Are these settings OK?

[Gideon]

we tend to suggest supplier#2 in our supplier list (see the black banner above). They even offer a warranty on used equipment, and they do stand behind it. Call them and ask how many hrs on the units they currently have. Some have very few hours.

[Sleeprider]

I buy off Craigslist and get information on use hours. I used my new to me Vauto last night for the first time. $150 + shipping, about 6300 hours, which is 11,100 fewer than my primary machine.

[BobbieM]

My latest problem. Apparently I need a prescription specifically for a bilevel machine. My current one is for a CPAP. My doctor wants another sleep study (which is expensive) before filling the bilevel subscription. I am trying to persuade the doctor that I don’t need a new study. Will keep you all posted.

[BobbieM]

I had a talk with my doctor with my doctor and he says the reason for the sleep study is so the sleep techs can supply the numbers for the titration on the prescription (he frankly admits he he relies on sleep techs to provide the numbers and has no particular expertise in bilevel sleep apnea machines). I plan to argue that he only needs to give the range for my bilevel therapy and that the standard numbers will do. What are your thoughts on the following:

Max IPAP 16
Min EPAP 4
PS 4

Also, do you need a prescription to buy off Craiglist?

[SarcasticDave94]

Craigslist being non medical, so no script there.

On the settings unless there's a particular need, I'd maybe do a Min of 6 as there is a trend to not have enough air into the mask at very low settings like 4. Wait for the board consensus but that's my take.

[BobbieM]

What about online retailers like supplier number 2. Would they need a prescription?

[Sleeprider]

I would counter that with the Resmed Aircurve 10 Vauto you will quickly self-titrate. We don't need no stinkin' techs, and it only increases the costs.  It's fine to evolve your titration in cooperation with your doctor, but it is your choice and not an insurance requirement that a titration occur.  Show your doctor this "plan" for your personal titration nd he may relent on this requirement. Let him know the alternative is not titration, but self-treatment.  This is the Resmed recommended clinical titration protocol. You would intend to apply it to optimize a a Vauto machine.  Your plan is to start with EPAP minimum pressure of 5.0 cm and maximum IPAP of 20.0 with PS 4.0 and observe the events that occur, then act in accordance with the titration protocol.  For obstructive apnea you will increase EPAP pressure. For hypopnea, flow limitation or RERA you will increase IPAP or more accurately pressure support on the Vauto.  This simple titration protocol will rapidly provide the titration without the costs, and you can collaborate with the doctor on your results. With the Vauto, the machine will make the pressure adjustments automatically rather than a technician. The graphs will allow you to determine what works and how to narrow the optimal range and adjust pressure support.

[SarcasticDave94]

I'm not exactly sure how it works at Supplier #2, but I think someone said they've got a script assistance section to help with that need.

[Sleeprider]

Supplier #2 will generally accept the prescription for your CPAP as sufficient for BiPAP, but would not do so for more advanced bilevel options like ST or ASV. We have had many members obtain a Vauto there without a specific prescription for bilevel, using their CPAP prescriptions.

[BobbieM]

IT WORKED!! My doctor accepted my argument and wrote me a prescription. He said I sound like I know what I was doing. I didn’t let on that I had a secret weapon: The Apnea Board. 

The only caveat is that I keep him informed of my settings and any changes that I make and that I keep a record. 

You guys are wonderful. I couldn’t have done it without your help and support. THANK YOU SO MUCH.