DME told me I have to stick with prescribed pressure of 5

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Mackij
Posts: 2
Joined: Tue Nov 08, 2022 9:42 am

DME told me I have to stick with prescribed pressure of 5

Post by Mackij » Fri Dec 02, 2022 10:54 am

I just completed my first month on CPAP and was prescribed a constant pressure of 5. (My sleep study said AHI of 19 with about 50% central). I found it somewhat hard to draw in breath at that pressure-- I eliminated the ramp which started at 4 and I continue to use an EPR of 3.

After reading all the great info on this forum I tried Increasing my pressure to 6 with good success in easing my breathing. I've slept through the night for the last week with AHIs 2-3. Last night the AHI was 6.3 for some reason and my DME called to lecture me about not changing the prescribed pressure. I called my sleep doctor's office to schedule my follow up (I've been 100% compliant) and asked if I can keep using a pressure of 6 until my appt which is 5 weeks away. The sleep nurse is unavailable until next week and needs to get approval from the doctor first she said. Agh!

What happens if I just keep it on 6? Can the DME take the machine away? Does Medicare care what pressure I'm using?

Thank you!

_________________
Machine: AirSense 11 Autoset
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: I am still getting used to Bleep but using p10 for now

User avatar
LSAT
Posts: 13229
Joined: Sun Nov 16, 2008 10:11 am
Location: SE Wisconsin

Re: DME told me I have to stick with prescribed pressure of 5

Post by LSAT » Fri Dec 02, 2022 11:20 am

It's your therapy...you are the patient...if you are sleeping better at that pressure, I doubt that your doctor would object. If he does, he's the wrong doctor for you. The DMEs are not medical professionals. From my experience, they are mostly salespeople....ALSO....with a prescribed pressure of 5 an EPR setting of 3 would only reduce the exhale pressure by 1 down to 4 which is the lowest the machine goes. EPR is probably not needed.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: Fisher & Paykel Vitera Full Face Mask with Headgear (S, M, or L Cushion)
Additional Comments: Back up is S9 Autoset...... Buckwheat hull pillow

User avatar
babydinosnoreless
Posts: 2325
Joined: Fri Nov 02, 2018 2:53 pm

Re: DME told me I have to stick with prescribed pressure of 5

Post by babydinosnoreless » Fri Dec 02, 2022 11:31 am

Mackij wrote:
Fri Dec 02, 2022 10:54 am
I just completed my first month on CPAP and was prescribed a constant pressure of 5. (My sleep study said AHI of 19 with about 50% central). I found it somewhat hard to draw in breath at that pressure-- I eliminated the ramp which started at 4 and I continue to use an EPR of 3.

After reading all the great info on this forum I tried Increasing my pressure to 6 with good success in easing my breathing. I've slept through the night for the last week with AHIs 2-3. Last night the AHI was 6.3 for some reason and my DME called to lecture me about not changing the prescribed pressure. I called my sleep doctor's office to schedule my follow up (I've been 100% compliant) and asked if I can keep using a pressure of 6 until my appt which is 5 weeks away. The sleep nurse is unavailable until next week and needs to get approval from the doctor first she said. Agh!

What happens if I just keep it on 6? Can the DME take the machine away? Does Medicare care what pressure I'm using?

Thank you!
Are you here in the US ? If so tell your DME to kiss your hiney and do what you want. I would put in a sd card to prove compliance (you only have to prove that you use it not that you are using it at their pressures ). and put it in airplane mode so the DME can't switch anything. If your doctor has a problem fire him and find another one. Your body, your machine, your choice. I was put on a pressure that would have ensured failure if I hadn't switched it on my own. Went to my follow up appointment and the doctor didn't even look at the pressure he looked at the ahi and the compliance and said good job see you next year.

User avatar
lazarus
Posts: 1290
Joined: Sat Mar 12, 2022 3:21 pm
Location: NY

Re: DME told me I have to stick with prescribed pressure of 5

Post by lazarus » Fri Dec 02, 2022 1:11 pm

As a general rule, I disagree with anything prefaced with "DME told me."

DME answers to the doc; the doc answers to you. Lowering your AHI is your right, since your sleep and body logically matter most to you, not either of them.

Ditch the ramp if you're more comfortable without it. Maybe even ditch the EPR if you don't need it for comfort at that low pressure.

Good sleep docs love having informed participants as patients.

Last sleep doc I spoke to said: "It's good you handle all that yourself. It isn't exactly rocket science."
The people who confuse "entomology" and "etymology" really bug me beyond words.
---
A love song to a CPAP? Oh please!:
https://youtu.be/_e32lugxno0?si=W4W9EnrZZTD5Ow6p

Janknitz
Posts: 8410
Joined: Sat Mar 20, 2010 1:05 pm
Location: Northern California

Re: DME told me I have to stick with prescribed pressure of 5

Post by Janknitz » Fri Dec 02, 2022 3:28 pm

DME answers to the doc; the doc answers to you
I agree with all you said except this part. I would put it this way:

DME answers to the company and stock holders who are concerned about their profit margin and to the regulatory agencies. They make nice to the docs for referrals, but the docs also have to do the compliance documentation so that the DME gets paid, so the doc answers to them for that. The DME generally only care about compliance, because that's how they get paid.

It's interesting that this DME even noticed or cared that you increased the pressure by one whole cm/H2O--did you tell them or ask permission to change the pressure? The DME's supposed to follow your prescription, so cannot advise you to change the pressure without the doctor's order. But unless you somehow flagged it for the DME, I have no idea how they even noticed. If the DME was monitoring efficacy and noticed that way, you have a rare DME, and because of your diagnosis of central apneas (which can be sensitive to increases in pressure) maybe you actually have a DME who cares. That would be a rarity.

The doc should answer to you, but doesn't. The doc answers to regulatory agencies and to your insurance company that pays the bill. Way back when I worked in healthcare in the Pleistocene era, we once had a lecture on "who is your customer" when the bean counters were trying to apply business efficiency principles to the healthcare setting. :roll: I was a direct care provider and sure thought the answer to that question was my patient. But I was told, no, not really. My "customers" were the doctors who made the referrals to me and the insurers who paid for my services. Patients barely rated on the "customer" scale and concerns about their needs were considered secondary (and THIS is why I eventually left healthcare!).

Again very rarely you will find a doctor who actually monitors his/her patient's treatment efficacy and prescribes pressures accordingly. The vast majority (even specialists in sleep medicine) just want to make sure that the compliance is documented so everyone gets paid and then get you out the door as fast as possible so that they can increase their revenue by packing more patients into the schedule.

Maybe you have a doctor who actually cares, and may have been firm with the DME that his/her patients need to stick to the prescription. But that's almost never the case.

With Central Apnea, you do need to watch that pressure increases are not causing you more central apneas. But if you understand what to look for, and you're more comfortable and compliant with the higher setting, there's no CPAP police who are going to be knocking on your door because you dared to make reasonable changes.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

User avatar
lazarus
Posts: 1290
Joined: Sat Mar 12, 2022 3:21 pm
Location: NY

Re: DME told me I have to stick with prescribed pressure of 5

Post by lazarus » Fri Dec 02, 2022 3:50 pm

All true.

But in the medical context of at what pressure a PAP machine is run, the DME only cares what the doc says (and ignores the patient), and the doc only cares about patient response to therapy (and does not [usually] consider the DME part of his doc-patient medical team).

And patient-adjustmemnts for low AHI automatically takes centrals into consideration.
The people who confuse "entomology" and "etymology" really bug me beyond words.
---
A love song to a CPAP? Oh please!:
https://youtu.be/_e32lugxno0?si=W4W9EnrZZTD5Ow6p

User avatar
ChicagoGranny
Posts: 14409
Joined: Sun Jan 29, 2012 1:43 pm
Location: USA

Re: DME told me I have to stick with prescribed pressure of 5

Post by ChicagoGranny » Fri Dec 02, 2022 5:19 pm

Mackij wrote:
Fri Dec 02, 2022 10:54 am
my DME called to lecture me about not changing the prescribed pressure
Tell the damn busybody to GTH.
Mackij wrote:
Fri Dec 02, 2022 10:54 am
Can the DME take the machine away?
No.
Mackij wrote:
Fri Dec 02, 2022 10:54 am
Does Medicare care what pressure I'm using?
They don't even know what "CPAP pressure" means.

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: DME told me I have to stick with prescribed pressure of 5

Post by palerider » Fri Dec 02, 2022 5:35 pm

lazarus wrote:
Fri Dec 02, 2022 3:50 pm
and the doc only cares about patient response to therapy
HAH, funny. have you taken a look at the american medical system in the last 20 years? :roll: :lol: :lol: :lol:

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

User avatar
lazarus
Posts: 1290
Joined: Sat Mar 12, 2022 3:21 pm
Location: NY

Re: DME told me I have to stick with prescribed pressure of 5

Post by lazarus » Fri Dec 02, 2022 6:36 pm

palerider wrote:
Fri Dec 02, 2022 5:35 pm
lazarus wrote:
Fri Dec 02, 2022 3:50 pm
and the doc only cares about patient response to therapy
HAH, funny. have you taken a look at the american medical system in the last 20 years? :roll: :lol: :lol: :lol:
Maybe I had the last good sleep doc.

Besides, dead patients pay no bills.
The people who confuse "entomology" and "etymology" really bug me beyond words.
---
A love song to a CPAP? Oh please!:
https://youtu.be/_e32lugxno0?si=W4W9EnrZZTD5Ow6p

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: DME told me I have to stick with prescribed pressure of 5

Post by palerider » Fri Dec 02, 2022 8:31 pm

lazarus wrote:
Fri Dec 02, 2022 6:36 pm
palerider wrote:
Fri Dec 02, 2022 5:35 pm
lazarus wrote:
Fri Dec 02, 2022 3:50 pm
and the doc only cares about patient response to therapy
HAH, funny. have you taken a look at the american medical system in the last 20 years? :roll: :lol: :lol: :lol:
Maybe I had the last good sleep doc.

Besides, dead patients pay no bills.
If sleep docs were all as good as yours was, this forum wouldn't exist.

All too many docs these days are like my nephrologist. ... "Hi, are you doing OK? need anything from me? Rx refill? tell the nurse, bye". Less than a minute, $200 bill.

He can, and often does, "consult" 12 patients in the clinic, and he's in and out of the door in less than 20 minutes.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

Mackij
Posts: 2
Joined: Tue Nov 08, 2022 9:42 am

Re: DME told me I have to stick with prescribed pressure of 5

Post by Mackij » Sun Dec 04, 2022 6:34 am

Thanks to everyone for your replies and support! I'm so grateful.

To Janknitz: I think my AHI rising to 6.3 must have somehow been flagged which got the DME's attention. I never contacted them about changing my pressure.

The good news: My sleep doc's staff got ahold of their nurse who called me back and told me to sure go ahead and use the higher pressure if I'm more comfortable. She also contacted the DME and told them to back off. :lol: So all is well!

_________________
Machine: AirSense 11 Autoset
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: I am still getting used to Bleep but using p10 for now

User avatar
Dog Slobber
Posts: 3954
Joined: Thu Feb 15, 2018 2:05 pm
Location: Ontario, Canada

Re: DME told me I have to stick with prescribed pressure of 5

Post by Dog Slobber » Sun Dec 04, 2022 8:35 am

ChicagoGranny wrote:
Fri Dec 02, 2022 5:19 pm
Mackij wrote:
Fri Dec 02, 2022 10:54 am
my DME called to lecture me about not changing the prescribed pressure
Tell the damn busybody to FO.
Fixed.

User avatar
ChicagoGranny
Posts: 14409
Joined: Sun Jan 29, 2012 1:43 pm
Location: USA

Re: DME told me I have to stick with prescribed pressure of 5

Post by ChicagoGranny » Sun Dec 04, 2022 11:55 am

Dog Slobber wrote:
Sun Dec 04, 2022 8:35 am
ChicagoGranny wrote:
Fri Dec 02, 2022 5:19 pm
Mackij wrote:
Fri Dec 02, 2022 10:54 am
my DME called to lecture me about not changing the prescribed pressure
Tell the damn busybody to FO.
Fixed.
Sounds like the doc's staff did it for him.