Medicare Payment of Oral Appliance & CPAP

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
RAnn
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Medicare Payment of Oral Appliance & CPAP

Post by RAnn » Fri Feb 06, 2015 11:03 pm

I've tried CPAP. My sleep physician has recommended that I now try an oral appliance. I've been fitted for a TAP III Elite by a sleep orthodontist and expect to have the appliance shortly. Does anyone know if it's possible to go back to CPAP with Medicare coverage if the oral appliance is not tolerable once Medicare has paid for the appliance? Thanks very much.

BrooklynCPAPer
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Re: Medicare Payment of Oral Appliance & CPAP

Post by BrooklynCPAPer » Sat Feb 07, 2015 9:24 am

I'm curious what made your doctor recommend the oral appliance after trying CPAP? Was it because you had trouble tolerating the CPAP therapy or just want to see if you can get effective treatment from an oral appliance instead?

I'm not sure about Medicare but Aetna made the sleep dentist and doctor explicitly sign off that I was against trying CPAP therapy to start with. They had no issues switching over to CPAP three years later when it became clear that was the only option left for me.

However, I think if they had paid for the oral appliance and in just a few weeks I said I changed my mind and wanted to try CPAP, it would have raised some flags.

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Pugsy
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Re: Medicare Payment of Oral Appliance & CPAP

Post by Pugsy » Sat Feb 07, 2015 9:58 am

Call Medicare and ask them.
How long did you give the CPAP a try?

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Re: Medicare Payment of Oral Appliance & CPAP

Post by RAnn » Sat Feb 07, 2015 10:26 pm

I've tried the CPAP over the past month and lowered the exhale pressure because I have a competing issue -- normal tension glaucoma. Studies have shown that CPAP can raise eye pressue (not good if you have glaucoma). There's not enough information out there as to why. I've speculated that it may be because it takes so much effort to exhale when the CPAP inhaling and exhaling pressure is the same. After consultation with my glaucoma specialist and the sleep specialist, the oral appliance was recommended. Since I've also had a TMJ problem in the past, I don't know how my jaw will react to this, which is the reason why I posed the question. I may have no other option other than CPAP or perhaps Bi-Pap as an alternative. I'm also still trying to find a comfortable mask -- not easy.

If I thought I could find someone at CMS/Medicare who could answer the question, I would have already done so. Calling Medicare for an answer to a more complex billing issue is hit/miss.

demogirl2015
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Re: Medicare Payment of Oral Appliance & CPAP

Post by demogirl2015 » Sun Feb 08, 2015 3:44 am

My friend has Carmore and the primary doctor told him that caremore does not provide CPAP machine my friend every other night catches his breath

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Julie
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Re: Medicare Payment of Oral Appliance & CPAP

Post by Julie » Sun Feb 08, 2015 6:46 am

Please don't take this wrong, but... are you sure they told you the glaucoma was due to Cpap? Apnea is associated with glaucoma, Cpap fixes apnea, so it seems quite unlikely that Cpap caused (or aggravated?) the glaucoma. Cpap lowers blood pressure, so I imagine it would also lower your eye pressure... you might want to re-check that.

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Re: Medicare Payment of Oral Appliance & CPAP

Post by BrooklynCPAPer » Sun Feb 08, 2015 9:06 am

RAnn wrote:I've tried the CPAP over the past month and lowered the exhale pressure because I have a competing issue -- normal tension glaucoma. Studies have shown that CPAP can raise eye pressue (not good if you have glaucoma). There's not enough information out there as to why. I've speculated that it may be because it takes so much effort to exhale when the CPAP inhaling and exhaling pressure is the same. After consultation with my glaucoma specialist and the sleep specialist, the oral appliance was recommended. Since I've also had a TMJ problem in the past, I don't know how my jaw will react to this, which is the reason why I posed the question.
Well, I learned something new today which caused me to find this abstract: http://www.ncbi.nlm.nih.gov/pubmed/18326715

You're 100% right - there is research to show CPAP raises IOP. I wonder if there is a glaucoma support board out there similar to this one you might be able to cross-post and see if others with diagnosed glaucoma are on CPAP. I suspect there must be.CPAP helps a lot of things but I know sometimes otherwise completely healthy people develop high eye pressures and glaucoma so it isn't a direct path.

As for the TMJ/oral appliance - if you can find a doctor or sleep dentist who is highly skilled in managing the oral appliance and ensure you have a perfect fit/willing to work with you for adjustments without charging you an arm and a leg every time, it may work out as a treatment option. I had TMJ issues last year and I've wound up on CPAP but eventually I'll try a MAD again myself.

Good luck with this - let us know how things progress.

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Re: Medicare Payment of Oral Appliance & CPAP

Post by chunkyfrog » Sun Feb 08, 2015 9:15 am

Cpap has no negative effect on my glaucoma. If anything, my eye pressure is better with cpap.
Some masks allow air leakage to flow by my eyes, making them even drier than
the side effects of my glaucoma eye drops.
(I would have to move to Colorado to quit the drops.).

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Tatooed Lady
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Re: Medicare Payment of Oral Appliance & CPAP

Post by Tatooed Lady » Sun Feb 08, 2015 9:28 am

so...wouldn't a bilevel machine be a logical thing to try? You could have a pretty low exhale pressure, along with a higher inhale.

Maybe I'm off base again. If so, smack me with a wet frog and tell me to go sit in a corner.

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chunkyfrog
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Re: Medicare Payment of Oral Appliance & CPAP

Post by chunkyfrog » Sun Feb 08, 2015 9:41 am

IMHO, there is no reason to blame the machine for glaucoma.
There is, however, scientific evidence that untreated apnea can exacerbate glaucoma.
If the current machine is providing inadequate treatment, then a Bipap might indeed help.
(((TL, I don't fight that way!)))

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Re: Medicare Payment of Oral Appliance & CPAP

Post by amenite » Sun Feb 08, 2015 10:09 am

chunkyfrog wrote:Cpap has no negative effect on my glaucoma. If anything, my eye pressure is better with cpap.
Some masks allow air leakage to flow by my eyes, making them even drier than
the side effects of my glaucoma eye drops.
(I would have to move to Colorado to quit the drops.).
Just curious if you've seen the actual pressure readings go down or stop going up? I've got a baseline pressure from my days before CPAP, but I didn't even think to ask what my numbers were at my last eye exam since the pressure was not even mentioned (guess I should make sure pressure was actually taken too? I'm pretty sure it was...) so it's something I can compare going forward.

library lady
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Re: Medicare Payment of Oral Appliance & CPAP

Post by library lady » Sun Feb 08, 2015 11:43 am

FWIW,I have a couple of vision disabilities, although glaucoma is not one of them. I visit my retina specialist often, in addition to the optometrist, and my eye pressure is stable... the same as it was before I started papping....

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Re: Medicare Payment of Oral Appliance & CPAP

Post by chunkyfrog » Sun Feb 08, 2015 11:55 am

My ophthalmologist checks twice a year, and my pressure dropped slightly when I started,
just not enough to go off these expensive drops!

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RAnn
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Re: Medicare Payment of Oral Appliance & CPAP

Post by RAnn » Sun Feb 08, 2015 12:48 pm

Thanks for all the responses regarding CPAP and IOP pressure increase. This is a long post, but the issue is a complex one. There are several studies regarding CPAP and increase in intraocular eye pressure in glaucoma patients including: "Correlation of CPAP, Bi-PAP, and Auto Pap Use with IOP in patients with Sleep Apnea and Glaucoma". The study was published by the Stritch School of Medicine at Loyola University, Chicago. Another recent clinical study was done by the Einhorn Clinical Research Center in New York. It did not show an increase in IOP in people without glaucoma, but cautioned that they had not yet done a study in glaucoma patients and recommended that it be done. The Loyola University study showed that the least amount of IOP increase occured with Auto Pap. My situation is such that I only have moderate OSA and require a pressue of 6 (low). Auto Pap may not provide enough consistent pressure to make a difference. My next try is Bi Pap, only based on the fact that I feel I have to strain too much to exhale on CPAP. Here's an interesting quote from the Loyola study: "We believe patients with both OSA and GLC will have increases beyond these findings because patients with OSA have more connective tissue flexibility which may allow for a greater increase in intrathoracic pressure and subsequently increased intracranial pressures and intraocular pressure." There is a website devoted to patients with Glaucoma (Fit-Eyes). I've never seen a post on there regarding CPAP and IOP increases. Actually, having OSA never occurred to me (I don't fit the profile -- many people don't) until my glaucoma specialist mentioned it as no eye drops were stopping my glaucoma progression despite IOP lowering. Out of desperation I did the sleep study. When I tried the CPAP, I thought the exertion of exhaling could possibly be affecting my IOP. It was then I did the research and found the studies. No doctor ever brought it up! I had to find it myself. BTW, living at 8,500 feet doesn't make a difference as far as the IOP is concerned. I still have to use two separate eye drops to keep the IOP where is is currently. My next steps are: Try the oral appliance. If it doesn't work, try Bi-Pap. I'm also going to buy a tongue device just in case and will check it against an oximeter, which I also plan to buy. Thanks again for all the responses.

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Re: Medicare Payment of Oral Appliance & CPAP

Post by memphisbound » Mon Oct 05, 2015 4:02 pm

I was diagnosed with glaucoma 9 years ago. I have some vision loss and thin corneas as a result. After cataract surgery my pressure dropped to acceptable levels but recently has started to creep up. My ophthalmologist ask about sleep apnea. I suspected for years that I had sleep apnea but I thought it was only an annoyance to anyone that had to sleep in the same room with me. The doctor immediately contacted my medical doctor to set up a sleep study. Sure enough I have severe apnea. I've been on my cpap (ResMed AirSense 10) for 4 nights and I'm hoping my pressure will be down again when I go back to my ophthalmologist at the end of the month.