POLL: Machine Pressure is not accurate?

[grandmma]

I didn't vote, since there was no choice really for "no, never occurred to me". Sad, I know, but there you are.

Never thought about it. And there's no way I'd go back to the sleep doc or the sleep centre, without a drastic reason, machine issues or not.

However, if the therapy wasn't working, I'd tweak it - which I did a year or so ago, and upped the pressure 1.5. Never occurred to me it could have been the machine, but I had put on some further weight, so presumed I needed a higher pressure due perhaps to that, or just ageing.

Sadly uninformed and ignorant machine-wise, I know!

[blakepro]

I didn't vote, since there was no choice really for "no, never occurred to me". Sad, I know, but there you are.

Never thought about it. And there's no way I'd go back to the sleep doc or the sleep centre, without a drastic reason, machine issues or not.

However, if the therapy wasn't working, I'd tweak it - which I did a year or so ago, and upped the pressure 1.5. Never occurred to me it could have been the machine, but I had put on some further weight, so presumed I needed a higher pressure due perhaps to that, or just ageing.

Sadly uninformed and ignorant machine-wise, I know!

Well, based on my own suspicions and confirmed so far through this poll, It seems to me that it is extremely rare for a machine to be dramatically off the pressure its set to. I'm guessing you would be more likely to have a variation based on altitude changes more than the actual machine not working properly. And many machines automatically compensate for altitude changes so even that seems like it would be rare.

[grandmma]

I'm guessing you would be more likely to have a variation based on altitude changes more than the actual machine not working properly. And many machines automatically compensate for altitude changes so even that seems like it would be rare.

Well, I have moved from a house to a top floor apartment!

[kevincoop]

There used to be a way on the older machines to where you could do a fine pressure adjustment to adjust the pressure slightly without changing the actual number on the screen. The newer machines don't have that feature (at least the ones I'm currently dealing with). It is pretty cool to hook a newer style machine up to a manometer and create a leak on purpose and see that the machine will compensate for that leak pretty accurately.
Kevin

[SleepyInIndy]

I tend to be of the same mind as LinkC - as long as it works, who cares what the number on the screen shows.

I do find it interesting though that my doctor has only looked at my machine once - the first visit after titration. He has never shown any interest since. And when he did look at the machine, no testing or verification of readings was performed. He didn't even pull the data card.

I would think that the more important question is "how accurate are the AHI and leakage numbers".

[Photomatt]

It seems to me that STATIC pressure tests may not be telling the true pressure. A static test does not take into account resistance within the tube while air is flowing. When air is not flowing, the resistance is effectively zero no matter how squashed or small the tube is. What is needed is a DYNAMIC test. That is, a test that measures the pressure at the mask with your mask in place. There is a 30 to 40 liter per minute leak built into the mask. What we don't know is how much that will modify the pressure.

The Respironics One machines have a "resistance" setting which is an attempt to overcome varying mask built-in leaks.

It seems that a T-type tube would be necessary so that one could connect the T to the mask, then one side would go to the machine and the other to the manometer. If that is done, resistance in the tubing and loss from mask leakage would be accounted for.

Has anyone done this or tried this?

[6PtStar]

The F&P Water Manometer has a vent in it that lets air flow while it measures the pressure. Don't know what the leak rate for the vent is, just never checked after using it.

Jerry

[finchy]

Just remember altitude has a direct affect on pressures, as well as settings such as C-Flex when you test with a manometer be sure to turn the C-Flex to off or to 1 to get an accurate reading. DME providers should test this without charge.

[blakepro]

Just remember altitude has a direct affect on pressures, as well as settings such as C-Flex when you test with a manometer be sure to turn the C-Flex to off or to 1 to get an accurate reading. DME providers should test this without charge.

Does Altitude affect manometers?

[6PtStar]

Just remember altitude has a direct affect on pressures, as well as settings such as C-Flex when you test with a manometer be sure to turn the C-Flex to off or to 1 to get an accurate reading. DME providers should test this without charge.

Does Altitude affect manometers?

Does not really effect manometers but does effect the pressure put out by the cpap. Higher the altitude the thinner the air the higher the blower needs to turn up to maintain the same volume/pressure of air. If the altitude is not compensated for the pressure will read low and manometer will read low. The dianogistic program that lets you set the pressure lets you set the RPM of the blower to the manometer. At least that is how it works on older Respirionics machines. I don't have anything on the new System One or Resmed.

Jerry

[kevincoop]

If you put the manometer in line with the mask you can see the CPAP pressure (on newer machines) go up to the prescribed pressure on inhalation and drop slightly on exhalation depending on what you have Cflex or EPR set at. You can also create a small leak and see that the machine will effectively adjust the pressure to compensate.
Kevin

[GTOJim]

Today I took my machine to Apria, the past six months I've been having a lot of trouble with mask leaks. Machine is set for 15, measured was 22. Apria wanted to send it out for repair, it's five years old. Apria offered to let me rent a machine while mine is being fixed. I said no thanks. Unfortunately I can't trust my local office not to pad the bill with 1,000% markup, they can't or wouldn't quote a repair price.

No much luck getting the cost for a new machine from Apria. Apria quoted $2,500, called "walk in pricing" for an S9 Auto. When I got home I phoned and spoke with another rep who stated, it's a three month rental, then I own the machine. The cost for rental is just under $1,000 per month, my 50% share would be slightly under $500 per month. Pricing is for machine only.

I called my insurance but they can not or will not give me my cost for new machine, only stating they cover 50%. Below are a couple of examples of why I can't trust Apria pricing/billing.

For the past 4 years Apria has been trying to charge me with a 20% co-pay on every order, even though my insurance covered 100% of the cost. Last year my spouse joined me as a hose head, Apria tried to pull the same 20% co-pay scam with her.

In April our insurance changed, now co-pay is 50%. I paid the 50% co-pay Apria said I owed. Later I discovered Apria over charged me after receiving an insurance statement showing the amount I'm responsible to pay.

Four weeks ago my wife had a knee replacement, doctor ordered an adjustable porta potty, height is adjustable, has handles to making it easier for her to stand up.
Apria sent us a bill, spouse checked with our insurance, cost is covered is 100%

When I picked up my current CPAP, I was given a factory sealed box containing my new machine, pressure was not set per my doc's prescription. I had to spend a night in a sleep lab to determine the proper pressure for my doctor to prescribe. Apria couldn't be bothered to set the pressure my doctor had prescribed for my CPAP. It was an auto, RT told me how to install the filter, stated if I wasn't capable of doing it myself, he would do it for me. I told him I could do it, taking the unopened box home.

I could go on for hours with examples such as these. I'll probably end up just paying out of pocket for a new CPAP. If I could save 50% on the cost using insurance it would be a plus.

[Goofproof]

Once Again, XPAP isn't Rocket Science. As with all things, the Specs have a range, most XPAPS that range is .5CM +\-! the set level, that allows a 1 CM difference to still be correct. It really doesn't matter what the number is, as long as it keeps your airway open without blowing the top of your head off. Using the Cheap blow type meters isn't any good as they read junk. Most DME's you deal with will test XPAP pressures, but you don't know the quality of the people or test equiptment. Surely there are better things to worry about, maybe your high leak rate. Jim

[GTOJim]

Yes the leak was a huge problem.

It felt like air bubbles were being blown under my eye lids, eye lids fluttering, like they were being raised up away from my eye. Don't know how to describe it. My eyes would be irritated all day. When this happened I could not get it to stop, even switching to a different mask, different brand didn't help. I found if I got up for a couple of hours, then after going back to bed I could get leak stop for a couple of hours. It was destroying my sleep, I felt like I did before being treated for sleep apnea.

My last new mask didn't seal at all, the Velcro would straps would pop apart before I could get the mask properly tightened. I tried the head gear from my old mask and still could not stop the leaks. Finally I took the cushion from the new mask and used it with my old mask. This worked just the same as the old cushion. Before switching the cushion, I tried to return the new mask to Apria since the Velcro would not stick well enough to allow me to adjust the mask. Apria refused to exchange, stated the mask had been tested. Six months ago I tried exchanging an unopened mask for a smaller size, thinking it might help, Apria refused to exchange it. I purchased a smaller size paying out of pocket, it was much worse, blew even more air under my eye lids.

I'm using ointment in my eyes every night, often more than once. Seems my machine went slowly, my mask leaks got gradually worse over a period of months, pressure slowly increasing so it wasn't noticeable. My Encore Pro stats haven't really changed, showing the correct pressure, same AHI. I have a range of 15-17.5. Encore Pro shows me spending a little more time at a pressure of 18.

I do volunteer work three days a week to give back to the community. One would think someone at Apria would have some compassion. I need to replace my machine and I can't even get them to provide the cost. Spoke with two people at Apria yesterday both gave a different price. Yesterday I got a new prescription from my doctor. I'll drive back out to Apria again today, maybe having the script in hand will make a difference. It would be nice if I could save a few hundred dollars using my insurance. If I fail again today I'll just order on-line and be done with it.

Last night I briefly tested with my spouses machine set to my pressure. The pressure difference was amazing, it felt like her machine wasn't working. I had to put my hand over the exhaust vent of my mask to verify air was escaping.

I was grasping for straws when I asked Apria to check my machine, I fully expected Apria to refuse. Its great to knowing there is cause for my problems. All this time I thought it was me, forgetting how to properly adjust my mask after 7 or 8 years as a hose head.

I'm really looking forward to getting a new machine, getting a decent nights sleep, not feeling like crap every day. Getting some energy back to enjoy doing things.

[GTOJim]

I just got home with a new XPAP (S9 auto) after spending 4 hours at Apria.

It started with the typical run around, I could not have a S9 auto. I was told my insurance coverage would only allow a cheaper machine, per Apria CS rep when I handed her a new prescription from my sleep doctor.

I asked to speak with a manager. I ended up meeting with the branch manager, she wanted to speak with me about a complaint I opened with Corporate a week or so prior.

She took lots of notes, said she will be speaking with her staff. We agreed on a cost for a new S9 auto machine. I know this sounds strange. It will take a few days to determine if my insurance will cover a new XPAP. I was told, sometimes with an old machine such as mine (5 years old) out of warranty, insurance companies sometimes require sending it out to determine the repair cost. If it's cheaper to repair, the insurance will repair an out of warranty machine rather than allowing a new purchase.

I agreed to pay 50% pending insurance approval. Depending on the outcome I might be paying the total cost out of pocket. I was quoted a reasonable price, not the $2,500 to $3,000 range quoted yesterday.

I have the branch managers business card along with one of her other managers cards. If I have any future problems they want me to call either of them. Apria and I started a new relationship today, a fresh start so to speak, putting the past behind us. I really hope to have positive things so say about Apria going forward. We are off to a good start.