Issue With Resmed S9

BillH wrote:The sleep doctor I go to also supplies the equipment. I see the doctor and then pick up what I need from her clinician

You don't happen to be using Medicare do you? Aren't supposed to do that to Medicare people, no referring to areas that the doctor or a family member might have a vested interest in. Big no no.

Anyway, any luck getting them to get you the real Autoset you want?

If you do the math with your insurance, co pays, deductible how does that amount match up to online provider cost?
With a CPAP machine at cpap.com you can get the Autoset you wish.

I guess this is a unique situation. The sleep doctor I go to also supplies the equipment. I see the doctor and then pick up what I need from her clinician.

So, you see now why doctors are not supposed to have an interest in the retail establishment that supplies necessary medical equipment? YOUR DOCTOR is going to make less money if she prescribes the more expensive machine--there is a direct conflict of interest with your need for optimal care.

There is another sleep doctor in this area, patients who go the him then have to pick up their equipment from a local medical supply store. Most of the patients who go this route don't like it. They like the doctor fine, but the retail store can be very difficult to deal with.

Nobody is saying that free standing DME's are any easier to deal with, but at least your doctor won't have her hands in that DME's pocket.

Yea, I wondered about that myself. Usually the distribution of these types of products are tightly controlled. I suspect that the people I go to were established long before the other place was and long before the medical supply store started being a DME supplier. I know that for a long time, they were the only facility around here that did sleep research.

Last year I needed a new mask but I had yet to meet my insurance deductible. I asked them if I could just have them give me a prescription to get one mail order, they said sure but offered to quote me a price to just purchase it from them. They said that a lot of their patients had no insurance and they had a pricing structure for people who pay cash. The price they quoted me, on a Resmed Quattro was $15.00 LESS than the best price I could find on line. Since then I purchased a spare hose, filters and a spare water tank for my M series. I compared the prices to mail order and found they were in all cases less, with no shipping charges. These people are really good to deal with, but I still verify.

I will have the S9 Autoset either Monday or Tuesday. They indicated that there will be no problem with insurance billing, (not Medicare).

Thanks everyone for the help, I would have been lost without it.

The beatings will continue until morale imporves!

BillH wrote:...
The beatings will continue until morale improves!

Congrats! Besides me and an old friend, you're the first person I've seen use that phrase. Between that and "No good deed goes unpunished" a LOT of ground is covered!

BernieRay wrote:

BillH wrote:...
The beatings will continue until morale improves!

Congrats! Besides me and an old friend, you're the first person I've seen use that phrase. Between that and "No good deed goes unpunished" a LOT of ground is covered!

Back in the early 90’s, I was employed as a computer repair technician. There were three techs servicing about 1200 systems city wide. Computers were not nearly as reliable as they are today and the three of us were very busy. After one particularly grueling day when all three of us got our butts kicked, we were comparing notes and we decided that there were three absolute truths that were engraved in stone:

1) He who touches it last loses. (No matter what happens, it's always the fault of the last guy who worked on it)

2) No good deed goes unpunished. (Trying to save a customer money resulted in unforeseen things happening that got the tech in a lot of trouble)

3) The truth, while interesting and amusing is totally irrelevant. Perception is everything. (If they like you or think you know what you are doing, you can do no wrong. If they don’t like you or think you don't know what you are doing, you can do no right, no matter what)

BillH,

I'm very happy that things look like they're working out for you.

But at the same time, I feel extremely sorry for all the rest of this doctor's patients who will still be set up with dataless bricks. Truly a sad, sad situation.

Got the real deal today. They finally came up with a genuine S9 Autoset. (Says Autoset on the front!) They insisted on setting it on CPAP and not auto compensating. The clinician told me that the reason was people who sleep on their sides can have problems with the machine increasing pressure and affecting their heart. ??????? No opinion here, just reporting what he told me. For now, I will go along with it.
Since insurance had not purchased a mask for me in over a year, I also had them get me a new Quatro FX.
Tonight will be the first use.
Film at 11.............

BillH wrote:Got the real deal today. They finally came up with a genuine S9 Autoset. (Says Autoset on the front!) They insisted on setting it on CPAP and not auto compensating. The clinician told me that the reason was people who sleep on their sides can have problems with the machine increasing pressure and affecting their heart. ??????? No opinion here, just reporting what he told me. For now, I will go along with it.
Since insurance had not purchased a mask for me in over a year, I also had them get me a new Quatro FX.
Tonight will be the first use.
Film at 11.............

You're dealing with either idiots or liars......or both.
It's actually more likely that the machine will have to increase pressure for those who sleep on their backs......which would probably put more strain on the heart......because apneas are typically more prevalent for supine (back) sleepers (tongue falls backward to close off the airway).


Den

Wulfman... wrote:

BillH wrote:Got the real deal today. They finally came up with a genuine S9 Autoset. (Says Autoset on the front!) They insisted on setting it on CPAP and not auto compensating. The clinician told me that the reason was people who sleep on their sides can have problems with the machine increasing pressure and affecting their heart. ??????? No opinion here, just reporting what he told me. For now, I will go along with it.
Since insurance had not purchased a mask for me in over a year, I also had them get me a new Quatro FX.
Tonight will be the first use.
Film at 11.............

You're dealing with either idiots or liars......or both.
It's actually more likely that the machine will have to increase pressure for those who sleep on their backs......which would probably put more strain on the heart......because apneas are typically more prevalent for supine (back) sleepers (tongue falls backward to close off the airway).


Den

I completely agree. I'll also add that, with APAP, my blood pressure and pulse upon waking are noticeably lower than they were when I was on straight CPAP.

If you get a chance, ask that person to explain exactly how increasing pressure can affect the heart in a negative way. If the response is that it takes more effort to breath against the higher pressure, point out that EPR is designed to avoid that extra effort and it works regardless of sleeping position.

I had to question what they told me also. I actually sat there and kept a straight face when he told me that. When we were tallking about the S9, I remember saying at least three times and I thought that I made my position clear; I was expecting an Autoset, when I walked out of there, that's what I thought I was getting. After spending a lot of time browsing around the menus, I find that I got the stripped down, "VW Beetle" model (As opposed to the Mercedes Benz S600 version). When I called them on it, the guy I was dealing with said that they had never sold an S9 Autoset. He implied that he didn't think the extra features were worth it. Today, when I picked up what I thought I was getting in the first place, the same guy said he was using an Autoset. I didn't say anything, but the thought crossed my mind that a really good liar remembers his lies. I am starting to think that these people really are incompetent. It all makes me wonder if my sleep study was done right.

BillH wrote:Got the real deal today. They finally came up with a genuine S9 Autoset. (Says Autoset on the front!) They insisted on setting it on CPAP and not auto compensating. The clinician told me that the reason was people who sleep on their sides can have problems with the machine increasing pressure and affecting their heart. ???????

BillH, take the time to add this one to the Whoppers I have been told from DME, techs, etc thread 'cause this one is right up there.

I have Rescan version 3.13.018. I downloaded last nights data. Here are the results:

Pressure: 11.0 EPR Full Time
Leak: Median 1.2 95the Percentile 16.8 Maximum 37.2 (I am still trying to find a mask that will go all night without leaking. Lost cause so far)
Apnea Index: 0.5 AHI 0.5 Obstructive 0.3
Cental 0.1

So, is there a guide on how to read the data?
Thanks

BillH wrote:Got the real deal today. They finally came up with a genuine S9 Autoset. (Says Autoset on the front!) They insisted on setting it on CPAP and not auto compensating. The clinician told me that the reason was people who sleep on their sides can have problems with the machine increasing pressure and affecting their heart. ??????? No opinion here, just reporting what he told me. For now, I will go along with it.

They can set it to anything they like, but if you hold down the dial and the lower button for three seconds, you can do that too.

It's hard to see how pressure increases in response to obstructive apnea in any position would be worse for your heart than the apnea itself. But don't touch those buttons! That will make hair grow on your palms.

BernieRay wrote: If you get a chance, ask that person to explain exactly how increasing pressure can affect the heart in a negative way. If the response is that it takes more effort to breath against the higher pressure, point out that EPR is designed to avoid that extra effort and it works regardless of sleeping position.

CPAP pressure increases intrathoracic pressure. Most of us CPAP patients tolerate that intrathoracic pressure increase just fine. However, certain types of cardiovascular patients can incur a potentially problematic decrease of venous return as a result of that CPAP pressure:

Shahrokh Javaheri, M.D wrote: Central Sleep Apnea in Congestive Heart Failure: Treatment of Central Sleep Apnea

Furthermore, caution should be exercised with use of nasal CPAP. Because of increased intrathoracic pressure, cardiac output may decrease resulting in hypotension, particularly in patients with atrial fibrillation[99] and those in whom right ventricular volume pressure characteristics are on the ascending limb of the Frank-Starling curve. In such patients, right ventricular stroke volume is preload dependent, and a decrease in venous return could result in hypotension. A similar mechanism may result in hypotension in patients in whom left ventricular stroke volume is preload dependent. Such reduction in cardiac output could result in reduction in coronary blood flow and ischemia, particularly in patients with established coronary artery disease.

In those cardiovascular cases unnecessary CPAP pressure is not at all a good idea.

-SWS wrote:Most of us CPAP patients tolerate that intrathoracic pressure increase just fine. However, certain types of cardiovascular patients can incur a potentially problematic decrease of venous return as a result of that CPAP pressure:

Shahrokh Javaheri, M.D wrote: Central Sleep Apnea in Congestive Heart Failure: Treatment of Central Sleep Apnea

Furthermore, caution should be exercised with use of nasal CPAP. Because of increased intrathoracic pressure, cardiac output may decrease resulting in hypotension, particularly in patients with atrial fibrillation[99] and those in whom right ventricular volume pressure characteristics are on the ascending limb of the Frank-Starling curve. In such patients, right ventricular stroke volume is preload dependent, and a decrease in venous return could result in hypotension. A similar mechanism may result in hypotension in patients in whom left ventricular stroke volume is preload dependent. Such reduction in cardiac output could result in reduction in coronary blood flow and ischemia, particularly in patients with established coronary artery disease.

In those cardiovascular cases unnecessary CPAP pressure is not at all a good idea.

I understand this concern for patients with established coronary artery disease. But presumably the problem would exist for such a patient using APAP regardless of sleeping position. And the DME simply said: APAP is bad for side sleepers and said nothing about patients with heart disease.

So -SWS. please correct me if I'm wrong, but here's my understanding of APAP, heart disease and side sleeping :

1) Some patients do need to be cautious about too much CPAP pressure and among that group are patients with existing coronary artery disease and existing heart disease. APAP may not be the best choice for these patients regardless of the patient's preferred sleeping position. And the quoted text seems to indicate that CPAP itself may be problematic for these patients to use as well.

2) Patients who prefer to sleep on their side are no more or no less likely to belong to the patients in the category listed in item 1) than those who prefer to sleep on their back or stomach. (And if this is not true, can you point me to some evidence that side sleeping is an indicator of higher than normal risk for coronary artery disease, for example?)

3) Therefor, there is no reason to tell a patient who you know sleeps on their side that side sleeping and APAP use are not a good combination. If you know the patient has real risks (such as the cardiac risks) with an APAP potentially providing too much pressure, cite the real reason the APAP is a bad idea for them. If you don't know whether the side-sleeping patient has any real risks associated with APAP use, then treat them the same way you'd treat a back or stomach sleeper.