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Need to convince my Dr to prescribe an Auto BiPAP
#1
Need to convince my Dr to prescribe an Auto BiPAP
Hello everyone, this is my first post and I'd like to thank you for a fantastic & helpful forum!

For my question, please note that:

  1. I'm NOT in the US or UK, and insurance rules where I live are more relaxed than what I read about in the US or UK
  2. My sleep Dr prescribes only Philips Dreamstation machines
So after decades of unexplained day tiredness, I finally got referred to a sleep Dr. Dr asks for a sleep study, I did the study and when they put me on the PAP machine for the last part of the study, I woke up feeling like I haven't felt in ages: AMAZING! I will see the Dr in a few days for the results. I want to get ready for the appointment, so here I am asking for your advice and help.

From reading the forums and doing research, it seems that an Auto BiPAP machine is what provides most options, potential for comfort and future adjustability. I also understand that most Drs will prescribe CPAP first before moving to BiPAP. I chatted informally with my Dr's staff & machine supplier and it seems that indeed my Dr usually starts first time users with CPAP.

Now, I believe I suffered enough for long enough and if there is anything I can do to end the suffering faster I'll do it. So instead of doing the dance of cpap->Dr->bipap->Dr etc etc taking months, I want to try to convince my Dr to prescribe an Auto BiPAP from the get go!

I need your help coming up with reasons to convince my Dr. I compiled a list but would appreciate any advise:
  • During the sleep study exhale was difficult -> I need the difference between IPAP & EPAP
  • Flex on CPAP offers a max of 3cm difference, BiPAP can go up to 8cm difference
  • During sleep study I couldn't sleep on my back so the prescribed pressure might not be high enough in real life -> I need Auto
I know my insurance will cover an Auto BiPAP if the Dr pushes for it, and the Dr just needs to justify it to the insurance company. Any tips? Advise? I need to try and get nightmare over with as soon as I possibly can.

Thanks!
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#2
RE: Need to convince my Dr to prescribe an Auto BiPAP
Oh, one more piece of info: I chatted with the sleep tech after my study and she told me my pressure would be 9. She also told me I didn't have central or obstructive apneas, just shallow breathing? hypopneas? She also told me my O2 got down to only 90%. This is all just informal chat, I'm yet to get the official report. I thought maybe any of this info might help with my OP question?
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#3
RE: Need to convince my Dr to prescribe an Auto BiPAP
If you want BPAP and believe you can get it go for it. Over here in the US we start pushing for BPAP if running higher pressures OR if the patient exhibits traits that BPAP over CPAP is more comfortable. I say you'd fall into more comfortable on BPAP within descriptions in your own post.

I'm going to suggest you get this PAP as I give the name in full and do not accept any other variant unless our discussion here leads us to agree a different machine is necessary. I want you to focus on obtaining the ResMed AirCurve 10 VAuto.

Welcome to the forum BTW.

PS shallow breathing may be helped some on BPAP, so another check for saying yes. This VAuto has time controls for breathing and has PS or pressure support. It's not a ventilator but the settings can be edited to favor making breathing easier to a degree. Not nearly as much as an actual Ventilator/NIV but it'll be helpful. Hypopnea is a half strength apnea basically.
Dave

OSCAR
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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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#4
RE: Need to convince my Dr to prescribe an Auto BiPAP
The only reason to deny bilevel therapy is if insurance has to pay for it. The best bilevel machine on the market is the Resmed Aircurve 10 Vauto. Supplier #2 ships internationally and is worth looking at to see if it saves you some money. Bilevel not only treats obstructive sleep apnea by holding the airway patent with positive air pressure, but it allows more comfort by allowing for lower exhale pressure. This bilevel pressure can directly treat flow limitation, hypopnea and other breathing disturbances that can contribute to respiratory effort related arousals (RERA), which may be responsible for your lack of satisfactory therapy in the past.

You can discuss your past therapy and comfort issues with the doctor, with a request to try an auto-bielvel, specifically the Aircurve 10 Vauto. For someone with a titrated pressure of 9.0, a typical bilevel setting will be:
Mode Vauto
EPAP min: 7.0
PS: 4.0
Maximum pressure: 16.0

This will result in a pressure range of 11/7 to 16/12 (IPAP/EPAP), and you have the choice to try lower initial pressure settings. The pressure support (difference between inhale and exhale pressure) actually assists the inspiratory effort and can be very comfortable. You can become very educated about bilevel therapy by reading sections of the Resmed Clinical Titration Protocol related to CPAP and VPAP in this link. https://www.resmed.com/us/dam/documents/...er_eng.pdf

If you are self-funding, the choice is yours. Anyone with a CPAP prescription can generally buy a VPAP with that prescription. I know Supplier #2 allows it. Convincing your doctor is more a matter of letting him know this is your preference based on past CPAP results and demonstrating you are informed of the differences.
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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#5
RE: Need to convince my Dr to prescribe an Auto BiPAP
MADAwake, one last thought. The Resmed Airsense 10 Autoset provides up to 3 cm of pressure support in an identical way to the Vauto, using EPR (exhale pressure relief). There is no comparison of the Autoset to your old Respironics CPAP, and you can have comfort and save some money. For example in Autoset mode you can set minimum pressure to 9.0, maximum pressure to 16.0 with EPR 3, and get bilevel pressure in a range of 9/6 to 16/13. I doubt you would know the difference.
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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#6
RE: Need to convince my Dr to prescribe an Auto BiPAP
Sleeprider's got an excellent point. The AutoSet is disguised as a CPAP but it's a BPAP. It'll do about everything a VAuto does but the PS it's called EPR limited to 3 instead of 10. I'm certain you'll not be needing PS of 10. AND it'll be less expensive.
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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#7
RE: Need to convince my Dr to prescribe an Auto BiPAP
(12-15-2020, 08:00 AM)SarcasticDave94 Wrote: PS shallow breathing may be helped some on BPAP, so another check for saying yes. This VAuto has time controls for breathing and has PS or pressure support. It's not a ventilator but the settings can be edited to favor making breathing easier to a degree. Not nearly as much as an actual Ventilator/NIV but it'll be helpful. Hypopnea is a half strength apnea basically.

Thank you @SarcasticDave. Your above point is interesting and I missed it from my initial list. So this "shallow breathing" while asleep is a good, independent, justification for asking for BiPAP instead of CPAP? Did I understand you correctly?
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#8
RE: Need to convince my Dr to prescribe an Auto BiPAP
Yep you did. But I've changed to suggesting getting an AutoSet instead of VAuto BPAP.
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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#9
RE: Need to convince my Dr to prescribe an Auto BiPAP
(12-15-2020, 11:32 AM)SarcasticDave94 Wrote: Sleeprider's got an excellent point. The AutoSet is disguised as a CPAP but it's a BPAP. It'll do about everything a VAuto does but the PS it's called EPR limited to 3 instead of 10. I'm certain you'll not be needing PS of 10. AND it'll be less expensive.

@Sleeprider: thanks for your reply. Unfortunately my doc will only prescribe Philips DreamStation machines since that's what they have at the hospital and the insurance will only cover these. So basically I'm stuck with Phillips.

I know I can get any machine if I pay out of pocket, but since this will be my first-ever PAP treatment, I want to find a way to convince the doc to make insurance cover a BiPAP.
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#10
RE: Need to convince my Dr to prescribe an Auto BiPAP
I feel bad for you. Philips is a lesser machine and you'll never know great therapy until you get ResMed.
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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