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Medicare Question
#1
Currently I am on APAP which has reduced my AHI from 81 untreated to 7.5. I also have COPD. Many of the users head on the Apnea Board find better treatment using BPAP. I do feel after studying my charts that there is room for improvement. So I discussed this with my doctor this morning.

He said that he did not think Medicare would approve BPAP since APAP had reduced my AHI to 7.5 (under 10 with no demonstrated problems.) Instead he recommended that I consult a Sleep Specialist. As I said elsewhere, I probably know as much or more about sleep apnea as my doctor does as I doubt he had it as part of his training. I have confidence in my doctor's advice and will find a Sleep Specialist.

Where I live, Lander, Wyoming, I probably do not have a Sleep Specialist within 150 miles! When we do find one, I will probably have another sleep study with him.

So my question is this: Is my doctor right about Medicare?

Thank you in advance for your replies. Thanks


Walt
Walter W. Olson, Ph.D., P.E.
Professor Emeritus
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#2
Given that your apnea is still above 5, chances are you would qualify for a bipap, but it would depend on the results of a sleep study. The qualification is medical necessity. A consultation with a Sleep Specialist certainly WOULD be covered and you can ask what his/her thoughts are on that before participating in another sleep study. When you consult said sleep specialist, you also want to make certain that a split night is done, if necessary, so that you don't have to drive 150 miles for a second titration study.
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#3
Walt,

I do not remember the details of your apnea. How do you feel that a bilevel machine might help you?

Best Regards,

PaytonA

Admin Note:
PaytonA passed away in September 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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#4
(01-26-2016, 11:39 AM)PaytonA Wrote: Walt,

I do not remember the details of your apnea. How do you feel that a bilevel machine might help you?

Best Regards,

PaytonA

I started with an AHI of 81. I have COPD. On APAP, the AHI is averaging 7.5. By using BPAP, it provides less expiratory back pressure. My apneas are mixed. APAP has more or less addressed the OSA's but I still have CA's, RERA's and hypopneas. In the expiration part of the cycle, it appears that the expiration is being drawn out excessively. Most COPD people have problems getting air out. By lowering the EPAP you address that problem while using a higher IPAP to keep the airway open. For a number of COPD hoseheads, BPAP has helped reduce the AHI to an acceptable range.

Walt

Walter W. Olson, Ph.D., P.E.
Professor Emeritus
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#5
Yes, Bilevel does help people with COPD. And, I have heard that: "Most COPD people have problems getting air out."
COPD + AHI>5 should qualify for a Bilevel. (I don't know what Medicare's criteria are.)

Bilevels are also useful for people like me who need higher pressure. Exhaling against 18 cm-H2O would be difficult.
As is my case. Bilevel is also the next step for people who cannot comply on CPAP.

The one downside of bilevel can be that the larger split between IPAP and EPAP expels more CO2.
That can cause more CA to be scored as the CO2 in the blood is a trigger to breathe while asleep.

Admin Note:
JustMongo passed away in August 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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#6
(01-26-2016, 02:50 PM)wolson Wrote:
(01-26-2016, 11:39 AM)PaytonA Wrote: Walt,

I do not remember the details of your apnea. How do you feel that a bilevel machine might help you?

Best Regards,

PaytonA

I started with an AHI of 81. I have COPD. On APAP, the AHI is averaging 7.5. By using BPAP, it provides less expiratory back pressure. My apneas are mixed. APAP has more or less addressed the OSA's but I still have CA's, RERA's and hypopneas. In the expiration part of the cycle, it appears that the expiration is being drawn out excessively. Most COPD people have problems getting air out. By lowering the EPAP you address that problem while using a higher IPAP to keep the airway open. For a number of COPD hoseheads, BPAP has helped reduce the AHI to an acceptable range.

Walt

Makes sense to me. As I said, I could not remember your situation. In addition, at least with the Resmed Bilevels, one has some other breathing adjustments available that may help the COPD expiration problem.

Best Regards,

PaytonA

Admin Note:
PaytonA passed away in September 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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#7
(01-25-2016, 04:19 PM)wolson Wrote: He said that he did not think Medicare would approve BPAP since APAP had reduced my AHI to 7.5 (under 10 with no demonstrated problems.)
...
So my question is this: Is my doctor right about Medicare?

I think a "demonstrated" problem may be if you experience Excessive Daytime Sleepiness (EDS) as demonstrated by a high score on the Epworth Sleepiness Scale.

http://www.apneaboard.com/sleep-apnea-in...iness-test

(01-26-2016, 02:50 PM)wolson Wrote: My apneas are mixed. APAP has more or less addressed the OSA's but I still have CA's, RERA's and hypopneas.

(01-26-2016, 03:39 PM)justMongo Wrote: The one downside of bilevel can be that the larger split between IPAP and EPAP expels more CO2.
That can cause more CA to be scored as the CO2 in the blood is a trigger to breathe while asleep.

Right:
http://www.apneaboard.com/forums/Thread-...9#pid14389
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#8
Resmed also has a CPAP for COPD, you should check it out. Expelling more CO2 is a good thing for someone that tends to retain CO2 caused by COPD.

You should have zero problem qualifying for a BiLevel, that's what I have-the only way I can sleep. Read up on the T1 & T2 settings, they have a table for setting those for COPD, of course being different my setting are opposite those for COPD.
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