My “all too typical” follow-up with ENT

After waiting 15 minutes in the room (15 minutes after my appt time), the doctor came in and spent a total of about 5 minutes with me. During that time, he looked at my nose and throat (not sure why since he didn’t even comment on my dry nostrils that are beginning to bleed – I’m using Ayr Gel now and hoping to get them healed soon). I had split my reports into 2 sets – one showing the lower min pressure that I started at and one showing the higher min pressure that I’m at now. I suspected he may not look at the daily info, so this way, the summaries were separated for lower min pressure and higher min pressure. As suspected, he only looked at the summary page of each report.

He said it’s time to get a permanent machine and insurance companies don’t usually approve Auto-PAP. I told him I like Auto better and would prefer it. He said he didn’t have any problem writing a prescription for one, but I might have to pay the difference that the insurance company refuses to pay. Then he asked if I’m doing okay with my mask and what type I have. I told him I have a nasal only mask (micro mirage) and I have a full face mask. I told him the full face mask is okay when I inhale, but leaks when I exhale. I asked him if I might do better with a Bi-PAP. At that point he looked again at my numbers (I’m wondering if he actually LOOKED at them before) and said when a person needs 15 or above, he starts leaning toward Bi-PAP and it looks like I’m needing anywhere from 15 to 17. I asked him if Bi-PAPs are also auto adjusting and he said he would write the script for an auto adjusting one. He said the only other option is surgery. He didn’t think surgery would cure me, but after surgery I might be okay on a lower pressure. He said usually the insurance companies will pay for a Bi-PAP if you tell them the only other option is surgery. I don’t know what type of surgery he has in mind, but I had surgery some years ago to straighten my septum and clear a polyp in my sinuses. Maybe there is something they can do though? – I didn’t ask any questions – just wanted my Bi-PAP script.

I asked him about pressure settings and he said he wants to leave it open so the machine can judge what pressure I need. He said to take the card in to the DME (ha, ha) in 2 weeks so they can fax him a report. At that time, he will let me know what pressures to use long term. I don’t need to come back!!!

Since the DME put me on an S8 Vantage as a loaner, and since he’s located in small town, I’m assuming he may only carry the Resmed line. So, I’m hoping I’ll get the S8 VPAP Auto. If he bring out something other than that – any suggestions as to what I should do? I didn’t get the script to specify that machine like I had planned (didn’t even think about it at the time – I guess I was too shocked at how the whole appointment went). The only other Resmed Bi-PAP I see on cpap.com is the Resmed Malibu VPAP. Does anyone know the difference between the S8 VPAP and the Malibu VPAP?

I’m thinking after getting the Bi-PAP and at least a few weeks under my belt, I’m going to see my Pulmonologist and have him take over my OSA therapy.

Bluebonnet.....

Figure out exactly which machine you want......then, write up a set of specifications......an exact list of what will work best for you.

Hand the list to the ENT....and request that he write your prescription with your specs included.

I wrote my own prescription....handed it to the ENT....got a "deer in headlights look".....and my prescription was written perfectly.

I haven't been back since...........and I've been totally compliant for 2-1/2 years. I manage my own therapy.....my AHI is below 1.0....and my O2 saturation is where it should be.

You can do it too!

I will echo putting what you want in writing. My Doc did not understand from my phone call and faxed a strange prescription for an M series Auto MASK to my DME. I found out AFTER I got to the DME but then I also never SAW it so ... I then faxed my Doc with the exact title of what I wanted and went to PICK UP the prescription that time to make sure it was correct .. and carried it in my hands to the DME.

Thanks for the advice. Since I already have an appt with the DME tomorrow, I think I might go ahead and go and hope for the best.

Does anyone know the difference between the S8 VPAP and the Malibu VPAP?

Bluebonnet_Gal wrote:Thanks for the advice. Since I already have an appt with the DME tomorrow, I think I might go ahead and go and hope for the best.

Does anyone know the difference between the S8 VPAP and the Malibu VPAP?

The Malibu is old technology, an S7. It is louder, heavier, larger, with an older, less-convenient humidifier. The VPAP Auto is technically an S8 II . You can go to cpap.com and on the left side under "tools" and "compare," click on "BiPAPs and Bilevels," then "choose bipaps to compare" to compare any machines you want.

jnk wrote:You can go to cpap.com and on the left side under "tools" and "compare," click on "BiPAPs and Bilevels," then "choose bipaps to compare" to compare any machines you want.

Thanks. I've done a comparison. I don't see on the comparison where it tells me if a machine is auto titrating or not. Any tips on that?

Bluebonnet_Gal wrote:

jnk wrote:You can go to cpap.com and on the left side under "tools" and "compare," click on "BiPAPs and Bilevels," then "choose bipaps to compare" to compare any machines you want.

Thanks. I've done a comparison. I don't see on the comparison where it tells me if a machine is auto titrating or not. Any tips on that?

http://www.resmed.com/en-us/products/fl ... u=products

http://www.resmed.com/en-us/products/fl ... u=products

On those pages, when they say "auto," they mean auto-titrating.

Personally, I think that the easybreathe technology of the VPAP Auto makes it a much more advanced piece of plastic. Search Slinky's posts for "easybreathe."

jnk wrote:

Bluebonnet_Gal wrote:

jnk wrote:You can go to cpap.com and on the left side under "tools" and "compare," click on "BiPAPs and Bilevels," then "choose bipaps to compare" to compare any machines you want.

Thanks. I've done a comparison. I don't see on the comparison where it tells me if a machine is auto titrating or not. Any tips on that?

http://www.resmed.com/en-us/products/fl ... u=products

http://www.resmed.com/en-us/products/fl ... u=products

On those pages, when they say "auto," they mean auto-titrating.

Personally, I think that the easybreathe technology of the VPAP Auto makes it a much more advanced piece of plastic. Search Slinky's posts for "easybreathe."

Thanks! Very useful information! Why didn't I think to go to the ResMed website?

Bluebonnet_Gal wrote:. . . Why didn't I think to go to the ResMed website? . . .

I think you did think of it earlier, but I distracted you.

From Rested Gal who got an error message, therefore I'm posting for her and see if i'm getting the same thing. I'm even doing a view preview option.

Good info, jnk!

I kept getting that darned Internal Server Error while trying to
submit this post (will still submit it to see if it will finally go
through) but I see that you've covered everything Bluebonnet_gal
needs to know. Good job, jnk!

.... what I was trying to submit... LOL!!
I may be wrong, but I think the Malibu is the older, larger
VPAP Auto...Malibu looks like the same size as the older S7 series machines.
http://www.resmed.com/en-us/products/fl ... u=products
I wouldn't want that one. I'd want the smaller S8 VPAP Auto.

The newer, smaller (and probably quieter) S8 VPAP Auto (product #
26301 ) is the machine you want the doctor to specify on the prescription:
http://www.resmed.com/en-us/assets/docu ... sa-eng.pdf

There's also an S8 VPAP Auto 25. 20 cm H2O is the most the
S8 VPAP Auto can blow for IPAP. The model with "25" tacked onto its
name can be set for 25 cm IPAP if needed. Doesn't sound like you
need that much, but it won't matter which of those two machines the
DME gives you. If the "25" is the one the DME has, that's
ok. Either one will be set for your prescribed EPAP/IPAP pressures anyway.

If you want to stick with an integrated humidifier, I'd also have the
doctor specify the Humidaire 4i heated
humidifier. Otherwise, the DME is most likely to give you the older
3i humidifier. Again, I may be wrong, but I think the newer 4i
humidifier may heat better. Some users have reported on the message
board that ResMed humidifiers have to be turned up to the maximum
heat adjustment to put out any useful humidification at all. Or at
least have to be set considerably above the halfway heat adjustment
mark to get the same amount of humidification that other brands of
humidifiers give at lower heat settings.

I know that two 2i humidifiers I used were very wimpy...felt
like no humidification until turned up as much as they would
go. I've not used the 3i. At any rate, I'd insist on the
4i since that's their newest humidifier now.

Looks like ResMed's humidifier product page has not been updated to
mention the 4i yet, but it is out there. You can do a Google
search for 4i humidifier and see it at a lot of sites.

Thanks, Trinh!

Thanks, rested gal. Very good points on the Auto 25 and 4i.

I was wondering where you were!

I do like my Humidaire 4i heated humidifier but all I can compare it to is the Respironics integrated M series one. The 4i does hold more water so it does not run out in the middle of the night like the M series. The 4i also seems to warm up more quickly than the M series. Sorry, I never used the 3i to know the difference between the 3i and 4i.

AuntieNae