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[CPAP] New but not new
#11
the price is the same whether you get a regular CPAP or an auto set tell your insurance is not going to care the difference us and I think what you might be hearing is that normally speaking you have to try a regular CPAP before you can get a bilevel Blue Cross Blue Shield bought my first machine that was an auto set and it was not a rental they just paid for it straight up. it is true that even with Medicare failure to make progress with a CPAP is what is required before you can have a bi level which is a totally different code than CPAP whether it be C PAP or CPAP auto set tell your insurance is going to pay the same for either one
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#12
Thanks guys for your input. I got a hold of Blue Cross Blue shield and there is an 80 20 copay after the deductible is met. They had an old rule that you had to fail at regular cpap first to get auto machine. Now I just have to make sure the doctor writes perscription for the one I want.



Cindy lots-o-coffee
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#13
With your respiratory problems, you may have a valid concern about exhalation pressure. You may be best served by an auto bilevel machine. It wouldn't hurt to discuss your concerns and respiratory medical history with your doctor. No one wants you to fail, or put you in a position where the machine actually causes problems. It can't hurt to discuss it either way.

As mentioned above, APAP and CPAP have the same billing code. The APAP will have full data capability, and can be configured to minimize pressure, but provide increased pressured when you need it. That has some advantages in your case. Even though machines have EPR or Aflex for pressure relief during exhale, they are not true bilevels, which can provide a great deal of pressure relief if needed.

With deductibles and 80/20 copay, you might want to find out what your total out of pocket will be with whatever DME they set you up with. I had the same arrangement, and just bought a couple good machines off Craigslist. Both the BiPAP and APAP I got had less than 200 hours and are the newest models for much less than my costs of a single machine going through insurance.
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#14
(02-04-2015, 02:17 PM)Sleeprider Wrote: With your respiratory problems, you may have a valid concern about exhalation pressure. You may be best served by an auto bilevel machine. It wouldn't hurt to discuss your concerns and respiratory medical history with your doctor. No one wants you to fail, or put you in a position where the machine actually causes problems. It can't hurt to discuss it either way.

As mentioned above, APAP and CPAP have the same billing code. The APAP will have full data capability, and can be configured to minimize pressure, but provide increased pressured when you need it. That has some advantages in your case. Even though machines have EPR or Aflex for pressure relief during exhale, they are not true bilevels, which can provide a great deal of pressure relief if needed.

With deductibles and 80/20 copay, you might want to find out what your total out of pocket will be with whatever DME they set you up with. I had the same arrangement, and just bought a couple good machines off Craigslist. Both the BiPAP and APAP I got had less than 200 hours and are the newest models for much less than my costs of a single machine going through insurance.

Thanks for the info. I can't do anything the normal way. I have to have a funky form of asthma complicating things. I guess now I just wait a week or two to get the results and then see where things so with the insurance company. The DME's here charge rent of 129.00 to 150.00 per month on the units up to 13 months when you purchase them so they are double the price I am seeing them online. I would be afraid to purchase off craigslist without solid advice because I would end up getting a piece of junk knowing my luck.

My breathing is not the best when I am awake so I don't need it dropping when I sleep.

Not sure what all of this means except I suck at breathing. Unsure

Spirometry demonstrates a severely reduced FVC of 1.46 liters, 41% of
predicted and severely reduced FEV1 at 0.99 liters, 35% of predicted. This
yields a reduced FEV1/FVC ratio of 68%. Findings are consistent with a
severe ventilatory defect. Following bronchodilator administration, there
is a 31% rise in the FEV1 representing an improvement of 310 mL. There is
also a 31% rise in the FVC, representing an improvement of 460 mL. MVV
maneuver at 55% of predicted is appropriate for the FEV1. Lung volume
assessment shows a preserved total lung capacity at 5.15 liters, 100% of
predicted. There is an elevated RV and TGV however, at 178 and 123% of
predicted respectively consistent with air trapping. DLCO at 26.11 is
preserved at 104% of predicted and a gas transfer coefficient of 7.01 is
elevated at 144% of predicted. Flow‐volume loop contour shows reduced
amplitude of deflections plus concavity in expiratory limb.
IMPRESSION: Comprehensive pulmonary function tests are consistent with a
severe obstructive ventilatory defect. There is substantial response to
bronchodilator administration. There is evidence of air trapping on lung
volume assessment and gas transfer reflected in the DLCO is preserved. Gas
transfer coefficient is elevated and this likely reflects the effects of
decompensated asthma

Cindy lots-o-coffee
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#15
Cindy, sent you a PM.
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#16
Got it and responded.
Cindy lots-o-coffee
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#17
HI CL,
For what it's worth, I too have cough variant Asthma (though mine is well controlled) and my O2 levels went down to 76 percent as well in my sleep study but I am not on oxygen, so it isn't a given. Just depends on your situation.

Looking forward to hearing how it goes. I'm sure you'll do wonderfully.

It is funny how some folk don't want to know anything about their conditions and others, want to know everything!
That's me too.

Susan
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#18
Susan,

You are right I think the vast majority of the folks on this forum are the ones that want to know everything. Smile

I actually can't wait to get my cpap started, I am sick and tired of being sick and tired all the time.
Cindy lots-o-coffee
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#19
(02-05-2015, 12:57 PM)clrapstad Wrote: Susan,

You are right I think the vast majority of the folks on this forum are the ones that want to know everything. Smile

Not me. I don't want to know everything. There are some things I'd rather not know.

Like where Mongo keeps all those carburetors he has accumulated all these years.

....and who exactly takes care of the little hamsters that keep the squirrel cages in our machines running so smoothly. ...and while we're at it, why don't they call them hamster cages instead of squirrel cages/

Where exactly does Herb keep his hair?

Is it even possible to make trish6hundred mad? What would that be like?

Yes, these and many more are things I really don't want to know.

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#20
(02-03-2015, 05:33 PM)eseedhouse Wrote: With O2 levels that low CPAP alone is unlikely to help. My levels were similarly low and after a month on two CPAP machines (one for testing and assessment, one purchased) they were still low. An oxygen concentrator was bought to my house and added 3 liters of oxygen per minute into the air flow.

I immediately began to feel better after that. However oxygen is not the only approach.

I did another overnight oxymetry and will return the device to my supplier, and we'll see if this is the way I should be going.

Ed, just a headsup my friend. You have to take what you hear from your sleep docs and DME with a grain of salt. One thing I can tell you for a fact and this is simply that any SpO2 desat below 89% during the night, regardless of how brief or insignificant it may seem, is absolutely urgent and serious. What happens is that the body assumes that you are suffocating and the heart goes into overtime (ask me how I know), your pulse rate skyrockets as does your BP. A surefire recipe for stroke. A surefire contributor to "inflammation" internally and associated with things like Atrial Fibrillation (ask me how I know), diabetes Type II (ask me how I know), chronic hypertension and so on and so forth.

Any SpO2 below 89% at ANY time should be taken as an urgent situation and addressed immediately. In my case they infused 4/5L/M of O2 from an Everflo Q into my airline to increase the oxygen content of the air I was breathing. Kept my SpO2 above 90% solidly. Served to provide me with a better night of sleep to be sure and somehow (I do not understand the mechanics) reduced my AFIB, allowed medication to keep me in Normal Sinus Rhythm and permit my left atrium to shrink and now I will be off much of my medication within the next year and am booked for a catheter ablation of the offending nerves in my heart to rid me of this horrific Atrial Fibrillation - in and of itself a life altering condition and a serious stroke threat provider.

My head is spinning from how one little issue, brought out by MYSELF using a Contec CMS50EW recording pulse oximeter, snowballed into such a huge and serious situation. My left atrium has now shrunk to the point where I am a candidate for catheter ablation (just waiting for the date). No more spikes in pulse rate and BP during the night causing the heart to go into overdrive and enlarge (and thank goodness that little bit of O2 infused into my APAP air line took care of things and permitted my left atrium to shrink back down... many are not as lucky).

IMHO all of these "MINOR" issues are linked together and linked to "inflammation" of one's innards and what we have is a dog chasing its tail.

I would tend to this drop in SpO2 first and foremost as it is a clear and present danger, more so than your apnea. What you are likely to find is that when all is aligned you will sleep better and wake more rested. For sure I would NOT ignore or postpone any treatment addressing your desats in SpO2 as it is far too dangerous a condition. If you are not on blood thinners you probably should be until this situation is resolved and at the very least a 'baby' aspirin once or twice a day.... but I would talk to your docs about Warfarin/Coumidin which needs to be monitored by a blood test every couple of weeks. And I would stay away from the new blood thinners as they do not have an antidote like Warfarin does (vitamin K, etc., will reverse Warfarin's effects quickly in the event of a bleed).

There was a time when I simply would not even travel overnight without taking my oxygen concentrator with me.... it was that important.

I do not mean to be an alarmist and apologize for resembling same, but I have the T shirt and have been there. What I suggest is only my opinion and one needs to educate themselves and get a professional opinion before making a decision or taking action.

Desats of the extent you describe during the night are a recipe for disaster. At the very least you are aiming yourself at such monsters as Atrial Fibrillation, Type II diabetes, chronic hypertension, increased stroke risk, etc. All for want of a wee bit of oxygen infused into your airline to increase the oxygen content of the air a few percent (and presto your problem is resolved).

A few of us even got together and put together a self-regulating valve assembly that could be set at the SpO2 that you desired. It would turn the flow of O2 off and on such that the end result (95% SpO2) regulated the amount of O2 that was actually infused. It was almost perfect excepting that it cost $1,000 and would have been double that had we used a solenoid valve that was certified for human use.

Good luck to you. A major problem with a minor resolution. Don't ignore it.

Regards,

Murray L.
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Educate, Advocate, Contemplate.
Herein lies personal opinion, no professional advice, which ALL are well advised to seek.



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