Rx Pressure for APAP Machine

Hi. I noticed that CPAP.COM said they do not require any pressure settings on the Rx for an APAP machine.

But my local DME said they want a pressure on the Rx.

So what's up with that ? Is it "required" to have a pressure setting when it's an APAP ?

I would think not since the whole idea behiond an APAP is to self adjust, no exact pressure "setting" is needed.

Ya..... I know.... it's crazy to leave the entire range of settings to be wide open, it's best set 2 below and 2 above, but I was just asking what experience all of you have had with ther DME's and requiring settings on your Rx for your machines, particularly if it's an APAP.

Thanks

pratzert wrote: Hi. I noticed that CPAP.COM said they do not require any pressure settings on the Rx for an APAP machine.

I agree with them. APAPs can be used in different ways by different people for different reasons. A lack of a specified pressure level on the Rx is no reason to deny someone an APAP.

pratzert wrote:But my local DME said they want a pressure on the Rx.

I agree with them. Different docs want things handled different ways. So from a local DME's point of view (especially one that wants to keep local docs happy), the more specific the doc's instructions to them, the better.

pratzert wrote:So what's up with that ? Is it "required" to have a pressure setting when it's an APAP ?

It is not a requirement for getting one from CPAP.com, but is useful for your local DME if there is a sleep doc in the loop who has a preference.

pratzert wrote:I would think not since the whole idea behiond an APAP is to self adjust, no exact pressure "setting" is needed.

Ya..... I know.... it's crazy to leave the entire range of settings to be wide open, it's best set 2 below and 2 above, but I was just asking what experience all of you have had with ther DME's and requiring settings on your Rx for your machines, particularly if it's an APAP.

Thanks

Some have found that having the minimum set two centimeters below prescribed pressure works best for them, but that may not be true for all. Some prefer a lower pressure for falling asleep and that is more important for them. Others find that setting the minimum at the exact prescribed pressure works best for them if that pressure is not uncomfortable to them--that way the machine stays at that prescribed pressure unless something makes it go higher in certain occasional circumstances during the night, or night to night. As long as a macine is not "running away" with you (delivering a higher pressure for no good reason because it is misreading your breathing), there is no reason to restrict the maximum, as far as I know. I consider the minimum to be the crucial setting, not so much the maximum in most instances.

In my case, although my doc did not exactly fulfill my request that he specifically prescribe an autobilevel, he did write "Patient may use an Auto" on the bilevel Rx. That allowed me the ability to argue with my DME that the word "Auto" was on my Rx and that I therefore would accept nothing less than than an autobilevel machine for my bilevel Rx. The DME eventually gave me an autobilevel, but set it up in a non-auto mode at the exact prescribed bilevel pressures my doc had given. In order for it to function as an auto-titrating machine, I then had to change modes and set up my own pressures and other settings. I am glad the DME didn't do try to do any of that, since they just would have blown it. There is no IQ test for working at a local brick-and-mortar DME. As long as you are a good liar, you're hired. On the other hand, I have found CPAP.COM to be helpful and accommodating and knowledgeable. YMMV.

FWIW....I am one of those who used APAP but with a wider range (not the traditional 2 above and 2 below thing) because sometimes I had events that sometimes needed much higher pressures (but didn't happen every night). Once I had my minimum set appropriately at 10 cm I let my machine go up to 20 cm if it felt the need (pressure changes never bothered me) and I would see it go up there maybe 2 or 3 times a week but never for very long. So there are reasons why some people do have a wider range and why some people might do better with a wider range.

Even now using a Bilevel machine in Auto mode....sometimes I push that upper limit for a short while and sometimes the machine barely changes pressure.

Can't comment on the DME side of things. I use a DME only for masks. All my machines have been private purchase. Worked out well for me...prices were always less than my co pay if I had used insurance anyway and I got what I wanted, when I wanted it and without any hassles.

DME are sometimes silly. I just upgraded to S9 Auto and Rx from my sleep center doc was written as "4-20". It was written so that I would qualify for apap but the therapist that delivered the unit literally insisted on setting up the range 4-20, even though I asked politely for a 9-13 range. Obviously I changed it once he left

dtsm wrote:DME are sometimes silly. I just upgraded to S9 Auto and Rx from my sleep center doc was written as "4-20". It was written so that I would qualify for apap but the therapist that delivered the unit literally insisted on setting up the range 4-20, even though I asked politely for a 9-13 range. Obviously I changed it once he left :lol:

The DME has to follow the doctors prescription. Asking them to set the machine differently is like asking your pharmasist to give you 3 mg lunesta instead of the prescribed 2 mg, or asking an X-ray Technician to x-ray your hip as well as your knee when the order was for an x-ray of the knee, or asking the people in the lab to draw a vitamin d level that wasn't ordered, etc. Since you knew how to do it yourself why did you even put them on the spot by asking? What if your doc had ordered 9-13, but they felt 4-20 was better and so set you up that way. LOL. Who is silly, now?

Mary Z wrote:LOL. Who is silly, now?

Well said, spoken like a typical therapist working at DME....

Mary Z wrote:

dtsm wrote:DME are sometimes silly. I just upgraded to S9 Auto and Rx from my sleep center doc was written as "4-20". It was written so that I would qualify for apap but the therapist that delivered the unit literally insisted on setting up the range 4-20, even though I asked politely for a 9-13 range. Obviously I changed it once he left

The DME has to follow the doctors prescription.

If the DME "HAS TO" follow the doctor's prescription, than why is it we are always having to fight them to fill the prescription for a specific machine when it's clearly spelled out on the Script ? In that case, all of the sudden, they say they don't have to follow the doctor's prescription.

Seems like they follow such "rules" to their advantage... like when it means more profits in their pockets.

Seems like they follow such "rules" to their advantage... like when it means more profits in their pockets.[/quote]

You just hit the nail on the head!!!!

When you take an RX to a DME you have licensed RT's that are required to set the exact levels, the documentation for insurance is insane and has to be followed to the T. When I sign my name behind a patient with license to practice anything that goes wrong will fall my on me as the person who setup your machine from the start. You can come back at me with a not only a company lawsuit but probably a personal lawsuit as well. Yes it is a pain in the but to have to be that strict and true maybe sometimes some patients can tolerate a higher lei-way, but there are patients that can not tolerate a huge range. Rx are also written based on what is going on with your body and what your body needs, if therapy one does not work, then it is the RT's job to do the very best to help the customer get the best care by communicating with Dr. and changing settings or machines to best meet the customers needs within the insurances parameters.

When you go to an online site, they are designed for people who do not have insurance or because the DME company already has what equipemnt vendors it carries and that is it. Sometimes it is more expensive for pt to order via DME for a brand they don't carry if they even order it (each one is different) plus with DME you have staff to help personally. It depends there are pros and cons to all scenerios.

To patients it is not a big a deal, but it is my integrity and oath on the line and reputation; or loss of medical license.... believe me my heart wants to do more to help, but it is not worth it.

Nadine_Selph wrote:When you take an RX to a DME you have licensed RT's that are required to set the exact levels, the documentation for insurance is insane and has to be followed to the T. When I sign my name behind a patient with license to practice anything that goes wrong will fall my on me as the person who setup your machine from the start. You can come back at me with a not only a company lawsuit but probably a personal lawsuit as well. Yes it is a pain in the but to have to be that strict and true maybe sometimes some patients can tolerate a higher lei-way, but there are patients that can not tolerate a huge range. Rx are also written based on what is going on with your body and what your body needs, if therapy one does not work, then it is the RT's job to do the very best to help the customer get the best care by communicating with Dr. and changing settings or machines to best meet the customers needs within the insurances parameters.

When you go to an online site, they are designed for people who do not have insurance or because the DME company already has what equipemnt vendors it carries and that is it. Sometimes it is more expensive for pt to order via DME for a brand they don't carry if they even order it (each one is different) plus with DME you have staff to help personally. It depends there are pros and cons to all scenerios.

To patients it is not a big a deal, but it is my integrity and oath on the line and reputation; or loss of medical license.... believe me my heart wants to do more to help, but it is not worth it.

Using that Logic, you should also refuse to do any set-up on a XPAP machine that was not specifically prescribed by the Doctor.

Let's say my Doctor wrote a prescription for a specific machine and the DME Refused to fill the prescription as written. The Dr prescribed an APAP but the DME supplied only a straight CPAP (because it's cheaper). If you program the pressure on that wrong machine and let the patient take it or use it, you are in trouble.

Anybody down stream of that error is liable as well.

It's like the Doctor writing an Rx for a certain medication and then the Pharmacy decides it's OK to give you something different because it's cheaper regardless of the side affects.

The Nurse sees on the chart that you are prescribed a specific medication but gives you whatever the pharmacy sent in spite of the fact that it's the wrong medication. Yep.... everyone in line gets sued.

But it all started at the DME office.