Results of my sleep study. . .

[episodic]

Start time 09:56
End Time 16:06

Recording time 370 minutes
Actual sleep time 320 minutes
Sleep efficiency 86.5%

Sleep Stages:
Stage 1 4.1%
Stage 2 65.9%
Stage 3 0%
Stage 4 0%

REM sleep; 30%

Latency to REM Cycle 140.5 minutes
Latency to Sleep Onset 5.5 minutes

Hyponeas 103
Apneas 37
Oxygyn Saturation 92-85%
Electrocardiogram 85

The patient was started at a level of 3CM/H20 and titrated to a level of 12 CM/H20 at which time all snoring and apneic episodes ceased.


The recommended CPAP titration is 12CM/H20


The doctor's prescription says the following:
CPAP AUTO
12 CM/H20
With Humidifier
Face Mask


Since noone else has bothered, I thought someone could translate all of this.

Am I going to have trouble getting an APAP machine with that script? I told him I wanted an auto adjusting, so he wrote auto. I told him I wanted a heated humidifier, and of course all he wrote was humidifier. . .(sigh). . .


I added in bold the stuff I'd love some explanations to . . .



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CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, Titration, CPAP, Prescription, auto, APAP

[episodic]

Is this weird stuff?

I'm just asking cause noone has took one moment and really 'talked' to me about this.

[Snoredog]

Looks like you got some pretty good data.

The 37 apnea per hour puts you in the severe range. Your oxygen desats are not really too bad at 85, should come back up to 95% once you go on cpap. Your quality of sleep should also improve where you get some deep sleep (stages 3&4). Your Stage2 is high because that is where most people land when they bounce from the other stages/REM. For example, an arousal can occur just when you go to enter Stage3 and it bounces you back to Stage2 which is why its percentage is the highest.

Suggest:

1. Getting a hardcopy of your prescription. You can use that script to buy any machine you want, and it never expires (save it you will need it).
2. Make sure the DME gives you the "new" prescribed AUTOPAP (they like to give you the cheapest thing they have in stock, will give you all kinds of excuses of why they cannot give you one, it is all BS) if they give you excuses tell them you will take your business elsewhere.
3. Make sure you get the box, manuals and everything that comes with the machine.
4. Masks: I suggest you let the insurance company pay for the expensive masks, you will most likely at some point need a full face mask (colds, allergies, mouth breathing etc.)., so let them buy those.

[episodic]

Thanks.

Apnea - not breathing

What are hyponeas?

Also, since I had 0% REM 3 or REM 4 does that mean I'm not really sleeping? What is normal REM 3 and REM 4?

I'm faxing over all the stuff to the DME tommorow. I the two REMSTAR autopap pages out here on CPAP.com. I blacked out the prices to be nice, and wrote on top "Which of these 2 machines am I getting?" I'm going for the full face mask right off, cause I think I'll need it.

[linda b]

One thing I noticed on your prescription was it only said 12 cm. If the doctor truly means for you to have an autopap, it should be a range. I also titrated at 12 and my doctor set my range for 7 - 15. This allows me to spend most of the time at the lower pressure with the machine rising as it needs to in order to stop an apnea or hypopnea.

You may also run into a problem with the prescription just saying 'humidifier' rather than 'heated humidifier.' You should try to get the heated one in my opinion.

I can highly recommend the Respironics Remstar Auto with C-flex and heated humidifier. Due to the high humidity where I live, I've only had the humidifier set up to #1, but it really does make a difference. And for a mask, I really like the ComfortLite2 with simple cushion. As it says below my signature, I also use Poligrip Strips to keep my mouth closed. I may try the new Hybrid for my next mask to have on hand in the event of a totally clogged nose due to a cold or something, but other than that I cannot imagine using a full face mask.

Good luck with your therapy. The more educated you are on this subject, the easier it will be for you in dealing with your DME and your doctor. Keep us posted as to how you are doing.

[clyder]

suffice it to say as far as i know there is only heated humidifiers which can be used with or without heat. It is important to note that all CPAP users shold have humidifiers. The reason for this is that with the forced air of a CPAP it is common to dry out the sinuses. The nasal and sinus passageways make up for the lack of humidity with mucus to supply moisture to the sinuses.

Obviously this is not good to cause this reaction due to low humidity. I have no known reason for a sleep specialist to prescribe a CPAP without a humidifier.

These units are low cost compared to the cost of medical complications. The doctor and the insurance companys involved should be aware of this fact. If not spend the money yourself. The best units out there are in the 800 dollar range with the humidifier, our lives are definitely worth the cost.

[episodic]

I finally have some time to go to a DME tommorow. Should I postpone to get a new script for the 'range' and specify heated? If I demand heated, can't they just call the doctor for an ok? Yea, I have no intents on handing over the original script.

Basically, can't I set the 'range' on an APAP myself? Or is this one of those mysterious guru hardcoded things the DME does? Can you guys tell me how to set the range if they don't?

I hope you guys let me know tonight, cause I have to make a decision to go or not first thing in the morning. . .


[quote="linda b"]One thing I noticed on your prescription was it only said 12 cm. If the doctor truly means for you to have an autopap, it should be a range. I also titrated at 12 and my doctor set my range for 7 - 15. This allows me to spend most of the time at the lower pressure with the machine rising as it needs to in order to stop an apnea or hypopnea.

You may also run into a problem with the prescription just saying 'humidifier' rather than 'heated humidifier.' You should try to get the heated one in my opinion.

I can highly recommend the Respironics Remstar Auto with C-flex and heated humidifier. Due to the high humidity where I live, I've only had the humidifier set up to #1, but it really does make a difference. And for a mask, I really like the ComfortLite2 with simple cushion. As it says below my signature, I also use Poligrip Strips to keep my mouth closed. I may try the new Hybrid for my next mask to have on hand in the event of a totally clogged nose due to a cold or something, but other than that I cannot imagine using a full face mask.

Good luck with your therapy. The more educated you are on this subject, the easier it will be for you in dealing with your DME and your doctor. Keep us posted as to how you are doing.

[snoregirl]

clyder

There are indeed passover humidifiers that are not heated. So one must make sure that if one wants a heated humidifier that it is specified.

Episodic,

I agree, most DME's won't give you an autopap without a range specified.

Be careful that you don't take something from a local DME that you really don't want. It may be hard to return and get what you actually want.

Also, make sure that your copay from rent to purchase total is less than buying online yourself.

[episodic]

This was the letter I was going to fax with my script based on what I've learned here:

What do you think, will this peeve them? Or is this a good thing to do?

-----------------------------------------------------------------------------------
Here is a faxed copy of my proof of insurance with *blank*. Also, there is a copy of my sleep study.

I was wanting to know specifically which Remstar machine would be provided?
The Remstar M series (part #DS500S) with the heated humidification for the Remstar M (part #1022257) would be my number one choice. This model is an Automatic CPAP (apap). Is it possible to get this one in particular? I’ve done a lot of research on this, and talked to a lot of other persons with sleep apnea, and this machine is consistently recommended, and their newest APAP model.

If the newest one isn’t possible, I’d be equally as happy with REMstar Auto C-Flex CPAP Machine model number #1017453 with the heated humidifier from respironics model #1005792.

My doctor wrote the prescription for humidification, if it needs to specify heated, I’m sure he will add that on request.

Can you also let me know what full face masks that you can provide? Can I try on more than one mask? Respironics makes a full face mask call the Comfort Full 2. This particular mask also comes highly recommended. I’m not sure what size I will need as of yet, but the Respironic’s numbers on this are below:
ComfortFull 2 Mask
Item Part# HCPCS Code(s)
SMALL MASK WITH HEADGEAR 1004880 A7030 & A7035
MEDIUM MASK WITH HEADGEAR 1004872 A7030 & A7035
LARGE MASK WITH HEADGEAR 1004950 A7030 & A7035


Would it be possible to get this specific mask? The original Comfort Full Model 1 seems to have been as well regarded by some I've spoken with.

I wanted to ensure that your products are all ‘new’. I would also like to have the box and all manuals/literature that comes with the product.

I will call you tomorrow evening regarding my coverage and what you all can do for me.


Thanks for your time on the phone with me:
-----------------------------------------------------------------

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, respironics, humidifier, C-FLEX, CPAP, Prescription, auto, APAP

[episodic]

Could I not say, well just call the doctor for an updated prescription? The doctor specifically wrote cpap AUTO on the script, but unfortuantly indeed only say 12 as a setting. This is getting to be a big pain in the arse . . . I should not have to guide a doctor through this. . .


[quote="snoregirl"]clyder

There are indeed passover humidifiers that are not heated. So one must make sure that if one wants a heated humidifier that it is specified.

Episodic,

I agree, most DME's won't give you an autopap without a range specified.

Be careful that you don't take something from a local DME that you really don't want. It may be hard to return and get what you actually want.

Also, make sure that your copay from rent to purchase total is less than buying online yourself.

[clyder]

Unfortunately the presciption has to be written by a doctor or sleep therapist. Why I have no idea as this is just forced air (similar to riding a motorcycle).

However, I can say most doctors are easy to work with they have your health in mind.

Some insurance companies do not cover the cost of a humidifier so discuss this with your doctor in the AM. What is important is that you get the solution that works best for you. If you order through CPAP.COM the cost for even the best and newest units out there are so low compared to the potential complications that if you let your doctor know that you are willing to spend the money ($800) that you want the humidifier, I can not imagine him (or her) not prescribing one.

[linda b]

If your doctor is easily available by phone, you should be okay. And it also depends on whether you end up with a 'good' DME or one of the many bad ones and there really is now way to know until you see how they deal with you. Your letter should let them know that you are an informed patient. I agree that if they don't seem to want to give you what you want, then leave empty-handed until you can get things squared away with your doctor, maybe even finding another DME.

About those manuals. When the RT delivered my machine inside a sealed box with Respironics on the outside, I thought "Wow, I'm going to be lucky and get ALL the manuals." I even looked really close to see if I could tell whether or not it had been opened and then resealed. It appeared to have been factory sealed. However, the magic manual also known as the Clinician's Manual was not in the box!

However, if it becomes necessary, you can either buy a manual on Ebay for a couple of bucks or perhaps someone on this forum who has the manual can walk you through the steps for setting the apap pressures. But if your doctor comes through for you, this should not be a problem.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, DME, APAP

[Goofproof]

[quote="clyder"]suffice it to say as far as i know there is only heated humidifiers which can be used with or without heat. It is important to note that all CPAP users shold have humidifiers. The reason for this is that with the forced air of a CPAP it is common to dry out the sinuses. The nasal and sinus passageways make up for the lack of humidity with mucus to supply moisture to the sinuses.

Obviously this is not good to cause this reaction due to low humidity. I have no known reason for a sleep specialist to prescribe a CPAP without a humidifier.

These units are low cost compared to the cost of medical complications. The doctor and the insurance companys involved should be aware of this fact. If not spend the money yourself. The best units out there are in the 800 dollar range with the humidifier, our lives are definitely worth the cost.

[rested gal]

Could I not say, well just call the doctor for an updated prescription? The doctor specifically wrote cpap AUTO on the script, but unfortuantly indeed only say 12 as a setting. This is getting to be a big pain in the arse . . . I should not have to guide a doctor through this. . .

Actually, you're lucky your doctor was willing to write "AUTO" on the Rx. A lot of doctors wouldn't be as cooperative about going along with what a patient suggests, especially when it comes to prescribing an autopap.

Yes, I bet just a call to the doctor's office would get another prescription, written out the way (with pressure range) it should be; faxed to you, or waiting at the doctor's office for you to pick up. I'm not a doctor (!) but since your doctor seems to be willing to prescribe what you want, I'd suggest you ask him to re-write the prescription this way:

Auto-titrating cpap - Respironics REMstar Auto with C-Flex and integrated heated humidifier
pressure: 7 - 15 cm H20
c-flex setting: 2
ramp: off
mask - patient's choice
The patient is to be given the therapy setup instructions card/booklet in addition to the User manual.

I definitely would NOT go to the DME to get the machine until you get at least the pressure range specified on the Rx you have now. If the doctor's office offers to send the prescription on over to the DME, I'd decline that. Say, "Thanks, but I'd rather come by to pick the prescription up." Make a copy of the Rx and give the copy to the DME. Keep the original.

A prescription written out like that example would be good for either of the Respironics autopaps - the smaller M or the larger one - and would take the DME off the hook about leaving the set-up instructions with you. Normally the DME is not supposed to let you see those instructions at all. But if the doctor orders it, they should not balk about leaving the "secret" instructions with you.

Good luck getting exactly what you want to use in your treatment! Keep us posted how it goes.

[snoregirl]

Rested Gal's last reply was absolutely perfect!!