Questions about first DME appointment

Hi everyone! I feel very lucky to have found this forum. I'm amazed at the level of knowledge and willingness to help others exhibited by so many of the members. I'm a newbie, so apologies if I make any mistakes in posting.

I have my initial appointment with the DME the day after tomorrow and I wonder if someone can help me know what to expect. After waiting several weeks for the DME to contact me, I've spent a lot of time on the phone the past week with my insurance company, the DME, and the doctor's office trying to sort things out and am already feeling a little bit frustrated at all the foul-ups and miscommunication.

My main question is, can I assume that the DME is going to offer me a choice of machines and masks and perhaps do some kind of titration when they visit my home??

I had a home sleep test through a sleep specialist with no follow up other than a brief call to give me my OSA diagnosis and say the DME would call. When I went in to pick up a copy of my report from the doctor, I asked if there was going to be a titration study and the receptionist looked at me and said in a confused way, "I don't know what that word means." I called the DME to ask what kind of machine I would be getting and they emailed me a list of codes (E0601, etc.), but if I understand correctly that code can refer to a number of different types of machines. It seems that other people on the forum have had titration studies in a sleep lab or have had trials with APAP (?) to determine their pressures. Is this correct?

I have lupus, fibromyalgia, migraines, DSPS, lots of problems recently with paresthesias,weakness, cognitive difficulties, etc. I was kind of surprised that I didn't have an in-lab sleep test with EEG (and wonder about the validity of the at-home test since it didn't seem to know I was up and down most of the night). My dx was moderate OSA (AHI 19, RDI 22, prolonged oxygen desaturation with lowest O2 of 78%. The doctor said the home tests tend to underestimate the severity of OSA and also said he expected I'd feel a whole lot better after treatment, which gives me hope, but the way things are starting out I have the nagging feeling that this process is going to take an awful lot of work on my part.

Thanks so much for your help! I've received almost no information from my providers so this group is a godsend!

oyasumi wrote:My main question is, can I assume that the DME is going to offer me a choice of machines and masks and perhaps do some kind of titration when they visit my home??

The DME probably won't offer you a choice of machines but it's important for you to know that you do have a choice. The insurance billing code E0601 is for straight CPAP or an auto-adjusting (APAP) machine. It covers both. Since you haven't had a titration yet you should definitely be getting an APAP machine. ResMed S9 or AirSense 10 Autoset, or PR System One 60 Series Auto (560) or PR System One REMstar Auto CPAP Machine with A-Flex (550)*. ResMed and PR are the two major manufacturers and there is easy-to-use software available free for both makes.

When they bring out the machine, check the make and model -- for ResMed the S9 should say "Autoset" right by the Start/Stop button. It should say Autoset and not Escape Auto. On the AirSense 10 machine it says "Autoset" on the bottom-right side of the machine front, under the name "AirSense 10." If a PR machine look on the bottom of the blower unit (not the humidifier unit), for a label with a number that includes either 550 or 560.

If you are supposed to be getting a new machine then you also want to check to make sure it's really new -- ask the rep to plug the machine in and show you the RUN hours. This is different from therapy hours or USE hours. Those can be reset by the DME, but RUN hours cannot be reset to zero.

We suggest you do not accept a machine if it is not what you want or if you're unsure. It's more difficult to return/exchange a machine than to refuse delivery until you are sure about what you're getting. You can use any DME that your insurance (not your doctor) approves.

You have to be asleep for titration so that won't happen when the DME rep delivers your machine. At-home titration involves using the APAP for a week or more, at which point the doctor reviews the data from the machine and decides on a pressure or range of pressures for you.

Masks -- you may be offered a few choices but just know that there are many, many mask types out there. Most people have to do some trial and error with masks once they get started using their machines. What works when you're just trying on for the first time may not be the mask that ends up being your "keeper."

* The difference between the 550 and 560 models is that the Series 60 (560) machines have the heated hose option.

Thank you so much, kaiasgram! You've answered my question about titration and given me very clear-cut steps to follow during the appointment. I can't thank you enough!

oyasumi wrote:Thank you so much, kaiasgram! You've answered my question about titration and given me very clear-cut steps to follow during the appointment. I can't thank you enough!

You're welcome.

BTW, it's hard to read the sleep study you posted in your other thread (small and blurry). Can you try another way?