New person with insurance/DME annoyances

[teresamichele]

Not to just jump in and start asking questions but I need to vent. I thought there was a question in here when I started this post, but now I think I'm just annoyed.

I had my sleep study Friday night and it came back with an RDI of 61.3, AHI of 42, and my lowest SaO2 was a rather alarming 82%.

So, as you might imagine, they started me on CPAP (split night study) and I fell back asleep. They started me at 4cm, and went up to 18cm. They finally decided 16cm was optimal, which brought my desaturations at the lowest point to 92%. Also, I got 21 minutes of REM sleep during the 55 minutes they kept me at 16cm.

I want an APAP because I don't want 16cm of pressure blowing in my face all night. I was lucky that I liked the first mask they tried (small Mirage Quattro Full Face) but 16cm seems like a lot of pressure. I figure an APAP would go down to 14cm when I don't need 16cm. The doctor who gave me my report (not my normal sleep doctor) said that I didn't need an APAP because they knew what my pressure was. I wasn't under the impression the APAP was only for when they didn't know your pressure. I'm correct in thinking the APAP can be used by people who know their pressure, right? The doctor didn't know what he was talking about?

The insurance company (United Healthcare) says they'll pay 80% of the CPAP unless the doctor says I need the APAP and can justify it. That said, aren't CPAPs and APAPs charged under the same code at the DME? The insurance company says that the DME (I don't know who it is yet) has to contact their care coordinator and they'll basically decide what machine they'll pay for. This is, as you might imagine, a bit annoying. I also worry that with the pressure that high I should be using a VPAP but I probably have to fail CPAP first. I'm not really sure.

Whatever I end up getting it, it will be rent-to-own (UHC policy and I can't afford to not use it) so what I'm thinking I'll do is just take whatever they offer at first because I don't know if I can hold out a few weeks while we duke it out. Now that I know what I can feel like, I have no desire to continue feeling like a wet paper towel. They said that I can just keep it, then when I need to move to APAP, I can return the CPAP and start a new contract for the APAP (or VPAP if it comes to it).

I can't help but feel that people trying to recover from OSA are at a disadvantage. We're suffering from chronic sleep deprivation and then we're given all this information and told to make a choice by people who may or may not have our best interests at heart. The whole thing is just exhausting me but I refuse to let them push me around. I just need to get a CPAP/APAP/something before I really can't handle going to work and the like.

I did have some well-meaning co-workers offer to set up a Sears ShopVac on the blower setting for me (I work with engineers) and make some tubing and rig up a humidifier. I told them I'm not that bad. Yet.

I promise more coherent posts in the future and less whining but GRR. I want this to be resolved and I want to feel better!

[Necro]

Welcome to the frey!
I too feel that same way a lot!
One thing though Im on CPAP and some do have comfort settings that start at low pressure and slowly build to th high pressure. The thought being that you will be asleep by the time it gets there and you wont notice. I would say give it a try first and see how it works for you.
BTW Im a noob too so I dont know crap.

[Pugsy]

First battle:
Data capable machine

Educate yourself on which machines offer more than compliance (hours of use data). Don't be fooled if it says it has a data card. Compliance only machines will have data cards but they only show the insurance company hour many hours you use the machine.

Consider software for optimal data collection.

Welcome to the forum.

[Wulfman]

Hi Teresa,

Welcome to the forum.
You're pretty much correct with all of your assumptions (that you phrased as questions).
APAPs and CPAPs have the same insurance billing codes.
THEY may THINK they know what your pressure should be.....right now......but that may change over time.

However, with that said, the minimum you should shoot for is a data-capable machine. You could then use the software available for it and determine for yourself if the pressure they prescribed works for you on a nightly basis.
I was titrated at a much higher pressure than what I actually needed......I started out with a data-capable CPAP and the software (as shown in my profile information)......I didn't acquire an Auto until over a year later and then found out it didn't give me any better therapy (actually worse than the CPAP).

At pressures as high as you mention, some exhale relief would be very beneficial......that narrows the selection down to the Respironics and ResMed machines. ResMed machines don't respond to "frank" (abrupt/out-of-nowhere) apneas without preceding events above the pressure of 10 cm. because they use the A10 algorithm. So......that narrows the selection down to the Respironics machines.......currently the M Series Pro or the M Series Auto (w/A-Flex). Respironics has a brand new machine coming out now, but there is no software available for it yet.....especially to the end-user. (I'd put my money on what's available, tried and true.)


Den

[teresamichele]

So of course, after I post that they called!

I talked to the DME, which is a local hospital (which is comforting somehow), and they said that they have to give me a CPAP because the prescription is written for the CPAP set at a pressure of 16. If I want an APAP, the doctor has to write a new request.

Then I asked what machine - it's an S8 Elite II! Yay! That was the CPAP I wanted if I couldn't get an APAP.

They're waiting to get confirmation from the insurance and then they'll have the RT call me and set me up. SO ready!

It's so nice to realize that I've actually got a problem and I'm not just fat and lazy. I'd convinced myself my fatigue was only due to my weight so the idea that I might soon have the energy to work out and the like is mind-blowing for me.

[Wulfman]

So of course, after I post that they called!

I talked to the DME, which is a local hospital (which is comforting somehow), and they said that they have to give me a CPAP because the prescription is written for the CPAP set at a pressure of 16. If I want an APAP, the doctor has to write a new request.

Then I asked what machine - it's an S8 Elite II! Yay! That was the CPAP I wanted if I couldn't get an APAP.

They're waiting to get confirmation from the insurance and then they'll have the RT call me and set me up. SO ready!

It's so nice to realize that I've actually got a problem and I'm not just fat and lazy. I'd convinced myself my fatigue was only due to my weight so the idea that I might soon have the energy to work out and the like is mind-blowing for me.

That's a good, data-capable machine.

Congratulations!


Den

[JimIllinois]

That sounds an awful lot like my own story. My outcome had the doc prescribing 17/17 in my fully auto machine. The doc feels that auto units do not respond fast enough to events, which allows some non-breathing to occur.

But the 17 came from the worst-case experience that night. On my back, jaw hanging open, tongue relaxed and dropping back, etc.

When I tried 17 the first night at home, it was an impossible pressure, so I found out how to program a pressure range and ended up setting 10 to 17. My data shows I never get higher than 15 or so, and most nights am under 14 at peak. But the best news is that those peaks only happen briefly, once or twice a night (I prefer to sleep on my side). My 90% number is 11.5.

The doc ended up accepting my choice, because the most important thing is overall compliance.