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New AS 10 to replace S9
#1
New AS 10 to replace S9
Just replaced my 6 year old S9 with an AS 10. S9's display has been hard to read for the past year or so - LCD failure. Stripes through the display, but it worked. Interesting fight resulted when MD submitted request for new machine to supplier. MD reported back that no new machine unless I do a new sleep study. NP. I figure good idea since maybe thing had changed since last SS. Last SS was 2014, and really a titration study for the one I had in 2006 or so. (2006 - 2014 was a respironics I think). 
Called insurance a few days prior to ensure all was good. (Ins. through med center employer (wife's ins) and they make you use them for anything they can do... Cat, MRI, Surg., etc) so wanted to make sure that all ok. So..  Ins co. says not approved yet since req. was only days prior and MD / Sleep study center didn't provide requested info. 
Gets interesting here... Ins co. ends up denying SS since no med records, and no history indicating Sleep Apnea. Called MD. Told them what ins response was. MD - actually PA / Nurse - says that she can't find record of Sleep Study since 2006. Told her to look harder since I had one in 2014 - and I can see it on THEIR online portal. All of a sudden she finds the report. Ins. company comes back again denying SS since no indication of Sleep Apnea in med records - never mind what the SS says. I can appeal, but who knows how long. In the midst of this, DME leaves message saying new machine, but ins. will pay 80% - rent for 13 months, and I pay $11 a month for 13 months then I own. I figure no need to fight since I get a new machine for $143 total, and if Lincare didn't do something right with ins., and ins denies... here's YOUR machine. That should come up in a month or so if it's gonna I would think. 

Something else interesting is that I thought the S9 was failing beyond the display issue because it seemed to not really adjust sometimes. Pressure seemed to like "peg" out at times. I'd press stop and restart, and  move on. Could't read the display, etc. and that's why I hit MD up for new machine. Also didn't really mess with my sleep since I don't have an issue going back to sleep, and I'm really used to CPAP. Hadn't read data from S9 for a long time. Downloaded OSCAR to start looking at new machine data. Turns out that autoset max on S9 had been reset to 12 at some point. S9 was pegging at 12 kinda frequently. That seems to kill EPR, so that's probably why I noticed it. I suspect that maybe when the card was "read" at MD at some point, they altered the setting. I know it was 16 while I could still read the display, and I know my RX from last titration said 12. So maybe some helpful person "found a config error and fixed it". Who knows?  I know I'll be watching closer now.

Here's a 1 year summary:
   

4 July on S9 showing pressure pegged
Around 3:30 it shows a stop and restart since I must not have liked it
You can probably see that didn't faze me much

.pdf   4 July on S9.pdf (Size: 995.2 KB / Downloads: 4)

10 July on AS10. Pressure runs up a bit higher than the 12 that was the prior max
Still working on mask to lower leaks

.pdf   10 July on AS10.pdf (Size: 1.01 MB / Downloads: 4)
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#2
RE: New AS 10 to replace S9
As far as insurance goes it all varies how bad or really bad they are..  One thing you might check is does your PCP "Regular Doctor" have all of these conditions noted in your Primary Chart.  In other words when you refer to your MD is that your Primary doctor or a specialist?  Most insurance look for history related to your conditions at primary doctor not a specialist.  

Your Primary care doctor is sort of the hub to your care.  All conditions from other areas and disciplines should be reported back to them so they can keep all of that in your Primary care record.

I would post a daily detail with f12 from oscar so we can see better how you are.

OSCAR Chart Organization and preparing for Screen Shot
For a brief tutorial on the best way to arrange your OSCAR charts for review, follow this link: For advice on attaching charts and images to Apnea Board forums, follow this link:
Thank you,
Brent aka Factor

Just a Regular guy.
My untreated AHI was 87.  You can do it hang in there.
"You can if you will"   Jerry Kramer

Got OSCAR?
Organize Charts
Optimizing Therapy

My Story
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#3
RE: New AS 10 to replace S9
(07-14-2021, 12:52 PM)factor Wrote: ...I would post a daily detail with f12 from oscar so we can see better how you are....

The 4 July one is with the S9. The 10 July one is with the AS 10. To answer questions, MD = PCP. Last trip was a PA where I asked about getting a replacement. Original path to Sleep Study / CPAP around 2005 was different Dr. Machine replacement with titration in 2014 was different Dr. at same group. Not actually sure what's in chart. Not sure what conditions related to SA there would be since original Dr. was at a different place, and I've been using a machine pretty consistently for a long time, so probably many of the bad things that could happen don't Comment from woman at sleep study place in 2014 - I remember this - in the morning was that she could tell that I use my CPAP. Apparently people that don't react differently to them messing with the pressure or whatever when they do their adjustments to figure out pressure. 

S9 settings
Machine Settings
Mode
APAP
Pressure Min
4.00 cmH2O
Pressure Max
12.00 cmH2O
EPR
Full Time
EPR Level
2 cmH2O

AS 10 settings

Machine Settings
Mode
APAP
Pressure Min
5.00 cmH2O
Pressure Max
20.00 cmH2O
Antibacterial Filter
No
Climate Control
Auto
EPR
Full Time
EPR Level
3 cmH2O
Essentials
Plus
Humidifier Status
Off
Mask
Pillows
Ramp

Ramp Pressure
4.00 cmH2O
Ramp Time
45.00 Minutes
Smart Start
On
Temperature
27 ºC
Temperature Enable

       
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#4
RE: New AS 10 to replace S9
(07-14-2021, 09:56 PM)Atsc3 Wrote: AS 10 settings

Machine Settings
Mode
APAP
Pressure Min
5.00 cmH2O
Pressure Max
20.00 cmH2O
Antibacterial Filter
No
Climate Control
Auto
EPR
Full Time
EPR Level
3 cmH2O
Essentials
Plus
Humidifier Status
Off
Mask
Pillows
Ramp

I would recommend change the settings on the AS10 
to 
Machine Settings
Pressure Min
9.00 cmH2O or even 10
Pressure Max
20.00 cmH2O

EPR
Full Time
EPR Level
3 cmH2O
Ramp
OFF or turn the time way down to like 15 min. 

Because your minimum 5 cmH2O is so low your not really getting the treatment you need your median pressure is 11 cmH2O.  Plus with the EPR at 3 which you need because of FL its not really affective until the pressure is above 7 cmH2O or 8 cmH2O.  Also the long ramp time with 4 cmH2O is 45 min you are almost losing an Hour of treatment because you need at least 11 cmH2O.  I would work hard to nix the ramp. 

You also seem to have a large leak issue which to me looks to be your mouth is coming open?  Do you have a dry mouth sometimes?  Are you using a Pillow mask?

I am sure others will comment but it what I see currently.
Thank you,
Brent aka Factor

Just a Regular guy.
My untreated AHI was 87.  You can do it hang in there.
"You can if you will"   Jerry Kramer

Got OSCAR?
Organize Charts
Optimizing Therapy

My Story
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#5
RE: New AS 10 to replace S9
(07-15-2021, 11:22 AM)factor Wrote: ...You also seem to have a large leak issue which to me looks to be your mouth is coming open?  Do you have a dry mouth sometimes?  Are you using a Pillow mask?...
The leak I know about. It's a nasal pillow mask. It leaks around my nose, and I have to reposition it. It's new and I think maybe it was too tight squishing the seals. I know the old one was leaking too at times. As far as the ramp, I had already knocked it down to 5 min last night - silly me left the card out of the machine, so no detail after, but below is the summary. TMI... But the multiple sessions is because I had THAT procedure today where you have to keep getting up the night before. 'Nuf said on that.  eeew 
As far as ramp goes, I can deal with falling back to sleep at pressure since I do sometimes feel the leak on my face, fix it, and didn't make the S9 ramp up again. IOW, mask and pressure don't bother me. 
So, on to the question about changing the min pressure.... Does the cell radio in the machine transmit that, and will it raise some sort of flag? As I mentioned before, it's a "rented" machine and they have to see compliance, so they will be looking - I assume. Does anyone know if they care as long as the machine is used? If I was bringing the card - which by the way, this machine didn't have since Lincare removed it before I got the machine - like I did on occasion when I first got the S9, they didn't seem to pay attention to adjustments. 

AHI   3.20

ResMed
AirSense 10 AutoSet
PAP Mode: APAP
Min 5.0 Max 20.0 (cmH2O)


Date
Start
End
Hours
7/14/2021
23:34:00
06:43:00
05:41:00

Large Leak
0.00%
Clear Airway
1.20
Obstructive
1.00
Unclassified Apnea
0.00
Hypopnea
1.00
RERA
0.00


Statistics
Channel
Min
Med
95%
Max
 
Please Note This day just contains summary data, only limited information is available.


Machine Settings
 
Mode
APAP
Pressure Min
5.00 cmH2O
Pressure Max
20.00 cmH2O
Antibacterial Filter
No
Climate Control
Auto
EPR
Full Time
EPR Level
3 cmH2O
Essentials
Plus
Humidifier Status
On
Humidity Level

Mask
Pillows
Ramp
On
Ramp Pressure
4.00 cmH2O
Ramp Time
5.00 Minutes
Smart Start
On
Temperature
27 ºC
Temperature Enable



Session Information
 
CPAP Sessions
On
Date
Start
End
Duration
ResMed Session #1626320040

7/14/2021
23:34:00
03:00:00
03h 26m 00s
ResMed Session #1626336420

7/15/2021
04:07:00
04:17:00
00h 10m 00s
ResMed Session #1626337500

7/15/2021
04:25:00
04:39:00
00h 14m 00s
ResMed Session #1626339120

7/15/2021
04:52:00
06:43:00
01h 51m 00s
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#6
RE: New AS 10 to replace S9
I can really speak to how a dme or insurance would react. In general the consensus is if you are using it the correct amount of hours they don’t care.

I don’t use insurance its a hassle.
Thank you,
Brent aka Factor

Just a Regular guy.
My untreated AHI was 87.  You can do it hang in there.
"You can if you will"   Jerry Kramer

Got OSCAR?
Organize Charts
Optimizing Therapy

My Story
Post Reply Post Reply


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