleep apnea or UARS. I have had years of terrible sleep, depression, anxiety and feel like I am just never able to get a good night's sleep. Anyway, I have just completed a lab sleep study and am awaiting results for that.

I can see on this forum that the Resmed Airsense 10 Autoset for Her is the most recommended APAP and the Aircurve 10 series is the most recommended BIPAP.

Also, it looks like the normal course of treatment is that people try the APAP and if that doesn't work, they go on to the BIPAP like Aircurve 10 series. The BIPAP however can function as an APAP, CPAP, and in various other modes depending on the model.

My question is, in order to save the time required going back and forth to get prescriptions, titrations, waiting for the machines to be delivered, adjusting to the machine, and the money in case the APAP doesn't work, should I just directly go for the BIPAP machine to begin with? Since it can function as APAP, I can test that to begin with and then go on to the more advanced modes if necessary.

What do you all think?
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RE: Start with APAP or go directly to BIPAP?
IMHO, yes. Assuming you have uncomplicated OSA or UARS. Getting such a prescription can be problematic as that is not the norm.
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RE: Start with APAP or go directly to BIPAP?
IF you can get the Dr to prescribe it I think that is best the VAUTO is an excellent machine. Your insurance will not cover it if it is not prescribed.

Have the Dr to list it and put in dispense as ordered. That way they have to give you that model.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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RE: Start with APAP or go directly to BIPAP?
Welcome Salchicha  Smile

I see you are in Singapore, not sure of medical process there.

My own Aircurve 10 Vauto came from the USA but is actually manufactured in Singapore. Not sure of that will impact price for you.

Would you be prepared to wait for the sleep study results? Get the full detailed report, not the summary, redact it by removing personal info/data, and post the sleep study here. You will get some quick replies about the best course of action for you.

Moving up from AutoSet for Her to Vauto can be a bit daunting with the extra settings, but if you are up for it and have the resources it certainly wouldn't be a bad move. However if all you need is the AutoSet for Her, why waste the resources  Bigwink?

All the best.
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RE: Start with APAP or go directly to BIPAP?
Hi everyone, thanks for the input!

Gideon, what exactly do you mean by "uncomplicated" UARS or sleep apnea?

Will try to post the detailed report here. 

Feeling a bit worried as the sleep doctor mentioned that I am very low risk as I am not male, older, or with a high BMI and that I need insomnia therapy not treatment for sleep apnea. However, after observing myself for the past 25 years, I am sure I have sleep apnea, given the absolute inability to sleep restfully no matter what I try or how hard I exercise, jerking awake when my jaw/tongue relax.

Also I have been receiving treatment for depression and anxiety for many many years and have reached a point where there seems to be a huge missing piece and I don't seem to be making more progress.

 I guess the docs here aren't too well-informed. Wanted everyone's input about how I can go about advocating for myself if the AHI/RDI number comes too low. Here are some of the points I plan on bringing up if the doctor says I don't meet the threshold for sleep apnea:
  1. Women are more likely to have sleep apnea during REM sleep than NREM sleep.. Since REM sleep is on average about 20% of our sleep duration, this may mean women have less total number of apneas during the entire night (1)
  2. Additionally, women are less likely to terminate their sleep apnea with an awakening out of sleep. This means oxygen level drops that accompany sleep apnea may be less observed or less severe in women and therefore sleep apnea less appreciated in women (1)
  3. Women may have the classic symptoms of snoring, gasping or witness apneas, they are more likely to present with less classic symptoms such as insomnia, sleep fragmentation, depressed mood, fatigue or morning headaches. (1)
  4. In a recent study, severe daytime sleepiness (Epworth Sleepiness Scale [ESS] >= 16) was associated with the male gender. Female patients are less likely to present as sleepy so this diagnostic tool has to be used with a grain of salt. Due to this atypical clinical presentation, female patients may be misdiagnosed and treated for other diseases such as depression, insomnia and hypothyroidism. (2)
  5. Compared to male patients, female patients have shorted apneic episodes, and less severe oxygen desaturations. These may be missed by the 10 section threshold required for apneas, hypopneas and RERAS. However, despite less severe OSA in terms of AHI, female patients are not less symptomatic compared to males. (2)
  6. Physical examination of my tongue and the airway behind the tongue. Uvula is completely hidden and there is a very narrow airway even upright and awake.
  7. Bad sleep study - I was really stressed during the sleep study and uncomfortable with all the wires and felt like I was moving around too much and kind of holding my breath due to bad anxiety. Even though the sleep tech said they got the data required (I slept more than 4 hours), I am not sure how the stress of the study affects the results and if it needs to be repeated. 
Kindly let me know if there are any other limitations of polysomnography or any other way I can advocate for myself.


(1) From Jun 2021 Forbes article "Sleep Apnea in Women may be Undertreated"
(2) From journal article, "Evaluation of Obstructive Sleep Apnea in Female Patients in Primary Care: Time for Improvement?"
(Forum is not allowing me to post links as I am a new member.)
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RE: Start with APAP or go directly to BIPAP?
If all else fails, you could self-fund the AutoSet for Her and if this does not work out resell it and buy/acquire the Vauto later (if needed)

When I had my sleep study I commented that I found it weird that I had sleep apnea with a BMI of only 23. Essentially been skinny my whole life.

The sleep tech said they see a lot of OSA in lean Asian females because of different craniofacial morphology.

If you do an online search for something like sleep apnea in low BMI asian females you will find some data that might (might) impress your medical team, there does seem to be an anthropomorphic component.

for example here: link

I have a thin flexible neck and the that is why the neck collar helps me so much.

There is a difference in sleep apnea between male and female and that is the rationale for ResMed producing the For Her version.

Hoping you make some progress quickly!
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RE: Start with APAP or go directly to BIPAP?
By uncomplicated I mean without other issues, neuro muscular, or respiratory issues that CPAP can assist with who lch frequency means a timed assist or backup rate.

My wife was diagnosed and treated for depression, meds and all, and diagnosed with asthma. She had neither. She had a growth, not cancer, in her trachea that restricted her breathing. The immediate fix was a trach, followed by throat surgery. You do not have her problem ( she was told there were only 2 people in the world that had it, her response was now there are 3) but depression can be caused by restricted breathing.
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RE: Start with APAP or go directly to BIPAP?
This article in our wiki is very helpful in guiding you to understand the best approach to therapy for UARS http://www.apneaboard.com/wiki/index.php..._and_BiPAP Bilevel pressure is recommended to help make inspiration easier and to reduce flow limitation. A Resmed Airsense 10 or 11 Autoset CPAP has bilevel pressure capability with up to 3-cm difference between inhale (IPAP) and exhale pressure (EPAP). The Resmed Aircurve 10 Vauto is a true bilevel, and does not have that 3-cm limitation, and allows pressure support to be used in fine increments along with some other advanced capabilities. So you can get bilevel therapy on either the Resmed Autoset or the Vauto, but for a price, the Vauto has more capability.

I don't know anything about the health system in Singapore other than people seem to be well cared for. In the U.S. and many other countries, for someone with UARS or flow limitation without sleep apnea, it is unlikely that insurance will cover any machine as medically necessary, although there may be exceptions based on the "respiratory disturbance index" which relates to flow limitation. It is even more unlikely that bilevel will be prescribed unless the doctor really understands or specializes in UARS. If you want a bilevel machine, it is often best to plan on buying it with your personal funds and not bother with titration studies. A sleep study can be useful in establishing a baseline and better understanding of any sleep disordered breathing.

For your consideration, Supplier #2 (SecondWindCPAP) will sell a new Resmed Airsense 10 Autoset for Her or a refurbished, low-hours Resmed Aircurve 10 Vauto for $1279 USD. They will ship internationally at additional cost. That may be a good option if you find it difficult to source a device in Signapore. Finally, I recommend new users start with a nasal pillows mask interface. It is smaller, lighter and usually more effective and better tolerated than a full-face mask.
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RE: Start with APAP or go directly to BIPAP?
Hi everyone, thank you for the input. This is very helpful! Will try to get the full report.
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RE: Start with APAP or go directly to BIPAP?
Hi everyone, thanks for the help! I visited the doc yesterday and was told that my breathing was all good during the sleep study. (I was not provided the report or numbers as that's not really given out here). Thanks for all of your help. I definitely have sleep issues and for now I am putting the sleep apnea/UARS stuff at the back of my mind and continuing on making progress with mental health issues, slow as it may be!

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