Central vs Obstructive Sleep Apnea

BTS wrote: ↑

Tue May 08, 2018 10:52 pm

I wish people would stop taking bricks ... DMEs are scum giving these out when you can get an Auto or at least the Pro.... Take it back, do more research and never walk away with a brick ... And if you go ResMed the same thing take the Auto and if not that nothing less than the Elite ... Research people... Look things up, no reason walking away with this shit when you are reading all about how not to take a brick here on the forums..

but, doesn't the DME have to give the patient what the insurance will pay for? Doesn't the insurance dictate which cpap we get?

Barb (Seattle) wrote: ↑

Wed May 09, 2018 5:19 am

but, doesn't the DME have to give the patient what the insurance will pay for? Doesn't the insurance dictate which cpap we get?

Nope....the insurance company pays by HCPCS billing code only and all they care about is if someone meets the criteria for that particular billing code.
Insurance companies don't care about brand, model, features, data or whatever.

Now DMEs will tell people that "your insurance only pays for this model" but it's a bold face lie.

There's like 3 different HCPCS billing codes for cpap machines of various sorts....that's all...3 different codes (the 4th one is for people with trachs).
The most commonly used code....E0601 includes all cpap/apap machines bricks, half assed bricks, or full data machines.
This below is what insurance companies go by...when cpap gets billed out. No where is brand or model ever mentioned in the billing process.

Barb (Seattle) wrote: ↑

Wed May 09, 2018 5:19 am

but, doesn't the DME have to give the patient what the insurance will pay for? Doesn't the insurance dictate which cpap we get?

No.

palerider wrote: ↑

Tue May 08, 2018 9:49 pm

I'm so sorry, the CPAP model, as you were told, is the junk model.

Take it back and refuse it... You need *AT LEAST* the pro model, preferably the auto model.

Barb (Seattle) wrote: ↑

Wed May 09, 2018 5:16 am

I totally AGREE!!!!!

I understand that AutoPAP is significantly better than CPAP. But I don't understand why the DreamStation Pro CPAP is significantly better than the regular Dreamstation CPAP.

The regular CPAP has bluetooth, a "ramp up" option (from 5 to 45 minutes), and "SmartRamp" which "uses an Auto-CPAP algorithm, making adjustments to the decreased pressure based on a breath by breath basis. Once SmartRamp reaches the prescribed pressure, the device will begin operating as a CPAP machine at the prescribed pressure."

The Pro model has all of this, and in addition has an "Auto-Trial" feature which lets the machine act as an AutoPAP for the first 30 days of use. "During this period, the machine will function as an auto-adjusting machine that will automatically adjust pressure during the night to provide optimum pressure on a breath-by-breath basis. After the auto-trial is complete, the machine will provide the pressure the user was at or below 90 percent of the time."

Unless I'm mis-reading the data pages I linked to, the only difference between regular and Pro is this Auto-Trial feature. Is this the reason that you are all saying that the Pro is much better than the regular?

JerryL wrote: ↑

Fri May 11, 2018 10:01 pm

Unless I'm mis-reading the data pages I linked to, the only difference between regular and Pro is this Auto-Trial feature. Is this the reason that you are all saying that the Pro is much better than the regular?

The CPAP model records no effectiveness data.

The PRO does.

It's the difference in driving to work normally (pro) and driving to work with the windows of your car painted black (CPAP).

You have no way to tell whether the machine is working or not, and there's no hints on what to do to make it better.. You're flying blind.

Getting effective treatment with the PRO is doable, though it takes more effort and may not work as well as the AUTO.

Getting effective treatment with the CPAP is a crapshoot. and you can't even see what you rolled.

The basic Dreamstation CPAP model only records compliance data. Meaning documented use so they can get insurance payment.
The other models have:
Advanced event detection: Where types of events are detected and recorded for review by yourself with free software or your doctor. With your machine there is no data recorded for your doctor to review.
Advanced event detection include the events:
•Apnea Hypopnea Index (AHI)
•Respiratory-related arousal (RERA)
•Snore •Flow limitation (FL)
•Leak
•Vibratory snore (VS)
•Obstructive airway apnea (OA)
•Large leak (LL)
•Clear airway apnea (CA)
•Periodic breathing (PB)
•Hypopnea (H)

And you also have the ability to see the flow waveform and how you were breathing throughout the night.

Any of the events may be important to the success of your treatment.

Aha -- yes, that makes a huge difference. Before accepting the machine, I looked at their descriptions on the website I linked to. But when I saw that both the regular and Pro models had some data, I jumped to the conclusion that they had the same data. And the guy at the medical equipment supply told me it was awesome, great, brand new, et cetera.

Now I have to figure out how to take it back. I have Medi-Cal (Medicaid for California), and so all of my benefits are funneled through a complex bureaucratic process. If I simply return to the medical equipment supplier and say "Here, I don't want this, I want the better model," they might accept the return, but they won't be permitted to give me a better model since that's not what the Medi-Cal bureaucrats approved. But if I return to my doctor and say "I want a prescription for a better model," he'll probably say "Did this one not work?" And if I reply, "I didn't try it -- some folks on the web told me I need a better machine," I don't know how he'll react.

As I said before, the folks on this forum clearly know more about apnea than my ENT doctor, and he's so busy that my three visits to his office were each about 5 minutes long. But I don't know if he would take kindly to my saying "You gave me the wrong prescription"....

If I can't switch machines, should I use this one, or none at all?

I always want to ask the Drs who say that basic machines are fine how they intend to know how well my treatment is proceeding, and how they will know what to adjust if the results are not as good as they would like. If all they get is AHI, there is no way to know the type of events driving the AHI, so do you need more pressure, higher starting pressure, have central which say maybe less pressure is good. Oh, they can screw around making changes, all the time you the patient is not sleeping well, and being exposed to all of the potential poor health outcomes that SA is known to be associated with.

Just take it back to the DME and say you want the Auto or Pro and that you want to have a machine that you are able to see data with and make adjustments as needed.. There is no cost difference with the brick and the Auto as they have the same coverage code.. That is of course if you want to be in control .. If not and you want to leave it up to the Drs and the DME and not be in control then yeah stick with the brick.

BTS wrote: ↑

Sat May 12, 2018 1:13 pm

There is no cost difference with the brick and the Auto as they have the same coverage code..

There is a cost difference, however most insurance companies pay the same amount whether it's a brick, data, or auto machine and the insurance company therefore doesn't care.

In the OPs case, that may or may not be true.

I would call the doctor's office and tell them they gave you a machine that doesn't break down your events into categories and with the sleep study showing some central apnea you need one where that can be monitored. Ask if he would write a prescription for an APAP where he could monitor the data to see if changes are necessary. It can be run in CPAP mode if that's what he wants but you have the flexibility to use auto if that works better.

Now the DME wants to make profit so it may take some convincing to return. But if you have a prescription for an APAP it might make it easier.

OkyDoky wrote: ↑

Sat May 12, 2018 1:43 pm

I would call the doctor's office and tell them they gave you a machine that doesn't break down your events into categories and with the sleep study showing some central apnea you need one where that can be monitored. Ask if he would write a prescription for an APAP where he could monitor the data to see if changes are necessary. It can be run in CPAP mode if that's what he wants but you have the flexibility to use auto if that works better.

Now the DME wants to make profit so it may take some convincing to return. But if you have a prescription for an APAP it might make it easier.

+1 ... this right here ... I agree go back to the Dr first and request a script for APAP ... After that it should be no issue in trading in the brick ...

OkyDoky wrote: ↑

Sat May 12, 2018 1:43 pm

I would call the doctor's office and tell them they gave you a machine that doesn't break down your events into categories and with the sleep study showing some central apnea you need one where that can be monitored. Ask if he would write a prescription for an APAP where he could monitor the data to see if changes are necessary. It can be run in CPAP mode if that's what he wants but you have the flexibility to use auto if that works better.

Now the DME wants to make profit so it may take some convincing to return. But if you have a prescription for an APAP it might make it easier.

That sounds like a great idea. If I simply take it back to the DME folks, they won't want to accept the return, and the doctor may feel that I disobeyed his instructions. But if I get approval from the doctor for the exchange, then the DME will hopefully be more friendly.

Should I ask for the Pro, or push for the AutoPAP? I think I know how to make the case for the Pro: as you (and several other folks here) said, it's important to have a machine that monitors how well things are working. But how do I make the case for APAP? Should I point out that the sleep study does slightly favor 9cm pressure but it's hardly certain? Should I say that I plan to lose weight and that if I succeed my pressure needs might change? Or is there some other good argument?

(As I mentioned earlier, one of my worries is that I'm not sure my ENT doctor actually knows much about sleep apnea. If he does, he sure didn't share his knowledge with me. 95% of what I know about apnea and xPAP I have learned here!)

I would explain to the doctor that you really want to be successful with the treatment, and you are afraid that a machine without data won't be able to help you be successful.You didn't realize until you got home that the machine they gave you won't be able to show you what type of events you are having, how often, etc, or even if your mask is leaking much. Since you are not able to afford anything without medi-cal, this is your only chance to get a good machine. Get the doctor on your side.

zoocrewphoto wrote: ↑

Sun May 13, 2018 2:31 am

I would explain to the doctor that you really want to be successful with the treatment, and you are afraid that a machine without data won't be able to help you be successful.You didn't realize until you got home that the machine they gave you won't be able to show you what type of events you are having, how often, etc, or even if your mask is leaking much. Since you are not able to afford anything without medi-cal, this is your only chance to get a good machine. Get the doctor on your side.

That makes sense. If I understand you correctly, you are suggesting that I try to persuade my doctor to help me upgrade from the CPAP machine with no data ("DreamStation CPAP") to the CPAP machine with data ("DreamStation Pro CPAP") -- but you are not suggesting that I push for the AutoPAP machine. Is that correct?

It seemed as if BTS, Palerider, and Barb were recommending that I push for the AutoPAP (but perhaps settle for the Pro if my doctor won't help me get an AutoPAP).