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Looking to get a biPAP. Is titration necessary?
#1
Looking to get a biPAP. Is titration necessary?
I was recommended by one of the members here to get a biPAP or a ResMed AirSense 10 Autoset. His name was Fred/Bonjour. Right now I'm using a PR Dreamstation 200x110. I've been using it for a bit more than 2 weeks, have not seen any improvement. Still need 12+ hours of sleep, wake tired, fatigued, concentration nonexistent, plus insomnia at night. The Nasonex I've been using to clear my nasal polyps, a $15 spray, has been more effective. 

Additional info: I've got primarily UARS, my p score was 14 or so, my sleep apnea score was 6. (pRDI and AHI or something). I've got severe allergies and so my septum was deviated and swollen, blocking my nose, but with nasonex mostly cleared. I've also got depression, anxiety, and ADHD which may partially be exacerbated by my UARS. 

I tried using OSCAR but was dismayed to find that I couldn't even retrieve any useful data from my machine, other than my hours of usage and pressure. It seems I really got a brick for my machine. So I've been looking to get a different machine. The doctor/DME must've given me a really cheap model, do they scam patients a lot in this line of work? 

Is there a general consensus or preference for ResMed devices over PR? Fred highly recommended it over my PR because it could mimic a biPAP and flow limits, is it true that it's a lot better for UARS?

Furthermore, my understanding from what the clinic told me is that to get a biPAP you first need an in lab sleep study and titration, is that true? Or can you just get one and set the pressure yourself?  He recommended a ResMed Aircurve 10 VAuto, any other biPAP suggestions? I'm seeing my doctor tomorrow so I'll ask further to see if I can get a biPAP or autoset.
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#2
RE: Looking to get a biPAP. Is titration necessary?
Trust Fred he is one of the most knowledgeable people on this site, I would take his opinion over 90% of the Drs out there.

See if you can return the dreamstation. I owned one for 5 years (a top model unlike the one you got) and I never got good therapy. Once I got a ResMed VAUTO my events went from 25 a night to less than 4. It was a night/day difference.

If you have a high deductible you can purchase from supplier # 2 on the suppliers list at the top of the site. I paid 799 total for one that had 1 month use. Great machine great company and service.
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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#3
RE: Looking to get a biPAP. Is titration necessary?
Welcome to the Apnea Board. I'm sure you will get the help you need here.
You have asked for some second opinions so I'll just be in the background for a bit.
Everyone note: The machine here is a brick thus no OSCAR charts.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Looking to get a biPAP. Is titration necessary?
Yes, I figured brick by lack of data and the low model number. I'd go for a ResMed, AirSense 10 AutoSet or AutoSet For Her if an Auto CPAP is good enough. If BPAP is needed go for the ResMed AirCurve 10 VAuto.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Looking to get a biPAP. Is titration necessary?
The best bet is the Aircurve 10 Vauto. You won't need a titration test because the machine offers complete therapy data and in your case, we will be focused on flow limitations from upper airway restrictions, and using pressure support (the difference between inhale and exhale pressure) to treat that problem. With upper airway restriction, inspiration is flow-limited, kind of like a hose with a kink in it. We can overcome that airway restriction by replacing your respiratory effort with pressure support that helps do part of the work during inhale, by raising pressure, then reducing that pressure as exhale begins. Most sleep studies focus on respiratory events like hypopnea and apnea, and don't really consider flow limitation. As a result, they are not very helpful for those that need bilevel.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Looking to get a biPAP. Is titration necessary?
Great, thanks a ton all. Very much appreciate it!
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#7
DME/Doctor unethical
I recall Fred warning me previously that DMEs, especially when directly connected to the doctor prescribing, are greedy for profits. I didn't think too much of it at the time but can see it now. I'm using a DreamStation 200x110 currently that has been utterly useless. According to OSCAR it is a brick - no data. It's probably the cheapest model there was. Virtually no capabilities - all it could tell me was my hours of usage and amount of pressure. 

So I pressed the doctor about the machine's uselessness today, told him I had contacted another doctor who had prescribed me a biPAP, so doctor 1 hurriedly swapped out my brick for an APAP that could collect more data and had a bipap mimicking function. So why not just give me the damn thing (the better APAP) in the first place?? My suspicions are to charge the insurance the max amount and spend the least possible for a brick. He also tried to persuade me out of the bipap. Doctor also gives me 4 tiny pieces of plastic, which are so small I assumed they'd be free. Puts one in my nose so there's no way I can return it with COVID going around. You could probably manufacture 50 of those tiny pieces for a buck. Not exaggerating either, found a pack of 10 online for 4 dollars. At leaving I'm told they're gonna cost me 30 dollars, and no, I cannot return them. 

I'm really thankful for this community. You guys probably saved me a lot of time and money. These "services" are seriously unethical, preying on people who are already in pain, probably have been for years or decades. Thanks to the great moderators too for the patience and OSCAR development.
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#8
RE: DME/Doctor unethical
I think you should have continued your thread on Which BiPAP to Get. Let me know if you want me to merge this. In that thread I made a post that showed the Airsense 10 Autoset has bilevel capability, but suggested that with your current pressure of 18, you could justify getting a true bilevel like the Aircurve 10 Vauto http://www.apneaboard.com/forums/Thread-...#pid369317

The doctor is doing exactly what I would expect in order to learn the nature of your problems with the Dreamstation 200 series and getting you on a machine with data. You did not say what that machine is, but I suspect it is the Resmed Airsense 10 Autoset. The first thing you should do when you get the machine is look at the run hours and see just how used it is. You sound properly skeptical about your doctor, so learn how to read the run hours in the settings. https://www.apneaboard.com/resmed-airsen...setup-info

In my opinion, if what I have assumed above is correct, you will have better and more comfortable therapy. Whether you need a true bilevel is an open question. let's give this a fair chance, but check the run - hours.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: DME/Doctor unethical
Ditto covers it all. I will add about the run hours check, do that before you sign.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: DME/Doctor unethical
Yeah sure merging will be fine. Thanks, I'll definitely check the run hours when I get it. It is the Resmed VAuto.
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