setting up Aircurve auto

[RLMMG]

Thank You for sharing as I just bought a pre owned Aircurve 10 Vauto too

[car54]

I saw my doctor and showed him the results that I was getting with the Aircurve in comparison to the Airsense. He said he was going to put in a prescription for the Aircurve. The DME called today and said medicare would only approve the Airsense and if I fail with that I'll have to go back to the doctor and have another sleep study to prove that the Aircurve is the way to go. It sounds like a mess. I know the results that I was getting with the Airsense and maybe I have to fail to move on.

I have used the Aircurve for 24 nights. Instead of posting a bunch of charts here are some averages for the 24 days

CA 0.11 
HY 0.06 
OB 0.02 
medium pressure 11.3
medium respiratory rate 16.3
medium tidal volume 472
95% flow limit 0.02

 Thanks for all of your input!! It a great group of people here.
car54

[Gideon]

What is your pressure support? It needs to be >=4cmw

Question, is that medicare is refusing or your DME saying that medicare will refuse it?

Talk to your doctor and see if he can write a letter of medical necessity for a BiLevel (VAuto).

[Sleeprider]

Just to expand on what Fred is saying, your may not actually need bilevel, but a Resmed Airsense 10 which can provide the same pressure algorithm and pressure support as we have setup. What you have is an intolerance for the Philips CPAP algorithm, but I'm sure your results on Resmed Autoset would be very close to the Vauto. To achieve the same results, a Resmed Airsense 10 Autoset can be set to 8.0 to 16.0 pressure with EPR at 3 full-time. I'm certain the experience would be nearly identical.

[car54]

Bonjour,
 
PS is at 3.

It sounds like the DME was paraphrasing what Medicare was saying because my previous results with my Dreamstation were under 5.0  They said the Doctor would have to prescribe a new sleep study to prove that a bipap is the way to go. My doctor seems rather indifferent about what I say because as he has said my treated apneas are under 5.0 and that's all the insurance company really care about even after  showing him my graphs and results with the Aircurve. 

I guess I'll try the Airsense again. If I get the same results with high and very erratic respiratory rates, low tidal volume and high flow limits it will give me more ammunition and actually get him to be on my side. I am the patient but my numbers are under 5.0, so I'm really only a number.

Sleeprider,
 It was with the Airsense that I was  having the problems with. I believe that I initially set it up with the same pressure and EPR as the Dreamstation. Not sure because it was 2 years ago. I didn't have it for long. I returned it because of false cost  information from the insurance company. I guess I'll find out, maybe I'll be able to dial it in with your help. It's worth a try. 

All I know is that I am getting better results and feeling better with the Aircurve instead of my old Dreamstation. The DME doesn't even offer Dreamstations which is interesting.


car54

[Matt00926]

At the end of the day it's your health we are talking about. You can get a very low hour VAuto online for less than $500 and own it outright. The machine clearly works better for you and you will be using it every night for the rest of your life.

[SarcasticDave94]

car54,

I hear you on the numbers thing. We the patients know (AHI of) 5.0 only isn't enough to tell the whole story. FWIW 5.0 sounds great if you've got a 5.0 Mustang, not so if it's 5.0 apnea.


SarcasticDave94

[Gideon]

To "demonstrate" the effectiveness of the VAuto you need to show that your settings cannot be duplicated on an AutoSet, thus the suggestion for PS=4 as that cannot be duplicated on an autoset. We can do a lot with an AutoSet.

Keep in mind that CPAP Titrations are done without EPR, I presume because EPR is just a comfort feature. So, for the purpose of demonstrating CPAP failure us no "comfort" features, No EPR.

[Sleeprider]

Whatever it takes. The doctor can tell the DME that his opinion is you failed CPAP and have demonstrated efficacy on the Aircurve 10 bilevel. If he writes the script, then the DME must fill it. If insurance denies the equipment, your doctor can help the DME appeal that decision based on his prescription and medical opinion. It is not up to the DME to screen your prescription and tell you it can't be filled, tell them to submit it to insurance and let the chips fall where they may.

There is nothing in the insurance or Medicare regulations that says efficacy is what a sleep study demonstrates, it is a medical opinion of medical necessity. Try working that avenue. Sleep studies are a con game of high costs to get a snapshot of results in a system that is designed to provide you with the lowest cost "effective" machine. The threshold of efficacy is based on AHI so it isn't going to help you...don't do a sleep study. Either self-fund or get the doctor to work on your behalf. The first step may be to change DME providers.

[holden4th]

I'll back up Sleeprider's comments.

I came out of my sleep study with a recommendation for CPAP fixed at 13. My initial machine was a loaner from a DME so I could work out how I was going to respond to PAP therapy before spending money on a machine. By sheer luck I got to try a Resmed S9 autoset and the difference it made convinced me that this was a necessity. When I went to the DME and asked to change the loaner machine to this she pointed out that as it wasn't in the prescription she couldn't do that and she was right.

I then went to my local GP who I've known for along time and explained. He said that as I seemed to know a heck of a lot more about PAP therapy he was happy to write a script for whatever I wanted. I was very specific and got him to put in the S9 autoset. The look on the DMEs face when she saw this script was priceless. She queried it and asked how I'd got the script. I politely pointed out that this immateriel as it was a script from a doctor and it needed to be put into action.

This is what SR is suggesting that you do. If your GP does this then your DME and insurers have no choice but to action it. Best wishes.