Trilogy or Bipap

[Grace89]

The Trilogy machine was prescribed for me by my neurologist due to decrease in breathing while laying down. It is setup like a bipap machine for me. (no sleep study performed, just clinic PFTs)

My neurologist that I continue to see that was my third opinion does not agree with the Trilogy due to the expense to me. I had a sleep study performed and read by a Pulmonologist. She is prescribing the AVAPS bipap.

My RPT said that the setup is exactly the same for both machines. What is being requested for the AVAPS is what I am already doing on the Trilogy. Which btw I have failed to mention--I already have the Trilogy at home and using it.

I honestly am not sure what to do. My biggest concern is if I go with AVAPS now, how hard is it to get the Trilogy once on Medicare? I recall reading that it is very difficult to get this approved. So do I pay more now not to have the hassle later? I am thinking that might be the better option.

Pros/Cons
Trilogy $190 a month
AVAPS $125 a month
$65 difference

Trilogy will be a lifetime lease with RPT support every 3 months which includes filters, hoses, etc..
AVAPS will be a 10 month lease then I own with no support.

Trilogy I will have to ability to take with me on a power chair and includes backup battery.
AVAPS-not a option

 

[lgelb]

Well, actually any modern BiPAP can be fitted with an external battery if/as needed -- but certainly more cumbersome. The economics hinge on your finances and on the time until you need something more portable, though we successfully used a portable CPAP with EPR for this purpose instead of a BiPAP. Off the cuff, w/o seeing your PFTs or sleep study (feel free to post/PM for a better answer), you certainly might have a year before you need to use BiPAP during the day. As to how hard/long it is to get a Trilogy approved by Medicare, I'll let the Medicare folk speak.

 

[bigmark1954]

The new Res-Med VPAP's can be programmed to do Bi-Pap functions. I say save the 65 bucks a month.

I see no reason you would need to use it during the day with your wheel chair, if you are only needing it when you lay flat.

Keep in mind that you can get a Res-med VPAP for $1200.00ish, if you buy it on-line. These units can last well over 5 years. In that amount of time you would pay for the VPAP 6 times on your current plan.

The home medical industry victimizes us with their rental programs. Just my opinion.

 

[lgelb]

Umm...the V[ariable]PAP is BiPAP. Respironics uses the term BiPAP, ResMed VPAP. Same concept, though I like ResMed's algorithm better. The differences between the various models (volume support mode, called AVAPS on a Respironics machine and iVAPS on a ResMed; backup rate, ability to adjust both trigger and cycle sensitivity, ability to adjust temp independent of humidity, etc.) are where the rubber hits the road.

So the Trilogy (Respironics) and Astral (ResMed) are notable simply as BiPAPs with internal batteries, nothing more substantive that differs them from other BiPAPs, unless you want/need a trache, which other BiPAPs won't work with.

And as I've said before, I do support purchasing used if it pencils out, why I keep pointing people to SecondWind.

 

[JimInVA]

Darcey started with a ResMed BiPAP. She loved it... particularly the heated hose (which did wonders towards keeping condensation at bay). When Darcey began to use it during the day, too... the Trilogy was recommended. She hated the Trilogy at first... particularly at night when condensation became a real issue (Darcey is ALWAYS cold... and the humidifier settings with the Trilogy had to be lower (temp) to minimize condensation. It made her feel cold. All this having been said...

Darcey still comes into work with me 4 days a week. She now needs the "Breather" 23 of 24 hours out of a day. It hangs from the back of her PWC when traveling. Because of the built in batteries, we're good for about 8 hours before we need to "plug in" to AC power. While traveling, she doesn't use the humidifier... but being able to DO THINGS and BREATHE at the same time override all other considerations. That the Trilogy allows her to continue to LIVE, go places and do things... rather than being confined to a single location... keeps Quality Of Life at some pretty amazing levels. As a sign on the back of her PWC says, - "KICK ALS!" Last month we traveled to a Joe Bonamassa concert. This last weekend we spent the time at the beach in Nags Head... where it snowed. Nothing like the beach, waves and water in the middle of winter. The Trilogy allows us to do things that the typical BiPAP would not. Darcey was told by her neuro last March that she had less than 6 months left to live. In two weeks, we'll see the next March arrive. How does one truly put a price on the freedom that the Trilogy provides day in and day out?

I can't tell you what is right for you... but I can share what has worked and has absolutely been the right choice for us. Hopefully, you will find something in our story that can fit well in the story that you are attempting to write for yourself. if I can help with any questions you might have, know I'm only a click away. Our best goes with you...

Jim & Darcey

 

[affected]

Jim that post really hit me as a fantastic response on what may influence the choice from that QOL perspective of how much more portable your trilogy is and what it has meant for Darcey and yourself.

Thanks so much for being so clear, it made the picture so much clearer for me than just talking technicalities of one over another models. Not that these are not important, but the human side is, to me, what makes the technical differences worth checking over.

 

[lgelb]

It's a false dichotomy to say it's one or the other, Tillie, I don't want to leave that impression. Many people use one first and then the other, since the Trilogy has distinct disadvantages as a bedside machine, like its humidifier. Many also have 2 machines at the same time, if only for backup.

Finally, since the Big 2 "portables" are actually heavier and larger since they have batteries inside, they don't work in all certain situations. We literally could not have fit Larry's wheelchair w/ a Trilogy or Astral shelf into our building's elevator. As it was, we put the [truly] portable PAP that we did use between his feet or on his lap.

 

[affected]

Laurie, I was responding to Jim.
I never said portable is the reason everyone would now choose the particular piece of equipment he uses over another.

It's not a false dichotomy at all to look at your individual needs and goals first, then match the technical specs to that.

I appreciated the way Jim explained how they made choices and what it has done for their particular situation. I think my reply to those things was perfectly valid. I was not in any way saying that any other reply was not valid. We really should feel we can say things here, and have those things appreciated without feeling we will be pulled up or told we are wrong. Jim's choice for him and Darcey is obviously right. Doesn't mean it will be the same choice everyone will make, but it may help someone work out how to make a choice, even if a different one. Such as you describe that with your particular elevator a different choice worked better for you. Actually, I think that is exactly what I was saying in my post - the human side of your particular needs will affect the technical specs you look at.

 

[JimInVA]

Laurie,

I am guessing that Larry's wheelchair may have been smaller than Darcey's. When I hang the Trilogy off the back of her PWC, it adds absolutely nothing to the silhouette of the chair. To say it another way, the outside spacial dimensions remain unchanged (with or without the Trilogy hanging from the back).

The Trilogy also has features that allow it to continue to be used if one were to decide to "vent". Because that option is not one that Darcey has any interest in, I am not sure right I am as to those features. But I did want to mention that if such was a consideration that might have some weight in your decision process.

Jim

 

[lgelb]

I doubt Larry's chair was smaller than Darcey's! (20x22" cushion). I was just making the point, Tillie & Jim, as both of you did, that there is no one-size-fits-all in these situations, any more than BiPAP should be "set and forget." And I had already mentioned that the Astral & Trilogy work w/ a trache.

When I said "false dichotomy," I was referring to the notion that one had to select one machine and only one, forever. That is factually incorrect and yet a commonly-held view. So yes, I will say that is "wrong."

And since the "technical specs" have a lot to do with how well respiratory function is maintained, and because the technology is advancing (as in other electronics) I encourage a focus on what's needed now, not trying to predict the future. Today, those options include buying a used BiPAP of one's choice (that can be traded for cash any time) rather than paying rent for what a DME chooses to offer. Even Trilogies and Astrals are increasingly available on sites like dotmed.

Best,
Laurie

 

[gooseberry]

Steve's chair size, his comfortable position in it, and the trilogy bracket mounted on the back made it difficult to fit in regular elevators. We often had less than 2 inches of clearance on the door.