(Help pick new DME)Newbie with information overload!

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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tazman
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(Help pick new DME)Newbie with information overload!

Post by tazman » Wed Mar 11, 2015 2:44 am

I would like start by saying what a great community this is I have learned so much already from reading through this site for a couple of days.

I am on the prescription phase of my treatment and want to make sure I don't make a mistake at this point. My first sleep study I had an AHI of 16.6 with a sleep efficiency of 60%. For the titration test I used a N10 nasal mask with 6cmw of pressure using a c-flex of 3. My AHI did go down to .67 but sleep efficiency was 54.4% with a note stating patient shows severe sleep fragmentation as well as decreased sleep efficiency. After reading that I am worried I will not see any benefits from CPAP if my sleep does not improve.

Starting with the DME I called the closest one to me Preferred and from talking to them and what I have read on here I tried a different one a little further away which is Apria. I am told they use the ResMed AirSense 10 but I think after they receive my prescription which is for a CPAP machine they are just going to give me the most basic one. I would be willing to pay some more out of pocket to get something that is going to suit my needs better but I don't know if it is worth it with my low settings but of course my techno side wants a top of the line model. I think I am going to try nasal pillows first either the P10 or Swift FX depending on what they carry.

I guess at this point I am mainly curios if people think my sleep will improve on CPAP once I get used to the machine? (Not that it is going to stop me from trying)

Will a better machine have any benefits for me besides at least getting the Elite for the full data?

I know my insurance is 70% after my deductible which I'm not sure how much I have left on that but if I don't like how things go with Apria I was curious about what the online options are for getting my prescription filled?

I think that is all for now thanks for any input you can give to help me through this phase!
Last edited by tazman on Wed Nov 25, 2015 6:44 pm, edited 1 time in total.

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archangle
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Re: Newbie with information overload!

Post by archangle » Wed Mar 11, 2015 3:35 am

Fragmented sleep, efficiency.

To me, it doesn't sound that unusual to have fragmented sleep, and poor "efficiency" from poor sleep lying in a strange bed, hooked up to strange equipment, with facehugger from the Alien movie blowing air into your nose.

You won't really know if you'll sleep better with CPAP until you try it at home, in your own bed, and have a few nights to get used to it.

An APAP machine is always at least as good as the corresponding manual CPAP because it can be set to work exactly the same as the manual CPAP, if needed. APAP has the ability to "experiment" and find the right pressure. Even if you know "the right" pressure, the APAP machine can be set to allow you to be at a lower pressure for most of the night, but then raise the pressure as you need it. This works for some people, but others do better on manual pressure.

Read the Useful Links in my signature line at the bottom of this post for more info.

We'd be really interested if Apria gives you an A10 AutoSet without any argument if you have a fixed pressure CPAP prescription.

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Sheriff Buford
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Re: Newbie with information overload!

Post by Sheriff Buford » Wed Mar 11, 2015 5:03 am

Do whatever it takes to get the Resmed A10. Can you get a prescription that has Resmed A10 on it? Tell the doctor (or nurse) that you need the comfort of an autoset (you can run an autoset in the cpap mode or the autoset mode... whatever your comfort level is), and you need a machine that provides data. You take charge of your therapy! If you stay on this forum long enough, you will take complete charge of your therapy unless something unusual happens... - health-wise. Start it now. You won't regret it.

Sheriff

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tazman
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Re: Newbie with information overload!

Post by tazman » Wed Mar 11, 2015 7:31 am

Well my sleep at the sleep center did not feel any different to me than the sleep I get at home in my own bed (crappy). My prescription has CPAP on it so I am sure it is going to be difficult to get something different from a DME that is why I asked if anyone knew about the online options. I tried to call the woman I talked to from Apria yesterday but she never got back to me so I will try again today. I guess I need to call my insurance again because they told me the 70% after deductible but I could not get them to go into more detail I don't know if I am not asking the right questions or if they are purposely trying to make it difficult for me. As I have read on here it just seems like everyone is jerking me around.

Thanks for the feedback I am trying to stay positive about the treatment even though I know it is going to be a challenge to get the equipment I want and I might have to go back to the doctor to try and get the prescription changed.

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Re: Newbie with information overload!

Post by robysue » Wed Mar 11, 2015 8:27 am

tazman wrote:Starting with the DME I called the closest one to me Preferred and from talking to them and what I have read on here I tried a different one a little further away which is Apria. I am told they use the ResMed AirSense 10 but I think after they receive my prescription which is for a CPAP machine they are just going to give me the most basic one. I would be willing to pay some more out of pocket to get something that is going to suit my needs better but I don't know if it is worth it with my low settings but of course my techno side wants a top of the line model.
Hold out for a top of the line model instead of the most basic model. Even though your settings are low and your apnea is only in the moderate range.

Why? Well a lot of people have some pretty serious problems adjusting to PAP and you are already worried about the additional sleep fragmentation. With a top of the line model, you'll be able to get the feedback you will crave (due to your techno side) if/when you hit the inevitable snags during CPAP adjustment. When things are going rough, it really can be useful to see that the machine is doing its job of preventing the apneas by looking at the data. While the basic model of the AirSense 10 does record summary AHI data, it doesn't break the AHI data down by type. And more imporatanly, it does not record leak data. And a lot (but not all) of newbie problems are connected to leaks. Without the leak data you'll never know (for sure) that the leaks are under control.

The five acceptable models from the big two manufacturers are:

The Resmed AirSense 10 ELITE
The Resmed AirSense 10 AutoSet
The Resmed AirSense 10 AutoSet for Her

The Philips Respironics System One Series PRO with CFLex+ (model 460)
The Philips Respironics System One Series Auto CPAP with AFlex (model 560)

Since you say that you were titrated " with 6cmw of pressure using a c-flex of 3" we know you were titrated on PR equipment. If you really didn't like the feel of the c-flex, you might want to go with the Resmed equipment. If you liked the feel of the c-flex, then the PR equiment will feel more like what you were titrated on. It's your choice: Both the PR and Resmed machines are top notch.
I guess at this point I am mainly curios if people think my sleep will improve on CPAP once I get used to the machine? (Not that it is going to stop me from trying)
Yes, I think that your sleep will (eventually) improve once you become a long term CPAPer. But you might not feel much improvement for several weeks or even a few months. And your sleep may get worse in the first several weeks while you are working on getting used to the machine. If the sleep fragmentation continues for more than 4-6 weeks after starting PAP OR if you start to feel much worse while using the machine, you will need to be proactive about calling the sleep doc and letting them know you need some serious help in combating the sleep fragmentation issues.
a better machine have any benefits for me besides at least getting the Elite for the full data?
The APAPs provide more flexibility if/when you run into problems. Some people find a tight Auto range more comfortable than straight CPAP. Others find straight CPAP more comfortable. With an Auto, you can try both modes and use the one you like better; with an Elite or a System One Pro, you can only use straight CPAP.
I know my insurance is 70% after my deductible which I'm not sure how much I have left on that but if I don't like how things go with Apria I was curious about what the online options are for getting my prescription filled?
Our host, cpap.com, is a good on-line DME. You could call them and ask how the paperwork for getting reimbursed by insurance company would work.

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tazman
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Re: Newbie with information overload!

Post by tazman » Wed Mar 11, 2015 10:51 am

I talked with my insurance company for 20 minutes who said they really can't say much until the Apria sends something to them. Then I called Apria and got them to tell me the CPAP and APAP are the same codes but they can not give me an APAP unless the prescription states that. I called the doctors office and just got an answering machine so once I can talk to them I am going to see if I can get them to change the prescription based on the sleep study stating about the sleep fragmentation and lower quality of sleep to give me a better chance of success. Also my insurance company could not tell if cpap.com is in my network so I would have to have them contact my insurance to find out.

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spmccord
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Re: Newbie with information overload!

Post by spmccord » Wed Mar 11, 2015 11:54 am

I work for a large blue insurance company, and it's imortant to use a network DME if at all possible because your insurance company has negotiated discounts with the DME that will save you money!

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Re: Newbie with information overload!

Post by palerider » Wed Mar 11, 2015 3:43 pm

spmccord wrote:I work for a large blue insurance company, and it's imortant to use a network DME if at all possible because your insurance company has negotiated discounts with the DME that will save you money!
yeah, huge discounts so they're only 50% more than online places.

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tazman
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Re: Newbie with information overload!

Post by tazman » Wed Mar 11, 2015 5:51 pm

Well I never heard back from the doctor and nobody answered the phone all day so I will try again tomorrow. I did call cpap.com and they will sell me an APAP with a CPAP prescription but I will have to find out what my insurance would reimburse me for an out of network purchase so that is an option if I can not get the prescription changed. This sucks I can see it is going to take forever just to get a machine unless I just settle for whatever. I guess that is what they want for you to just give up.

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Sheriff Buford
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Re: Newbie with information overload!

Post by Sheriff Buford » Wed Mar 11, 2015 6:04 pm

When my doctor doesn't call me back, I go and see them. I'll bet if you are nice, you'll be able to talk them into putting the Resmed A10 on the prescription and walk out happy!

Sheriff

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Re: Newbie with information overload!

Post by sc0ttt » Wed Mar 11, 2015 6:29 pm

palerider wrote:
spmccord wrote:I work for a large blue insurance company, and it's imortant to use a network DME if at all possible because your insurance company has negotiated discounts with the DME that will save you money!
yeah, huge discounts so they're only 50% more than online places.

Not my experience:

Image

I don't think my insurance would cover out of network DME at all.

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tazman
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Re: Newbie with information overload!

Post by tazman » Wed Mar 11, 2015 6:57 pm

Sheriff Buford wrote:When my doctor doesn't call me back, I go and see them. I'll bet if you are nice, you'll be able to talk them into putting the Resmed A10 on the prescription and walk out happy!

Sheriff
Unfortunately it is not my GP that is writing the prescription it is some one from the sleep study whom I never laid eyes on. Maybe I should call my GP and he would write me a prescription because he sent me to the sleep study.

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Re: Newbie with information overload!

Post by bwexler » Wed Mar 11, 2015 9:48 pm

Any MD, Dentist or PA can write the prescription for a PAP machine and supplies.
You want the prescription to be very specific. It should say resmed S10 Autoset for Her with heated tube humidifier and mask of patients choice. You should get the prescription in your hand along with the full sleep study report, not just the summery. You can then provide the prescription to which ever DME you choose and retain the original. If a DME does not perform to your satisfaction, just take your prescription down the street until you find the one you like. Often just the threat of walking will get a positive response from even the worst DME.
If the doctor doesn't return your call go to his office with a pillow and blanket and let the receptionist know you are willing to wait to see the doctor and get your prescription. Then let her know what it needs to say. She may be able to prepare the prescription and interrupt the doctor long enough to get a signature.
Take charge and get what you want.

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Sheriff Buford
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Re: Newbie with information overload!

Post by Sheriff Buford » Thu Mar 12, 2015 8:26 am

tazman wrote:
Sheriff Buford wrote:When my doctor doesn't call me back, I go and see them. I'll bet if you are nice, you'll be able to talk them into putting the Resmed A10 on the prescription and walk out happy!

Sheriff
Unfortunately it is not my GP that is writing the prescription it is some one from the sleep study whom I never laid eyes on. Maybe I should call my GP and he would write me a prescription because he sent me to the sleep study.
Heck yea... call the general practitioner's office. Talk to a nurse. Tell her your problem. Be sure to have your settings, and ask her to write a script. Tell her to put "Resmed Airsense 10 Autoset" on the script along with the settings. Request a separate script for the mask. It should say, "Cpap mask of patient's choice". Go get the prescriptions and hand deliver to the DME. That should speed things up. Be sure to make a copy of the prescriptions.

Sheriff

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tazman
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Re: Newbie with information overload!

Post by tazman » Thu Mar 12, 2015 11:17 am

I tell you these people are making my head hurt so bad! Ok I did get in contact with the sleep study office this morning Apria is going to give me an a resmed a10 with the auto setting but it will be set in cpap mode with the 6cm setting on the prescription. I tried to get this out of the Apria person before but it took the sleep study place calling Apria and me calling Apria afterwards for them to tell me that. So all of this stress has been for nothing. Now I have to wait for the verification to go through the insurance and hopefully when I am off work this coming Monday Tuesday I will be able to get my machine. Should I call the insurance company to try and light a fire under their buts? I did find out also that the doctor from the sleep study does want to see me in his office maybe to talk about the severe sleep fragmentation that was noted on the sleep study so this helps to lift my spirits even more.

Thanks so much for the support I would have been lost without this site and the great board members here who support it!