advice welcomed please

[quietmorning]

Brief background: I have been on cpap (apap) for about 3-4 years. I learned of my apneas from a gf whose father had a cpap. I snored very loudly and woke up alot, and was tired all day. I had no medical insurance but was able to get a resmed APAP black market and through experiment set it for min 12. I sleep alot better. But I still have some tiredness during the day and alot of memory/concentration issues. Not sure is I need adjusting of the settings or if I need something else.

Advice needed: I recently got medical insurance. It does not cover pre-existing conditions. Do I tell the doctor the background story and that I have been on APAP for several years and that it has helped but not enough, or do I just tell him I'm having sleep issues?

Zenman - pre-existing conditions have to be proven from a doctor's diagnosis. The insurance company will initially deny all of your claims for 'pre-existing condition'. This tells the dr's office or hospital to do a search of all diagnoses that they have to see if there is a diagnosis code matching what they are denying. The thing that people don't realize is that it has to be the EXACT code - or the insurance has to pay for it. The hospital or doctor's office will send the insurance company a copy of all diagnosis codes within the last year proving that this code was not in the mix - and the insurance will paid.

So, if you have never been DIAGNOSED with apnea, you do not have a pre-existing condition.

Do not go in telling them that you HAVE apnea - as your spoken history can be used as a testament to this and it will slow payment down. They will have to do more research - and could possibly deny on this. Just tell the doc you wake up at night having trying to catch your breath and that your past gf told you you snore. Let the doc do all the diagnosing.

If this is a past diagnosis from a doctor - if you have not been seen within the last six months for this issue, then it will not be considered per-existing. (It looks like you haven't been under a doc's care for at least the last two or three years?)

(Just a note: I did this for a living for twenty plus years.)

[zenman72]

Which specific model is the S8? Elite?.....Autoset/Vantage?......or Escape/Compact? The first ones are data capable and the Escape/Compact are not........they only collect hours used.

Which mask do you have? Yes, the online sellers started requiring prescriptions for complete masks a few years back, but will sell parts for them without an Rx. They are frequently available from individuals (on the forum) who wish to get rid of some that they have accumulated and/or didn't work for them. Sometimes they're available for free or for very little money. Some parts to nearly complete masks are also available on Ebay.

Den

If your S8 has Escape or Compact in the model name there is no useful data on it.
If it says Elite or Autoset...it does.
Tell us what it says and if it is the Elite we can tell you how to get what data it offers off the LCD screen.

Masks...yes, you have gone way too long with that mask.
What mask type/name are you using?
Yes, they do require prescriptions but depending on what mask you want to use there are ways to buy the replacement parts and build your own mask. EBay sellers get around the RX requirement by selling each part as a replacement part because replacement parts don't require a RX. The down side is that you don't have a huge selection to choose from because they tend to offer the most popular masks.

Awesome advice! Mine is an autoset, If there is some way to get data off of it that would be awesome if you guys can help. I think there is a slot for an optional data card though but no card in it fyi.

The mask is resmed mirage activa.

So, if you have never been DIAGNOSED with apnea, you do not have a pre-existing condition.

Do not go in telling them that you HAVE apnea - as your spoken history can be used as a testament to this and it will slow payment down. They will have to do more research - and could possibly deny on this. Just tell the doc you wake up at night having trying to catch your breath and that your past gf told you you snore. Let the doc do all the diagnosing.

If this is a past diagnosis from a doctor - if you have not been seen within the last six months for this issue, then it will not be considered per-existing. (It looks like you haven't been under a doc's care for at least the last two or three years?)

(Just a note: I did this for a living for twenty plus years.)

Thanks for the advice. I have never been diagnosed with apnea or even spoken to a doctor about sleep related concerns.

[Pugsy]

The S8 Autset is a full data machine and there is some data on the LCD screen.
You would need the provider/clinical manual to figure out how to get it though. I am not familiar with that model but you can request the manual here.
While this tells you how to get into the menu you won't know which settings are what so request the manual..instructions down near the bottom of the page.
Large leak territory for the S8 is 0.4 L/sec...

http://www.apneaboard.com/adjust-cpap-p ... tup-manual
ResMed S8 Compact, S8 Elite, S8 AutoSet Vantage & AutoSet Spirit: Press the right and down arrows simultaneously for about 3 seconds until the word "clinical" appears. Select Menu, then use the left and right arrows to cycle through the settings. Use the up and down arrows to make adjustments.

You have to turn sleep quality on to have the data available on the LCD screen

[big_dave]

Awesome advice! Mine is an autoset, If there is some way to get data off of it that would be awesome if you guys can help. I think there is a slot for an optional data card though but no card in it fyi.

If you need to order a data card, you can order one from http://1800cpap.com/resmed-s8-series-re ... cards.aspx. The data card is a smart card, which is a narrow strip of credit card stock with an embedded electronic chip. You do not leave it in the slot all the time, unlike the SD cards used by newer machines. Instead, you insert it for 30 seconds when you want to collect the data. The machine will not write any more data to the card if you leave it in the slot.

If you want to download the data to a computer, you will need to order a specialized data card reader from eBay (search for "ResMed card reader"). It records graphical data for pressure, AHI, leaks, and events, as well as usage. It does not record detailed flow data or snoring. You can also read some limited data on the LCD display by holding down the left and right arrow buttons for three seconds.

[zenman72]

Thanks Pugsy and Big Dave and others for your help. I think I have stumbled onto some data that has been saved, however I need assistance interpreting what it means to me and how I can use the information.

Pressure: 14.2 week, 13.8 month, 13.6 6 months, 13.4 year
Leak: .40 week, .40 month, .28 6 months, .26 year
AHI 9.8 week, 10.1 month, 7.6 6 months, 6.4 year
AI 2.3 week, 2.9 month, 1.7 6 months, 1.5 year
HI 7.4 week, 7.5 month, 5.6 6 months, 4.9 year

Soemtimes I leave the machine on if I have to get up in the middle of the night for something, it might be left on at times for 10 minutes before I get back, so not sure how that may effect the leak data. Still, it seems the leak data has increased noticably in the last month

[idamtnboy]

Zenman, tell the Doc you have a problem with being sleepy during the day, your gf complains about you snoring, her father had sleep apnea so you've become aware of it, you've been doing a lot of internet searching, and you think you should have a sleep study. Leave it at that. If you tell him about the CPAP he may castigate you for doing your own medical treatment. When he asks how long you've been suffering from daytime sleepiness tell him it's been years, but since you haven't had insurance you couldn't afford to seek treatment. He'll take it from there. He'll probably have you do oxygen monitoring for a night. If so, don't use your CPAP that night. If you show desats, which you should, he'll move on to sleep study and prescription.

Your AHI numbers show you're not getting adequate therapy.

If you haven't already, read the many threads here about what kind of machine you want. Don't settle for a brick!

[Pugsy]

How long have you been using this S8 machine? Very long? I bet some of those old averages are from prior user maybe???
Unless you have been using it for a long time??

General rule of thumb...we like for the AHI to be less than 5.0
On the S8 machine... 0.40 is the beginning of large leak territory. What you are seeing on the machine's LCD screen is the 95% leak number..means for 95% of the time you were at OR below that number. The "or below" part of the definition makes it kind of hard to tell you if your leaks are seriously impacting your therapy or not. You are pushing that limit but it's possible that the time spent above .40 is not excessive to the point of seriously impacting therapy. We would need to be able to see the actual detailed leak graphs to know for sure.

The S8 machines have been known to perhaps score Hyponeas a little more aggressively than the newer machines when compared side by side. It looks like it might be doing that for your with the much higher HI numbers.
The AHI is still higher than I would want to see if it were my report.

[zenman72]

If you haven't already, read the many threads here about what kind of machine you want. Don't settle for a brick!

I'll try looking for them. Their are brick machines?

How long have you been using this S8 machine? Very long? I bet some of those old averages are from prior user maybe???
Unless you have been using it for a long time??

General rule of thumb...we like for the AHI to be less than 5.0
On the S8 machine... 0.40 is the beginning of large leak territory. What you are seeing on the machine's LCD screen is the 95% leak number..means for 95% of the time you were at OR below that number. The "or below" part of the definition makes it kind of hard to tell you if your leaks are seriously impacting your therapy or not. You are pushing that limit but it's possible that the time spent above .40 is not excessive to the point of seriously impacting therapy. We would need to be able to see the actual detailed leak graphs to know for sure.

The S8 machines have been known to perhaps score Hyponeas a little more aggressively than the newer machines when compared side by side. It looks like it might be doing that for your with the much higher HI numbers.
The AHI is still higher than I would want to see if it were my report.

I've been using the machine for 4 years. I got it brand new from a guy who had another machine and received this as a replacement but had already lost alot of weight and was free of sleep apnea. So it had no usage when I received it.

Thanks to your advice I found a place I could order a new mask and tubing without prescription and have done that. I'm thinking that can help alot. I'm guessing that the numbers have gone up a bit as the mask really does seem to have some fitting issues from being worn. For last night the AHI was 12.6

Meanwhile I will get to the doctors next week.

[idamtnboy]

I'll try looking for them. Their are brick machines?

We call them bricks because that's about how smart they are in recording data. One example is the S9 Escape. Hopefully Pugsy, or someone else, can direct you to some links off the top of their keyboard! I don't have those references memorized like she does!

[Pugsy]

Hopefully Pugsy, or someone else, can direct you to some links off the top of their keyboard! I don't have those references memorized like she does!

Memorized?? Gosh no. I have them saved for quick easy access though.
http://maskarrayed.wordpress.com/

Personally...I would zero in on ResMed S9 and Respironics PR System One machines.
ResMed S9...avoid anything with Escape in the name.
Respironics..names are hard to decipher since Respironics likes to use the same model names which are confusing.
Instead I prefer to learn the model numbers...model numbers to avoid..anything below 450.

[zenman72]

Thanks for the links. Do the insurance companies generally dictate what type machine to get, or do I have much of a choice or does it depend?

[chunkyfrog]

Ah, yes, the dance.
Insurance, Medicare, etc. pays the same for HCPCS code A0601, which covers your machine,
my machine and the Escapes, Pluses, and other non-data machines the DME would like to get you to take.
(their cost is less for the bricks, making their profit large---very large)
It is up to you to make sure your doctor specifies a full efficacy data machine,
even to the point of specifying the EXACT MACHINE YOU WANT.

[Pugsy]

Do the insurance companies generally dictate what type machine to get, or do I have much of a choice or does it depend?

Insurance companies rarely care. DMEs are the ones who try to dictate the machine model and they often try to supply the cheapest (cost wise to them) so that they make more money.
Check with your insurance company if you are going to be using them to find out which DMEs your insurance works with and then go shopping to find out which one will give you what you want...and not necessarily what they want to supply.
Some DMEs actually automatically dispense the full data machines anyway...but some don't.
That's why you need to know about which models do what.

[grapeshly]

My insurance company has an on-line listing of all the Durable Medical Equipment (DME) suppliers they work with in my area. So I took the names and started researching. Some of those DMEs had websites, and they listed the CPAP machines they supplied. I got lucky in that the second place I checked listed the Respironics, otherwise I'd have been calling these places by phone. By the time I saw a doctor and got the official prescription, I knew which machines, and who to tell him would be the DME my insurance company would work with. I must say that I got a bit lucky with my Doctor, who also has sleep apnea, so he didn't object to what I asked for. Also, for whatever it's worth, my doc had a list of DME's that were "good to work with" from his point of view, and my the DME I picked also was on his list. So...to sum all this up, do some research, make some phone calls, and ask some questions.

FYI, I have the Respironics 560, and I am pleased with it. While I am not feeling up to to messing with with the settings, the fact that I can call up details about my sleep and breathing, and let's me check for myself how things are going gives me satisfaction, and a measure of control over my treatment. I am not at the mercy of a callous medical establishment. (My doc isn't callous, but the DME seems to be. I guess that DME was "good to work with" in that they didn't try to palm a sub-standard machine off on me, but no way were they going out of their way to help me pick a good mask!)

[zenman72]

Thanks for the advice on the DMEs etc to all. It's nice to have new friends who are so knowledgeable and empathetic

Had such a difficult time sleeping last night. AHI was 14.6, leak .46. I realized that I was able to talk and breath through my mouth even with 13.0 pressure on the cpap, something that I certainly could not do at the beginning of therapy. I think the mask I have been using is just totally non-effective at this stage, but it has been a gradual change so I have had a hard time realizing it. Like I said, I have had it for 4 years. Do you guys and girls replace it every year or get new cushions every year, or at what interval generally?

New one should arrive today