What do I have to do to get APAP with oxygen?

[Irishrow]

   
So, after setting the minimum pressure to 10, here is a comparison of the oximetry.  The actual session at 10 had a much higher leak rate as shown in the Screenshot.  44% vs 5.7% .  I may try another night after adjusting the strap.

Comparing oximetry between 6-20 APAP and 10-20 APAP.  The Basal measurement shows LESS effective oxygenation at the higher setting in virtually identical session periods.  Despite the larger leak, the increased pressure minimum doesn't seem to help oxygenation.  I did feel that the increased pressure made it easier for me breathe from the beginning of the session and get to sleep sooner and, despite the leaks, I slept better.

SpO2 Data at 6-20
Basal SpO2(%) 86.1
Time(min) <88% 411.2
Events<88% 159
Minimum SpO2(%) 73
Avg. Low SpO2(%) 83.4
Avg. Low SpO2<88% 82.7
PR Data
Avg. Pulse Rate(bpm) 58.6
Low Pulse Rate(bpm) 46

SpO2 Data at 10-20
Basal SpO2(%) 84.1
Time(min) <88% 517.6
Events<88% 213
Minimum SpO2(%) 71
Avg. Low SpO2(%) 82.3
Avg. Low SpO2<88% 82.1
PR Data
Avg. Pulse Rate(bpm) 55.4
Low Pulse Rate(bpm) 45

The bottom line is that the DME will not sell an oxygen concentrator, only rent one.  They also are demanding an in lab sleep study and basically being as uncooperative as possible.  I will contact a new DME today, see my PCP on Thursday and either get a machine through the new DME or simply purchase one online.  I'm looking at the EverFlo Home Oxygen Concentrator Package with OPI (5 LPM) for $669.

[Sleeprider]

I hope you have better luck with the new DME. It appears there is plenty of documentation of your medical need and with a prescription in-hand, you should get approval. As I suggested earlier, the DME is there to submit the claim, not to screen it on behalf of Medicare or your insurer. If denied, it should come from the insurer. Please contact your insurer for a list of in-network DME providers and get clarification of their requirements for supplemental oxygen. Do not rely on third parties to deny you the care you clearly need.

Since higher pressure does not effectively change the dynamics here, I suggest using a lower pressure once supplemental oxygen is available. That will cause fewer leaks and less dilution of the supplemental O2 keeping the fraction of inspired oxygen higher.

[Gideon]

I call that a success in that we definitely learned that that didn't work.

I'll point out the benefit of titrating the O2 in the lab. They will determine how much flow you need. How many concentrators do you need?

Our task now should be to back off as much as we can with set pressures to reduce the dilution effect higher pressures, with their higher flows, dilute the added oxygen. In other words for right now we need to mostly ignore your DeSats and see what can be done to prep you for an oxygen addition. This i believe is what Sleeprider is saying.

[Gideon]

Please set min EPAP=4. This is as low as it can go. Only change for now. Please continue to provide your full DeSats info in addition to the daily charts and how you feel..

I think you know that leaks will cause havoc with supplemental oxygen in the form of unwanted dilution.

[Irishrow]

Again, thanks to all of you who have responded with helpful tips, things to try, and certainly the advice to seek a different DME.

In the end, the DME of record refused to submit the physician's prescription, letter of medical necessity and Oscar reports unless I signed a Medicare Statement of Liability and agreed to rent an oxygen concentrator in perpetuity from them in the event my claim/request for oxygen therapy with CPAP was denied.  I bought a concentrator outright for $659 (Respironics EverFlo 5L) and have filed the claims paperwork directly with the insurer.

I noted to the insurer that their DME "is convinced that HYPOXEMIA is the name of a new nightclub in Boulder."

What happened next:

I went back to my long-term successful Airsense 10 settings.  I got the concentrator on January 3 and set it up with my CPAP with an inline bleed adapter between the Resmed Climateline hose and the P10 Mask Assembly.  It fit perfectly between the two Resmed hoses and I turned the barb to face back toward the source.  My wife made a quick hose jacket that runs along 6' of the hose to the oxygen bleed valve and we put the oxygen line in with the Climateline hose for a "neat" setup.  It works great, I don't foul or twist the lines at night even when I'm wearing a pulse oximeter.

When I first turned on the oxygen I was shocked at what a miniscule trickle of air came through the oxygen line and was convinced it was not going to deliver anything significant.  I turned the concentrator up to 5 liters a minute.  After consulting my oximeter within a few hours, I turned it down to 3.  Plenty of pure oxygen was getting through and it was evident by the readings.  I have adjusted it over the past few days, from 5 to 2 liters, but have settled on 3 liters for now.

Here are some screenshots of the results, including a single left panel showing all of the settings and result statistics for last night.
   

Clearly, the oxygen therapy delivers the intended results, and it is really simple to introduce with CPAP.  I don't feel any additional pressure from it, and my overall pressure has gone down.  My Basal O2 went from 86% to 91%.  My "minutes under 88% oxygenation" went from 411 minutes to 24.  The average low Spo2 went from 83 up to over 88%.

   


I'm waking up more rested than I have in many years and feel that I'm getting the actual complete therapy that CPAP promised.  Thank you all for your interest and kind assistance.

[withtao]

Interestingly I'm at a similar point in therapy. Have had Air Sense 10 and now 11 for 7+ years. Thanks to OSCAR I was able to solve Leaks and obtain low AHI of .3 - .8, BUT still not feeling as well as I thought I should. Sleep study in September revised recommendation from CPAP 10 to APAP 8-15 with EPR 3. Little mention of O2. I bought a Checkme O2 Max and immediately was alerted by it that O2 was going up and down all night (84-99) and pulse as low as 34! Told PCP and they ordered an oximeter from another DME (not my ResMed DME). Got the results yesterday and PCP prescribing oxygen supplementation via APAP machine. My PCP did not involve my main DME at all, which is good because its useless. Anyway, should have oxygen within a few days and will post the results. PCP is going to order another oximeter session, but I'm not waiting and will be importing ResMed and oximeter every morning. Wonder what would have happened if I hadn't been proactive and bought my own oximeter. BTW, really like the Checkme O2 Max. Wear on my thumb with the 'brains' on my wrist. Easy to download to Windows and OSCAR.

[withtao]

Opps didn't think my post made it, so re-typed. Haven't figured how to delete and post.

[Irishrow]

Withtao, not bothering with the DME seems like the right way to go.  When you say your PCP "ordered oximetry," was that at home or did you have to go into a sleep lab?

That Checkmate oximeter is a handsome device but over $200.  I simply use an FDA approved CONTEC CMS50DA+ I got from CONTEC store on EBay for $26 bucks--mostly because OSCAR input cited the product, but you definitely have some fine features suitable for nightly use.  I'll monitor mine once a week now that I've settled on an appropriate oxygen liter setting, and less as time goes by.  Because it's "loose" on my finger, I don't actually sleep as well with it on.

My AHI averages 1.2 over a year, and may go down with oxygen therapy, but that's not what oxygen addresses--it's my heart and, to some extent, pulse rate.  It has been really gratifying to see other users that are really invested in their sleep and health commenting on the approaches to adding oxygen therapy.

Good luck to you.  I am 100% enthused with the simple addition of oxygen.  Incidentally, I'll continue to use an AirSense 10 because I'm a camper and they don't have a 12v adapter for the 11 yet. Also, I didn't add any humidifier to the oxygen feed, and left my Resmed Humidifier at 3. I see no increase in dryness with 3 liters of continuous oxygen.

[withtao]

Withtao, not bothering with the DME seems like the right way to go.  When you say your PCP "ordered oximetry," was that at home or did you have to go into a sleep lab?

The oximeter was sent to my home by the alternate DME.  It was a ResMed/Nonin device that has a big clunky 'brains' and a finger sensor.  First night I woke up and it was flashing on and off and I thought it was alarming (my Checkme buzzes when out of limits), so I was concerned.  Turned out the thing flashes the heart rate and is so bright it lights up the walls and ceiling!  Keep it a second night (turned it over so didn't light up the room) and then sent it back.  Took two weeks to get the results!  DME's just don't seem to be patient centric.  I'm guessing PCP will do it the same way after 30 days, but I'll be using mine every night.

BTW, I bought my Checkme during Black Friday sales for $160.  Not cheap, but don't regret getting it.

Take care

[Crimson Nape]

withtao - If you used the Resmed oximeter that plugs into your CPAP, then its data is integrated with the CPAP data that you import into OSCAR.

- Red