Trying to upgrade machine

[Breathe Jimbo]

She's "going to check if there will be an extra charge for you." Heh...

Call your insurance company. Explain that your doctor wrote you a new Rx for a specific machine. Explain that the DME has agreed to make the exchange. Ask whether, under the provider agreement, the DME is allowed to charge you an additional amount, above the payment under the provider agreement, for the new machine. I suspect the provider agreement says the DME cannot charge you more than what the provider agreement allows. Be prepared both (a) to argue that the insurance company said they cannot charge more than is allowed under the provider agreement, and (b) to demand that they show you anything that you signed agreeing to pay a return, restocking, or exchange fee.

[randyshipp]

Cigna just informed me in no certain terms that their contract does not allow charges in excess of the negotiated amount. So that's good to know.

[archangle]

If you get any pushback about the specific machine, have the doctor write the prescription for an "AUTO CPAP" machine with some range of pressures. Most, if not all, auto adjusting CPAP machines also do data collection. Avoid the RESMed S8, if possible, because even though it does record data, they don't sell the card readers to read the data any more. The RESMed S9 uses a standard SD card.

[randyshipp]

I'm happy to report that while I'm not sure my PCP understood my desire to have access to these data, she had no problem writing me a more specific Rx, down to the exact model number. Global Sleep, once they had the new Rx, gave me no problems, cheerfully exchanging my REMstar Plus for a PR System One Auto. They even exchanged the humidifier at the same time and threw in a new chinstrap to help me solve some mouth leakage I've been experiencing.

Though the whole thing took longer -- and took more phone calls -- than I would have liked, I'm happy with the results so far. I have a few things about the new machine that are slight concerns (it's a bit noisier, and its "A-Flex"/C-Flex features behaves in an odd, slightly vibrating/shuddering way when I exhale with some force) but nothing that's a dealbreaker. My next step -- and I hope you folks can point me in the right direction -- is to find the real manual for my machine, figure out what my software options are, and start looking at my data! What should I do first?

Thanks to all of you for being super helpful and supportive to people during a difficult adjustment period. I appreciate it.

[Pugsy]

I have same machine as you do. I have the clinician manual in pdf format. Send me a private message with your regular email address and I will send you a copy of the manual as attachment. We can't do attachments at this forum email.

Software options.
EncoreViewer 2.0 $99 patient version of the software. Small and easy to use. No waveform data though.

EncorePro 2.4 xx Doctor/clinic version of the software. Big, bulky and sometimes a PITA to install. Available by request.
Both of these are Windows based software. Pro comes in 32 bit and 64 bit versions.

You can also use Onkor online analyzer. Same data reported but visually different. Developed by another forum member and free to use.
http://www.onkor.net/

[archangle]

Congraduations, randy. Far too many people don't support success stories.

[randyshipp]

Thanks to Pugsy for helping me find both documentation for my machine and helping me understand my software options. The central apnea thing is freaking my wife out a little bit, but I already feel vindicated in my desire to gain access to the data and to manage my own health.

Thanks again!

[Janknitz]

Congratulations on getting a data-capable APAP--you're an A++ student.

[rested gal]

Congratulations on getting a data-capable APAP--you're an A++ student.

Absolutely!

You did great, Randy!

[randyshipp]

Thanks folks! Pretty good news so far. I had AHI >50 during my PSG, and it's averaged 1.2 over the last week or so. I would like to figure out whether there's anything that can be done about the CAs, since they're the part that scares my wife the most. But yeah, mostly good so far!

[Hawthorne]

If you are only having a few CAs then there is nothing to be worried about. I have the same machine as you do. I had the M Series before this one. They are both Respironics machines.

This one, the PR System One seems to be sensitive to CAs. I have a few regularly with this machine. Many of mine are sleep onset CAs and don't count. Sometimes, when we move in our sleep, we tend to hold our breath and it shows as a CA on this machine.

If you are having a lot then you should consider doing something. With an average AHI of 1.2, I doubt you need to be concerned about your CAs.

[rested gal]

I would like to figure out whether there's anything that can be done about the CAs, since they're the part that scares my wife the mos

No need for your wife to be scared of some scattered centrals. They're a normal part of practically everyone's breathing at times, whether asleep or awake. She has them, too.

I agree with Hawthorne:

If you are only having a few CAs then there is nothing to be worried about.
-----------------------------
With an average AHI of 1.2, I doubt you need to be concerned about your CAs.

If people using a PR System One or ResMed S9 machines notice a few "clear airway apneas" or "central apneas" appearing on their data, it can be reassuring to check out some of these discussions about "central apneas":
_____________________________________________

christinequilts (who was diagnosed with almost pure Central Sleep Apnea -- severe case) wrote:

6 centrals is not a lot- less then 1 per hour, and is perfectly normal. Everyone has central apneas- take 3 or 4 very slow & deep breaths right now, then count how many seconds after the last inhale until you feel the need to inhale again. Was it more then 10 seconds? If it was, you just had a central apnea. Next time you sigh take note how long before you inhale again....yep, another central apnea. Yawn? same thing can happen. Pick up a heavy box or weight- did you remember to breath? if you didn't, then you had another central apnea. Think of what you hear exercise trainers lecture about breathing while exercising- its human nature to not breath when we exert themselves.

Of course all of these are awake apneas- but any time you don't breath for 10 seconds, you technically have an apnea. While sleeping, you can have similar things happen- you can take several deep breaths and not need to breath for several seconds. During transitions between sleep stages, it is common to have central apneas because the acceptable levels of O2/CO2 are different for each stage...sort of like when you're still going 55MPH as you enter the 35MPH zone. When you turn over at night, it is common to not take a breath- just like when you lift something or exercise when awake. In people with OSA, they don't consider centrals a problem until they are well above 5 per hour- central apneas can be a symptom of OSA, just like snoring, arousals, etc. A few centrals are nothing to worry about- most sleep labs don't get concerned about centrals unless there are a lot of them.

viewtopic.php?p=47781#p47781
_________________________________

Also by christinequilts:

Having CENTRAL SLEEP APNEA, as a diagnosis, is rare. Having a few central apneas during the night isn't, its very common & is completely NORMAL.

viewtopic.php?p=179463#p179463

----

More of christine's well informed comments:


THink about when you exercise or concentrate hard- if your not aware you can hold your breath which is essentionally central apnea. Turning over in your sleep is basically like an exercise- you go from doing nothing to moving. If you were to have your breathing monitored while you are awake you would see a lot of 'central' events.

viewtopic.php?p=15061#p15061
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and here, where Christine was accidentally "guested":

Most people- even those without sleep disorders- have a few central apneas while sleeping. A common cause is when you roll over...have you ever noticed when you're exercising or lifting something heavy that you hold breath unless you actually think about your breathing? The same thing can happen at night as you toss and turn. THere are other things that cause centrals too- there is a certain amount of variance in our breathing patterns when we sleep just like there is when we're awake.

I wouldn't worry about central events unless there were a significant number per hour

viewtopic.php?p=6176#p6176

_________________________________

http://www.apneasupport.org/viewtopic.php?p=24677

In a reply titled "Nope" sleepydave (RRT, RPSGT and manager of an accredited sleep lab) responds to honda's question:

honda wrote:

Thanks for the comments, one other question though, do the 4 central apneas have any significance ?

None whatsoever.
sleepydave

sleepydave's nicknames on cpaptalk are "StillAnotherGuest" (SAG), "Muffy", "NotMuffy", and "deltadave."

_____________________________________

viewtopic.php?p=154811#p154811
On page 2, from a post by StillAnotherGuest:

Assuming that the obstructive events are properly managed, then the likelihood of these being sleep-onset centrals is fairly high (you'd need PSG to be 100%) and those things are pretty much a normal event.

________________________________

viewtopic.php?p=428835#p428835

DreamOn quoted this passage from the book:
"Sleep Apnea: The Phantom of the Night" by T. Scott Johnson, M.D, et al.

"Small numbers of central apneas are seen in virtually every normal and abnormal patient that is studied in the sleep lab and are usually a normal part of the transition to sleep.
....
"We have an automatic breathing control system that maintains the carbon dioxide in our blood at a stable level. This system helps to control the rate at which we breathe....During the day when we are constantly overriding our automatic breathing, most people maintain their carbon dioxide level at a fairly low level. With the onset of sleep, however, the sensor mechanism that detects levels of carbon dioxide in the blood becomes slightly less sensitive and accepts higher levels of carbon dioxide....This change in sensitivity occurs quite suddenly as we drop off to sleep from a normal awake breathing state, and we suddenly do not have enough carbon dioxide in our blood to drive regular breathing during sleep. For this reason, at sleep onset and after arousals there is often a pause in the effort to breathe that may last as long as 10 to 15 seconds. These events may be normal."

________________________________


JohnBFisher wrote:

"Here's an article that discusses how central sleep apneas occur during sleep onset:"

Ventilation is unstable during drowsiness before sleep onset
http://jap.physiology.org/cgi/reprint/99/5/2036

viewtopic.php?p=457468#p457468

________________________________


viewtopic.php?p=122303#p122303
Last paragraph in StillAnotherGuest's post at the bottom of page 2:

The phenomena of pressure-induced central apneas is tossed around far too freely. The vast majority of people do not get centrals because of ultra-therapeutic CPAP levels. BiLevel, Pressure Support (PSV) and Proportional Assist (PAV) Ventilation are another matter. You need some mechanism to drive the pCO2 below the sleeping apneic threshold, and plain old CPAP rarely is able to do that. OK, if you wanna argue that CPAP increases base lung volume (Functional Residual Capacity)(FRC), and since that increases gas exchange, some people can generate centrals that way, fine. But it's not as many as you might think.
SAG

______________________________

Those quotes and much more about true "Central Sleep Apnea" and "Complex Sleep Apnea" (CompSA) can be found here:

Links to Central Apnea discussions
viewtopic.php?p=22702

[dave50]

test

[dave50]

Fascinating story randyshipp for one who had no idea how the US system works , and great teamwork there.

I only discovered this place today, and have already learned some useful tips. My AHI's have been at 0.0 for a few days ( instead of around 1.4) so now I will unplug to reboot, for one. I'll be looking to download the software for mine so I can become an apnea-nerd too.

archangle wrote 26/4 am -- "The machine they charged your insurance $1000+ for can be bought for $400 online including humidifier."

The same the whole world over ... some people are making out like bandits.

[dave50]

Just getting used to yet another blog-system...