Missed Compliance by One Day

[lwieland11]

So frustrating. I have been using my BIPAP most every night during the 3 month compliance period required by BCBS. During that time, I have addressed a number of difficulties. This past week. my AHI scores were all under 5. Making great progress. I find out today that I missed compliance by one day. I was at 67% instead of 70%. So, the DME filed for an extension and the extension was granted. I will still be monitored closely until Nov. 1! Just can't believe this. Has this happened to anyone?

[rohdej]

Sounds like you need to watch some tv or read with it on to be awake to either learn to trust the machine or be awake to discover what is wrong and why you are unable to use it.

Compliance is only a number of hours in a day not when you use it or if you are sleeping.

[lwieland11]

I do that.

[TASmart]

Seems like you used it more than 4 hours on 20 out of 30 days? What is happening on the days where you are not getting in at least 4 hours?

[LSAT]

You should be using it 7-8 hours a night 100% of the time...67% sucks. What's your problem? In an earlier post you said you have been using CPAP for years.

[rohdej]

But if you did use it but only 4 hrs a day (not enough for anybody to be successfully treated) you would have passed the compliance.

Something is a miss...

Either there is a machine trust issue. A system performance issue. (poorly fitted mask, bad pressure settings) or a Spousal support issue. Did I miss one?

Any one of the 3 can severely sabotage your treatment.

[D.H.]

I think it has to be 70% of nights and 4 or more hours per night. I don't think you can "borrow" hours from one night to cover the "deficit" in another.

Anyhow, be grateful that they granted you an extension rather than took the machine backs or sent you a large bill!

BTW, the number of hours it the number of hours with the machine running and the mask connected and on your face. They do not distinguish if you are awake or asleep!

They can, however, tell if the machine is blowing but you're not wearing the mask.

[lwieland11]

There were some nights that I simply fell asleep before I got the mask on. I have solved that problem.

[palerider]

Sounds like you need to watch some tv or read with it on to be awake to either learn to trust the machine or be awake to discover what is wrong and why you are unable to use it.

I do that.

so, you failed to adequately cheat the system, and still got by with it... and are complaining...

[gman41]

I think the above response is a bit harsh....this is not for everyone for various reasons....I think the insurance companies either over pay or over charge for these machines and make it way more an ordeal than it should be. I bought my own so it can be used on my terms and what works for me....67 percent is a great attempt at being compliant....no where trying to beat the system

[LSAT]

I think the above response is a bit harsh....this is not for everyone for various reasons....I think the insurance companies either over pay or over charge for these machines and make it way more an ordeal than it should be. I bought my own so it can be used on my terms and what works for me....67 percent is a great attempt at being compliant....no where trying to beat the system

It's not harsh....In his very first post on this board in Dec 2016, he indicated he has been struggling with CPAP for years.....Obviously he did not take it with a positive attitude or he would have gotten better help before this. 4 hours a night for 63 out of 90 days should not be hard to accomplish after years of CPAP treatment.

[chunkyfrog]

Agreed, LSAT.
This is not "easy" for anyone, but most of us are able to take it seriously and put forth the necessary effort.
Many have had way more difficulty that I can even imagine; but still they prevailed. They are examples for the rest of us.

[lwieland11]

Thanks to those who commented in a positive, helpful way. Your comments are most appreciated.

The past couple of weeks, my AHI was way, way down(to 5 from 29), I could finally wear the mask for 4+ hours a night regularly(have never been on such a high pressure and had to get the pressure lowered and the mask refitted), and had cured the problem of falling asleep(from exhaustion)before I got the mask on as well as the nightly aerophagia problem, which was extremely painful. I'm really proud of that. Do I have more work to do? I do. My goal, of course, is to wear it all night and I'll will get there. I'm hoping to continue to receive positive, helpful comments here. For the mean spirited few who are more interested in launching a personal attack, no need to comment. I've learned whose comments aren't worth my time to read and do skip over them.

[Pugsy]

A brief history about OP here for those of you thinking she (not a he) hasn't been really trying all these years.

....she has/had complex sleep apnea...cpap pressures triggered centrals and until recently with this last machine simple wasn't getting anywhere near effective therapy. Plus to make things worse aerophagia prevented using the pressures needed to at least deal with the obstructive side of things. It wasn't until just this year that she finally got someone to listen to what her old cpap machine was telling everyone.
It wasn't until recently that anyone actually listened to the complaints about the aerophagia.
Because of the aerophagia issues she isn't using a regular ASV that will fluctuate the pressures and auto adjust....she has to use fixed pressures and pressures at some sort of compromise between treating the centrals and the obstructives at the same time.
And before anyone goes down the "Let's just limit the ASV road"..I know that could have been tried but for some reason her medical team didn't go there so nothing we can do about it now.
Coulda, shoulda, woulda is kinda like spinning our wheels. I feel it's best to try to fix the now problems instead of dwelling on what should have been done in the past because there's not a damn thing we can do about it anyway.

A lot of things could have or should have been done differently in this OP's situation. Some of the responsibility lays at her feet but a good chunk can be blamed on improper follow up. No one ever bothered to look at the data on the cpap/apap to see that the centrals were there in truck loads.

It's only been very recently that the AHI with the new machine has even come close to being within acceptable limits.
Yes, maybe she should have used the machine more while watching TV to get those hours up.
Yes, she should have not removed the mask in the middle of the night and leave it off because she never woke up.
Yes, she should done a few things differently with the medical team that left her high and dry.
Beating a person up doesn't help...especially when the person is already down to start with.

She knows she made a mistake and is trying to fix it. Why do we have to keep swinging the "you should have tried harder" 2 X 4?

[lwieland11]

Thanks, Pugsy. I'm truly appreciate your support. Compared to where I've been, I'm in a very good place at the moment. The BIPAP is working. The pressure is right. AHI is where it should be now. Just need to find a way to make the mask/hose more comfortable so I can wear it all night. Maybe the P10 is the answer there. I know that increasing my level of exercise will help me sleep better as well. That's not hard to achieve either. So maybe I'm in the home stretch here. Sure hope so.

My doctor said this morning that I should just get at least 4 hours in the next few nights and that I should be fine with compliance. Guess the DME jumped the gun on the extension so they'd eventually get paid. Hopefully, BCBS will go along with what my doctor is saying instead of the DME. As someone said on the other thread, I'd feel so much better(and probably sleep better) using the machine/mask on my terms instead of having my insurance company watching and waiting for me to fail so they don't to pay.