CPAP Compliance for Medicare

I saw the nurse practitioner at the sleep clinic today for the first follow-up since my sleep study and starting to use the CPAP. When i asked about compliance, I was told I hadn't met it. When I asked how to meet it, she looked at the print-out from the SD card and said since I had 3 straight nights of use, I needed to have 19 continuous days to meet the 21-day requirement.

I didn't want to argue since I wasn't sure, but I came home and looked and found this: Compliance is defined as CPAP usage of 4 hours per night for 70% of the nights in a consecutive 30-day period during the first 90 days of therapy.

The compliance report from Oscar says I have 90% compliance in the last 30 days.

Has anyone run into the problem of incorrect interpretation of the regulations? If so, how did you combat it? There are times when it's not possible for me to use the CPAP (like last weekend at a campground), so I could theoretically never have 21 straight days.

I guess you can plan 21-day period with no interruptions.

You have to point the idiots to the actual stated requirement on the Medicare website and have them read it until they understand it.

Or...if you have a DME who supplied you with the machine that is different from the NP office....have them supply a statement once you have met the 70% within 30 day requirement. They should know how to furnish it....it's up to them anyway because they are the ones that Medicare pays.

Hopefully you didn't get the machine from the office that the NP is in.

4 hours does not count if it has been rounded up to that number.
They will only accept 4.01 or greater.
It is barely enough to satisfy the pencil pushers.
Work on getting ENOUGH as soon as you can.

The machine came from a different place than the sleep doctor. And the compliant nights are all 4.01 and above. And most range between 4.01 and 6 because the damn machine has made my sleep quality HORRIBLE! I went to a campground last week and couldn't use the machine and guess what? I slept great. I'm in the process of losing weight and was told if I can lose 15 pounds I can qualify for another sleep study and evaluation. I can assure you this - it will not be done at the same place as the one that put me on the CPAP.

Nobody promised me life would be great, but most people told me the CPAP would make a big positive difference. They didn't lie; I'm just the apparent exception to the rule.

And does someone have a link to the Medicare site where the compliance rule is stated? I've searched and searched and obviously am not entering the proper search terms. I can find it on sleep center sites but not Medicare. Thanks.

I suggest that you download OSCAR (formerly SleepyHead) and start analyzing the data.

You might want to consider tweaking your settings (after you get data from OSCAR).

I suggest that you download OSCAR (formerly SleepyHead) and start analyzing the data. You might want to consider tweaking your settings (after you get data from OSCAR).

I've done that and understand some of the data. I think the settings are okay. I have no problem with the pressure and I'm not sure what other setting I could tweak.

BamaGramma wrote: ↑

Thu Aug 01, 2019 6:58 am

I've done that and understand some of the data. I think the settings are okay. I have no problem with the pressure and I'm not sure what other setting I could tweak.

Just because you have "no problem" with the pressure doesn't mean that it's *effective* at stopping your breathing problems.

Just because you have "no problem" with the pressure doesn't mean that it's *effective* at stopping your breathing problems.

That's a good point. I'm not sure how to know if it IS effective though. I had to take the SD card to the sleep clinic and the nurse practitioner looked at the data and asked me a bunch of questions. No changes were made to the settings with regard to pressure. I'm going to work on putting together my Oscar data to post here for those of you who understand it better than I do.

BamaGramma wrote: ↑

Fri Aug 02, 2019 5:38 am

Just because you have "no problem" with the pressure doesn't mean that it's *effective* at stopping your breathing problems.

That's a good point. I'm not sure how to know if it IS effective though. .... I'm going to work on putting together my Oscar data to post here for those of you who understand it better than I do.

That's the way to find out if it's effective, by posting it here, getting guidance, and learning, in time, to interpret your own data. Soon enough, you won't need us, or the ineffectual sleep clinic.

BamaGramma wrote: ↑

Fri Aug 02, 2019 5:38 am

Just because you have "no problem" with the pressure doesn't mean that it's *effective* at stopping your breathing problems.

That's a good point. I'm not sure how to know if it IS effective though. I had to take the SD card to the sleep clinic and the nurse practitioner looked at the data and asked me a bunch of questions. No changes were made to the settings with regard to pressure. I'm going to work on putting together my Oscar data to post here for those of you who understand it better than I do.

Unfortunately, many doctors and clinics only look at the compliance data and/or the ahi. They don't really look at the full data and what it means.

For example, my mom had been off and on cpap for 20 years before I started cpap. Her machine at the time had ahi, but not all the detailed data that is now available. After I had my followup with the sleep doctor, I let my mom use my machine for half a night so that we could lookat the data. I set the machine for 10 which was her prescribed pressure. Her ahi was 3.4 shich sounds good to doctors (under 5). But many people don't feel much better until they are below 2. Also, when I looked at the events, I saw that she was having clusters of longer events. 8 events over 30 seconds in less than 15 minutes. One was 62 seconds long. No wonder she still felt like crap.

We did another partial night with the machine set for 10-13 to see what the machine wanted to do. I printed both graphs, and she made an appointment with my sleep doctor. He review those and he last sleep study. He then prescribed a new full data auto machine and set it for 10-15. She does MUCH better now and finally feels better.