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COPD with OSA and obtaining CPAP machine
#1
COPD with OSA and obtaining CPAP machine
Hi to all,

I am writing on behalf of my mother.  She has been diagnosed with COPD and prescribed O2 and breathing treatments.  I suggested she might want to have a sleep test and results were AHI of 15(I have requested that she get a copy of the sleep report and prescription).  Apparently the medicare rules dictate that her o2 saturation must fall below 88% while exercising in order to qualify for a cpap machine, and still keep her oxygenators.  She cannot give up the oxygen as this is what keeps her going.  Does anyone have any experiences with both COPD and OSA?  She is frantic about trying to get some improvement in her quality of health.  Any suggestions are most welcome.
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#2
RE: COPD with OSA and obtaining CPAP machine
silversnore, I'm guessing if she is already using O2 during the daytime than she must of qualified at or below 88% O2 levels already.

Even with CPAP I doubt that it will improve her O2 levels during the day. She should still qualify with 88% or below during the day.

If she does improve her O2 during the day from CPAP than I would think getting rid of the O2 hose would be a blessing.
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#3
RE: COPD with OSA and obtaining CPAP machine
I have read the Medicare rules on qualifying for CPAP, Bilevel and Bilevel with backup rate, and none of them specify oxygen levels while exercising...indeed it is possible to combine CPAP or BPAP with oxygen. Her sleep study results qualify her for CPAP treatment. She may benefit from bilevel therapy if she has a tendency for hypoventilation. If the AHI was predominately hypopnea, that is likely the case. Her next step is to do a titration study to demonstrate that she will benefit from CPAP, and given her COPD a bilevel should be considered to improve her tidal volume. I would discuss this with the doctor and ask questions about CPAP, BPAP and the possibility of an oxygen bleed into the CPAP circuit. Try to ensure she gets an appropriate test for someone with COPD and supplemental O2, and not the run-of-the-mill obstructive apnea titration.
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#4
RE: COPD with OSA and obtaining CPAP machine
Thanks guys.  Sleeprider as usual you are spot on and and have come up with a very good approach.  I could not find anything in the medicare literature concerning the combination of equipment, but she has been tested while walking and they say she does not qualify and to get a machine she has to turn in her concentrators.
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#5
RE: COPD with OSA and obtaining CPAP machine
Medicare does have rules about Supplemental Oxygen. So I'm a bit confused on how she got oxygen in the first place?
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#6
RE: COPD with OSA and obtaining CPAP machine
most likely she had a nocturnal oximetry on room air which showed the SpO2<88% for greater than 5 minutes. This qualified her to use O2 at h.s. only. DME is only getting reimbursed at h.s. rate.

Since the concentrator is already in her home she probably uses during the day even though she doesn't desat.

Most likely the desats at h.s. happened due to OSA. It's possible that she doesn't need O2 at night but cpap. Also possible she could need both. That can be determined during a titration study. If testing shows O2 levels are fixed with cpap then the O2 would not be covered by insurance and thus d/c'd.
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#7
RE: COPD with OSA and obtaining CPAP machine
Thanks for the insight.
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Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#8
RE: COPD with OSA and obtaining CPAP machine
Something is screwy here.

I was prescribed a o2 generator while waiting for my cpap machine.

They say I have COPD.

I could have kept both no discussions of exercise etc.
I didnt keep the o2 generator because I didn't need it after cpap.
I am on Medicare.

But I could have kept both.
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#9
RE: COPD with OSA and obtaining CPAP machine
dmeRT would know all the rules around it.
I think the walking machine is the one for whether o2 is daytime supplemented and you have to be pleased there were no desats on the walker.

My mum had asbestosis, so I know what you are going through with o2 and bpap. I think it's too early to say that the o2 machine isn't needed at night. I would ask for a titration study. They will start with a cpap. Given the COPD, a bipap/bilevel machine may be needed. The o2 levels will be monitored and see if any supplemental o2 is needed. If you mum can drop the o2 for now, that would be a good outcome.

Your mother may feel a lot better during the day, if the night time desats are sorted. I really would push for titration.

Your mum may also have feelings of being scared that handing back the o2 may hurt her. This may not be the case.

does your mum have a recording o2 sensor? even a cms50f off of ebay for $50 could be worth having. You would have data to discuss with the doctor about. They would then confirm with their equipment.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#10
RE: COPD with OSA and obtaining CPAP machine
Thank you for all of your replies, most helpful
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