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What brand of BiPap is best?
#11
RE: What brand of BiPap is best?
Ask your doctor straight-up if he is aware of, and supports ASV therapy. Ask if he will support moving that direction if efficacy is not demonstrated on the BiPAP. It will be interesting to see what the prescription calls for in light of the notes you posted above. Modern AutoASV machines can provide adaptive pressure support and maintain the breathing rate. It sounds like they trialed an S/T BiPAP machine with pressures of 12/5 and backup rate of 12 breaths per minute. Not bad, but not the right solution either.

Let's consider a Resmed Aircurve 10 ASV, or Philips Dreamstation Auto SV machine, set to Auto mode with EPAP min 5.0, EPAP max 15.0, PS 3.0 to 15.0. With ASV, the machine will automatically increase EPAP to prevent obstructive apnea, or reduce pressure as necessary (compare to no adaptive pressure for ST). For central apnea, it will have up to 15 additional cm of pressure to add to cause a breath (compare to only 7 cm provided on every breath with ST). So when no apena takes place, his pressure may be a comfortable 8/5 pressure which supports normal respiration. When apnea or hypopnea occur, ASV will provide the amount of pressure needed, when it is needed to terminate the event. The ST cannot do that because it is the wrong solution. So the question ito your doctor is, Why is ASV not being tried now? The cost of ST and ASV is the same. There is absolutely no reason not to use the right machine! Ask the doctor, Why aren't you prescribing ASV. That is the answer we need to hear. If he doesn't believe in it, you need a different doctor. If he confides that he is required to try the ST or BiPAP first, then fine, but ultimately the ASV is what you need.
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#12
RE: What brand of BiPap is best?
Well, considering it looks like medicare will not pay for an ASV machine until he fails to improve using a Bilevel machine without a backup rate( HCCPS code E0470) first and prove it is not helping his situation.  Am I understanding this right and we need to complain to dr often so he can document this as well as he machine keeps data? So if he has to get a Bilevel with no backup..any suggestions as to best brand and model we should advocate for?  TIA
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