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Very High Leak Rate
#11
Okay, you'll have to let me know if this worked for the data:
http://imgur.com/jBmU08K

I've read the mask primer - tried to follow all the steps last night; with the size guide - i really do hit right in between the Small and Medium.
I tried to keep it looser, but ended up tightening it down to get the noise to stop.
its worse with the small mask, it feels like its being blown off.
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#12
Sleeprider thanks for the links; I doubt if my provider even has the newest machines; they don't have the newer headgear that was used on me during the sleep study.
Do you think my machine was supposed to be set on ST instead of S?
I need to get a copy of my prescription - but my equipment provider didn't have that yet when I got the machine.
I can't imagine I am having no apnea events though; Don't you think the machine is inaccurate in that because of the high leak rate?
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#13
I think you were mistakenly issued a ST and could have been issued a S or an Auto. Do you have a co-pay or deductible? If so, I would seriously get that prescription and take this machine back if it is an error. It is at least 3X more expensive than you need.

I have SERIOUS doubts your clinic properly determined your pressure. Let's look at this latest chart you posted below. You are using ramp, and while resolution is not great, I can see your leaks begin at a pressure of about 14/10. I can also see enough of your breathing waveform to know you have no events at those pressures. I can also see that as the machine crosses 17/13 you have a sleep disruption due to leaks and pressure.

I would love to try an experiment with lower pressure if you are willing. You can always go back to higher pressure, but let's see what happens at 14/10 or 15/11. At worst you will have some apnea, but you might get some sleep.

[Image: jBmU08K.png]
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#14
So I just realized its showing a very small portion of the night. Bear with me, I'm trying to learn alot of new stuff at once!!
here is a screenshot of the whole night, and I show the respirations too.
Does that change your thoughts at all? Thanks I really appreciate your insight!
http://imgur.com/9DDyzqS

its set for a ramp of 45 minutes.
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#15
Not at all. Your entire night is spent being awake or in ramp. As soon as the machine reaches pressure you remove the mask and start over. You can't sleep like that. What do you think? Want to try lower pressure?
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#16
So just for comparison - this screenshot is from the 3rd night I was on the machine. The only break during the night was when I got up for the bathroom.
I'm just not sure why the first 3 nights went well; although I did come down with an acute upper respiratory infection with extreme wheezing and coughing;
I thought as I got over that things would straighten out and go back to the first few days.
http://imgur.com/N60iPHs

I am going to call the equipment provider this afternoon and see if she has the prescription yet and ask her some questions.
I know I have to take the sd card in to show compliance to insurance sometime; will that mess up insurance if i mess with the settings?
It makes sense to me though that the settings could be lower.
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#17
Thanks for the additional data point. In the 2/24 chart, there are some hypopnea, and several unidentified apnea. Leaks are still high. Nothing there would contradict a lower pressure, but might point to some benefit in higher pressure support for the hypopnea. I wonder if during your clinical study, your sleep was typical. Did you have your pillows and neck support? It can make a lot of difference.

Settings will not affect compliance. Compliance is based on machine use for at least 4 hours for at least 21 days out of any 30 day period in the first 90 days. Once compliance is demonstrated it doesn't need to be done again under Medicare and most other insurance. You also have to have a follow-up with your doctor that discusses your treatment and establishes you are benefiting from the therapy.

It will be interesting to see the prescription, and you didn't respond to the question of whether you have co-pays in this. Again I only ask because you were dispensed a much more expensive machine than necessary, and you are not using the features of that machine and never will. You don't need timed backup breaths because you don't have central apnea or other conditions that a ST machine is used for.
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#18
We live in a small town; I went to a different town for the sleep study; a doctor comes from the "big city" to read the sleep studies and then sends the info to the family doctor; I was never told anything about seeing a doctor after a period of time. ANd the only one to discuss this with me was the equipment provider.
So I'm not even sure who to talk to so I'm starting with the equipment provider!!
I took my own pillow to the sleep study, I think it was pretty typical of my sleep routine. I felt like I wasn't falling asleep, but the tech said I was asleep, but my brain kept trying to wake me up by moving legs, or arms so make me breathe.
I have a deductible (already met) then pay 20% until my stop loss. The equipment provider said that insurance will rent the machine on a monthly basis until its paid for. So I didn't think about the possibility of what I will be charged.
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#19
If you are paying 20% of $5000 instead of 20% of 2000, you should be concerned. Get the prescription, and we'll be glad to help get this straight. The DME world is very opaque, and it's not unreasonable for you to ask what rate they are billing this machine at. Here is what it looks like in insurance terms. The numbers are HCPCS codes and are used for billing.

You are being billed for this
E0471 Respiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with noninvaRespiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

This is the machine you needed;
E0470 Respiratory assist device, bi-level pressure (BiPAP) capability, WITHOUT backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

The difference is a bunch of money you don't need to spend. Get the prescription. I'm sure we're going to save you some money and get a machine more suited to your needs and comfort.
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#20
Well, I got a call back; in checking her notes, I was supposed to get an "S" but all she had was the "ST"; she is out again and will order more in and swap this one out for an "S" once she has some in.
I will try the neck brace tonight and see what that does to the readings.
Then I will consider changing the pressure settings.
Thanks for all your advice and suggestions. I wouldn't know I had the wrong machine and never questioned it if you wouldn't have told me the difference. Now I will save on that difference!
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