Newbie prescription, mask, provider questions

[bobmc]

First off, I've spent a few hours going through the site, and I want to thank everyone for the very informative posts--Pugsy, robysue, Janknitz, jdm2857(Jeff)--there's just too many to thank individually, so I will thank you all collectively. You all have helped me tremendously already.

I was diagnosed with severe sleep apnea 9 years ago, and received a Resmed S8 Escape (which I believe is commonly referred to as a 'brick' on this site) for my cpap machine. That's the machine I'm still using today. Reading here, I learned that could get another cpap machine through my insurer (Tricare). I called Tricare, and confirmed--score!

I am not currently under the care of a sleep doctor, and will be getting my prescription through my primary care manager. They will be pretty clueless about what the prescription should say, so I'm planning on giving them a script derived from information on this site, and wanted to run the language through you first to see if there were any suggestions. Based on the most excellent advice on thi site, here's what I was intending to ask my PCM to prescribe to avoid getting another 'brick':

1) Resmed Air Sense 10 Autoset CPAP machine with HumidAir Heated Humidifier
2) Min pressure/Max pressure (based on my Dr's settings)
3) EPR setting 3
4) Ramp off
5) Patient access to Efficacy & Usage Data, including: Events per hour, leak rate, and AHI
6) ClimateLineAir Heated Tube
7) Filter
Nasal Mask, Full Face mask, or Nasal Pillows mask of patient's choice

Is there anything that I should add, or do I have something there I should take off?

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I've tried different masks over time, and settled on nasal pillows despite having a very deviated septum. My current mask is an old one (Comfortlite 2). There was a metal band around the nasal pillows that could be manipulated to better position the pillows for my DS. Wishing to stay with nasal pillows, and with my current mask no longer manufactured, is there a nasal pillows mask particularly suitable for someone with a DS? Right now I'd be intending on going with a Swift FX or an AirFit P10, but really can't tell much about them by looking online.

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I also have questions about a DME. As stated previously, my insurer is Tricare, and Optigen works with them. I've seen good comments on Optigen, but they are a subsidiary of Lincare, which does not seem to be highly regarded. Any recommendations for/against Optigen? The other main ones in my area also appear to be widely reviled here (Lincare, Apria, American Home Patient, etc).

Thank you in advance for any advice you may have.

[Julie]

Hi - great idea you have, but you've made it more complicated than necessary. Your MD does not have to put the numbers (pressure or EPR) on the script, nor the ramp setting (we can help you with all settings, etc.) though if he does, you'll still be free to make your own changes as the rest of us do. And the spec. re data - as long as it reads 'full efficacy data' it should be fine - specifying the 3 you mentioned is not needed - it could be asking for other info to be withheld if they're really anal, and there's so much more you'll want access to. Plus "mask of patient's choice" is completely adequate. So good luck and let us know when you have your machine and we can go through everything with you.

[bobmc]

Thank you, Julie!

Based on your suggestions, I think I would have:

1] ResMed AirSense™ 10 AutoSet CPAP Machine with HumidAir™ Heated Humidifier
2] Patient access to Efficacy and Usage Data
3] ClimateLineAir™ Heated Tube
4] Filter
5] Mask of patient's choice

Greatly appreciate the advice!

[OkyDoky]

You need to avoid the Airsense 10 CPAP because it has very little data. The Airsense 10 Autoset is the APAP machine which can also be run in CPAP mode and Airsense 10 Elite is the straight cpap machine. Both of those are data capable. The Autoset for her also has an additional algorithm that can be useful for both male and female.
Here is a site with machine info. https://sleep.tnet.com/equipment/cpapmachines/resmed

[robysue]

Thank you, Julie!

Based on your suggestions, I think I would have:

1] ResMed AirSense™ 10 AutoSet CPAP Machine with HumidAir™ Heated Humidifier
2] Patient access to Efficacy and Usage Data
3] ClimateLineAir™ Heated Tube
4] Filter
5] Mask of patient's choice

Greatly appreciate the advice!

Add: Dispense as written.

That should prevent the DME from "substituting" an AirSense 10 CPAP for the AutoSet that you want.

[archangle]

Thank you, Julie!

Based on your suggestions, I think I would have:

1] ResMed AirSense™ 10 AutoSet CPAP Machine with HumidAir™ Heated Humidifier
2] Patient access to Efficacy and Usage Data
3] ClimateLineAir™ Heated Tube
4] Filter
5] Mask of patient's choice

Greatly appreciate the advice!

You absolutely DO need to specify pressure for bureaucracy/insurance/dummy DME reasons. Be sure to specify a pressure range to justify the APAP. You could specify a pressure of 4-20 just to have a pressure setting specified to keep everyone happy. Or specify what's on your Escape +2 and -2 cmH2O. For instance, if your current pressure is 8, specify "auto pressure 8-12 cmH2O."

You can change the pressure yourself later if you need to. Or any other settings you want to change on the machine.

Don't worry about patient access to efficiency and usage. You can easily fix this yourself on a ResMed AutoSet or PRS1 Auto if they don't set it up that way.

They'll provide a filter without asking.

The AirSense 10 AutoSet for Her is slightly better than A10 AutoSet, so accept that if offered. I'm not sure I'd go to a lot of trouble fighting for it, though.

[archangle]

That should prevent the DME from "substituting" an AirSense 10 CPAP for the AutoSet that you want.

Yet another reason to specify a pressure RANGE on the prescription. The A10 CPAP can't do a range, so dispensing an A10 CPAP or other manual CPAP would be illegal. It gets around any "dispense as written" questions with insurance, too.

[bobmc]

Adding back in the pressure settings, and Dispense as written leaves:

----------
1] ResMed AirSense™ 10 AutoSet CPAP Machine with HumidAir™ Heated Humidifier
2a] Minimum pressure 7 cm H2O 2b] Maximum pressure 15 cm H2O
3] Patient access to Efficacy & Usage Data
4] ClimateLineAir™ Heated Tube
5] Filter
6] Mask of patient's choice.

Dispense as written
----------

[bobmc]

Add: Dispense as written.

That should prevent the DME from "substituting" an AirSense 10 CPAP for the AutoSet that you want.

Thank you! Done!

[bobmc]

You absolutely DO need to specify pressure for bureaucracy/insurance/dummy DME reasons. Be sure to specify a pressure range to justify the APAP. You could specify a pressure of 4-20 just to have a pressure setting specified to keep everyone happy. Or specify what's on your Escape +2 and -2 cmH2O. For instance, if your current pressure is 8, specify "auto pressure 8-12 cmH2O."

You can change the pressure yourself later if you need to. Or any other settings you want to change on the machine.

Don't worry about patient access to efficiency and usage. You can easily fix this yourself on a ResMed AutoSet or PRS1 Auto if they don't set it up that way.

They'll provide a filter without asking.

The AirSense 10 AutoSet for Her is slightly better than A10 AutoSet, so accept that if offered. I'm not sure I'd go to a lot of trouble fighting for it, though.

Thank you, archangle! I have put the pressure range back in.

The AutoSet for Her is better than the Autoset???

[bobmc]

You need to avoid the Airsense 10 CPAP because it has very little data. The Airsense 10 Autoset is the APAP machine which can also be run in CPAP mode and Airsense 10 Elite is the straight cpap machine. Both of those are data capable. The Autoset for her also has an additional algorithm that can be useful for both male and female.
Here is a site with machine info. https://sleep.tnet.com/equipment/cpapmachines/resmed

Thank you, OkyDoky--I will try and avoid the straight up Airsense 10 CPAP.

And I see that the Autoset for her has an additional algorithm. That makes sense. Thank you!

[palerider]

Adding back in the pressure settings, and Dispense as written leaves:

----------
1] ResMed AirSense™ 10 AutoSet CPAP Machine with HumidAir™ Heated Humidifier

----------

leave off CPAP because, as others have said, they have a CPAP model, that's crap.

[bobmc]

Adding back in the pressure settings, and Dispense as written leaves:

----------
1] ResMed AirSense™ 10 AutoSet CPAP Machine with HumidAir™ Heated Humidifier

----------

leave off CPAP because, as others have said, they have a CPAP model, that's crap.

Thanks, PR!

1] ResMed AirSense™ 10 AutoSet with HumidAir™ Heated Humidifier
2a] Minimum pressure 7 cm H2O 2b] Maximum pressure 15 cm H2O
3] Patient access to Efficacy & Usage Data
4] ClimateLineAir™ Heated Tube
5] Filter
6] Mask of patient's choice.
Dispense as written box checked

[palerider]

Adding back in the pressure settings, and Dispense as written leaves:

----------
1] ResMed AirSense™ 10 AutoSet CPAP Machine with HumidAir™ Heated Humidifier

----------

leave off CPAP because, as others have said, they have a CPAP model, that's crap.

Thanks, PR!

1] ResMed AirSense™ 10 AutoSet with HumidAir™ Heated Humidifier
2a] Minimum pressure 7 cm H2O 2b] Maximum pressure 15 cm H2O
3] Patient access to Efficacy & Usage Data
4] ClimateLineAir™ Heated Tube
5] Filter
6] Mask of patient's choice.
Dispense as written box checked

I know some may say it's not necessary with 'autoset' in there, but why give 'em wiggle room

[Pugsy]

Here's the deal on the slight difference between the AirSense 10 AutoSet and the AirSense 10 AutoSet for Her machines.
They both have regular cpap mode and regular apap mode available but the for Her model has an additional special apap mode available that has a different algorithm...which they (ResMed) has marketed towards women as being especially helpful for women but in reality that algorithm could potentially benefit men also.
Plus that special algorithm will flag RERAs (Respiratory Event Related Arousals) and the other regular modes don't.
Now how critical is it to know about RERAs? I don't know that it is something that is urgent but I have always been of the opinion that it's better to have something and not need it than need it and not have it....and that goes with these machines too.

So is the "for Her" model "better"...it might be for some people and we never know who those people might be so I say get it if you can just in case you might be one of those people.

If you haven't seen the provider manual for the AirSense I suggest that you download it and read it as it explains in a little more detail what each model does.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

Now since the for Her model is being target to women...ResMed in its infinite wisdom elected to add flowers to it.
So it is white with some flowers on it...and the other AirSense machines are black.
Now the male species may not be too keen on having a machine with flowers on it...and that's up to them but I don't know about you all but I don't/can't see flowers at night with the lights off and if my husband had OSA and was going to need the apap machine...he would be getting the flowers whether he liked it or not. I don't know that he would even need that other algorithm but he might and that "might" would be good enough reason for me (otherwise known as "she who must be obeyed") to put my foot down.

It's supposed to have a "gentler" response designed for women but there's no reason to think that there might not be some men who could maybe benefit from it.

The flowers are small so not horribly annoying.
https://www.cpap.com/productpage/resmed ... idair.html