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How to get prescription for auto-BiPAP machine?
#1
Question 
Hi, I'm new to Apnea Board. I'm a skinny 32-year-old white male, and I've always been a light/nonrestorative sleeper. I have problems with both sleep quality and sleep maintenance. I wake up tired even after 7–8 hrs of sleep, wake up with headaches, have hypnagogic and hypnopompic hallucinations, and all that good stuff.

I've had two sleep doctors over the past three years (had to leave the first one due to moving across the country). We didn't really get anywhere with the first one. When I first met with my current doctor in October, she immediately suspected UARS and ordered a sleep study. The day finally came in December, and I slept a total of four hours. (Fun fact: They unintentionally had the thermostat set to 74 ºF, so it was too hot in the room overnight.) Of those four hours, only 15 minutes were REM sleep. I had no apneas or hypopneas, as expected. My RERA score was 1.92, but she said that this is not enough information to determine whether or not I had UARS, since UARS is worst in REM and I spent so little time in REM. Therefore, she is recommending a clean-living / good-sleep-hygiene approach for me. However, I'm worried that I might be having breathing problems overnight (i.e., UARS).

Is it reasonable for me to request a prescription for an Auto-BiPAP machine so I can try one out? I'm hoping to purchase one (e.g., PR DreamStation Auto BiPAP) out-of-pocket. While the initial cost is significant, it would be trivial in the long run if it could actually improve the quality of my sleep.

Alternatively, does anyone know a sleep doctor who might prescribe an Auto-BiPAP to me based on my history, so I could try it out? I feel like I would be foolish to give up on this possibility after one bad sleep study.
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#2
If you intend to purchase your own machine, then any doctor (primary care?) can write the needed prescription based on you health history and symptoms. Some doctors may be reluctant to write a prescription for PAP without confirming sleep studies, but in truth there is no difference between CPAP and bilevel PAP other than the pressure differential for IPAP/EPAP. In other words, this cannot hurt you, and might easily be a significant benefit. Persuading insurance to pay for it is another matter.

In addition to purchasing through online suppliers, you might also look at the resale market. Bilevel machines are readily available at significant discount on Craigslist. As long as you know what you are looking for, and practice safe purchasing methods, like meeting in public places it is a great way to get a machine less expensively.

If you want a prescription, do your homework so you are prepared to discuss what you want with your doctor, and why a bilevel machine can potentially address your needs. Read and understand the rather simple titration protocols so you can address how you will set pressure (self-titrate), and monitor your own progress. Any of your current or past doctors might be willing to write the script, so ask around. It is a prescription item, but it certainly isn't a restricted material or dangerous to your health.
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#3
I have heard that even a dentist can write the prescription.
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#4
Thanks, Sleeprider—lots of great info here!

(01-08-2017, 12:03 PM)Sleeprider Wrote: Read and understand the rather simple titration protocols so you can address how you will set pressure (self-titrate)...

If I get an *auto* bilevel machine for UARS, will I still need to set the pressure at all? Is the idea that one should home in on a specific setting/range over time, or can I just use it on auto indefinitely?
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#5
You still need to make settings that will guide the machine to provide the greatest comfort possible, while reducing RERA. Also, I would encourage you to consider the Philips Respironics 60 series or Dreamstation auto BiPAP because they allow variable pressure support, and report RERA. The Resmed Aircurve 10 does neither of those.

You will need to define a minimum EPAP pressure and pressure support that relieves your UARS. Without those settings the machine will simply blow air at a default pressure which may provide no benefit at all. Remember, that UARS may not provide the cues the machine relies on to make pressure changes that normally happen with an apnea patient. Since obstructive apnea is unlikely to be a problem for you, the minimum EPAP must provide a comfortable level of flow, and you want enough pressure support to improve your ventilation rate. In auto mode, you may want to start at EPAP 6.0 PS 4 -6 and IPAP max at 14. From there, you will just use trial and error to increase/decrease EPAP and pressure support. Higher pressure support will overcome upper airway resistance, but you don't want to over-ventilate to the point that you cause central apnea.
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#6
(01-09-2017, 01:58 PM)Sleeprider Wrote: I would encourage you to consider the Philips Respironics 60 series or Dreamstation auto BiPAP because they allow variable pressure support, and report RERA.

The Philips Respironics DreamStation [Auto] BiPAP it is!

(01-09-2017, 01:58 PM)Sleeprider Wrote: Remember, that UARS may not provide the cues the machine relies on to make pressure changes that normally happen with an apnea patient.

Excellent point. In that case, I wonder whether it would even be worth it to get the Auto BiPAP over the BiPAP Pro.

(01-09-2017, 01:58 PM)Sleeprider Wrote: Since obstructive apnea is unlikely to be a problem for you, the minimum EPAP must provide a comfortable level of flow, and you want enough pressure support to improve your ventilation rate. In auto mode, you may want to start at EPAP 6.0 PS 4 -6 and IPAP max at 14. From there, you will just use trial and error to increase/decrease EPAP and pressure support. Higher pressure support will overcome upper airway resistance, but you don't want to over-ventilate to the point that you cause central apnea.

Duly noted. Thanks so much! Smile
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#7
I like the BiPAP auto because the PS is variable. UARS is more related to hypopnea than apnea and changing pressure support is more valuable for hypopnea, and may help with UARS. That is kind of unexplored territory, but worth trying IMO. With the BiPAP pro, you will have a fixed EPAP and IPAP through the night. That might work well. The BiPAP auto I think makes it easier to narrow in on the settings you need and it certainly can do BiPAP S if you prefer it. The cost difference is not enough to justify not having the versatility.
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#8
Hi rbwilli,
WELCOME! to the forum.!
Good luck to you as you start your CPAP therapy and also with getting the machine you want.
trish6hundred
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#9
Hi there, welcome to the forum. Craigslist, Craigslist, Craigslist. Oh hey did I say Craigslist? The machine I bought was less than $300 and had 200 hours on it. They are literally everywhere, and people can't get rid of them fast enough. I had insurance and they wouldn't give me a BiPap just a standard and I hated it. these guys here sent me in the right direction, helped me set it up, and I've never looked back.
If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
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#10
Sleeprider:
Good to know regarding the variable pressure support! What's "BiPAP S"?

Galactus:
There's only one of the particular model I'm interested in on Craigslist right now, and it's 900 miles away. I'll keep checking periodically!

trish6hundred:
Thank you! This seems like a pretty great site and online community. Smile
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