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Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
I am more and more convinced that there is something wrong with your machine. You need to convince DME your machine is broken and for them to give you a replacement or loaner, messing with things like mouth tape etc isn't going to help until machine is working properly.

This last night the machine either turned off or stopped recording around 18 times (see all the gaps in your data). Since smartstart is turned off there is no reason for that unless you were sitting there playing around turning it off and on.

The flat topped graphs of flow limitation are also not normal.

I think this machine was half pooched right out of the box a year ago and has continued to fail since then.
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RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
(01-24-2022, 10:34 PM)Geer1 Wrote: I am more and more convinced that there is something wrong with your machine. You need to convince DME your machine is broken and for them to give you a replacement or loaner, messing with things like mouth tape etc isn't going to help until machine is working properly.

This last night the machine either turned off or stopped recording around 18 times (see all the gaps in your data). Since smartstart is turned off there is no reason for that unless you were sitting there playing around turning it off and on.

The flat topped graphs of flow limitation are also not normal.

I think this machine was half pooched right out of the box a year ago and has continued to fail since then.
Okay, how do,I convince the DME? Are they smart enough to understand the graphs?
That’s my big convincer. If they ask where I got the graphs, a little prevarication may 
be in order. I’ll say they came from my sleep doc. Won’t have to mention the Apnea
forums.

What say you?

Thanks, Geer1.

Harv
Thanks to everyone who helps us get a better night's sleep.

Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor.
An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies.
Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.

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RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
IMHO show the data from OSCAR, if they doubt it, have a COPY of your SD card (and a list of dates for the initial look) ask them to look at the detailed data with ResScan or AirView and verify the charts, (It IS the same data).
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RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
Yeah take your SD card in with you. The simplest argument is to say your machine keeps shutting off (show them an image of the gaps in data).

Can also let them know that the data all appears to be affected/wrong either by poor machine operation or data recording. Minute ventilation and tidal volume are too low. Flow limitation graph shows flat lines of data. Leaks were slightly present at first but not present now and even if blasting air fully out of hose the machine barely records a leak.

All of this would seem to indicate a failure of the pressure sensor I believe. If so I believe it would be affecting both your therapy and the data being recorded. Don't take no for an answer, if someone doesn't believe you talk to someone else or ask for a manager.
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RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
First step for any DME is to run a simple pressure calibration check. That will show if the machine pressure is correct or not. Most DMEs have this basic manometer to check pressure.
Sleeprider
Apnea Board Moderator
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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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RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
Thanks, guys, for the analysis, strategy and 
suggestions. Will use them.

I have a 5PM virtual appt. with the PA today.
If the machine is bad, she can save face about
her pressure changes not fixing anything. So
she may be willing to cooperate.

Getting the the date I got the machine, to see
if it’s under warranty. 

Harv
Thanks to everyone who helps us get a better night's sleep.

Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor.
An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies.
Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.

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RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
.I had a phone visit with the PA. It went surprisingly well.
She brought up all the things I was going to suggest, after
I said that “conversations with some very knowledgeable
CPAP users” had settled on a broken machine. She brought
up the pressure sensor. She noted that the machine was a
year old, and ResMed might cover what’s needed under 
warranty. 

I’m to bring the machine to their office (no big deal) after
she contacts a tech to look it over. I get a loaner. We talk
again after six weeks on the loaner, which should show 
the truth about the bad pressure sensor or whatever else
the tech finds. My fond hope is that they give me an A11.

She commented that Jan. 7 through 15 was “good” and 
those pressure settings should be used. I’ll take a look,
to see what “good” means, and use her pressure to keep
her happy.

Thanks again,

Harv
Thanks to everyone who helps us get a better night's sleep.

Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor.
An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies.
Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.

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RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
That period of time, your CPAP was set to 8-15 pressure with EPR 2. You experienced higher central apnea as soon as you increased EPR to 3, and there was some evidence of periodic breathing with EPR 2. We started to see strange flow rates with low inspiratory tidal volume and no expiration near the end of this time. The possibility of a machine malfunction remains an open question, but you generally had less than 1-AHI through the period cited by your PA. This image shows the periodic breathing, but you had several much better days.

[Image: attachment.php?aid=38962]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
Sleeprider as an fyi ventilation numbers dropped slowly and consistently over the first 4-5 months with this machine. Leak rate dropped similarly but off the page quickly. Data I have was from only the first few months (uploading issue) so not sure how it compares but here is the over view fyi. 

I have never been so sure that a machine is not operating properly. I am glad to hear they have arranged a loaner. It will be interesting to see what the results look like on the new machine. Will also be curious if it feels different to you (indicating not only the reporting but also operation of this machine was effected).


Attached Files Thumbnail(s)
   
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RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
Even the image I posted shows a shocking tidal volume of only 160 mL a minute vent of 2.88. Those are not survivable numbers for even a small juvenile male. I agree, something is drastically wrong here. I have never seen such low respiratory flow, even with small females. Your images show a continuous downward trend. It's pretty shocking.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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