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Advice re: changing CPAP settings
#1
Good morning! I am new to the forum and am looking for some advice regarding changing my CPAP settings.

I started CPAP therapy almost 1.5 years ago. My initial pressure was 13 cmH2O. I did fairly well at that pressure, but still didn't feel quite as good as I should. My average AHI during that time was 2.90, with very rare nights where it went above 10. I also found that I was still up 3-4 times every night.

 After a year of therapy, my doctor ordered another sleep study. My pressure was lowered to 6 cmH2O. Since then my average AHI has been 8.47, with several nights above 30. The majority of events are hypopneas. 

My first thought is to call my doctor and have him change my pressure back to 13 cmH2O. However, I am not very comfortable with this doctor. To my knowledge, he has never reviewed any of the therapy data. I found out that he has an undisclosed financial interest in the sleep center, so I suspect that his answer if I contact him will be to send me for yet another sleep study. Since the sleep center is out of network for my insurance, it has been a fight to get each of the past sleep studies paid for, with the sleep center telling me that the portion of the bill which I am responsible for will be written off once I schedule my next study. I still haven't seen a bill for the most recent study from December, although my insurance is denying it as not medically necessary.

I have found the clinician setup manual for my machine. My only concern is about the compliance data sent to my insurance company. I have read the part in the Wiki about changing your own settings, and the fact that it is not illegal to do so. But I don't know whether or not I could have an issue with my insurance company if I do change the settings, or if they would even know. My thought, since my machine is an auto CPAP, is to set it to auto with minimum pressure at 6 cmH2O. 

Also, is there any reason I need to continue seeing this doctor? What happens as far as my prescription if I were to switch to another doctor?
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#2
All the insurance cares about is the hours of use.

Download SleepyHead and post your data (see my sig if you need a reminder)

I don't know what setting is best for you, what I do know is that with data the members of this forum can help you find the best therapy for you, likely better than your Dr and a sleep study.

Get copies of your Rx and your Sleep Study if you don't have them.
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#3
I tried to include a screenshot from SleepyHead showing the change in AHI that corresponded with the change in pressure with my original post, but the forum wouldn't let me because I don't have enough posts.
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#4
Shhhh. Don't tell anyone add a space to the url until you have 4 posts.
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#5
Welcome!

If you truly have an Auto machine, I'm dumbfounded that your sleep dr would send you for a 2nd sleep study after you'd already done one that determined the pressure of 13. If you have an Auto, he could've just set it to Auto and see what it did. ... which is what I'd be inclined to do, if I were you. You're on 6 now. It'd be easy enough to switch it to Auto, set the max all the way open to 20, and see where your body takes the machine. (Just my humble opinion.)
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#6
(03-31-2017, 10:32 AM)Hydrangea Wrote: Welcome!

If you truly have an Auto machine, I'm dumbfounded that your sleep dr would send you for a 2nd sleep study after you'd already done one that determined the pressure of 13.  If you have an Auto, he could've just set it to Auto and see what it did.  ... which is what I'd be inclined to do, if I were you.  You're on 6 now. It'd be easy enough to switch it to Auto, set the max all the way open to 20, and see where your body takes the machine. (Just my humble opinion.)

That's where I was going after I saw the data.
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#7
I was also confused why he sent me for another sleep study until the technician let slip the fact that the doctor has a financial interest in the facility that did the study. That had never been mentioned before, although I suspected it from the way the doctor responded when I told him that the facility was out of network, and that I was being billed in excess of $9k for the first 2 sleep studies.

I took screenshots of the past 2 nights. Hopefully I can get them to work here. I also made one of the overview data from the first night of therapy through last night. You can see the way my AHI shot up after the pressure was reduced. My plan is to do exactly as Hydrangea suggested. Set the machine to Auto, with minimum pressure at 6 and maximum pressure at 20. My biggest concern with doing that, and what prompted me to make this post, is that I wasn't sure what data the insurance company (and the DME) gets from the machine. I didn't want to have a problem with either one.
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#8
I still can't get the screenshots to post, but hopefully I can after this post.
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#9
Well, you could be a control freak like myself and take the modem out! ;-) Then you can put the modem back in, temporarily, when you want to send your info to them.
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#10
You should be able to post now. See my signature on how to arrange your data. 9K for two sleep studies?? Holy smokes!
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