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DME, EPR, & O2 Help Needed!
#1
I am having a slow time with my DME. My prescription was sent to the proper department by Fax with receipt of them receiving it on October 17th. I am becoming a bit frustrated as I did my intake over the phone with them on the 19th, was told someone from the RePap Team would probably get hold of me by Monday, they didn't, so I called today and they are stating now they just received the Prescription today! My insurance company has told me they would probably need information with the Prescription as to why the current machine is not working and why I need the AutoSet. When I offer that information to DME they don't seem to want it although I told them without it my Prescription can be denied as it hasn't been five years (approx. 23 months). I explained that I am dealing with severe oversleeping and feeling fatigued and that my O2 levels have gotten worse since my sleep study, and my Doctor is trying different medications which so far have not helped, not to mention one prescription alone cost the insurance company $2000.00 and me another co-pay.

Having shared that chapter, sorry!, what would you suggest I try next? They are telling me it could take 3 months, now I see why if they are just receiving a fax from the 17th on the 24th although we got the print out it was successfully received when sent.

My next issue is when I had my sleep study my only issue was really the exhaling although I thought I could never get through it with my OCD and all those leads touching me all night (I did good there). I was able to tolerate the intake as it was started at 5cm and worked up to 7cm, they left it there as my O2 was up to 91-98. But it was hard to breathe back out. When they came to my house to set up the machine I was asked how it felt and said the same thing, it is hard to exhale but was told I would get used to it over time, I would feel better right away, and most people lose weight as they have more energy after a good nights sleep. I see my machine has EPR on it even though it is a "brick" and found the menu for it and it was set to off. Could this contribute to my lower oxygen levels? Is it better to have this EPR on? I was wondering if my exhaled air was getting back into me somehow and this is why I'm so tired and fatigued with lower oxygen levels. I do not smoke and certainly don't live in an air-tight house. So I am concerned why my O2 levels have dropped with 23 months of therapy, not to what I believe is serious but certainly lower, average 93-95, a few times hit 96 and in high 80's. My diagnosis was Severe Sleep Apnea OSA, 69.3 AHI.

Sorry to be so longwinded but I am feeling helpless as I can't work, I don't receive disability, I am self-employed out of my home and have to fight to get out of bed and when I do fall alseep at my office chair or recliner. Having said that I am not in a position to buy out of pocket right now. But will gladly if I have to once I can.
Tim
Finger Lakes Region, NY
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#2
(10-24-2012, 02:57 PM)2Tim215 Wrote: I see my machine has EPR on it even though it is a "brick" and found the menu for it and it was set to off. Could this contribute to my lower oxygen levels? Is it better to have this EPR on? I was wondering if my exhaled air was getting back into me somehow and this is why I'm so tired and fatigued with lower oxygen levels.
EPR is a comfort feature more like mini bi-level effect as it lower pressure at exhale by whatever it set on (1-2-3) and some find to be comfortable.
so if you have EPR set on at 2 .... the machine lower the pressure when exhaling by 2 cmh2o (7-2=5) also there is a setting in the clinical menu, how fast (fast/med) pressure come up to set pressure
don,t think have any effect on O2 levels but might help if having problem exhaling against pressure
make sure mask vents are not blocked by any bed covers
few folk here use oximeter can help with the setup and software to monitor O2 level

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#3
Hi 2Tim215,
WELCOME! to the forum.!
Hang in there for more suggestions and best of luck to you.
trish6hundred
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#4
The oxygen levels are with the breathing in, not the breathing out. But it is all connected.

Like zonk said, EPR is a comfort feature. You can set it to 1, 2, or 3. These numbers are the difference between the inhale and the exhale. So if you machine is set to a pressure of 7, the exhale would be 6, 5, or 4.

I would try it for a few days with it on 2. It does take some getting used to. I went 2 weeks with the EPR turned off. Other than some ear pressure problems for the first few nights, I didn't think there was that much of a difference. Then I turned it back on but at 2 and noticed a big difference!
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#5
(10-24-2012, 03:39 PM)zonk Wrote:
(10-24-2012, 02:57 PM)2Tim215 Wrote: I see my machine has EPR on it even though it is a "brick" and found the menu for it and it was set to off. Could this contribute to my lower oxygen levels? Is it better to have this EPR on? I was wondering if my exhaled air was getting back into me somehow and this is why I'm so tired and fatigued with lower oxygen levels.
EPR is a comfort feature more like mini bi-level effect as it lower pressure at exhale by whatever it set on (1-2-3) and some find to be comfortable.
so if you have EPR set on at 2 .... the machine lower the pressure when exhaling by 2 cmh2o (7-2=5) also there is a setting in the clinical menu, how fast (fast/med) pressure come up to set pressure
don,t think have any effect on O2 levels but might help if having problem exhaling against pressure
make sure mask vents are not blocked by any bed covers
few folk here use oximeter can help with the setup and software to monitor O2 level
Thank you, I appreciate the reply. I bought the Oximeter and have been using it. I have been using the software and recording at night. That is how I found my O2 has dropped since my Sleep Study approx. 23 months ago. Also took the extra step to check other adults with it to be sure it was working correctly, it is, everyone else was 98-99, of course these weren't overnight recordings. My daytime varies, average 94-95 when off CPAP. I'll see if I can locate the information to try and set the EPR. Thanks again!

Tim
Finger Lakes Region, NY
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#6
(10-24-2012, 03:57 PM)trish6hundred Wrote: Hi 2Tim215,
WELCOME! to the forum.!
Hang in there for more suggestions and best of luck to you.
Thank you, appreciate the welcome. I'm learning a lot reading other Posts also!
Tim
Finger Lakes Region, NY
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#7
(10-24-2012, 05:21 PM)2Tim215 Wrote: I'll see if I can locate the information to try and set the EPR. Thanks again!
whatever you set in the clinical menu to patient (including EPR, mask, climate control).. it,ll be displayed in patient setup menu
you can set EPR level in the clinical menu (setting) and also can be set to patient so you have the option to change it in the patient setup menu

S9 setup
http://www.apneaboard.com/resmed-s9-cpap-setup
the S9 manual available by Email (scroll down to section three)
http://www.apneaboard.com/adjust-cpap-pr...tup-manual
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#8
It's not surprising that your needs have changed after 2yrs. The Autoset will set you right, though.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#9
(10-24-2012, 06:45 PM)PaulaO2 Wrote: It's not surprising that your needs have changed after 2yrs. The Autoset will set you right, though.
I agree, just getting the AutoSet is becoming a nightmare by itself!
I heard from DME Corporate 800 number and didn't work out at all. They are telling me that I have to work through my local vendor as they don't handle CPAP prescriptions, the local distributor stocks them. What I don't understand is why did they bother with the In-take over the phone and have me fax them the prescription for then? The local DME hasn't returned my call in over three weeks, after finally getting a call from the 800 people they connected me directly to local who never picked up and went back to 800 who said local will call me shortly this morning, never did. I called them, they wanted my name, DOB etc. and obviously pulled up my info as I asked them if they had a S9 ResMed Autoset in stock as the 800 people advised they are stocked locally. They said they thought so, please hold, came back to the phone like they had one in stock and asked if I could come in Tuesday. Of course I am thinking to pick up the new machine with my prescription but asked, "so you do have one then?". They said no actually we want you to bring your machine to see what's wrong with it! Oh-jeez
Okay, so longer story short, they said AutoSet's are for clinician use and that they could just adjust my machine or set-up another sleep study even though I told them I already spoke with my insurance, told them the situation, who said to have my Doctor write a prescription for the proper machine I was initially led to believe I had. They wouldn't budge even after I explained my O2's are down since my first study, I have gained weight, the therapy isn't working like I was told it would, and I have severe oversleeping problems. Their problem is if they gave me the AutoSet I believe they know that would be admitting they didn't give it to me the first time! I politely said okay, I'll try another DME. Called another one in my network and they are stating same thing, the AutoSet's are for clinical use whether in home or at a facility to see what pressure to send the patient home with. I explained to them that things change over time like weight gain etc. but still told me that none of the Sleep Study Doctors prescribe an AutoSet to patients. The only difference was at least this lady was VERY nice about it unlike my original DME. They advised call the Sleep Study MD and see what they say. They must have closed at 4:00 so no luck there! It's looking like an Out of Pocket venture once I'm able but find it very frustrating they got away with dumping the brick on me to begin with! Sorry to vent so long, been working on this for weeks and gathering all the information I could but keep hitting this rock wall with a rubber hammer! Not sure of next step, stressed to the max!

Tim
Finger Lakes Region, NY
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#10
It sounds like they don't want your business. You may want to give them back their brick and order your Autoset online. See the supplier list (link at the top of the web page). The online suppliers do not handle insurance billing, so you have to pay up front and file for reimbursement. If insurance coverage is a problem, I would suggest contacting Secondwind (supplier no. 2).

Edit: At two years you probably own the machine, so you would not want to give it back.
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