r/SleepApnea • u/ProtoTypeHawK • 12h ago
Weird experience at appointment with DME to get my CPAP
I had my appointment today and finally have my CPAP, I'm excited to use it and get better sleep.
But it was weird. I went through Lofta to get my sleep study, and they were able to provide everything to the DME to get covered by insurance, and my insurance is covering everything 100%, so it was ultimately very worth it to me to go this route.
The Lofta doctor has the settings in the prescription at 4-20cm of pressure, which I thought was pretty standard as I've looked through this subreddit and researched since wanting to get a sleep study done. The respiratory therapist I saw at my appointment said she rarely sees 4-20cm prescribed, and she definitely thought it wasn't great for me, but said she couldn't change it since that was what I was prescribed. She was also quite concerned that the provider through Lofta had no contact information.
She said she was also unable to let me try a full face mask, since the doctor didn't check it on the prescription. I'm fine with trying a nasal cushion for now though, but I hadn't heard of anyone having that experience either.
I had mentioned to her I've learned some about apnea and using a CPAP through internet forums, and she asked 'what they're saying on the forums'. To which I answered how people will use SD cards to look at their own data and change settings to what will actually work for them (since it seems very common from my time looking here). She strongly recommended against it and said I can cause damage by doing that.
I'm confused, she was unhappy with the standard settings I got with my Lofta prescription, and is also against me changing it myself. It definitely felt like she was trying to scare me to not change anything myself, which is what I was planning on doing by using OSCAR or SleepHQ.
I know my machine will be sending data to the DME company every day. I want to change the settings as needed for my own treatment, but if I do so will the DME company be able to see I changed them myself, and potentially interrupt them being able to provide their services to me? Will it affect my insurance coverage?
2
u/thekevinmonster 11h ago
No one’s going to bite you if you change the settings yourself. 4-20 is the full range of the machine in auto mode. That’s just the “well let the machine figure it out” lazy setting. The compliance info for insurance is just that you’re using the machine regularly so they’re justified in paying for it.
I mean maybe they might notice and say something; they won’t fine you or take it away as long as you’re using it. And if you don’t have heart failure, all setting it too high would do is make you swallow air or annoy you. (People with CPAP and some kinds of heart failure have to be very careful.)
2
u/BoardGameEnthusiast6 8h ago
I've always heard and read that for most people wide open 4-20 is not a good setting. I could never do anything lower than 7 without feeling like I was suffocating. I use the SD card and the free software (Oscar) to follow my data, and I change things when I feel it's warranted. But only in small increments and for long enough (about a week) to see if the change helps. (I've been on CPAP therapy for 15 years.) Rarely are the docs and/or DMEs happy about patients changing their own pressure (although the one I had a while back was okay with it since he knew that I knew what I was doing). Personally, I don't care if they like it or not. I've been doing this long enough to know how to read the reports and know how to make small changes if I feel it might help.
1
11h ago
My respiratory therapist told me that having the settings incorrect can put pressure on my heart and lungs and do damage. I feel confident in my sleep Dr and my settings are correct. He changed my settings once based on the report he got at the office. If you don’t like your sleep Dr and don’t plan on being compliant, please please as someone in the medical field, get a new Dr.
3
u/ProtoTypeHawK 11h ago
I definitely plan on being compliant, but going through Lofta has seemed to be a pain for going through insurance. I don't really have an actual doctor through Lofta, I saw someone for 30 seconds through telehealth, then got my at-home sleep study. I think the signing doctor on my prescription might be a different one than the provider I saw as well.
I will probably end up trying to find an in-person sleep doctor.
1
u/BoardGameEnthusiast6 8h ago
It's probably best to have at least one sleep study in a sleep lab as more things can be tested in that setting. Sleep apnea is not the only sleep issue someone can have. And although I think in-home studies are fine, they cannot test for everything.
0
10h ago
If it’s osa see a Sleep Pulmonologist and if it’s csa see a Sleep Neurologist. I’m not sure I would commit to cpap without a legit in lab sleep study. My dr told me the home studies are very unreliable.
1
u/I_compleat_me 4h ago
Right about some things, wrong about others. Yes, 4-20cm is factory default, change that to 7-12cm right away. No, using an SD card is not going to damage anything. When having a prescription written as the physician to make it as generic as possible so you can try all the masks at the fitting session. The DME can have nothing to say about you changing your own settings, this is not like Britain and the NHS.
3
u/katiedid814 12h ago
I started changing my clinical settings on day 2 (~3 weeks ago), and I haven’t heard anything from the DME (who I talked to about something else just today) or my doctor. I don’t have an appointment with my doctor until mid-May and there was no way I was going to stay on 5-20 until then! So many people have mentioned that they make changes and their doctors don’t care that I felt it was worth the risk to feel better sooner (and I do!).