pressure plateau

[milboltnut]

Hi folks,
             just an update on my situation.

This friday I have to go and talk to my Dr. about a Titration sleep study, which should have been done BEFORE I was prescribed an APAP, which isn't doing enough. It clears up OA's but not CA's as some of you have seen on my OSCAR software. According to my Ins. Co. there was nothing in my records about a Titration study before the issuing of my APAP machine. UGH ! The good thing is the gal from my insurance company said if the Dr. deems it medically necessary for the second study then it will be approved. But the thing that gets me is my Dr. wanted me to come back in July...?? Thank You Bonjour for pointing me out to 2-3 months for changes..... otherwise I wouldn't have called my Dr. office about a different machine. The receptionist said well if your not feeling better as much as the machine should do, and BTW...they should know they see my charts on thier software....I'm glad I have my own, thank you again Bonjour ! Even the receptionist admitted ramp up triggers CA's. 

On another note I apologize for abusing the PM system.... I didn't see it mentioned in the rules section of the forum... I know two members did say, but wasn't clear enough, I guess.... but after the second time I was told, it registered. Sorry OpalRose.

It's frustrating after three months, that could have lead to 5 months of partial therapy. Yeah well, gotta be patient, I know.

Thanks again guys for helping out.... OSCAR and a few others ! I wouldn't have come this far without you... 

[Gideon]

Make a list of complaints, symptoms, and be critical.  The answer to the question "How are you feeling?" is not the rhetorical "I'm feeling fine", it's a list of symptoms and complaints.  Just because you have already told your doctor what they are, tell him again.  Tell him that you made a list because you didn't want to leave anything out, would you like it?  
Overall ResMed devices are better than PR devices.  one reason to get a BiLevel (ResMed VAuto) is 'noncompliance/ lack of efficacy with your dream station, this is the non-compliant OSA mentioned under VAuto below.

The below came from Resmed's Titration Guide.  These are the only machines that should be in play for you. You are currently on the first one.
AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA

VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA

ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats OSA, Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)


Why ResMed AutoSet vs Dreamstation?

1. Faster algorithmic response to events than PR.

2. Lower average pressure

3. Better to avoid Aerophagia.

4. EPR provides for better treatment of hypopneas, RERAs, Flow Limits, UARS, and snores

5. EPR acts like a BiLevel up to a limit of 3cmw and a max pressure of 20 cmw

6. EPR follows your breathing whereas Flex predicts it with a feeling of fighting to get a breath when it predicts incorrectly

7. More flexibility in treating a greater variety of Apneas and respiratory events.

8. In general, provides better therapy.

I have frequently told many DreamStation users that they need to get either the ReaMed AutoSet or. BiLevel to get better therapy. 

Respironics costs less

[milboltnut]

Thanks Fred !

[milboltnut]

Make a list of complaints, symptoms, and be critical.  The answer to the question "How are you feeling?" is not the rhetorical "I'm feeling fine", it's a list of symptoms and complaints.  Just because you have already told your doctor what they are, tell him again.  Tell him that you made a list because you didn't want to leave anything out, would you like it?  
Overall ResMed devices are better than PR devices.  one reason to get a BiLevel (ResMed VAuto) is 'noncompliance/ lack of efficacy with your dream station, this is the non-compliant OSA mentioned under VAuto below.

The below came from Resmed's Titration Guide.  These are the only machines that should be in play for you. You are currently on the first one.
AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA

VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA

ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats OSA, Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)


Why ResMed AutoSet vs Dreamstation?

1. Faster algorithmic response to events than PR.

2. Lower average pressure

3. Better to avoid Aerophagia.

4. EPR provides for better treatment of hypopneas, RERAs, Flow Limits, UARS, and snores

5. EPR acts like a BiLevel up to a limit of 3cmw and a max pressure of 20 cmw

6. EPR follows your breathing whereas Flex predicts it with a feeling of fighting to get a breath when it predicts incorrectly

7. More flexibility in treating a greater variety of Apneas and respiratory events.

8. In general, provides better therapy.

I have frequently told many DreamStation users that they need to get either the ReaMed AutoSet or. BiLevel to get better therapy. 

Respironics costs less

Make a list of complaints, symptoms

DONE ! 

and be critical

Roger that !

VAuto..... [b]It Treats OSA, non-compliant OSA[/b]

It's an alternative for me? Or what?.....

 ResMed AutoSet.......

In general....?  and then the Dr. will determine from the study....which type?

[milboltnut]

if there is anything else my OSCAR chart shows that I should address to my Dr. please tell me.

I hope he doesn't frown on OSCAR. I just left a message if my questions I ask in regard to OSCAR will conflict with their software.

[milboltnut]

I have a Dr's appointment tomorrow... so if you guys could go over my OSCAR from 5/12..... I'd appreciate it, and tell me what questions I could ask on top of what I took for notes.

[Gideon]

"I have got my obstructive events under control, how do I now manage my central events?"

[milboltnut]

"I have got my obstructive events under control, how do I now manage my central events?"

That's the thing Fred..... 

I just got a denial letter from the sleep center from my  Ins. Co.

Talking about dropping the ball.......you ready for this?

This request is for initial treatment of Obstructive sleep Apnea and not a follow up study during or after sleep Apnea treatment.

it get's better...

The request for a sleep titration study in a facility is denied as not medically necessary 

There is no documented reason why an APAP to treat your sleep problem. The decision was made using InterQual, Procedures, Sleep Studies

My pulmonary Dr's office told me they requested a titration study... and we know that a titration study is needed for central apnea 
But my insurance company doesn't know that......

[SarcasticDave94]

You may want to consider calling insurance and explain what you need and to compare that to what the doctor's office requested. I've had procedures denied before because the request was not phrased correctly for the insurance to approve the request. Sometimes, they need to see certain key words or phrases that help the request or pre-authorization fit within medical procedure codes. Make it easy on them as they don't like thinking.

[milboltnut]

You may want to consider calling insurance and explain what you need and to compare that to what the doctor's office requested. I've had procedures denied before because the request was not phrased correctly for the insurance to approve the request. Sometimes, they need to see certain key words or phrases that help the request or pre-authorization fit within medical procedure codes. Make it easy on them as they don't like thinking.

trust me bro... I'm on it believe me ! I emailed them a bit ago ! Wanna see the email?