Sleep test results. What should I do, now?

[SuperSleeper]

[parts of this thread were copied from the old forum]

Though I have been on cpap for about five years, I am just beginning to realize how little I know about it. Have been taking DME's recommendation on cpap machine, now I wonder if I should upgrade to an autoset machine?

Would the below information get my DME to replace the ResMed Escape II? I can afford to buy an S9 autoset (and maybe this would be a good idea), but, of course, would rather the insurance do this if a good case could be produced from the following:

Just got detailed sleep test results.
No mask for this portion: 127 apneas and hyponeas with an AHI index of 71.5 per hour. There were 114 Obstructive apneas, 9 mixed apneas,3 centreal apneas, 1 hypopnea, and 2 RERAs. The total RDI (A/H+RERA's) was 72.7. Moderate snoring was noted for 14.6% of TST.

CPAP Full Face
38 apneas and hypopneas with an AHI index of 11.8 per hour total sleep time. Stage R AHI was 9.0 33 obstructive apneas, 0 mixed apneas, 1 central apnea, 4 hypopneas and 1 RERA. The total RDI (A/H + RERA's) was 12.1. Snoring eliminated with CPAP.

I am having trouble concentrating, memory loss and falling asleep in the daytime.

[SuperSleeper]

If you live in Ontario Canada, there are specific guidelines for an autocpap to be given to a patient. They must have a higher pressure than 10 ( which you have) and you must change pressure of at least 4 pounds between sleeping on your back and switching to your side....

I don't know your specifics but it certainly can't hurt to ask for an auto. I think that in the US you can order an autocpap online even if you have a script for just a cpap. I don't know how that would work insurance wise.


tombarelybreathing

[SuperSleeper]

Thanks, Tom. Live in Atlanta Georgia. Have an appointment to view several cpap machines and masks on Friday. Insurance may pay, that would be nice. However I will probably buy something better than the Escape anyway if they won't.

Still researching. Whatever will give me the best results.

[SuperSleeper]

Hey there Dolla Bill
Before going to bed just wanted to tell you from my understanding that your doctor can recommend and write a new prescription for APAP after you have failed CPAP .
I don,t know much about sleep study results but i think your oxygen level with CPAP therapy should be in the high ninety,s and hopefully you get some informative replies from the doctors on this board .
Could you please explain what do you mean in saying this "I am having trouble concentrating, memory loss and falling asleep in the daytime" and did you talk about it with your doctor ? Take care .
Goodnight

[SuperSleeper]

zonk is right, only your doc can decide if an AUTO is the right machine for you. It's a mistake to assume AUTO is superior in results to straight CPAP. Please don't buy into the hype about AUTO being the best machine. You certainly need a machine that is data capable which the Escape is not.

They did not get you totally titrated- AHI under 5- during your sleep study, so your doc may opt for an AUTO for you to do self titration. I would have a good talk with the doc about what machine you need. Good luck with the AUTO if that's what's indicated.

[SuperSleeper]

Have noticed several other posts relating to upgrading CPAP machine to an autoset. I don't think the constant pressure ResMed Escape II is the best for me. Have a hard time adjusting to the increased pressure. Mask, that was marginal before, now moves away from my face. Had no problems with mouth breathing before. I also want to take more active role in my therapy. I can get the Dr to specify a machine and I think he will agree with me that the best machine will be the ResMed S9 Autoset, buy I will listen if he has other advice as long as I get an autoset.

Opinions?

[SuperSleeper]

zonk is right, only your doc can decide if an AUTO is the right machine for you. It's a mistake to assume AUTO is superior in results to straight CPAP. Please don't buy into the hype about AUTO being the best machine. You certainly need a machine that is data capable which the Escape is not.
They did not get you totally titrated- AHI under 5- during your sleep study, so your doc may opt for an AUTO for you to do self titration. I would have a good talk with the doc about what machine you need. Good luck with the AUTO if that's what's indicated.

I think everyone should get an Auto machine. They don't cost much more.

You can always put the auto machine in manual pressure mode. If you get a manual CPAP machine and need to try auto mode, you can't.

You can put an auto machine on a narrow pressure range if you're afraid of it running away. This gives you sort of a safety blanket to see if your needs have changed.

Also, specifying an auto machine increases the chances of getting a data capable machine.

One big mistake a lot of people make with auto machines is to set the minimum pressure too low. Leaving it set at 4-20 pressure is dumb. You start the night with a pressure that's too low and have to suffer through apneas for a while before it autos up.

I set mine so that the minimum pressure is what seems to be my optimum pressure. I leave the maximum at 20 because my machine doesn't seem to want to run away on me. If I started to notice the pressure bumping up, it would tell me that I need to see what's changed.

[SuperSleeper]

Trying to get an appointment with the Doc.

Did just talk with a DME about replacing the current CPAP with a autoset. They said they would need a new prescription from a Doc and also told me that "no insurance covers an autoset," and that this machine would cost about $200 more, which I would be expected to pay.

True, or are they blowing smoke about "no insurance covering an autoset"?

[SuperSleeper]

Dd just talk with a DME about repalcing the current CPAP with a autoset. They said they would need a new prescription from a Doc and also told me that "no insurance covers an autoset," and that this machine would cost about $200 more, which I would be expected to pay.

True, or are they blowing smoke about "no insurance covering an autoset"?

The DME is giving a line of complete and utter baloney.

They are trying to maximize THEIR PROFIT, period. Private insurance and public insurance such as Medicare/Medicaid pay for auto-CPAPs all day long.

Most DMEs get reimbursed by insurance or Medicare when they issue a CPAP to a patient. They usually receive a flat fee, no matter what CPAP they issue to the patient.

SO, if the DME gets a flat fee of $1500 for a CPAP machine, it is in their financial interest to give the patient the absolutely cheapest machine in their inventory.

If they give a patient a $700 basic "brain-dead" non-data-capable machine, they pocket $800 ($1500-700).

If they give a patient a nice new $1100 auto-CPAP, they pocket only $400 ($1500-1100).

That's why patients must INSIST strongly that a DME give them a data-capable or auto machine, or they will take their business elsewhere... you're essentially reducing their profit by asking such a thing. But if you threaten to walk out the door, they get no profit at all. Sometimes you gotta walk out the door and go elsewhere.

I'd go to the doctor and ask them to write another script for auto-CPAP. Take the script to an honest DME, not someone who lies to you.

If the doctor needs reasons as to why you need an Auto-CPAP, go here for more info:

http://www.apneaboard.com/APAP.htm

[SuperSleeper]

SS, you are very helpful! We have two of these DMEs we are working. I mentioned the other DME and this one said that maybe they could work something out. Will take the points in your article to the Doc and see what I can do.