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+--- Thread: What do I have to do to get APAP with oxygen? (/Thread-What-do-I-have-to-do-to-get-APAP-with-oxygen)
What do I have to do to get APAP with oxygen? - Irishrow - 12-19-2022
I'm tired this morning. I've been using APAP with a RESMED AirSense 10 Autoset "successfully" for three years, and using OSCAR to document it every day. When I do a 'complete' study of my sleep, which includes pulse oximeter recording, I consistently see lots of <88% conditions. In fact, my latest overnight Basil SPO2 is 86.1% and the low is 73%. During a ten hour sleep period I was under 88% for 411 minutes, or 68% of the time.
I thought this would mean that I need supplemental oxygen added to my therapy. My doctor looked at the report and agreed. The DME said I don't have any condition for which they can authorize insurance to get an oxygen concentrator. The prescription has gone unfilled for two years and I'm trying to get it approved now. I'm seeing "RERA" flags in my OSCAR reports.
My APAP increases pressure until leaks wake me up, or worse, I wake up with my heart rate having gone up from 50-80 bpm. What do I have to do to get the DME to approve oxygen? They keep saying, "but you don't have COPD or some other ailment." Both me and my doctor say, "Yeah, but I have hypoxia!" What am I missing here?
RE: What do I have to do to get APAP with oxygen? - staceyburke - 12-19-2022
You may have other problems instead of the need to increase o2. I would suggest you put up OSCAR charts. You my be having positional apnea or other problems.
If you really need added oxygen a prescription from the Dr.is about all that is needed.
RE: What do I have to do to get APAP with oxygen? - OpalRose - 12-19-2022
DME's have more authority than doctors these days. I would think that your doctor could send you home with an overnight oxygen meter and submit those results to your DME and/or insurance.
The prescription from your Doctor probably needs to include Documentation (meaning testing) proving your need for supplemental oxygen.
RE: What do I have to do to get APAP with oxygen? - Sleeprider - 12-19-2022
Any approved sleep study could verify the degree and duration of oxygen desaturation to qualify for supplemental oxygen. It would really help if you will download the free OSCAR program and provide us some data from your Resmed Airsense 10 Autoset so we could perhaps identify if there are issues contributing to your low SpO2. You can use an oxygen bleed with your Autoset. http://www.apneaboard.com/wiki/index.php/Oxygen_Bleed_with_CPAP Your location at a relatively high elevation can also contribute to this issue. Please consider posting a Daily Details chart. Instructions are here. http://www.apneaboard.com/wiki/index.php?title=OSCAR_Chart_Organization
RE: What do I have to do to get APAP with oxygen? - Gideon - 12-19-2022
I ran across the Medicare requirements.
Read this thread http://www.apneaboard.com/forums/Thread-Treatment-FYI-Home-Oxygen-Therapy-Medicare-Coverage-Checklist?pid=457422#pid457422
RE: What do I have to do to get APAP with oxygen? - Irishrow - 12-19-2022
[attachment=46489][attachment=46490][attachment=46491]
Thanks to each of you for your interest and assistance. I have attached screenshots for this night's Oscar report. I do have a pulse oximeter (CONTEC CMS50DA+) I've been using for some time and my PHP sees the results. The DME just simply isn't interested in anything that doesn't identify some kind of pulmonary disease. The insurer is a major company and, even though I'm over 65, I'm on a private plan -- my wife works in a hospital. My PHP wrote a prescription for nocturnal oxygen therapy at 2 L. We're now trying to submit a "letter of medical necessity" and other documentation. The first resistance I'm getting is that the oximetry is done at home, and they are vaguely hinting at needing "lab reports." Medicare even accepts home studies, and my original CPAP sleep study was a home study.
RE: What do I have to do to get APAP with oxygen? - Gideon - 12-19-2022
Two things possibly
On principle increase min pressure to 7. That allows full use of EPR which is happening post ramp and for all but a very small part of the night. Higher values of EPR do help with oxygenation.
You don't need the ramp so turn it off. Again not a big deal.
I would set you min pressure at 10 cmw, which is your median to see if that improves your oxygenation. Big jump yes, but at least 1 night please.
Finally, P10 pillow size. We often se users with smaller pillows complaining of being short of air. If you are not using the large pillows try them and tell us what you did.
I don't think any of this will totally solve your issue as I do believe you need supplemental oxygen. Just trying every trick I can think of to minimize your DeSats.
RE: What do I have to do to get APAP with oxygen? - Irishrow - 12-19-2022
[attachment=46492]
Gideon, thank you. I have ramp off, minimum pressure at 6. The original sleep study that was done before I was authorized to get CPAP therapy is attached here. Without any mask or settings, you can see the abysmal AHI rating...that IMPROVED DRAMATICALLY when I got therapy. But note that the average saturation rate even then was 85 (about where it is now) and the lowest recorded percentage was 63%. Hilariously, that was so low it didn't even fit on the graph. I started worrying about my oxygen saturation when I found that, on nights when I even had ZERO AHI, the pressure would be high enough during the night to wake me up.
I had expected the oxygenation to improve automatically with CPAP. That has not been the case. It does get much better when I take my therapy to sea level--from 5,000 feet--but that's just a few days a year.
I'm hoping someone here can give me guidance I can share with my PHP this week as we resubmit the prescription and documentation. Thank you, again, for your insight and assistance.
RE: What do I have to do to get APAP with oxygen? - Sleeprider - 12-19-2022
That study may be sufficient to demonstrate the medical need for supplemental oxygen. I strongly suggest changing DMEs. Their job is to submit a claim for the prescribed equipment and dispense the equipment on approval, not to tell you that there is not enough information. If more documentation is needed they can communicate that need to your doctor with specific testing requirements as required by your insurer. You may do better to ask your insurer directly what is needed to file a claim.
Gideon is suggesting a higher minimum pressure of 10.0 which will produce a pressure of 10.0/7.0 (inhale / exhale) with EPR 3. This is important because oxygentation often responds to increased "PEEP" (positive end expiratory pressure". If you are skeptical do a search for "PEEP oxygenation" and you will see this principle is used in setting up hospital ventilators. In this case, the minimum PEEP will be 7.0 cm instead of 4.0 cm. This can make a difference. Give it a try and judge for yourself if SpO2 responds positively, or if there are any problems with tolerance. It will make your pressure much more stable through the night and may be less disruptive to sleep.
RE: What do I have to do to get APAP with oxygen? - Irishrow - 12-19-2022
Sleeprider,
Thank you. Both you and Gideon have now tag-teamed me into agreement. Tonight I will increase the pressure to 10 and EPR 3, and run oximetry for the night, too. Let's see how that works. Because I just found out that my DME won't sell me a concentrator--only rent--and is demanding that I do a full in lab titration study which means it can't be done until my deductible resets for the new year. I also just learned that they had me listed as being on Medicare, instead of the private PPO plan that I'm actually on.
You stated " I strongly suggest changing DMEs." I couldn't agree more. Thank you, again, for your kind and supportive reply.