Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?

[midwestguy]

As it happens, my old DME had some samples around.I have a ResMed P30i and an F30i.
Also have a new cervical collar.

Will try the experiment with the blower and report results.

Which mask should I try first? 

We’ll check cathyf’s comment on how collars and FFMs don’t play well together.

Thanks!

Best,

Harv

[Geer1]

F30i, if anything is going to help you at this point it is a full face mask. If my interpretation of some of these "apnea" being your palate opening and closing while you mouth breath then the collar and a nasal mask won't help it.

Collars just make the lower straps a bit of a pain depending on model of collar and mask. I recently spent 9 weeks in a hard cervical collar (recovering from neck fracture) and was able to use my FFM (Resmed F20) with no issues.

[midwestguy]

Sounds good. F30i it is.

Thanks.

[midwestguy]

midwestguySounds good. F30i it is.

Thanks.

Well, no it isn't. The freebie mask from DME is the wrong size. 

Harv

[midwestguy]

Will try the experiment with the blower and report results.


Here's the graph set for the machine test.
thumb on time: 2 min.
thumb off time: 3 min.

Interesting that SH reported a session of about a minute.

[midwestguy]

Imo you should try increasing max pressure to 20 cm which will allow machine to run higher and let us see if that is helping. I would also consider increasing min pressure to 12 cm.

Will try this tonight with current mask.

Thanks!

Harv

[Geer1]

Not sure why your data only shows one minute of data. I did one myself for around 4-5 minutes and my machine recorded 4 minutes of data.

Your flow rate chart looks similar but your leak rate at 20 is low, it should have been noticeably higher than that and cause a large leak. As you can see my leak rate was around 120. The change in flow rate and leak rate on my data part way was me messing around with thumb blocking air.

   

I am starting to question that your machine is operating/recording data properly. If you have only had it for 1 year as the data appears to suggest I assume it should still be under warranty and I would approach your DME about it. You can mention that you do not believe it is operating correctly and that the data being recorded does not appear correct as your minute ventilation and tidal volume are too low and it does not appear to report leaks properly. If they seem hesitant ask to trial a different machine so you can collect some data with it and see if the data matches your current machine.

[Geer1]

Just looked back at your original data again. This is the 2nd night of data on the machine (of the data you sent me). This is something that looked a bit odd to me and the reason I asked you to do this test. That night you had numerous obvious mouth leaks but they were all low in amplitude compared to what I would expect (I would expect some to be large leaks).

   

Then this was just over a week later and amplitude had continued to drop even further.

   

Like I mentioned before you either learned to mouth breath without leaks (would be the first person I have seen to do so that successfully) or your machine isn't working right. I am leaning to the latter option now.

[midwestguy]

I’ve tried replying to you three times now, and just as I’m finishing, the post gets lost somehow. It’s getting frustrating.

Here’s the situation:

My PCP won’t touch OSA/CPAP, even for admin. stuff. Says it’s not in his skill set.
He has referred me to a sleep doc at the hospital. I need him to receive the records from the old sleep PA, who I want to fire. The sleep doc is the conduit to Medicare and my DME, who’ll also change. The previous one was great until they were bought by a total jerk DME company. If the sleep doc I’m referred to doesn’t seem cooperative, I’ll find another.

If my CPAP machine is broken, Medicare should pay to repair or replace it. I also need a full-face mask, also paid for by Medicare, I hope. In both cases, the sleep doc starts the ball rolling.

So, changes everywhere. Maybe enough analysis?

Thanks for your help, Geer1.

Harv

[midwestguy]

Not sure why I’m posting last night’s graph set.

Conditions: Pressure min. 12, max. 20
Usual mask, 3M Futuro collar.

Will tape mouth tonight, other conditions as last night,
unless someone has an insight.

-- Harv