Had my titration last night.  Definitely a weird experience.  The Sleep Tech said she described it as sleeping with your head out a car window.   Pretty true to what I was feeling.  I ended up using a full-face mask.  My pressure (she said) was 15 over 11 on a Bi-PAP machine.  Is that high?

The worst part (by far) was the dry mouth. It woke me up once (she forgot to turn on the humidifier heater).  I later complained again and she set it from 2 to 1.  She turned the heat down.  I didn't find this out til morning.  I think she equated hotter air with more drying, but I don't think she understood that warm air can hold more moisture. That's kind of the point of heating it I think.  I'm hoping that the dry mouth won't be a problem once I get my own machine.

Based on what I've heard BiPAP is more expensive so I kinda hope I don't have to have one (due to the $$).  It was weird breathing against different pressures anyway.

So this morning I feel pretty good but a little, um, dizzy almost?  Just slightly.  Like I need to go stretch for a while.  She said it might be REM Rebound (whatever that is)

So now I'm one step closer...

--Matt

Oh wow! She put you on a bi-level your first titration? You're right. Bi-levelS are CONSIDERABLY more expensive than CPAP or an autoPAP!

I was on a Resmed S8 Elite to start with (for 13 months to complete the capped rental agreement). I got "caught up" in the AutoPAP advocacy in the apnea forums and bought a Resmed S8 AutoSet Vantage out of pocket so I would have a back up machine but only used it for travel so my compliance stayed up until my capped rental was completed. I did quite well w/the Elite and the Vantage and LOVE them both. But I have COPD and after watching my data all that while and feeling better but still not sleeping all that well and reading the forums I realized that I probably could do even better and made an appointment w/my sleep doctor again. He suggested a bi-level titration due to the COPD and I agreed. The evaluation and titration indicated that I "would" do better on a bi-level and I insisted on the new Resmed S8 VPAP Auto Bi-Level. (I had been given a Respironics pre-M Series Plus as my very first CPAP when I had INSISTED that I would NOT accept anything LESS than a fully data capable CPAP and we had agreed on a Respironics M Series Pro w/C-Flex and returned the Plus immediately so all involved were very much aware I would NOT accept less than what I wanted - and my insurance DID allow me the option of 3 different local DME suppliers to "haggle" with). Given my prior "history of refusal" I had no hassle getting the new Resmed S8 VPAP Auto Bi-Level.

By this time I was aware of the poor design of the Respironics M Series integrated humidifier, the irritating blue lights, the occasional dropping of data sometimes twice a month, the 3rd piece power brick, the extra cords, etc. w/the M Series and so had also agreed that IF they could get the Respironics PRE-M SERIES Auto Bi-Level w/Bi-Flex I "would" accept it instead of the Resmed VPAP Auto but evidently they either couldn't get one or they didn't want to take any chances on not giving me my first choice. Whatever their reasoning I was provided w/the VPAP Auto and am delighted w/it! I kid you not, the minute I put that mask on my face the breathing is SO EASY and the VPAP so quiet I can't tell the machine is running - at least not until I pull the mask away from my face to check!! I don't know if is the new Resmed EasyBreathe technology or whether I would do just as well on any bi-level but I sure do love this VPAP Auto.

Oh there are a few things I like less about it than the Elite and Vantage. For one you can turn off SmartStop but not SmartStart. I hate both features. I don't like the device starting until I have my mask loosely on my face as it seems I put the mask on and I immediately get a nose tickle and I don't like the delay w/the SmartStop. Its habit to just reach over and turn the device off before I take my mask off. And I have never but once taken my mask off unintentionally or unknowingly. Plus there is a lot of extra data w/the VPAP that I don't quite understand that I have to go thru until I get to my nightly AHI, etc. (But I'll figure that data out too given time). Plus this new VPAP Auto required the newer ResScan 3.4 software so I had to upgrade to it and I liked the older AutoScan 5.7 software better. But then I never do like learning new software!!!!

Despite COPD being one of the indications for the need for bi-level therapy most insurances insist that one must "fail" CPAP therapy before they will pay for a bi-level. Often CPAP or autoPAP therapy won't work well for Central Sleep Apnea or Complex Sleep Apnea and the more intricate bi-level SV or Ts are needed. UARS often requires a bi-level.

My insurance paid about $975 for just my Elite. It looks like they are going to be paying about $2400 or so for this VPAP Auto which means buying a backup/travel bi-level is sure out of the range of "my" pocketbook!!! So much for that lovely convenience! *sigh*


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

There was a cancellation today and I got to meet with the Sleep Dr.  regarding my titration.  She is insisting on BiPAP instead of CPAP.  She said that I responded really well to the treatment (An AHI of .99 (less than one) even during REM).

I really would rather try CPAP due to the cost but, as I said, she insisted even after I asked twice.  She assured me that the sleep study results confirmed my need for BiPAP.

Anyway, she gave me a copy of the prescription. It says:

BiPAP at 15/11
ResMed Unit w/ EPR and integrated humidifier
downloadable compliance & efficacy & (something I cant read, looks like osape or uscpe ??) data.
Choice of FM (used FFM (M))

So I'm guessing I need to insist on ResMed VPAP Auto?  Is that the one you would recommend (ChronieToo)?

--Matt

Congratulations, Mundele!!! She sure sounds like a good sleep doc. And the script is a pretty darn good one.

That would be Usage that you couldn't read on the script.

Yep, the one you want is the same one I have, the Resmed VPAP Auto AND the Humidaire 3i integrated humidifier. Take a look at some pictures of the Resmed S8 Elite, Resmed S8 AutoSet Vantage. All the Resmed S8s look alike. Altho this new Resmed VPAP Auto isn't referred to by Resmed as the "Resmed S8 VPAP Auto Bi-Level" that does help to differentiate it from the other Resmed VPAPs, such as the Adapt or the Malibu. BUT the Adapt and Malibu are in the S7 or S6 "bodies" and they use the Humidaire 2i integrated humidifier is how you will be able to tell the difference.

And keep in mind, when paying out of pocket you should NOT have to pay the "billed" amount to insurance companies. There is a "billed" amount, an "allowed" or contracted amount which is the amount which insurance and copay ACTUALLY pay for the device. Unfortunately, that is JUST for the bi-level. The integrated humidifier and mask, etc. are extras (the carrying case is included in the price).

You should find that you do love this Resmed VPAP Auto! It is so easy to breathe w/it!!! Keep us informed! Don't let the DME give you the Malibu or the Adapt.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

Visited the DME and they gave me the Resmed VPAP Auto. I ended up with a resmed quattro full face mask also.  I think it'll work out ok.  Hopefully it's a good night...

--Matt

All, I know this thread is a bit stale, but I have a question that directly relates here.

We have the wonderful recommendations for prescriptions, but I wonder if anyone has a similar recommendation for an ASV (adaptive servo ventilation) device.

Without going into all the gory detail, I recently had a sleep study done, and I showed central apneas, obstructive apneas, mixed apneas, and hypopneas. To me that sounds like a good candidate for an ASV system.

From the searching I have done, it looks like two possibilities may be the ResMed VPAP Adapt SV, and the Respironics BiPAP autoSV. I do have good insurance, and I know that the insurance company may resist me getting a top-of-the-line machine from the first, but I figure that I may as well "go for the gold".

Your thoughts are much appreciated.

Waylon

Just had my first sleep study last night.  I have to say I was a bit nervous that it would be a waste, they wouldn't find anything because I wouldn't sleep or something.  Turns out I did sleep for 4 hours, once on my side, but it was characterized by alot of frequent stage shifts.
I felt really foggy and wiped out, like I had only slept 20 minutes.  I though when I saw the time on my cell, that Verizon was screwed up, LOL.  

Any how, called the physician who is in the sleep lab during the day b/c I wanted to see how long I slept and how many Apneas I had.  He told me my scores were so erradic, they were scored right away.  I think he said I had nearly over 100 apneas and that the only good thing is my O2sat did not go below 80 although it did stay around 82 for quite a while.  I do not have the scores yet, but long short of it, I will be going for my CPAP titration in 3 weeks.  

I will let you all know when I get the scores, but it does not sound good at all, in deed.

Noah

Noah,

Good luck on your CPAP titration study.  And yes, I hope you'll be able to obtain a copy of your sleep study report.  Sure, there are folks who have had much lower blood oxygen levels, but it's all relative.  How long you stop breathing, your AHI, how long you've had this condition, your overall health .... all factor into how bad it is.  Blood oxygen levels in the 80's is not normal.... there could be worse, but it's still not good.  So I'm glad you're going for the titration.



Waylon,

If I were you, I'd want to know the numbers and percentages of centrals and obstructive apneas.  If centrals are a very small percentage, then the ASV might be necessary.  Be sure to ask a lot of questions of your doctor.  If it's a significant number of centrals, then the doc writing a prescription for the ASV should mean that machine is covered by your insurance.  I work in the office of a sleep lab, and the medical director, a pulmonologist ordered an ASV for a patient (after he'd tried another type) and I understand he's doing much better.  But that's the only person I've known who got it.  Good luck in getting a machine.



Linda

W Smithers wrote:

All, I know this thread is a bit stale, but I have a question that directly relates here.

We have the wonderful recommendations for prescriptions, but I wonder if anyone has a similar recommendation for an ASV (adaptive servo ventilation) device.

Without going into all the gory detail, I recently had a sleep study done, and I showed central apneas, obstructive apneas, mixed apneas, and hypopneas. To me that sounds like a good candidate for an ASV system.

From the searching I have done, it looks like two possibilities may be the ResMed VPAP Adapt SV, and the Respironics BiPAP autoSV. I do have good insurance, and I know that the insurance company may resist me getting a top-of-the-line machine from the first, but I figure that I may as well "go for the gold".

Your thoughts are much appreciated.

Waylon

Waylon, it is up to your sleep doctor which device he will order but most certainly you should have some input on your results BEFORE you ACCEPT any device. If you haven't been scheduled for a consult w/the sleep doctor I would call the lab and request an appointment w/him to discuss your results AND which device he is intending to order and let them know that you will want to come to a MUTUAL AGREEMENT w/him/her on what is ordered.

If you receive a call from a local DME supplier to deliver or have you come pick up your equipment, ask them what device they will be providing and if it isn't what you want to accept just tell them you will not accept any equipment until you've had the opportunity to consult w/the doctor.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

I forgot to mention that when I called, the doc asked me if I wanted to come back that night for my titration as there was a cancellation, to which I replied "HELL NO!!"  I really needed to get what sleep I could in my own bed.  I might have reconsidered if I could have brought one of my labs in with me.  I am scheduled as I said for 3 weeks.  They want you to simulate a home environment as much as possible (hence bringing your own pillow), but they will not let me bring in the 70# lab that sleeps with me.  Sure hope that the CPAP won't scare her away.

Probably won't scare her unless she's the timid sort. More likely she might want to examine it, play w/it, get it off your face, give it a few paw pokes .....


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

I actually have a co-worker on CPAP and she has dogs.  She wraps a thin micro-fleece layer around her tubing and this not only deters the dogs, but also is not abrasive if the tubing rubs against her.

I think Dixie (my lab) will be more concerned than anything.  Gotta love labs.

   I am starting to get ticked that I have not received my scores yet despite being scheduled for a titration and told how shocking my scores were.  Actually emailed my doc yesterday and told him that I have been up all night with insomnia due to the anxiety this is creating (kidding).  If they are so shocking, I think I should get to see them seeing as he has them.  How f%@! hard would it be for him to reply to an email with the scores that are on his computer?.  If I need to get them in person, then he can at least tell me that.  Any thoughts of how long I should wait or how patient I should be with the email and phone calls?  I realize he is busy, but it has been 3 days, and no reply to my messages or email.  Maybe he is ducking me!!!

Insomniyak wrote:

   I am starting to get ticked that I have not received my scores yet despite being scheduled for a titration and told how shocking my scores were.  Actually emailed my doc yesterday and told him that I have been up all night with insomnia due to the anxiety this is creating (kidding).  If they are so shocking, I think I should get to see them seeing as he has them.  How f%@! hard would it be for him to reply to an email with the scores that are on his computer?.  If I need to get them in person, then he can at least tell me that.  Any thoughts of how long I should wait or how patient I should be with the email and phone calls?  I realize he is busy, but it has been 3 days, and no reply to my messages or email.  Maybe he is ducking me!!!

Call the actual sleep lab where you did your study.  Ask THEM for a copy of your full report results.  They will drop it in the mail that day most likely.

Understand the process. Your sleep is evaluated. The data is "scored". It is printed out and provided to the doctor. He goes over the scored report and dictates his interpretation of the results and makes his recomendation. His dictation goes to a transcriptionist who transcribes and types it up. The transcription goes back to the doctor to check for errors and apply his signature if it is correct.

Then and only then, when the sleep lab recieves his recommendation of a titration study, are you scheduled for the titration study - and WHEN you get scheduled depends on how full their titration schedule is. Most labs only allow 2 patients per tech per night. The techs work a 12 hour shift so they aren't working 5 consecutive nights. Much depends on how many "sleeping rooms" and sleep techs they have available.

A week would be a MINIMUM to expect any contact from the sleep lab or sleep doctor - UNLESS they happen to have a cancellation. Two to three weeks would NOT be an uncommon wait between sleep evaluation and titration studies.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.