Suffocation

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
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Re: Suffocation

Post by Pugsy » Sun Feb 10, 2013 12:16 pm

I wonder why the back up rate is prescribed when there are no centrals. Very odd.
You do need to see a specialist.

The VPAP Auto 25 is based on the S8 models. It is the model prior to the S9 VPAP Auto (see the link in my profile because that is what I use). They have removed the 25 in the model name.

The VPAP Auto 25 is a full data (at least for what was offered when it was the top of the line) and has some decent data on the machine's LCD screen. Do you know how to get to that data? Unfortunately the S8 models didn't flag centrals. Centrals didn't become available until the S9 models.

With your high pressure needs you definitely need a bilevel machine (that's what you have). It affords the most comfort for exhaling.
Be careful with partial nights. Medicare requires that for 70% of 30 nights that you use the machine for at least 4 hours.
If you don't meet that requirement they could deny the claim. I think you have 90 days to fulfill that requirement. Also requires a visit with the doctor sometime after 31 nights of use and no longer than 90 nights of use.

To see the data on your machine go get the clinical manual. How to access it is explained in the manual and you can request it here. Scroll down to almost the bottom of the page to see how to request the manual.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

The DME could have supplied the S9 VPAP Auto like mine but they instead chose to give you a discontinued model.
They didn't do you any favors. Medicare would have paid for the machine like mine based upon the pressure requirements. Only bilevel machines will deliver pressures in excess of 20 cm.
My machine doesn't have a back up rate either but it would flag any centrals which would document a need for a backup rate if that is what was going on.

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MsKelly65
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Location: Oklahoma, USA

Re: Suffocation

Post by MsKelly65 » Sun Feb 10, 2013 1:59 pm

My Rx from my PCP was for (as taken directly from the suggestions in my sleep study report):
~ ResMed S9, Auto Bi-level
~ Max: IPAP 25 cwp - Min EPAP 15 cwp
~ Back up rate 10
~ Full Face Medium Mirage Quattro Mask with heated humidification
~ RAMP time 10 minutes

Notes from Sleep study include (there is a lot of info on here that I don't understand but will include if anyone is interested and requests it):
~within 153 minutes of sleep:
6 Obstructive apneas; no central apneas; no mixed apneas
46 obstructive hypoapneas equal to or more than 3% oxygen desaturation
no REM sleep
AHI/RDI: 50/hr
Arousal index: 53/hr (no wonder I feel like I never sleep!)
~during therapeutic time
CPAP initiated at 5 cwp and gradually increased as per the tolerance and resolution of obstructive events
At max CPAP 19 cwp and due to persisting severe obstuctive events and intolerance, Bi-level 20/18 cwp initiated
At max attempted pressures of CPAP 19 & Bi-level 23/19 cwp 2 epochs of REM, AHI/RDI @ 32/hr and 0/hr respectively. Rebound sleep seen.
~Very severe obstructive sleep apnea hypoapnea and sleep disordered breathing syndrome with sleep fragmentation treated best with maximum attemted Bi-level therapy. {Other suggestions included elevating head of bed, ENT evaluation, basic sleep hygiene followed, avoidance of sedative/hyponotic meds prior to sleep, avoiding caffeine 4-6 hrs before bedtime - all done; also suggestion of weight loss - yeah, we'll see, it's not #1 on my list of things to do, though crocheting instead of eating when bored really helps ]

_________________
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Humidifier: HumidAire H4i™ Heated Humidifier
Additional Comments: Machine: VPAP Auto 25

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Pugsy
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Location: Missouri, USA

Re: Suffocation

Post by Pugsy » Sun Feb 10, 2013 2:22 pm

MsKelly65 wrote:~ Max: IPAP 25 cwp - Min EPAP 15 cwp
~ Back up rate 10
Wonder if the term back up rate should maybe have been Pressure Support? Pressure support is the difference between 15 and 25.
Normally when we think back up rate we think a timed response where the machine kicks in and forces a breath due to central activity.
This is what you got. Discontinued machine well over 2 years ago and replace by the S9 VPAP Auto
https://www.cpap.com/cpap-machine/resme ... chine.html

This would be the S8 model line of the machine that has ST (spontaneous timed) back up rate and is used for people with centrals.
https://www.cpap.com/cpap-machine/resme ... chine.html

This would be the S9 model used to treat centrals. Extremely high dollar machine and yes, Medicare wouldn't pay for it with documentation of centrals and probably some other requirements.
http://www.resmed.com/us/products/s9_vp ... nc=dealers

They gave you what appears to fulfill the RX requirements if by back up rate the doctor was thinking pressure support.
They just supplied a discontinued model. Very likely used. Have your checked the hours of use on the machine. It records total run hours along with therapy hours. Total run hours can't be reset but therapy hours can be reset to zero.

I don't see anything on your report that you show that points to any need for the machine that would treat centrals.

Pressure support of 10 is kind of high though.

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squid13
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Re: Suffocation

Post by squid13 » Sun Feb 10, 2013 3:22 pm

I don't no why they told you that Medicare wouldn't pay for it cause they paid for mine with no problems what so ever. I think they fed you a line of you know what just so they could get rid of an old machine from there business.

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Last edited by squid13 on Sun Feb 10, 2013 3:57 pm, edited 1 time in total.
US Navy Retired 1973,AirCurve 10 ASV, Mode: ASV Auto, Min EPAP: 7.2, Max EPAP: 15.0, Min PS:4.0, Max PS: 15.0, Mask ResMed Airtouch F20, Backup: (2) AirCurve 10 ASV

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Pugsy
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Location: Missouri, USA

Re: Suffocation

Post by Pugsy » Sun Feb 10, 2013 3:43 pm

BTW...the price that Medicare pays for the VPAP Auto 25 and its equivalent the S9 VPAP Auto is exactly the same.
Medicare pays by billing codes and not by model name.
They have 2 bilevel billing codes...1 for the VPAP Auto 25 and the S9 VPAP Auto and another for those high end ASV type of machines that are used for centrals.

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Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
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I may have to RISE but I refuse to SHINE.

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MsKelly65
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Location: Oklahoma, USA

Re: Suffocation

Post by MsKelly65 » Sun Feb 10, 2013 3:56 pm

I posted all this once and it disappeared! Probably did something wrong:

My Rx written by my former PCP, which she took directly from the sleep study report and recommendation:
Res Med S-9, Auto Bi-Level Therapy, maximum IPAP of 25 CWP and minimum EPAP of 15 CWP, back-up respiratory rate of 10, full face medium Mirage Quattro mask, heated humidification, and RAMP time of 10 min.

I have the sleep study report and don't know what all of it means but this is detailed under "Impressions:"
"Very severe obstructive sleep apnea hypoapnea and sleep disordered breathing syndrome with sleep fragmentation treated best with maximum attempted Bi-Level therapy."

Central apneas were listed at 0. Medicare said a less expensive machine than the S9 would have to be prescribed because I did not need the back up rate, since I don't have central apneas. Former PCP refused to re-write the Rx without the back-up rate or for another machine because she is not a sleep specialist and would only write for what was recommended. It takes 4-6 weeks or longer to go through the referral process from intiating an appt. to request a referral to a specialist to completion of report back to my PCP and the ability to act on it -- that's IF the Indian Clinic determines they have the funds available at the time I need the referral. At the time, I didn't request a referral to the specialist. I now have a different PCP than when this Rx was written and will call Monday to make an appt. with him to see if he feels comfortable prescribing another max IPAP CWP to alleviate the air swallowing problem, or if he wants to put in another referral to the sleep specialist.

Even with Medicare's help, I don't think I could afford a new machine (I'd have to pay 20% of the monthly rental fee for 13 months). A friend gave me the "VPAP Auto 25" and Medicare MIGHT help me with the ongoing supplies, otherwise, I may have to depend on my mother for help there.

_________________
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Humidifier: HumidAire H4i™ Heated Humidifier
Additional Comments: Machine: VPAP Auto 25

MsKelly65
Posts: 12
Joined: Fri Feb 08, 2013 10:49 pm
Location: Oklahoma, USA

Re: Suffocation

Post by MsKelly65 » Sun Feb 10, 2013 4:10 pm

Also, I called and spoke directly to Medicare who REFUSED to give me the information on why the machine prescribed was declined or what machine might be approved based on my sleep study results. I was told my provider would have to call the Medicare provider line - and they would not tell me the number for that. They did NOT want me having access to the information available to the providers to prevent fraud. They flat out told me that. I can appreciate that on one level, but on another, I could not problem-solve the situation without the information.

The medical equipment company could only tell me that Medicare said since I didn't have central apneas I wasn't qualified for what was in the Rx.

And my PCP (and prescribing dr. at the time) is not a sleep specialist, wouldn't call Medicare, and said that if the sleep study dr. said I needed back-up rate that evidently I needed it.

I was so frustrated I was in tears. I'm not stupid and I'm perfectly capable of advocating for myself but even I was meeting roadblocks at every turn!! Can you imagine how many people out there are suffering because of this crap who have no hope at all because they can't advocate for themselves??

Even after being gifted a machine that would do what I needed, it was almost impossible to find someone who would set it up according to the parameters in my Rx. If I even got call-backs from people I was told they would only set up machines they had dispensed. It was weeks after receiving the machine that I found a company who would set up the machine I had in order to earn my repeat business for replaceable supplies.

The absolutely ridiculous time frame of all this: my former PCP requested the sleep study in July, 2012, and it was the week of Jan. 28, 2013, that I was finally able to being using the machine. Now I have a new PCP at the Indian Clinic and I'm going to make him listen to all of this story before I let him set up another roadblock. I can't afford to self-refer to a sleep specialist to adjust my CWP and pay a co-pay, so I'm trusting God to grease the wheels. There are bunches of Indian Clinics in Oklahoma that I can go to for general care free of charge, but for a referral to a specialist I have to see the PCP I'm assigned to in the clinic in my district.

_________________
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Humidifier: HumidAire H4i™ Heated Humidifier
Additional Comments: Machine: VPAP Auto 25

MsKelly65
Posts: 12
Joined: Fri Feb 08, 2013 10:49 pm
Location: Oklahoma, USA

Re: Suffocation

Post by MsKelly65 » Sun Feb 10, 2013 4:16 pm

Whoa! I just realized there is a second page to this thread!! I apologize for the redundant information and will read what you all added right now!

_________________
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Humidifier: HumidAire H4i™ Heated Humidifier
Additional Comments: Machine: VPAP Auto 25

MsKelly65
Posts: 12
Joined: Fri Feb 08, 2013 10:49 pm
Location: Oklahoma, USA

Re: Suffocation

Post by MsKelly65 » Sun Feb 10, 2013 4:25 pm

Just to be clear - a DME didn't provide the machine I have - it was gifted to me by someone who no longer uses it. The resp. therapist who set it up for me said she's had a number of problems reported on the newer one. She said her husband uses one just like mine - has used it every night for several years and never had a problem with it.

So it wasn't the machine that Medicare was necessarily rejecting but the diagnosis codes that indicated I needed support for central apneas that means they would have to pay more? If we can get something prescribed that Medicare will approve, I'll let my current DME run it and see if I can afford the 20% copay so I know I'll have hardware support if I need it. Right now, if something went wrong with the machine I'm using I'd just be out of luck.

The recommendation on the actual sleep study specifies "back up respiratory rate of 10" but doesn't mention pressure support.

I wasn't impressed with this sleep study center's handling of everything, but I'm not sure if our clinic contracts with anyone else for sleep apnea support.

_________________
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Humidifier: HumidAire H4i™ Heated Humidifier
Additional Comments: Machine: VPAP Auto 25

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Pugsy
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Re: Suffocation

Post by Pugsy » Sun Feb 10, 2013 4:35 pm

Okay, machine was a gift.
RX points to a back up rate setting which normally goes with a machine that is treatment for centrals. So without centrals in the diagnosis Medicare won't pay (that part is correct).

This link shows what Medicare normally sets as allowable amounts for the bilevel machines...Your portion would be 20% after your Part B deductible is met. This was for last year but I doubt there was a large change this year.
http://www.resmed.com/us/documents/1013 ... et_rad.pdf

If you are doing well....feeling decent....sleeping well and all that...then there is no need to push for the new model S9 VPAP Auto if you don't feel the need.
There is data available on the machine's LCD screen that would greatly help you evaluate the effectiveness of your therapy. I already mentioned how to get the manual so you can figure out how to get to that data.

The RX needs to be rewritten so that a DME can provide a current model IF you aren't happy with the one you have and you want a new machine.
Based on what you have said so far...no centrals and you don't need a machine for centrals.

So how are you feeling?

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

MsKelly65
Posts: 12
Joined: Fri Feb 08, 2013 10:49 pm
Location: Oklahoma, USA

Re: Suffocation

Post by MsKelly65 » Sun Feb 10, 2013 6:13 pm

I can only tolerate the machine for 4-5 hrs at a time until I have to take it off to get rid of the stomach gas. If I lay down during the day, I use it also. I have many health problems besides the OSA, so I don't know how good I can ever expect to feel, but even with only 4-5 hours on the machine at night I've had a pretty significant improvement in my daytime sleepiness. Even sleeping on my side (without the machine) I experience severe obstructive apnea...it's been years since I've felt like I ever slept for more than 30-45 minutes at a time.

I'll continue to use it as I can while getting all the new stuff requested.

Other diagnoses: diabetes type 2, hypothyroidism, GERD, bipolar 2, possible fibromyalgia and/or polymylagia rheumatica and/or autoimmune disorder, undergoing testing for Celiac disease, undiagnosed random neurological symptoms, migraines, possible IBS, other chronic undiagnosed GI symptoms from throat to the out-going end, and, not surprisingly, severe obesity.

The OSA is one piece of my health puzzle that we know will make the other parts easier to handle if we can get it straightened out. Long-term goal is to be able to get off disability and get back to being able to work a regular job - preferably, as a preschool teacher again; possibly, secretarial work.

_________________
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Humidifier: HumidAire H4i™ Heated Humidifier
Additional Comments: Machine: VPAP Auto 25