Anyone Ever Had Insurance Cover Nightly Oximeter

[cmpman1974]

I have to admit I'm pretty perplexed just how little my DMC cared about my doctor's script for the ResMed oximeter module.   The request was more 'prompted' by me and agreed to.  My DME said we do not carry one, do not care to order one and submit anything through insurance (probably not payable anyways), etc.  Every person there was clueless what it even was. The person left a voicemail and said maybe you should bypass insurance and 'look online.'  I did see some Medicare guidelines (don't have it, but often a reference source for coverage with private insurance) stating very strict screnarios which an overnight oximeter would be covered. Mostly patients on a trach or infants with a specific health condition. It said sleep apnea and other similar conditions don't warrant the need for such a device.

I don't know know if I'm serious over-exaggerating my issues, but I feel quite compelled to verify my nightly SPO2 numbers with a top-notch oximeter as I find some of the data on the Wellue CheckmeMax quite concerning.  I know I have a real issue.  My cardiologist and pulmonary doctors are starting to take more notice.  I don't know if anything can be 'fixed' per se, but I can't imagine my life has a good outlook if these oxygen numbers are legit.  

Even last night with wonderfully low leak rates, I dipped into the high 70s according to my watch.  The longest apnea during the period was 21 sec and most 10-11 sec.  it's clear the 17/9 pressure doesn't always resolve stuff, though AHI is always under 5 so that's good I guess.  Maybe kinking my airway is at play as mentioned before.

The idea a single night or two nights of monitored SPO2 levels is sufficient for a patient's whole life seems very, very off to me.  People have one-off nights with some times things being severely worse or maybe a bit better than that monitored night.  Without some consistent data as a true reference point, it's all a wild ass guess.  it is very clear DMEs don't give two craps about a patient's health and it's a money game.

[Sleeprider]

I know you are using VPAP-S mode, and would like you to start using Vauto mode, even if it is in a fixed pressure setting. This would allow flow limitation to be tracked, and that might end up being useful. Vauto mode with EPAP min 9.0, PS 8.0 and Max pressure 17.0 should give the same therapy, but report flow limits. I still see clusters of OA that are suspiciously like positional apnea. More on this chart that others you have posted recently.

[cmpman1974]

I know you are using VPAP-S mode, and would like you to start using Vauto mode, even if it is in a fixed pressure setting. This would allow flow limitation to be tracked, and that might end up being useful.  Vauto mode with EPAP min 9.0, PS 8.0 and Max pressure 17.0 should give the same therapy, but report flow limits.  I still see clusters of OA that are suspiciously like positional apnea.  More on this chart that others you have posted recently.

OK, makes a lot of sense.  For a long time, I've wondered about the flow limit issue.  I will post results once I have them.

[cmpman1974]

Sleeprider, here are the results you asked for at those settings.  What do you think?  Even with the 3L supplemental O2, my CheckmeMax watch reported 30 min under 90%. Flow limit is reported now in VPAP Auto mode.

[Sleeprider]

Cluster of OA is positional. I'm stubborn and I'm sticking with this conclusion. The period of high leaks speaks for itself. You cannot maintain FiO2 (fraction of inspired oxygen) in the presence of a leak that large. All we can do is coach for mask leaks and positional apnea. You are aware of the issues and you're convinced you have done everything possible. I'm willing to accept that, but there is not much else I can suggest or recommend.

[cmpman1974]

Cluster of OA is positional. I'm stubborn and I'm sticking with this conclusion. The period of high leaks speaks for itself. You cannot maintain FiO2 (fraction of inspired oxygen) in the presence of a leak that large.  All we can do is coach for mask leaks and positional apnea. You are aware of the issues and you're convinced you have done everything possible.  I'm willing to accept that, but there is not much else I can suggest or recommend.

I would say I still have some room for improvement.  It's clear by now I'm 100% dependent on this machine and require the supplemental oxygen.  I have no margin for error when it comes to to leak rates or positional apnea issues.  Both quickly desaturate me.  Yes, that crazy high leak rate for 40 min or so certainly is a huge issue. I literally need to have 'perfect' therapy nightly to achieve a good result.  I think moreso than many others perhaps.  I'm fighting a pretty tough battle.  That's my take on it.  Not sure if I'm correct or not, but the oxygen drops coincide with the events fairly consistently.

Although I have no means to prove it, I would guess I get a very disproportionally low amount of REM sleep nightly and the little I do get is when I get these huge jaw drop episodes causing very prolonged high leaks. There is NO way to go from a consistently low leak level with a good fitting mask to these crazy spikes otherwise. Since I'm not in a lab setting nightly, I'll never truly know the full story. I do feel in general the Vitera mask has a good seal and maybe the best fit for me. Something weird happens in intervals ruining it.

[Sleeprider]

I have to agree, and I like that you acknowledge perfection is not the goal. "Fairly consistently" is a good goal to set.

[cmpman1974]

Last night's session...same old, same old story. Things going OK, until they weren't.   SMH. I have to admit while I'm very reluctant to spend a ton on an oximeter, I'm feeling pretty compelled to buy a top notch one to see how close these reported figures truly are. Don't feel like dying from hypoxia slowly. Dropping into the 70s seems like pretty severe territory nightly. The doctors seem to think a single night overnight pulse ox is all that's needed. It probably is if one's results are satisfactory or borderline. Drops like these nightly to me are a different story. Especially when ON BPAP.

Yes....I need to somehow / someway get control of the leaks. I think I may need to consult with LeftyLanky27. There has to be something I'm severely missing in this story. How the hell does a person go 90 minutes with a leak that large and boom it's gone right after?

[Sleeprider]

Well, your mask is clearly not sealed for 90 minutes allowing air to whistle out, and after 90 minutes you correct the leak. Maybe contact F&P support or use their My Mask App. I don't know about it, but anything is worth a try. https://www.fphcare.com/us/homecare/slee...ks/vitera/

[DevinJones]

cmpman1974,

See this post regarding a medical-grade oximeter:

https://www.apneaboard.com/forums/Thread...#pid478826