Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?

[midwestguy]

PA has tried adjusting pressure. If anything, the AHIs are worse.
I get the feeling she doesn't know what she's doing.
She wants a sleep study, so someone else can "fix it."

If she gets bent out of shape when you folks figure out what
needs fixing, can she mess with my Medicare reimbursement?
I know the sleep professionals are unhappy with groups like
this one. Someone mentioned that xPAP makers were
considering encrypting the data.

The setting summary and a SleepyHead overview are attached.
The setting summary got farkled, so it's not much use. Sorry.

Thanks, everybody, and a belated Happy New Year.

[attachment=38600][attachment=38601]

[Sleeprider]

Neither of the charts is particularly helpful to us in helping to identify the problem. The Changes to Prescription Settings shows three different settings that really are not very different. All use the same EPR and minimum pressure within 1-cm;
8.0-16.0, EPR 2
9.0-16.0, EPR 2
9.0-18.0, EPR2
The oldest results had the best AHI, but we don't know what these events consist of or how they relate to pressure or things like clustering. It would be best if you updated your Sleepyhead to OSCAR and posted some updated Detail View charts. If you want to post the Overview, be sure to include events. The one you posted shows extremely fragmented therapy. Why are you starting and stopping therapy so many times per night? If you really want to get to the bottom of why your therapy is yielding worse results and avoid a titration test, we are going to have to see the details and do some trial and error. We really need some feedback on what is causing the therapy disruptions.

Is the PA you are working with in a sleep specialty practice or your regular health provider?
Why are you working with a PA with a bad temper? Find someone you can work with, no someone that threatens your coverage. I use my regular doctor. All Medicare needs is to verify you are using the machine and continuing to benefit from it. You don't need a specialists for that.

[midwestguy]

I have an ancient Mac Pro that can’t use OSCAR.
If SleepyHead has equivalent detail graphs, they
will be posted.

The sleep therapist is in a sleep medicine practice.
It’s huge, and full of stupid bureaucracy.
Good news that my regular doc can handle this.
Therapist isn’t bad-tempered. I just want to tread
softly.

Can’t say why there are so many interruptions.
Usually get up at most once a night. Thought
mask was tight enough. Maybe not.

[SarcasticDave94]

Is the multiple start/stop session thing a smart start issue? Daily detail info is probably more helpful in therapy assistance.

[Sleeprider]

Your version of Sleepyhead can easily produce the daily detail charts we want. Just use the examples in the Organizing Your Oscar Charts in my signature. Next time you see your regular doctor, ask him to please take-over the management of your CPAP therapy. You will provide him with a summary of use and can discuss how you feel, and pass that on to your supplier so you can continue to receive equipment and supplies. It will save you time, money and aggravation. Let's start looking at your therapy with an eye toward improving your sleep comfort and results. If it turns out we cannot improve your results, we can at least help you to define what you need in a titration test. The only chart I ever saw from you suggested something more complex than obstructive sleep apnea. If your problem is central or complex apnea, it is pointless to get a CPAP titration.

[midwestguy]

Here is the Overview for the last two weeks. It's a PDF
SleepyHead doesn't seem to let me post a copy
of the original interactive chart.

Let me know what other charts will be useful. Or
tell me how to create a copy of the original in
SleepyHead.

Thanks

[midwestguy]

Here is the requested chart (I think).

[SarcasticDave94]

OK, we'll have to see what happens to the CA after you focus on combatting these Positional Apnea clusters. That's what most all those Obstructive events are; you're chin tucking and restricting your airway. Either use a thin pillow or you'll need a soft cervical collar to remedy.

You may need to lower EPR to lessen the CA, but it may make flow limits go up conversely.

[staceyburke]

You are having a lot of positional apnea. Positional apnea can NOT be controlled by pressure changes. You have to find out what position you are getting into and cutting off your own airway. Have you changed your sleep position? Sleeping on your back? Using more (or new) pillows? These things can cause positional apnea by chin dropping to your sternum and cutting your airway. Think of it of a kinked hose – nothing can get through – you have to unkink the hose…
IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar. I have a link to collars in my signature at the bottom of the page. It shows people who are not wearing a collar and the SAME person wearing a collar. There is a huge difference between the two.

[midwestguy]

OK, we'll have to see what happens to the CA after you focus on combatting these Positional Apnea clusters. That's what most all those Obstructive events are; you're chin tucking and restricting your airway. Either use a thin pillow or you'll need a soft cervical collar to remedy.

You may need to lower EPR to lessen the CA, but it may make flow limits go up conversely.

Thanks to Sarcastic Dave and StaceyBurke.

My Positional Apnea is partly the result of trying to reduce acid backflow from the stomach. I sleep  
on a wedge, so there's already a tilt downward. I can't change that wedge-pillow, so I'll use Stacey's
article on soft cervical collars to find one.

The repiratory PA pushed for a sleep study. She had no clue about Positional Apnea, and would
likely object to my bringing the wedge to the study.

Thanks again, you two.