Switching to an Auto Adjusting Machine - No help from DME

Hi all,

I am a newbie to cpaptalk and to using a cpap machine. I have had my Resmed CPAP Escape 8. After fighting with the machine for several nights (most nights the longest I could tolerate the machine was 2 to 3 hours max) I switched from a nose mask to a pillow style mask.

The pillow mask was slightly better but still didn't make it through the night. This forum was a great help in getting information on things. After spending several hours browsing posts and related articles etc. I was convinced that a auto adjusting CPAP machine made a lot of sense.

The ability to have the optimum pressure delivered as needed appeals to me as I can't seem to tolerate the constant pressure. I also liked the idea that an auto machine would provide more detailed feedback.

I got the impression in reading several posts that I may run into a problem with my sleep lab and/or DME when asking to change machines. My first machine is under a rental agreement for the 1st 2 months so I figured this would be a great time to try another one before purchasing one.

Talk about a ROADBLOCK - my DME said they didn't even know if they handled that machine, finally admitted they did. I talked to my sleep lab and they said they would send in a new prescription for an EPR machine (since that was what I talked to them specifically about).

When I went to my DME today they said they could change me to an EPR machine but not an auto machine. She also told me that the auto machine was almost twice as expensive as the CPAP machine. I asked her what the price of the machines was. She said the Auto adjust was $1,742 and the basic CPAP machine was $1,400. Twice the price ?? The only thing that is twice the price is their pricing compared to what I have seen the same machines selling on the internet. Even the more expensive auto adjusting machines on the internet are less expensive than their basic CPAP machine!

The DME said I had to make an appointment with a sleep therapist if I wanted to get a prescription for an auto adjust machine. She asked me why I wanted to switch and I told her some of the things I had learned online. Better comfort therefore better compliance, ability to get only the pressure you need etc.

I told her I wanted to return my rental machine and she did everything she could to have me keep it until I got a new prescription. I said I did not want to since I more than likely would be purchasing my next machine elsewhere (based on the prices she had given me).

I then called my sleep lab and the lady first said, you only said you wanted the EPR (reduced exhale pressure), I told her that was true, but I would like an auto machine since it would give me the EPR capability when using it in CPAP mode and the auto mode would be available to me as well.

She wanted to know where I got my information. They seem to hate hearing 'on the internet'. The sleep tech said they do not like automatic machines since they can deliver higher pressures than needed at times. I said if I don't use a machine at all because it is too uncomfortable that isn't good. And with a CPAP it sounds like most of the night (based on my reading) I am getting more pressure than I need. She said I would have to talk to a sleep doc about it.

So it is obvious I am going to have a battle to get the machine I want. Have others run into this? What are my options? I know I can't 'demand' they give me the prescription I want, but I don't understand their reluctance to accomodate my request, when the chances of my using a machine I am comfortable with are much higher????

I read messages in several different forums about people's preference of auto adjusting over a standard CPAP and I also read where some people still like their CPAP option so they use their machine in CPAP mode most of the time but will switch to auto on occasion.

Any ideas, suggestions, advice would be greatly appreciated.

Thank you!

The sleep Dr recommended a Bipap with Biflex. I went to my Medical Dr & told him what I wanted & he wrote the script. They wrote the script for a Bipap with Biflex, auto, fully data capable. Bipap provides more comfort. If you need a DME for insurance purposes, you'll have to call a few, but eventually you'll find one. If you do need to use insurance, try Orbit, online, they'll work with you & give you what you want.

allergyridden wrote:The sleep Dr recommended a Bipap with Biflex. I went to my Medical Dr & told him what I wanted & he wrote the script. They wrote the script for a Bipap with Biflex, auto, fully data capable. Bipap provides more comfort. If you need a DME for insurance purposes, you'll have to call a few, but eventually you'll find one. If you do need to use insurance, try Orbit, online, they'll work with you & give you what you want.

Thanks for the reply. I have an appointment with my sleep doc (actually a P.A. I've never even met my actual doctor) next week. Hopefully she will be more accomodating.

My next question was whether people are comfortable ordering equipment online. Any disadvantage not using a local DME????

Thanks again.

I too have had major issues with my local DME. I also had to go back to my Dr. to get an Auto machine. I would have not problem purchasing equipment online and I'm quite sure the next mask and machine i get will come from someone other then my local DME.

Mark

62Chev, At my sleep center, I guess you would call him a dme started me out (during the trial) with the Resmed Pro, with no auto capibility and let me tell you, that was the worst month of my life as far as sleepy and comfort goes! Finally, he told me to just go home because cpap therapy wasn't going to work for me, I was devistated! As I was walking out the door he told me to go to a dentist and have a device made but that I definately had to get something done! I went home, the phone rings 30 minutes later and it was my dme saying, I am looking at your data and you have to go ahead and try to sleep with that machine, he said I stopped breathing 40-50 times per hour and anywhere from 30-50 seconds at a time SO I go back and get the machine and try it again, still couldn't tolerate it so I took the machine back to him and I sad "GIVE ME A RESMED CPAP AUTO", I am paying for it with a credit card and I got it and have loved it ever since. My pressure is 9, my auto is set on 4.5/20 (cool)! Sometimes, I only need say a pressure of 5.6 or 7.5 rather than the straight 9! Sometimes my pressure has hit 12.5 so that's what an auto will do for you. Without an AUTO, I would of died! Goodluck, just demand it even if you have to pay with a card, you'll be glad in the long run, also records your data and has the exhale(cflex) built in it.! Let us know your results.. SleepyNoMore

62Chev, YES, definately order online at cpap.com, they are the absoulate BEST. You get youe equipment and supplies FAST! The are very professional and friendly as well! Check the packages out like the REMSTAR AUTO with Heated Humidifier, you'll be pleasently suprised at the low cost compared to the DME's prices!

I've made all my equipment purchases online. Never bought anything from a local DME.

62chev, if you want pressure relief (a pressure drop) each time you exhale, AND if you want auto-titrating capability at the same time, you don't want a machine with "EPR". You want an autopap with "C-Flex" or "A-flex."

The resmed autopap (the S8 Vantage) with "EPR" cannot use its EPR feature when the machine is being operated in auto mode. It can use EPR only when being operated in straight cpap mode.

In autopaps, the Respironics is the only brand that offers exhalation pressure relief WHILE being used as an autopap. Their REMstar autos with C-flex or with A-flex.

If I wanted an autopap that could give exhalation pressure relief at the same time, I'd get either of these (in this order):

Respironics REMstar Auto with A-flex M series.
Respironics REMstar Auto with C-flex non-M series (an older machine.)

Actually, what I'd really shoot for is a bipap machine that can auto-titrate at the same time. I'd want either of these (in this order):

Respironics BiPAP Auto with Bi-flex non-M series (an older machine.)
Respironics BiPAP Auto with Bi-flex M series.

In any case, if I got an M series machine, and had insurance, I'd let the insurance pay for an integrated heated humidifier for the M series machine.

If I were paying for the humidifier out of my own pocket, I'd not get the integrated humidifier for an M machine. Instead, I'd buy a separate Fisher & Paykel HC 150 heated humidifier...can be used with any brand/model of machine, including the M series machines.

The integrated humidifier that you can get for the pre-M series Respironics machines is fine, so if I were getting an older non-M Respironics machine I'd get either humidifier...the integrated one or the separate F&P humidifier.

If a person is interested in monitoring their own treatment with software, the new Encore Viewer software made by Respironics for patients to buy works with any of those machines. The least expensive place I've seen to buy the special card reader that's needed is at:
http://www.two-factor.com/shop/index.php?productID=115

I don't see where you listed your pressure so I don't know how much an auto might help you by keeping you lower much of the night.

As for your DME's comment about delivering higher pressure than you need, that is not an issue if you set the upper limit at or just slightly above the titrated pressure from your sleep study.

For the ResMed machines be aware that EPR is not available in auto mode, only when you use the auto in cpap mode unless something has changed really recently. On the Resmed machines (respironics) you can use the exhale relief in either mode.

As for comfort with online sales. CPAP.com is great. I have used for a machine and many supplies. I have no use for a local DME.

About insurance. You don't say what your insurance benefit is really worth. You need to look at what your copay is and deductable to get the real cost for you for buying a machine through insurance then compare this to online, non insurance cost. There may be very little difference, especially if your insurance year is the calendar year. You may be paying a deductable in both 2007 and 2008.

If what you will pay out of pocket is more with insurance, go onine and buy.

As for your doc giving you the prescription you want... If you buy online any CPAP prescription will be fine for any APAP or CPAP. Just go get the one they already wrote (and probably faxed to the DME without you deciding which DME YOU wanted to use. Get a copy of your sleep study(s) too.

On online companies taking insurance. Might be tough since you have already started a rental elsewhere. Can't hurt to ask but be prepared for the answer to be no.

snoregirl wrote:On the Resmed machines (respironics) you can use the exhale relief in either mode.

Great advice, as always, from snoregirl. I think she meant to write "REMstar" instead of "Resmed" in that quoted sentence, though. All those "R" names are easy to typo...been there, done that.

Yup RG you caught me. Sorry, I was writing at 2AM.

Thanks for the correction.

It’s pretty amazing isn’t it, how most of us come into this PAP world in pretty much the same way. At some point in time a light bulb turns on in someone’s head and the next thing you know, there you are, all wired up in a fake cheap motel with some college kid working a night shift as a sleep lab tech. Then a couple of weeks later (more or less) you are exhausted, dazed, and overwhelmed with all this respiratory equipment that you have to wear for the rest of your life -- and what it is, how it works, or how you will pay for it is the last thing on your mind and we feel lucky that the medical professionals and your insurance will take care of all those worries.

When I first started out I got lucky and found this forum very early on (a few days after my first night on the hose). At the time there were big debates going on about ResMed policy changes and price hikes for online vendors. I didn’t care about that stuff at the time … all I cared about was getting the right equipment to make me feel better because I had insurance that would pay for mine and I didn’t give a flying squat what ResMed did.

Fast forward a few months (more or less) on the cpaptalk forum and I realized that the CPAP of Oz hiding behind medical scrubs/lab coat and a fancy certificate on their sleep center office wall is nothing more than a medical equipment sales person doing their best to maximize profits for the sleep center … the success of my OSA treatment was only secondary if that. I realized that it is I who has my best interest with regard to my health. I realized that my insurance coverage is really not that much better than buying equipment out-of-pocket online (even with price hikes). I realized that the best equipment to have is an APAP even if you only use it as a CPAP. I realized that having software intended for clinicians and not patients should be intended for patients and not clinicians. I realized that I must be the one responsible for monitoring and managing my OSA treatment. I realized that the most important piece of your equipment is the right mask-interface -- otherwise the rest and more expensive pieces are useless. I realized that the right mask interface for someone else is more often not the right mask-interface for me. I realized that I am not the only one on the yellow brick road to successful treatment of OSA. I realized the great members of this forum have been there and done that …

Listen to their advice and be thankful for and to them. Best of luck!

Yeah......what HE said..... ^

Den

Dreamstalker, you have such an eloquent way of stating things...
O.

62Chev--buy and patronize your local authorized DME who gives physical service and same-day turnaround should something break, etc.

Anonymous wrote:62Chev--buy and patronize your local authorized DME who gives physical service and same-day turnaround should something break, etc.

OR......your could take the savings (from buying online) and buy one or two extra machines and masks to have as backup spares.
That's what I did.

Den