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[Equipment] Settings - DME changed
#1
Wanted to get everyone's thoughts...

I've been compliant (100%) since I started. Soon after I found this board and downloaded Sleepyhead I bumped my starting pressure from 4 to 6. I felt I was getting starved for air and my average 90% pressure was 7+ cmH2O. So, I pushed it to 6.4 and let it ride. I don't see excessive CAs and my AHI has been below 2 the entire time I've started.

I'm not sure if I should be irritated or not, but this evening I was looking for my AHI and noticed they changed my pressure back to 4 remotely. I'm a little pissed but not a huge deal, I get it. However, they didn't tell me and I'd gladly tell them why.

I have a follow up with my Dr. Next week and will be bringing it up with him. I guess worst case I'll switch it to Airplane mode.

My insurance says I have a year rental period, however, I'm not sure what this means. I'm fully compliant, so does it just mean they make monthly installments to the DME for the remainder of the 12 month rental period? Or can they say I'm not compliant since I switch it to Airplane?

Any thoughts? I've read a bunch here and I know the forum has a lot of expressive opinions. I'm open to all ideas and plan to keep an open mind. I get why but just annoyed they didn't tell me...
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#2
I would just be straight with the doctor about the change you made, and that it worked for you. Focus on the aspect that you felt air-starved at minimum pressure, and you feel better with the modified settings, because he is unlikely to care about machine data. He will likely just change the pressure prescription and you can move on. The doctor should be your partner in this. Give him a chance to deliver.
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#3
redskin.


Hello.

I got the same machine as you. My Dr. setting was at the beginning 4 cms. of water and later a fixed pressure of 12 cms . At the beginning I really did feel starving for air. I changed the setting to begin with 7 cms. and I feel much better, but I thinking very seriously to increase this setting until 8 cms.
I believe that the best solution to the remote change of settings is speak with your doctor about the machine setting. I think the insurance won't like, in a rent machine, to don't know what is going on. Remember that we don't have privacy anymore. You can change it manually everyday at night until your next appointment.
Ralph.
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#4
Hi Red... Evidently the Physician remotely changed your pressure back to the 4. Can't see any reason for the DME to change it, unless they thought that you accidently changed it. All they are going to want is the money. I'd definitely discuss this with your doc in next weeks meeting. Explain about your not getting enough air, your 90% mark.. Better feeling with a higher pressure. You and your Physician should be a "health Team".
As far as the rental fees go... The Insurance or Medicare will pay for the monthy rental for one (1) year, after which the CPAP/APAP machine is yours. They should also pay for any repairs needed during that 12 month period. Again, after 12 months, you assume full ownership and any repair costs if required.
Yesterday is history; Tomorrow is a mystery; Today is a gift; Thats why its called "The Present".
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#5
I think as a principle it is totally wrong for the doctor or DME to change your settings without consulting you. If they thought you'd changed it accidentally, at the very least they should ask you. I personally would be extremely annoyed - what ever happened to informed consent?

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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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#6
I would simply change it back to what you want it at and call the DME. Find out why it was changed and who authorized the change. They CANNOT change your settings without doctor authorization and they aren't going to check your settings unless the doctor orders a change. Could be a machine glitch. Could also be that the manager double checks everybody's settings and saw that yours was 6 instead of 4 and changed it to match the doctor order. No matter what, they should have knowledge of who authorized the settings change. You, as the patient, can change it to whatever you want.

As others mentioned, your machine is being paid for by your insurance company for 12 months and then you own it. You have to ask your insurance company what the compliance requirement is. For most insurance, if you have shown compliance for the first 30 days and then seen your doctor, you are done. They do not follow further.
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#7
Can I just put a different perspective on this?

1. Why didn't you notify you clinic/doctor/DME that you were going to change it and give them the reason why?
And inform them you were going to schedule an appointment with your doctor ASAP to discuss the changes and your current issue of not getting enough air.

2. Why didn't you call your doctor directly and discuss changing the settings and your reason as to why you where changing them?

A couple of phone calls could well have solved the situation without even seeing the doctor, he may have considered your issue and cleared the change you need directly with the DME [sorry if I'm not getting the terms for the clinic/CPAP supplier correct, we don't have quite the same system here in Australia.... but we do deal with a respiratory/sleep specialist, and a clinic that supplies the machine and controls all the settings ordered by the specialist]

I have phoned my CPAP clinic directly and asked them to change settings, and also to download and email me reports, all done remotely.

When I first started on the CPAP I had to take the whole unit back to them [specialist's orders], but once they got to know me I got the ok to take just the SD card instead of lugging the whole machine on trains and buses for two hours in each direction.
Now I just phone them up when I need anything done.

In reality your CPAP supplier has probably done the right thing in assuming you may have accidentally changed it, or that there had been a machine malfunction.

BUT.. they definitely should have called you to alert you to what they may have perceived as an inadvertent error with the machine.
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#8
Guess it would depend on the DME but neither my doctor or DME gave a darn that I changed it. When I got my replacement machine the DME said they *had* to set it to the prescribed settings but she said you can set it to whatever you had changed it to yourself. Couldn't have cared any less. My machine is in airplane mode now that I own it.


Using FlashAir W-03 SD card in machine. Access through wifi with FlashPAP or Sleep Master utilities.

I wanted to learn Binary so I enrolled in Binary 101. I seemed to have missed the first four courses. Big Grinnie

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#9
(08-13-2016, 07:52 AM)AlanE Wrote: Guess it would depend on the DME but neither my doctor or DME gave a darn that I changed it. When I got my replacement machine the DME said they *had* to set it to the prescribed settings but she said you can set it to whatever you had changed it to yourself. Couldn't have cared any less. My machine is in airplane mode now that I own it.

Funny how some places/people think they should have ultimate control over our health management, while others are quite happy to just go along with whatever we feel happiest and most comfortable with.

I thought maybe it was just an Aussie thing that we are a bit more relaxed about those things, but it seems that may not be the case after all.... some people/places are just a PITA and think they have the right to dictate to their patients [clients actually, we pay the bills]
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#10
Most DME's don't care as long as you're compliant and AHI is <5.

When I first started adjusting mine, the RT at my DME didn't clue in at all....in fact, she seemed quite pleased with herself that my AHI was down (she hadn't adjusted anything and didn't even look at the other numbers....just AHI and compliance %). Be proactive and involve your doctor...if the two of you have a good relationship and you can demonstrate you have a good clue (don't forget, the docs might get a 1/2 hour on it during med school), most will back you with your DME.
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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