Switched from CPAP to Auto CPAP - question

[JoyD.]

Today my DME called me and said that my sleep doc is going to switch me to the M Series APAP (from CPAP which I've had for a couple weeks). Yeah, I've been wanting that. I took my old machine in, and asked her what pressure range he wanted her to set the APAP. She said "4 to 20" PLEASE HELP ME UNDERSTAND WHY HE WOULD WANT TO DO THAT . . . when my titration last week showed that all H&A events were eliminated at a pressure of 13 cm HOH?!

Also, this sleep doc set the CPAP to 6 when he gave it to me prior to Titration. I figured he just wanted to get me used to it. But from all I learned from you all on this forum . . . I began resetting my CPAP daily to zero's so I could read my dailies on the machine (haven't been able to install my software yet). And I had been increasing my pressure myself every couple days by 1 cm . . . and was up to 12 cm pressure which showed 2 AHI.

I tried to go to bed tonight and got so frustrated to see the "4.0" pressure which stayed the same for AN HOUR. Is this 4-20 range as inane as it sounds to me? So what's going to happen . . . when the APAP senses a H or A event is it going to speed up from 4 to a pressure of 13 and knock me out of bed?

I did get my Titration follow-up appointment changed from March 23rd to the 3rd . . . (the Titration was a joke . . . I slept less than 2 hours so I can't put much confidence in it . . . but surely my pressure should be between 11 and 13 since I also watched my daily AHI's. (I hope I can get my software installed in a few days when the Reader is delivered), and look at what is happening with this APAP set at 4-20.

I'd appreciate your input . . . I'm getting very impatient with my sleep doc. Thanks!!

Joy

[danw61]

I think "4 to 20" is just nuts. If it were me, I would change it to a min of 11 or 12, max 20 and see what the stats look like after that for further adjusting.

Dan

[GumbyCT]

Joy,
The doc prob did NOT specify and the DME honestly prob doesn't know any better and thinks s/he is doing the right thing. Sounds like you know how to get in there - you know what WILL happen. Set it to where YOU know it will help you. DO NOT DELAY.

[Goofproof]

4cm to 20 cm, that's what they are taught in Fry School Now. When I was in Fry School, we were taught Old School 350 degrees until Golden Brown, w/lots of salt.

At 13cm CPAP, 11cm to 14 cm on APAP would be a good start, I'd get the software and reader ASAP, and leave these fools behind. Jim

[JoyD.]

by danw61 on Tue Feb 24, 2009 9:46 pm
"I think "4 to 20" is just nuts. If it were me, I would change it to a min of 11 or 12, max 20 and see what the stats look like after that for further adjusting."

by Goofproof on Tue Feb 24, 2009 10:15 pm
4cm to 20 cm, that's what they are taught in Fry School Now. When I was in Fry School, we were taught Old School 350 degrees until Golden Brown, w/lots of salt. At 13cm CPAP, 11cm to 14 cm on APAP would be a good start, I'd get the software and reader ASAP, and leave these fools behind. Jim
At 13cm CPAP, 11cm to 14 cm on APAP would be a good start, I'd get the software and reader ASAP, and leave these fools behind. Jim

When my DME's RT (whom I like) told me she had to do what the doctor said (I can understand that) re. setting it to what he asked for, 4-20, I told her, "Well, I'll just set it to 11-16 myself when I get home." She reminded me that if I want Medicare to pay for all my stuff (which I do!!!), that I'd better not get into the provider settings again. What she meant by that is that when I took my old machine in (it was all zeroed out to do daily readings) . . . and she took the data card back to read the compliance data for Medicare, no data was on it! It said "Error" and all the data was gone. She did retrieve the accumulated data for the blower, from the machine itself. But nothing was on the card to print out for Medicare. Medicare now requires a printout to prove "daily compliance" (over 4 hours of therapy daily minimum for every day). The RT is going to cover for me by blaming it on a corrupted card, but we know better. When I zeroed out the therapy usage daily after writing down the daily AHI, leak, and hours of therapy data . . . I believed that it wouldn't erase the data on my card . . . but this turned out not to be true.

Dan & Jim, I say all this to explain WHY I am fearful to "mess with" the pressure settings.. . I want my $1 Grand of equipment free (via Medicare)! But I do have an appt with the sleep doc on March 3rd, and if he doesn't give me some satisfaction and let go of his need for "total power" . . . I'm going to go to my primary care doc and tell her I think I can do a better job of monitoring my therapy without the restraints of the sleep doc, and prefer to just work with her on this. She, as I, are of the belief that the patient and doctor are a TEAM!

Joy

[JoyD.]

by GumbyCT on Tue Feb 24, 2009 10:05 pm
The doc prob did NOT specify and the DME honestly prob doesn't know any better and thinks s/he is doing the right thing. Sounds like you know how to get in there - you know what WILL happen. Set it to where YOU know it will help you. DO NOT DELAY.

Gum,
Actually I know it was the doc . . . because I asked her to call his office on the spot while I was there (I knew he was in today).

[sleeplessinaz]

If you like your primary care doctor why are going to a sleep doctor? I have never even seen a sleep doc---my primary doctor and I are the ones that set up the sleep study, titration, machines and masks. My Primary care doc knows way more about me than any other doctor --so if I were you--I would see your primary care doc. since you seem to get along better with her,
Carrie

[GumbyCT]

I don't know "how" you were resetting the machine but that should not erase ANY data from your card. But as I said I don't know how it was done. The card should not be moved in or out of the machine while it is writing to the card. But it could have just been a bad card too.

Your call certainly but if it was me - I'd call the doc right away and let him know you CANNOT breath at 4cm and tell him the pressure you want it to start at. Puzzles me why you didn't do this while she had the office on the phone, knowing what you know. After all breathing is what this is all about.

[JoyD.]

by GumbyCT on Tue Feb 24, 2009 10:56 pm

I don't know "how" you were resetting the machine but that should not erase ANY data from your card. But as I said I don't know how it was done. The card should not be moved in or out of the machine while it is writing to the card. But it could have just been a bad card too.

Your call certainly but if it was me - I'd call the doc right away and let him know you CANNOT breath at 4cm and tell him the pressure you want it to start at. Puzzles me why you didn't do this while she had the office on the phone, knowing what you know. After all breathing is what this is all about.

I never actually touched the card; have never removed it. To reset, I read a providers manual and followed it. Now I'm freaked out to alter any settings because I don't want to risk Medicare denying my claims for all this equipment.

If I could talk with the doc himself, I'd do it . . . the girls are impossible! Half the time I don't know if he ever got the message, and if they are just saying they spoke with him. But there's no harm trying again tomorrow to call his office . . . and I may just follow Carrie's advice and call my internist and ask her to manage my sleep care so I'm not so restricted.

Thanks for your ideas . . . I'm always open . . .

Joy

[Wulfman]

Have you gone through the Setup? Is it possible they turned the "Split Night Time" on? Maybe they set the Ramp time to 45 minutes, too.

It's not supposed to be possible to delete any data from the card by resetting the data in the LCD display......and wouldn't be logical for it to BE possible.
I suspect you're dealing with some folks on your "TEAM" who don't know much about Autos or even how to read a card. And, if they don't have the most current software (EP 1., it would quite possibly come up with an error or not give much, if any information.

You need to get your minimum pressure set TO or near where your CPAP pressure was for your machine to be effective.

I don't know if she/they can "legally" do the following, but to me, it borders on something like blackmail.

She reminded me that if I want Medicare to pay for all my stuff (which I do!!!), that I'd better not get into the provider settings again.

Good luck with your "TEAM".

Den


Hold down the <- -> buttons while plugging in the little power cord in the back, wait for 2 beeps release buttons. Then press the + key to enter setup mode, use the <- -> buttons to move to the next field, use the -/+ keys to decrease/increase values, when set press the On/Off button to exit Setup.

Therapy Mode = CPAP/AUTO (If Auto is selected, there will be A-Flex or C-Flex options)
CPAP Pressure = NN (only appears in CPAP mode).
AutoMax = 20 cm (default)
AutoMin = 4.0cm (default)
C-Flex Setting = Off, 1, 2 or 3
Ramp Time = (0:05 to 0:45)
Ramp Start Pressure = 4.0cm (can be from 4cm to AutoMin pressure).
Mask Alert = On/Off (beeps on large leak, mask removal).
Auto Off = Off (turns off machine on large leak/mask removal) Suggest leaving it "Off"
Split Night Time = Off (options are Off, 120, 180, 240) Should be "Off"
Show AHI/Leak = On (enables logging to display) Suggest leaving it "On"
Patient Reminder = Off (days to remind you that you get a new mask w/Insurance).
Returns to Therapy Mode
Pressing On/Off exits Setup.

[Wulfman]

I just had another thought that may not jeopardize your payment situation.
If you still have your prescription for your CPAP pressure, you could set the Auto to CPAP mode at that pressure and get through a night or two till you can get it straightened out with your doctor.

Den

[JoyD.]

by Wulfman:
I just had another thought that may not jeopardize your payment situation.
If you still have your prescription for your CPAP pressure, you could set the Auto to CPAP mode at that pressure and get through a night or two till you can get it straightened out with your doctor.

Thanks so much, Den. It's after midnight here and I wanted to go to bed but was dreading it. I had forgotten about using CPAP, however his Rx for that was 6 (I had the titration later and then he called in the Auto for me). It was I who upped it gradually to 12, based on the LED display of daily AHI's.

But I am very tempted to get in there and change the settings via your instructions which I SO APPRECIATE. Yes, I'm DISGUSTED . . . I'm gonna stomp right up the stairs and RESET!

Joy

[rested gal]

What she meant by that is that when I took my old machine in (it was all zeroed out to do daily readings) . . . and she took the data card back to read the compliance data for Medicare, no data was on it! It said "Error" and all the data was gone. She did retrieve the accumulated data for the blower, from the machine itself. But nothing was on the card to print out for Medicare. Medicare now requires a printout to prove "daily compliance" (over 4 hours of therapy daily minimum for every day). The RT is going to cover for me by blaming it on a corrupted card, but we know better. When I zeroed out the therapy usage daily after writing down the daily AHI, leak, and hours of therapy data . . . I believed that it wouldn't erase the data on my card . . . but this turned out not to be true.

Joy, that has distressed me ever since I read that your card had no data on it.

As I mentioned in our emails, I started experimenting, using the same machine as yours (M series Auto with A-Flex.) Starting with one night of my data already on the card, I've zero'd out the machine data on two consecutive days. I've downloaded the card three times now, and the data is all there. Nothing got erased.

So, when your DME found no data on your Smart Card, I think something was wrong with one of these things:

A. your Smart Card was bad from the start
or
B. the Smart Card module in the machine was faulty
or
C. the card was not seated well in the machine when the DME gave you the machine

Your DME can rest assured she'll be telling Medicare the truth -- even though you were using the machine, something was wrong with the card or the card module.

And you can rest assured that zero'ing out your machine's therapy data, following the steps in the link below, didn't erase the data that should have been on the card:
viewtopic.php?p=239127#239127

[ca_hosehead]

I have an APAP and I find that the machine is too slow to respond to breathing events. It does not respond to isolated events, even though they effect my sleep.

Some people seem to think that you can set the machine up with settings of 4-20 and the machine will take care of the rest. That may be true for you but it has not been my experience.

What I do is watch the reports and see how high the pressure needs to go to handle the events and then raise the floor pressure to that number. I raise it in increments and make sure I am comfortable at each level.

The reports are essential. Once you have them you can see what breathing events you have through the night and how the machine is dealing with them (or not). How you are feeling is the most important indicator, but the reports give you the why of it.

[JimW203]

by GumbyCT on Tue Feb 24, 2009 10:56 pm

I don't know "how" you were resetting the machine but that should not erase ANY data from your card. But as I said I don't know how it was done. The card should not be moved in or out of the machine while it is writing to the card. But it could have just been a bad card too.

Your call certainly but if it was me - I'd call the doc right away and let him know you CANNOT breath at 4cm and tell him the pressure you want it to start at. Puzzles me why you didn't do this while she had the office on the phone, knowing what you know. After all breathing is what this is all about.

I never actually touched the card; have never removed it. To reset, I read a providers manual and followed it. Now I'm freaked out to alter any settings because I don't want to risk Medicare denying my claims for all this equipment.

Joy

Joy,

First off, let me say that what I say from here on may simply be wrong - if it is, someone please correct me, I would like to know.

Assumptions:
1) The DME reports "compliance" data to Medicare to support their claim
2) "Compliance" data consists of usage pattern over a specified number of days
3) "Compliance" data contains no efficacy data, settings or treatment information
4) Your reporting medium is the card, not the machine (you take in the card only)

Questions:
1) Can you switch what is recorded on the card from "Compliance" to complete data at will?
2) Is that switch detectable in the compliance data record?

Conclusion:
If the set of assumptions is correct and the answers to the two questions are Yes & No, respectively, get a second card and deliver compliance data to the DME while keeping the second card with complete data for your own use and analysis.

The conclusion is only valid if the assumptions and answers are valid - someone please correct my logic - as I said, I may simply be wrong.

JimW203