The Miracle of the Soft Cervical Collar

[Sleeprider]

The Resmed Sleep Lab Titration Guide describes all of the Resmed PAP devices, their intended use, what they treat and how to titrate pressure. https://document.resmed.com/en-us/docume...er_eng.pdf On page 5, the ST "Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate". It is intended to treat "COPD, NMD, OHS and other respiratory conditions. The other devices such as the S/V Auto are also described, and I think those better meet your needs, starting on page 24. The ST is discussed along with it's more advanced cousin, the ST-A which has an intelligent algorithm, under the section titled Respiratory Diseases on page 34, and the ST protocol is on page 37.ou will quickly see the ST-A is far more appropriate for people that need a ventilation assist device to treat respiratory diseases and to maintain ventilation volumes and even oxygen saturation. The ST has essentially become a legacy machine, but has a following in the sleep medicine profession, particularly among doctors and ChatGPT bots that have not advanced their knowledge to include advanced adaptive pressure support. One of the things I want you to learn from reading this resource is how Easybreathe™ works to make bilevel therapy more comfortable and natural as compared to square-wave bilevel like you're using.

[spudhorse]

Let's see if I have this all straight. Attached is something I'm writing for my primary care physician. Comments solicited.

[Sleeprider]

I would suggest you start with a discussion of your sleep quality or lack thereof, and associate that with the square-wave pressure transitions of the ST. Your experience with the ST is more important than some of the technical facts. Your needs and comfort would be better served by the Vauto as you pointed out. You are correct that the Vauto provides for your pressure support needs with the more comfortable EasyBreathe™ pressure transition as well as automatic pressure adjustments. I would make a bigger point of the fact you do not have a medical need the ST timed backup rate and can't understand why this device was prescribed.

We could get into the HCPCS codes which are used for diagnosed conditions and insurance reimbursement of equipment. CPAP is E0601 and is for obstructive sleep apnea, Bilevel without a backup rate is E0470. A bilevel device with a backup rate including the ASV, ST and ST-A are 0471 and are known as "respiratory assist devices". In theory, an E0471 device like your ST is only approved after failure on E-0470 as indicated by low SpO2 or high PCO2 arterial blood gas levels. You seem to be using Veteran's services so rules may vary, but it's still unusual for a bilevel with backup rate to be dispensed without a need for that backup rate. I guess I'm just puzzled how that happened.

[spudhorse]

OK. Thanks. Good comments. I very much appreciate your time and interest.

No -- I'm not using veteran's services. I have a Medicare Advantage plan using an in-network doctor and hospital.

I doubt I'll find out. This particular machine (I come to find out using OSCAR) was given to me used. Someone had it for a month or so. It also turned out that they gave me a mask that wasn't the one the sleep lab recommended. Thus, the entire thing could be a FUBAR. I am less than impressed with everyone I've run into here. They are at best the C- Team.

Quick story: Went in for a  ECG with my primary care physician two weeks ago. They walk back into the room and say "the machine thinks you might have had a heart attack." [I almost have heart attack at that point] "but it's often wrong." Turns out they completely did not understand what the ECG was saying and I was totally fine but I had a very anxious few hours to say the least until I could find someone who actually could read an ECG!

[Sleeprider]

I think your letter is pretty good, but your medical team sounds scary. The run-hours on your machine are shown in the clinical . menu at the bottom. They are not resettable. I don't think Oscar displays that information unless they actually dispensed a used machine and didn't even delete the previous user's data. Wow. You don't belong on a machine with a backup rate. Tell them you want the NEW Vauto you should have been dispensed to start with.

[spudhorse]

They didn't delete the previous user's data.

[Sleeprider]

Well if you ever turn it in, be sure you do it for them. That's crazy and a violation of medical privacy.