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Continued DME Problems & Odd Pulse Oximeter Results
#1
I have really been struggling with my DME, not surprising I'm sure to others here. When I was first given my CPAP I was led to believe it was data capable, not compliance only, and it wasn't. That was nearly 23 months ago. I have been struggling with severe oversleeping and fatigue for several months. I do have multiple issues, Fibromyalgia, Gout, Osteoarthritis, Rheumatoid Arthritis, Severe OSA, and Hypertension, I believe that covers most of them! Most of these issues are for the most part under control. I do have the Flare-ups at times and often very difficult pain upon waking. I have medication to control the pain but unfortunately every thing we tried keeps me awake when taken before sleep. Finally found one that works without the nausea. If I take the pain med I have trouble sleeping, if I don't my norm is maybe 12-16 hours as I "nod" off after waking and doing minimal chores etc. and sleep another 3-4 hours.
So my Primary Care has been trying to treat the sleep issues with medication, both of us probably assuming the CPAP was affective for the OSA but maybe one of the other issues contributing to the fatigue and oversleeping, Fibromyalgia comes to mind there but the Cymbalta has reduced my narcotic needs substantially although with all my issues I have to have them on standby at all times for severe pain.

Sorry about the long story but without some history probably would be hard to find solutions from others here who may have been through the same thing or still going through it!

The medication to help stay awake didn't work, (cost my insurance $2000.00!), then tried me on generic Ambien (Zolpidem 12.5mg ER), but that is supposed to be a temporary solution due to side affects and dependency issues but my Doctor felt if it helped me get a "good nights sleep" and I would wake up rested I could stay awake, I didn't at all the first night I tried it so didn't use it again. I don't want medications to address my OSA if the AutoSet can do it!

My DME is refusing to fill the prescription written for a S9 ResMed AutoSet and dispense as written. They want me to come in with my first machine the ResMed Escape to fix it or adjust settings. They know if they fill the prescription they are sort of caught with their pants down as they misled me about what machine I was initially given. My insurance BC/BS PPO usually will only allow a new machine every 5 years. I explained my situation and they told me to have my doctor write it for the correct machine and might need additional information of why I need the different machine. The prescription was written 10/17/12 and still can't find a DME in network that will work with me! Not only is this causing me a great deal of stress that complicates my health but I am still suffering from severe oversleeping and fatigue. Financially I am not in a position to buy out of pocket and it wouldn't seem right to have to as for my wife and I we are paying over 3000.00 a year for our healthcare.

I bought the CMS 50D+ Pulse Oximeter and have been recording each night so I could at least have some data to try and help get my prescription filled, the last DME I tried said he doesn't want the Graphs just give him the prescription and initial sleep study, I sent a copy of the sleep study and said a copy of the prescription would follow if they could assure me they are willing to work with me in helping with my OSA therapy and obtaining the prescribed machine but they didn't sound receptive to the machine. Another DME wanted an "up charge" of 100.00-150.00 although I shared with them the machine is only about 100.00 more on-line, also they wanted me to sign a waiver stating I would pay for the machine if insurance refused to fill the prescription, I told them I don't want the prescription filled unless insurance will agree to cover it. They were talking about 2000.00!

In the mean time at home feeling a bit helpless and exhausted as each person refuses to work with me I change my pressure from the initial 7cm to 7.2cm, then after a while 7.4 for about 12 days. No noticeable difference but my oxygen did hit the higher 90's more often compared to usual low 90's. Last night I tried 7.6cm and my heart rate dropped back to 50's and oxygen back to low 90's??? Should I try to continue at the 7.6 and see if it was just a fluke for a one night trial? Are there any other suggestions on how to get a in network DME to help? I do sincerely apologize for the long post but felt it necessary to understand what I am up against. Thank you for ANY help or advice!!!
Tim
Finger Lakes Region, NY
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#2
Tim, it is quite a battle you've been fighting with medical issues and DMEs. Have you considered getting back to your insurance company to report your difficulty in finding a DME to fill your new script and ask them for help with this? They might be willing to provide you with something in writing stating that they will cover a new machine for you to share with a DME so you can fill the script. Even though they usually supply a new machine only every 5 years, the fact that they told you to have your doc write a script for the correct machine sounds like they may be able to make an exception to their 5-year rule in your case. Another thought that comes to mind is about the DME that indicated they would switch machines with you for an up-charge of $100-$150 for an S9 AutoSet doesn't sound like too bad a deal, especially if your ins. co. can't help you get your new script filled without paying anything.
One other thought about your apnea. I am not aware of any meds that reduce/eliminate apnea. The machine does accomplish that. Meanwhile, you may have other medical issues, such as the over-sleeping problem that are separate from apnea and which may be helped by meds. But for the apnea itself, an xPAP is the only answer I'm aware of. Some folks have tried surgery instead with what I read as somewhat mixed results over time. Don't know if any of these thoughts help, but wanted to share.
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#3
(11-06-2012, 03:33 PM)Dawei Wrote: Tim, it is quite a battle you've been fighting with medical issues and DMEs. Have you considered getting back to your insurance company to report your difficulty in finding a DME to fill your new script and ask them for help with this? They might be willing to provide you with something in writing stating that they will cover a new machine for you to share with a DME so you can fill the script. Even though they usually supply a new machine only every 5 years, the fact that they told you to have your doc write a script for the correct machine sounds like they may be able to make an exception to their 5-year rule in your case. Another thought that comes to mind is about the DME that indicated they would switch machines with you for an up-charge of $100-$150 for an S9 AutoSet doesn't sound like too bad a deal, especially if your ins. co. can't help you get your new script filled without paying anything.
One other thought about your apnea. I am not aware of any meds that reduce/eliminate apnea. The machine does accomplish that. Meanwhile, you may have other medical issues, such as the over-sleeping problem that are separate from apnea and which may be helped by meds. But for the apnea itself, an xPAP is the only answer I'm aware of. Some folks have tried surgery instead with what I read as somewhat mixed results over time. Don't know if any of these thoughts help, but wanted to share.

Quote:Another thought that comes to mind is about the DME that indicated they would switch machines with you for an up-charge of $100-$150 for an S9 AutoSet doesn't sound like too bad a deal,
I agree that wouldn't be bad and I could do that right away but they are the ones who want me to sign the waiver which would cost me 2000.00 if the insurance company doesn't cover it for some reason. I should have added that they told me they never had an insurance company pre-approve a prescription. I told them I wouldn't want the machine without the assurance it was covered as it could be bought online for less than half of what they would charge me. I am going to call my insurance company again as you advised and see what I can do, or what they can do! Thank you for taking the time to read my book!


Tim
Finger Lakes Region, NY
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#4
Another thought about your trying slightly different pressure on your current machine. Advice I have read here from well experienced folks is that one or two nights at a new pressure is not nearly long enough to see a real trend toward improvement or lack of it. It's often suggested that when a new pressure is tried, do it for at least a couple weeks and then look at what has been going on during that trial period. I've had the same situation when my sleep doc wanted to try a new pressure. He has had me use that new pressure for two or three weeks before reporting back to him to give it enough time to clearly see its effect. As far a pressure changes, the most common change that doctors here try out, according to my DME, is one full step (from 8 to 9cm for example), rather than something that's a fraction of one cm.
In your present situation with the S9 Escape, I guess you can't really know any specific info from the machine other than number of hours slept, but you can still keep track of how you have been feeling compared to the earlier pressure setting on the machine.
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#5
And here's one more thought, Tim, about a possible shortcut to getting a currently correct pressure for your apnea. If you ask your doc to write a script for a loaner S9 Autoset for something like two to three months, which is what I did, then having an Autoset for awhile will get you titrated (find the pressure or pressure range that works for your apnea). Then, if nothing else, you will know where to set your S9Escape pressure-wise. While you use the loaner AutoSet, you'll be able to see what's going on during each night. In my case, at the end of the loaner period, I asked my doc if he would write for an AutoSet on a permanent basis, and he did so. However, that occurred during the initial rental period of my machine (I'm Medicare), so the DME didn't seem to have a problem giving me the loaner and then making the permanent switch.
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#6
Thanks again for your replies! I did try 12 days at the 7.4 but only last night at 7.6, I'll up it to 8cm for a few weeks and see what happens.
Okay, now on your advice to call my insurance again I was a bit hesitant as I have called them probably 4-5 times since September when I really started researching for better answers. This time I believe I finally reached someone who is going to help me! She was very encouraging, gave me her e-mail, and step by step instructions on how to get the new machine. We left off with "don't worry, we'll get it done." And she put in place a back-up plan in case the first route doesn't work. I am truly encouraged now and my faith restored that help is on the way!!! Thanks again, I will post updates on this process and let you know how the 8cm works out. I will monitor it with my Pulse Oximeter, its all I have right now but does help in case I hit a dangerous O2 or heart level.
Tim
Finger Lakes Region, NY
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#7
Hi 2Tim215,
I sure hope after all the struggles you have had with your DME that you can (Ha-Ha,) put this to bed, (so to speak, (Ha-Ha.)
No, seriously, I'm sure all this has been frustrating and stressful.
Best of luck to you and it will be interesting to hear how things go for you.
trish6hundred
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#8
(11-06-2012, 03:01 PM)2Tim215 Wrote: So my Primary Care has been trying to treat the sleep issues with medication, both of us probably assuming the CPAP was affective for the OSA but maybe one of the other issues contributing to the fatigue and oversleeping, Fibromyalgia comes to mind there but the Cymbalta has reduced my narcotic needs substantially although with all my issues I have to have them on standby at all times for severe pain.

Tim,
When I tried Cymbalta, I found out the hard way that it can wipe out your REM sleep and leave you tired all day - I almost fell asleep several times driving home from work. I was so tired that I was wondering if I could die from fatigue. If you have to take it, you might try taking it early in the day (mornings). You might consider having a talk with your pharmacist about possible side effects of all the drugs you take, maybe even find another pharmacist for a second opinion. Ask if any of the drugs or the combinations would or could adversely affect your sleep, especially the REM stages, and if they do, try to find a different drug that will treat your condition(s) without the bad side effects.
You might also see the supplier list http://www.apneaboard.com/forums/Thread-...plier-List
and check out Supplier #2 for a nice price on another machine, if for any reason ins. can't arrange a swap on the one you have now. They have an S9 Autoset and a PR System One DS550HS (both data capable) at what I'd consider good prices.
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#9
Cymbalta had some nasty side effects for me. I tried it for the pain relief factor but decided the pain was better.

I can't remember if I had any sleep issues. The other issues were so great, there was no way I could have noticed.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


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#10
I am really hoping! Sounds like everything might finally go through for the AutoPap! The last step seems to be my Doctor sending in the prescription with new settings and the word, "New" so no one tries to slip me a used machine. He won't be in until the morning but my insurance has given the pre-authorization so I am a bit excited of finally getting proper treatment! I will up-date tomorrow when I know more. Coffee
Tim
Finger Lakes Region, NY
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