Hey look! It's the new guy!

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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ISnoreBadly
Posts: 19
Joined: Sun Jun 21, 2015 7:07 pm
Location: Lawn Guyland, Noo Yawk

Re: Hey look! It's the new guy!

Post by ISnoreBadly » Thu Jul 02, 2015 12:24 pm

poppi2 wrote:Get the 560. I have my 550 set to a single pressure (min=max). Don't rely on your doctor requesting the APAP.
Get your insurance info from your insurance company, not the DME.
You need to run the numbers. Eleven months times your copay. Don't forget that your yearly deductible gets reset in January. It might be more cost effective to buy from our sponsor, or used market.
They told me that my insurance pays 90% so the monthly co-insurance would only be around $4. I've already met my deductible and out of pocket maximum for the year, when I spoke to my insurance company a few weeks ago they told me that I shouldn't have to pay anything for the rest of the year.

I have an appointment to get the machine tomorrow (at the DME, not at home) and I'm going to push for the 560 instead of the 460. If they won't budge then I may walk out, which would be sad because I'm really looking forward to getting a good night's sleep for once.

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Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: SleepyHead software

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ISnoreBadly
Posts: 19
Joined: Sun Jun 21, 2015 7:07 pm
Location: Lawn Guyland, Noo Yawk

Re: Hey look! It's the new guy!

Post by ISnoreBadly » Fri Jul 03, 2015 5:46 pm

I got my equipment today. I wound up with the 460. I had asked for the 560 ahread of time but was told that I wouldn't be taking advantage of the capabilities since it would be set for a single pressure. The tech said that the pressure requirement sometimes changes during the night, or from day to day. I thought that was my in to get the 560 but was told that it wouldn't be configured as an APAP only not a CPAP since that's how my prescription was written. I pushed for it anyway, but they stood firm. I said I was going to have to think about it and got up to leave, they asked if talking to my doctor would help me make up my mind so they got him on the rap rod. He pretty much told me the same thing, but did say that once they review my data if it turns out that I would benefit from an APAP instead they would be able to swap the 460 for the 560. The next call was to my insurance to verify, they said yes, since it was being rented initially they would allow that if the doctor prescribed it. So I'm OK with that.

The tech I was working with seemed to be knowledgeable and was very helpful, he listened to all of my questions and had answers for all of them. During the titration the only thing they had offered me was the nasal pillow, today the tech told me that a nasal mask would probably be better with the pressure I'm using (12). I tried on the mask and it felt more comfortable than the pillows so I'm going to give that a shot. And since I've got a large schnozz they had to swap the medium size they had already pulled for an XL. If I'm not happy with the mask they said I could change to the pillows instead.

I left with the 460 fitted with a wireless modem, the humidifier, a Wisp mask (I think), a chinstrap to keep my mouth closed, a couple of of spare filters, a carrying case for everything and a bunch of manuals. I tried it all out when I got home and holy crap that 12 setting makes it tough to breath right off the bat, I'm gonna have to use the ramping function I guess.

I can't wait to go to bed tonight, I'm hoping to finally get a decent night's sleep and wake up feeling decent tomorrow.

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Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: SleepyHead software

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poppi2
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Joined: Thu Nov 18, 2010 2:54 pm
Location: Houston, near JSC

Re: Hey look! It's the new guy!

Post by poppi2 » Fri Jul 03, 2015 8:42 pm

ISnoreBadly wrote:I got my equipment today. I wound up with the 460. I had asked for the 560 ahread of time but was told that I wouldn't be taking advantage of the capabilities since it would be set for a single pressure. The tech said that the pressure requirement sometimes changes during the night, or from day to day. I thought that was my in to get the 560 but was told that it wouldn't be configured as an APAP only not a CPAP since that's how my prescription was written. I pushed for it anyway, but they stood firm. I said I was going to have to think about it and got up to leave, they asked if talking to my doctor would help me make up my mind so they got him on the rap rod. He pretty much told me the same thing, but did say that once they review my data if it turns out that I would benefit from an APAP instead they would be able to swap the 460 for the 560.
Your doctor did you no favor. If it were configured for a single pressure, you could still reconfigure it to APAP when needed. It's nothing but software reconfiguration via buttons. You just have to access the "secret" menu to adjust the settings. We will show you where to get the clinician instruction manual.
ISnoreBadly wrote:...During the titration the only thing they had offered me was the nasal pillow, today the tech told me that a nasal mask would probably be better with the pressure I'm using (12).
Pugsy uses the P10 pillow at a pressure greater than 20 cmH2O. I use it at 14.5, with no problem.
Now the 460 can operate as an APAP for a fixed number of days. Then it becomes a fixed pressure machine.
I think the DME and your doctor ganged up on you and maximized the DME's profit at your expense of losing the ability to easily self titrate in say, two years.
This reply was written on my phone over the last hour, so my thoughts may be disjointed. They will be others to follow with solid advice. By Monday you should have solid arguments for the 560 now, rather than a later "sure, no problem".
Archangle has some thoughts on the believability of DMEs.

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Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: PAPCap, 3M Microfoam Surgical Tape, PoliGrip Strip, APAP 12.0 - 14.0 cm

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MarylandCPAPer
Posts: 438
Joined: Fri Jan 15, 2010 1:15 pm

Re: Hey look! It's the new guy!

Post by MarylandCPAPer » Fri Jul 03, 2015 9:00 pm

I would not have accepted that machine or mask and would probably have gone to a new DME, knowing what you know. I was put on the Wisp nasal mask at a sleep study recently. It blows air out toward your eyes, which I find very unpleasant. If you don't use the machine or mask, can you return it and start elsewhere? Just don't even turn on the machine, because it registers the time it is on, so would be "used."

The problem is that you are essentially stuck with the initial machine for 5 years, because that is the typical replacement interval allowed under insurance, which often follows Medicare timeframes. Your sleep study is only one night's data and an APAP capable machine enables you, if need be, to essentially do a sleep study at home under normal circumstances.

Both DMEs I have dealt with have provided APAP capable machines, even when I was brand new and had a prescription for a fixed pressure. Of course, I knew what to ask for this time, after 5.5 years, and the sleep study center prescribed me a "brick." I was able to get an APAP-capable machine this time by sending my primary care dr. printouts from the last two years that showed I used an adjustable (self-titrating range) that supported what I was requesting.

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Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Have also used Opus 360, Swift LT for Her, Optilife, and Breeze Nasal Pillows masks.
Started CPAP 12/18/09 Pressure 13. Changed to APAP 1/18/10, Pressure 10-16. 4/2014:Switched to AirFit P10 mask. PR System One REMstar Auto Series 550 with A-Flex for 5.5 years. 7/2015 to present: AirSense 10 AutoSet FOR HER. Range: 10-20

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zoocrewphoto
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Location: Seatac, WA

Re: Hey look! It's the new guy!

Post by zoocrewphoto » Sun Jul 05, 2015 2:24 am

You said: The results from the first test showed this: "Supine for 237 minutes with a supine RDI of 85.6/hour, non-supine for 143 minutes with a non-supine RDI of 28.1/hour."

With results like that, you probably need more pressure while on your back, so a range would have been a better idea. But now you have a machine that can't do that. And the the DME will be unwilling to switch it out later.

My titration only went up to 11, and they recommended 11-17. WHY? Because I barely slept on my back during the titration, and they knew I was worse on my back. My pressure rarely goes above 13,but there are short spikes to 15 and sometimes 17. Then I must roll back onto my side as it goes back down. I probably spend less than 10 minutes a night above 13, but it keeps my apnea under control AND keeps me off my back (since the higher pressure starts to bother me a little, not enough to wake me up though).

You have a great argument for an auto machine. Not sure why the sleep lab didn't recommend an auto.

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Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
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Who would have thought it would be this challenging to sleep and breathe at the same time?

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ISnoreBadly
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Joined: Sun Jun 21, 2015 7:07 pm
Location: Lawn Guyland, Noo Yawk

Re: Hey look! It's the new guy!

Post by ISnoreBadly » Sun Jul 05, 2015 7:36 pm

MarylandCPAPer wrote:I was put on the Wisp nasal mask at a sleep study recently. It blows air out toward your eyes, which I find very unpleasant.
I haven't experienced that, it's been pretty good for me. The SleepMapper software shows a 100% mask fit for the 2 days that I've used it. However I've been blessed with an exceptionally large nose so even when using the XL mask, after a few hours it becomes a little uncomfortable. I've loosened up the straps and that's made it better but I think the nasal pillows like I used during the 2nd test would have been better. So I'm calling them in the morning to get them.

On the upside my AHI was 3.44 the first night and 2.75 the second. My wife says I haven't been snoring at all and she said that my breathing has been very regular. It may be all in my head but I've feel like the brain fog is lifting and I've been able to concentrate better. Today I read the Sunday newspaper cover to cover and actually processed what I was reading without having to re-read it. I can't remember the last time that happened.

I do understand what all of you have said about the APAP but as I said once the doctor reviews the data if he thinks I need an APAP instead of a CPAP I will swap it then.

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: SleepyHead software