what the...........

Echo, agree entirely about the well intentioned warm & fuzzy 2x4s. Always taken them in the spirit they're intended, although can't help feeling sometimes new folk should be 'edged' into them!

a couple of more points from 'the visit'
The tech admitted that the average 90% CPAP pressure was 12.7 but still insisted that the machine be put back to 4-20.

ozij wrote [b]4-20 it not a good idea for the reason's Kathy explained. Not knowing that is "lack of sufficient knowledge" - but I don't consider lack of sufficient knowledge to be stupidity. I know I was very very ignorant when I first came to the forum - I've learned a lot since. [/b]
sure lack of sufficient knowledge for the general layman is not stupidity but someone that is beating their chest and saying that they are the expert , that's done the training , to come out with a statement like that is stupid, I think.

kteague wrote I count my blessings that I have a sleep doctor that I don't feel my visits are wasted
do you know if she has a relative that works in the industry in Queensland, Australia?

echo wrote: Bev, glad you didn't give up on us sinners Do we ALL get x-mas cards from you?
you shouldn't ask. you don't get if you ask! honestly, you have a much better chance than she has!

ozij wrote Looks like you're stuck with us, Bev,a forum "full of people that are very negative and don't know what they're talking about"
Lord, how terrible for you!!!
oh well, I 'll just have to bite the bullet and get on with it I'm sure I'll be able to take it.

DreamStalker wrote : also so I could continue to get CPAP supplies.
as the original shipping from cpap.com was $202 I ordered plenty of spare filters at the same time, so I don't need to bother with the sleep doc for that.

and lastly Snoredog wrote: on another thread of 5 nights for BarBeHis 90% pressure is all over the place, the man should have been put on a Bipap and titrated with it.
Note on PSG: He shows some heart-related stress at 4:30AM on the PSG, above it shows a dramatic drop in O2 levels, yet there is nothing corresponding with that event on the PSG. Did they make note of that on the worded findings section? May be nothing but the heart went to 120BPM then down to 40 for some reason and O2 levels plummeted at the same time but there are no SDB events I see corresponding with that event. It would be something I'd ask the sleep doc about next time. If he is seeing a Cardiologist I'd show him the PSG report.
IF he does have a Cardiac condition, I would suggest he go back for another PSG on a bipap and use a pressure that doesn't fluctuate all over the place, the last thing you want is the machine responding falsely to events seen, jacking up pressure to cause central dysregulation to appear as that will put a lot more stress on the heart. In fact, I am inclined to suggest that you put the machine at 12 cm pressure in the CPAP mode. If he is sleeping with his mouth "open" he is doing a pretty good job at controlling mouth leaks.
your suggestion about needing a Bipap - when I mentiomed that the answer was no, I don't think so.
Not no he doesn't because.......just I don't think so.
As to the big difference of the BPM at 4:30am in the original sleep study, he came back with oh that's normal .
B being the sensitive type was really put off by their cr*****p and would use his machine for the time we were away and then the first night home.
I finally talked him around and he said : we need to lower the pressure as 12.5 is too high. When it was pointed out that using the Ramp helped with the pressure till him went to sleep ( I increased the time to 30mins) he still wouldn't budge until I put the pressure down to 10.
So I put the pressure down But to 11 and lied my ar***e off and said it was down to 10.
So, he's been using the machine again and has been doing pretty well with his reports being :
AHI 3.2, 4.6, 3.0, 2.5, 3.5
av 90%CPAP pressure 11.9, 12.0, 11.5, 11.6, 11.3
Will increase the pressure by .5 in another couple of days without mentioning it and see how he goes.
Thanks to all for your imput.
Bev

Hello. I've been using a ResMed cpap with humidifier since August, 2011. However, after I contracted tracheal bronchitis and other upper respiratory illnesses, I was told to use the cpap without the humidifier. That works much better.

After 60 days and 90 days, I had compliance sessions with a representative from the equipment company. According to the reading, I failed both times because according to the reading, I only used the machine 53% and insurance compliance requires 70%. I KNOW that I used the machine every night except Fridays, and have documentation to support my claims. I was told by the representative that the readings are very accurate, and because I failed compliance, they would no longer bill my insurance. I had the option of either buying the machine for the balance, or returning it.

For the past several months, I have been undergoing behavioral sleep therapy, requiring very detailed charting of my sleep patterns, cpap, and golite (SAD) usage. Also, a co-worker suggested that I monitor the cpap machine itself, for beginning and ending "usage" noting the number and time. I'm confused by what I found:

1. Machine usage records only a fraction of actual time used: 8 hrs. usage reads 6 hrs. used; 7 hours usage reads 5 hrs. used; etc.
2. A second setting indicates "usage" as a fraction: 167/277

The "ramping" is set at 40 minutes, and pressure automatically increases from 4 to 12, which was set by the representative. I have not changed any of the original setting. I use the nasal pillows, with no chin strap.

On the matter of my "compliance," I sleep from 5 to 9 hours per night, and put on the mask as soon as I turn on the machine. As I do not wake up with fewer than four alarms, I cannot remove the mask before my final clock goes off an golite comes on at 6:15 am. In the last month, I've even started using the machine seven days a week. Yet, the equipment company insists that I am "non-compliant" and has all but accused me of outright lying.

Can anyone help me? Can I be doing something wrong? Why doesn't the machine show actual hours used? What is that fraction for "usage"?

Thank you.

SAD Teacher wrote:Why doesn't the machine show actual hours used? What is that fraction for "usage"?

My first thought is that the clock on the machine is incorrect and possibly causing split sessions or perhaps you are a shift worker and sleeping when the machine resets to zero at noon each day.

Does it count the ramp time?

Are you getting 4 hours most night with the machine?

I know my machine counts a minimum of 4 hours for compliance. If it doesn't reach 4 hours, it doesn't count. And then it counts those days. For example, I have used my machine for 29 days. I did not reach 4 hours for 2 of those nights. That gives me a 93% compliance rate. Do you know what your insurance company requires?

As somebody else suggested, if you are sleeping at odd hours, then your nights could get divided. And if you were skipping one night a week, then having the nights broken up, could cause the hours per day to get messed up. I had to reset the clock on mine so that the machine believes that noon is at 4pm so that I can have my nights graph properly.

Can you post a summary graph that shows a month of sleep hours?

echo wrote:Bev, glad to hear B's doing so well, and as for the story... well snoredog's right!
I also bought my own machine (instead of renting it from them), and because of this i'm "officially outside of their system", so they told me to just call and schedule an appoitnment once a year anyway so they could "check up on me." I went in a few months early (a few weeks ago), complaining that I still wasn't sleeping very well. But since my AHI was so low, they said there's not much they could do for me. So the moral of the story is, if there's not actually being helpful, then why do we need to give them our money? That said, there are good sleep doctors out there (somewhere in the twilight zone).....

Lovely - nice avatar Your spirits MUST be better

Isnt it funny how so called "sleep doc's cant (or better yet, WON'T ) help you with poor sleep? They just want to make sure your airway stays open so you can breath through the night while you sleep. They dont really want to help with actual sleep problems.

"As long as the friggin check from the insurance clears,
who cares if the patient is suffering and slowly dying due to poor therapy."
Guess what? THE PATIENT DOES!

zoocrewphoto wrote:Are you getting 4 hours most night with the machine?

I know my machine counts a minimum of 4 hours for compliance. If it doesn't reach 4 hours, it doesn't count. And then it counts those days. For example, I have used my machine for 29 days. I did not reach 4 hours for 2 of those nights. That gives me a 93% compliance rate. Do you know what your insurance company requires?

As somebody else suggested, if you are sleeping at odd hours, then your nights could get divided. And if you were skipping one night a week, then having the nights broken up, could cause the hours per day to get messed up. I had to reset the clock on mine so that the machine believes that noon is at 4pm so that I can have my nights graph properly.

Can you post a summary graph that shows a month of sleep hours?

I just spotted this in the clinician's manual of my system - so BOTH major manufacturers do this. I hope the OP reads this - the systems have a quick-check function for compliance monitoring - but sessions less than 4 hours are NOT included in the quick-check count!

So if you wake up after 3 hours for a potty-break, you weren't "on" at all. Most Bogus.

ekubaskie wrote:
I just spotted this in the clinician's manual of my system - so BOTH major manufacturers do this. I hope the OP reads this - the systems have a quick-check function for compliance monitoring - but sessions less than 4 hours are NOT included in the quick-check count!

So if you wake up after 3 hours for a potty-break, you weren't "on" at all. Most Bogus.

It doesn't have to be 4 hours continuous. Just 4 hours within the 4 hour period. I have only a few nights where I went over 4 hours without getting up to use the bathroom. Yet, I am over 90% compliant since I have only been under 4 hours for 2 nights out of 5 weeks. Most nights, I do 2-3 hours, get up for the bathroom, and then another 2-3 hours. And then a mask change with 10-20 minutes of trying to fit it right. And another hour or two of sleep. I have had some nights where I slept 3 hours with the machine, took it off for a couple hours, and then put it back on for a couple hours. It counts as over 4 hours.

The one good thing about the "old brick" was that I would leave it on while I got up for the old bladder break. I put the mask under the pillow so the wife was not bothered by the blowing air. Thus there was no break in the session. I usually have 7-8 hours each nignt on the machine.

SAD Teacher wrote:Hello. I've been using a ResMed cpap with humidifier since August, 2011. However, after I contracted tracheal bronchitis and other upper respiratory illnesses, I was told to use the cpap without the humidifier. That works much better.

After 60 days and 90 days, I had compliance sessions with a representative from the equipment company. According to the reading, I failed both times because according to the reading, I only used the machine 53% and insurance compliance requires 70%. I KNOW that I used the machine every night except Fridays, and have documentation to support my claims. I was told by the representative that the readings are very accurate, and because I failed compliance, they would no longer bill my insurance. I had the option of either buying the machine for the balance, or returning it.

For the past several months, I have been undergoing behavioral sleep therapy, requiring very detailed charting of my sleep patterns, cpap, and golite (SAD) usage. Also, a co-worker suggested that I monitor the cpap machine itself, for beginning and ending "usage" noting the number and time. I'm confused by what I found:

1. Machine usage records only a fraction of actual time used: 8 hrs. usage reads 6 hrs. used; 7 hours usage reads 5 hrs. used; etc.
2. A second setting indicates "usage" as a fraction: 167/277

The "ramping" is set at 40 minutes, and pressure automatically increases from 4 to 12, which was set by the representative. I have not changed any of the original setting. I use the nasal pillows, with no chin strap.

On the matter of my "compliance," I sleep from 5 to 9 hours per night, and put on the mask as soon as I turn on the machine. As I do not wake up with fewer than four alarms, I cannot remove the mask before my final clock goes off an golite comes on at 6:15 am. In the last month, I've even started using the machine seven days a week. Yet, the equipment company insists that I am "non-compliant" and has all but accused me of outright lying.

Can anyone help me? Can I be doing something wrong? Why doesn't the machine show actual hours used? What is that fraction for "usage"?

Thank you.

I'm guessing it will be an S9.
You 167/277 means its compliant for 167 out of 277 days.

I'm guessing its clock is wrong. A resmed day starts at when the clock thinks its noon. If that is in the middle of your sleep schedule, it counts as two sessions but the sleep time should add the next day and add up properly.

Go into the clinicians menu and find out what it thinks is the date and time. Record that today and again in 24 hours. It should be off by the same amount of time. It could be running slow (i.e. reporting 50 minutes going by for every real 60, not behind). If its not the same, then you can watch when it clicks over the minute and record that to the second on a different clock. Do the same in 24 hours and report all 4 numbers and someone here can calculate just how bad the times are. If the clock is wrong, let us know and don't reset it. Someone here might be able to write up a reason your DME screwed up that your insurance will listen to.

I don't know the system there, but if it's like here, they need your compliance hours to get paid

when I noticed Dizzy's comment (the snoredog, great guy, passed away around 2008) I knew everyone was commenting on an old thread.

I am actually looking forward to my next visit with my sleep doc. Last visit he told me to keep doing what I was doing - I had removed the + sign from the C-Flex, and also stopped using the humidifier. For me, that reduced my AHI down from an average 2.36 to 1.88. Since then I reduced my pressure from 10 to 9 (original titration was 8, but the doc raised it to 10 when I complained of snoring). AHI dropped to 1.24, so I thought I would reduce it another 0.5 cm. AHI increased over 1 week to 1.56, so I raised it back to 9. Now, three weeks later my AHI is 1.12. Last night it was 0.57. With SleepyHead I can look at my data every day (if I choose to). The doc will just look at a snapshot and base his arbitrary decision on what I tell him (again, a snapshot). Who knows more about my therapy and what it is doing for me? I know there are no long-term data on me to say whether the low AHI is reversing the effect of long-term apnea, but if I am feeling good over a long period, and my numbers are looking good, I will continue to make those minor adjustments. The only thing I can think of that might improve things is to have an APAP - in which case I would insist that it be set at 7-11 (if not, I would set it there!). I would then adjust that range until I found my optimum pressure. Now, how would the average doc react to that?