My doctor wrote an script for cpap@21

So today I visited my sleep doctor to go over the re-re-titration of the 10th. We went round and round over the issue of how to write the prescription. I wanted him to write it for a bilevel machine. He said he cannot do that since it has not been shown to be medically necessary for me to have a bilevel machine. I said I don't think cpap machines go above 20. He asked did I at least try to set it to 21. I said the numbers stop at 20. (reminds me of the scene in "This Is Spinal Tap" where the guys amp goes to 11). He said he spoke to a vendor representative recently who said the cpaps and bilevels use the same pump now, which goes to 25. I said I thought he was mistaken. Understand, I was on my best behavior--the word "moronic" did not pass my lips. He said take the script that says cpap @ 21 to the DME; they are obligated to give me an appropriate pump. Then come back in eight weeks.

So I called Norco back this afternoon and set up an appointment to come in tomorrow at 11. So I'm going to bring my S8 in to Norco tomorrow, act oblivious, and see what they do. I'm kind of hoping for something really egregious from them, but who knows.

If anything amusing transpires (and how could it not?), I'll post it tomorrow.

there are some guidelines - not sure where - that over 15 bipap is suggested - maybe someone can post them or you can find them and take them to your DOC and insurance company - or of course you can choose to fail cpap at 21 with all these nasty farts and belching all day not to mention all that stomach pain

jules wrote:there are some guidelines - not sure where - that over 15 bipap is suggested - maybe someone can post them or you can find them and take them to your DOC and insurance company - or of course you can choose to fail cpap at 21 with all these nasty farts and belching all day not to mention all that stomach pain

That's right aerophagia makes a bilevel medically necessary so you could complain of gas or just ask this moron if he can exhale at 21cm. Not being able to exhale is another reason for a bipap.

You might want to keep an eye on Craigslist - for a bilevel.

If it were me - I would be keeping an eye out for a sleep doctor too.

I am trying to be kind.

If the DME is with it they WILL tell the doc how and what to write. If not you should be DME shopping too.

My heart goes out to you.

Good Luck

Why don't you just print out the product specification sheet and show them how to read the specs?

brain_cloud wrote:So today I visited my sleep doctor to go over the re-re-titration of the 10th. We went round and round over the issue of how to write the prescription. I wanted him to write it for a bilevel machine. He said he cannot do that since it has not been shown to be medically necessary for me to have a bilevel machine. I said I don't think cpap machines go above 20. He asked did I at least try to set it to 21. I said the numbers stop at 20. (reminds me of the scene in "This Is Spinal Tap" where the guys amp goes to 11). He said he spoke to a vendor representative recently who said the cpaps and bilevels use the same pump now, which goes to 25. I said I thought he was mistaken. Understand, I was on my best behavior--the word "moronic" did not pass my lips. He said take the script that says cpap @ 21 to the DME; they are obligated to give me an appropriate pump. Then come back in eight weeks.

So I called Norco back this afternoon and set up an appointment to come in tomorrow at 11. So I'm going to bring my S8 in to Norco tomorrow, act oblivious, and see what they do. I'm kind of hoping for something really egregious from them, but who knows.

If anything amusing transpires (and how could it not?), I'll post it tomorrow.

At least you manage to see the humor in what can only be described as clinical absurdity.

I suppose they could always set you up with a BiLevel machine at 21 cm fixed pressure to legally meet those RX requirements...

-SWS wrote: At least you manage to see the humor in what can only be described as clinical absurdity.

It's because I can afford whatever I need or want, with or without insurance or DME's. Or doctors. It's the folks who rely on these systems that I feel for. I'm going to get what I want, regardless, and what I want is a super cool bilevel ASV-thingee with a million knobs to turn.

But the machine is not even my main problem. For the fourth time at a sleep study within the past year, I had no slow wave sleep at all. Even though I slept good during the past two titrations, and there wasn't a lot of apneas or hypopneas going on, still no SWS. That's what worries me. I asked my doctor, the elderly neurologist, can it happen that a 47 year old dude might just up and stop doing SWS, even if the repiratory and leg crap got cleared away. He looked at me like I had asked him a trick question and said it would be very unusual.

Braincloud, Why don't you ask SWS about SWS? Sorry, I couldn't help it!

So I called Norco back this afternoon and set up an appointment to come in tomorrow at 11. So I'm going to bring my S8 in to Norco tomorrow, act oblivious, and see what they do. I'm kind of hoping for something really egregious from them, but who knows.

awaiting with baited breath for the next episode of the CPAP drama of the year

DoriC wrote:Braincloud, Why don't you ask SWS about SWS? Sorry, I couldn't help it!

On this point, I would even accept direction from the floccose bun.

brain_cloud wrote: It's the folks who rely on these systems that I feel for. I'm going to get what I want, regardless, and what I want is a super cool bilevel ASV-thingee with a million knobs to turn.

I agree about the frustration with how inefficiently and poorly the current system treats apnea patients.

But the machine is not even my main problem. For the fourth time at a sleep study within the past year, I had no slow wave sleep at all. Even though I slept good during the past two titrations, and there wasn't a lot of apneas or hypopneas going on, still no SWS. That's what worries me. I asked my doctor, the elderly neurologist, can it happen that a 47 year old dude might just up and stop doing SWS, even if the repiratory and leg crap got cleared away. He looked at me like I had asked him a trick question and said it would be very unusual.

Some of the more worrisome possibilities you have probably read about would show up on an MRI. You might ask your doctor to arrange an MRI to alleviate at least some of those worries. But we've had a fair number of posters report similar PSG results, and I'm not aware of any grave outcomes having been reported at least here because of missing SWS.

Are there any experimental treatment plans in the works to promote SWS via pharmaceuticals?
http://scholar.google.com/scholar?hl=en ... a=N&tab=ws

-SWS wrote: Some of the more worrisome possibilities you have probably read about would show up on an MRI. You might ask your doctor to arrange an MRI to alleviate at least some of those worries. But we've had a fair number of posters report similar PSG results, and I'm not aware of any grave outcomes having been reported at least here because of missing SWS.

The outcome I fear is simply that I will have to go on the way I am now. Not partaking in it myself, I see SWS as the key to feeling rested, maybe unreasonably.

brain_cloud wrote: The outcome I fear is simply that I will have to go on the way I am now. Not partaking in it myself, I see SWS as the key to feeling rested, maybe unreasonably.

Two questions come to mind:
1) Did you present an arousal rate during PSG that might have architecturally precluded SWS?
2) Do you now have outstanding daytime symptoms that might be associated with missing SWS?

If the answer is no to both of those, then I think I would be inclined to leave well enough alone. If the answer is yes to either, then I think further investigation is warranted. And that might entail getting a new sleep doctor on board if yours is reluctant to pursue the issue.

-SWS wrote:

brain_cloud wrote: The outcome I fear is simply that I will have to go on the way I am now. Not partaking in it myself, I see SWS as the key to feeling rested, maybe unreasonably.

Two questions come to mind:
1) Did you present an arousal rate during PSG that might have architecturally precluded SWS?
2) Do you now have outstanding daytime symptoms that might be associated with missing SWS?

If the answer is no to both of those, then I think I would be inclined to leave well enough alone. If the answer is yes to either, then I think further investigation is warranted. And that might entail getting a new sleep doctor on board if yours is reluctant to pursue the issue.

Hi SWS...

Not a thread Hi-Jack... just along the same thoughts

Could you explain your two questions...
I am exploring this issue myself and need to do some reading about missing SWS and REM.
I did the reading on Google Scholar and Wiki but it is quite limited.

Thanks
Nord

There are medications that enhance slow wave sleep, for example Gabitril (Neurontin/gabapentin may as well, but I am not 100% sure about that).

Is there evidence that bipap decreases aerophagia? If so, is there evidence that EPR decreases aerophagia?