I have a prescription but now what?

[Jeanne Ellen]

I posted my first message here about a week ago, asking for advice about a titration study that went south. It was way worse than the initial sleep study, which wasn't fun either. According to the tech, I never slept enough for her to record any apneas or hypopneas. Whenever I did start to fall asleep, she'd try to raise the pressure on the machine (which I think stayed at 5 the whole time) and I would wake up. I remember air coming into my mouth, which startled me. I had trouble with the Wisp nasal mask, but left it on until 4AM, when it really started to drive me crazy. It seemed to give me some congestion and eventually started hurting the bridge of my nose. Anyway, let's just say it was a really bad night and I felt pretty crummy the next day. I made an appointment with my sleep doctor to talk about this situation, but there seems to be a big waiting period for him to read the test results and he's really booked up, so my appointment's not until October 12.

Today I got a call from a DME who said she'd just received a prescription from my doctor and was ready to set me up for an appointment to receive a DreamStation. However, due to the fact that this DME gets really poor reports on Yelp and also that it's a good distance away, I told her I wanted to hold off on doing anything. Apparently, they're so far away that they come to you, which is nice, but makes me wonder how hard or easy it is to deal with them after I receive the machine. My neighbor recommends her DME who gets great Yelp reviews, accepts Medicare, and is affiliated with Stanford Sleep Center. She also recommended the Res Med Air Sense 10 for Her, which I see gets a lot of positive reviews here on this website.

So here's my questions: Does it make sense to get a machine at this point? I don't feel I can do anything with it since I don't have any data from the titration. Does it seem weird that the doctor would prescribe one for me with no data? If I do go ahead and get it, I'd rather go to the good DME, but what's the usual protocol for changing machines? If I start off with one (the DreamStation), and don't like it, can they switch it out for another one, or do I have to end up buying two machines? Right now I have Medicare, but I could afford to pay out of pocket if I needed to. Is it a big deal taking the prescription to a DME of your choice?

can use all the help I can get.

[chunkyfrog]

Go directly to the "good" DME. Don't waste any time or money on the one with the poor reputation.
I have the Airsense 10 Autoset for her; and it is awesome.
You may be able to try the Smartstart feature, which is said to help cases like yours.

[Cardsfan]

You can take your prescription to any DME. If you have insurance, and want to use it, then ask your insurance which DME's are In Network.
I would call the Dr. and ask if you got a diagnosis of sleep apnea from the limited data. I don't understand why the Dr would issue a prescription if, like the tech said, you did not get enough data.
You can always switch DME's, if you do not like the first one you chose. Make sure to keep a copy of your prescription and get a copy of your sleep test results.

[chunkyfrog]

"Not enough data" probably means they did not get enough to titrate you.
No problem! All you need is an auto cpap with full data.
Many sleep studies miss the correct numbers-- mine was off by 3 cm.

[Julie]

There are only a small handful of machine manufacturers to choose from, but the top two are so close to each other in features and quality (the other 3/5 also being very good) that it almost doesn't matter which you get and very few machines are exchanged or returned for intrinsic mechanical or quality problems, only to access particular features which may have not come with the model the DME doled out or doc. prescribed (and usually that happens as much out of their ignorance of the equipment as anything... one reason this forum is so helpful). What you may well 'not like' would be the first mask you try... rarely happens in fact, and most of us go through various ones until the right one is found. The mask is almost everything!

It makes sense to get a machine (up to date and definitely auto) if you have been diagnosed with apnea because you can titrate yourself as many do as long as you download Sleepyhead software (free) that we can help you with. It goes far beyond compliance (that only the insurance co's care about) and if you have your diagnosis results we can suggest where to start from and how to continue.

[palerider]

You may be able to try the Smartstart feature, which is said to help cases like yours.

huh?

[Jeanne Ellen]

I just got the prescription sent over to the good DME. Talked to the doctor's office and they said that there was enough information to diagnose sleep apnea, so maybe I slept more than I thought I did. I did not request a hard copy of the prescription, but perhaps I can get that when I see the doctor in October. All right, I think I'm OK for today. Thank you so much for your help.

[Cardsfan]

You def. need a copy of your prescription. It should be written for 99 months, or lifetime, so it will be good for a long time. If you are on vacation and break a part, or forget something, you need to be able to use your prescription at any DME. You need to have it "On hand" where you have access to it the same day you need it.

[Jeanne Ellen]

OK. I'll get it. Sounds like I need it.

[egzbuen]

I have the wisp mask as well.

For the nose bridge issue, you can either buy paddings or make your own.

For the clogging issue, are you, or did you, use a humidifier?

Sent from heaven

[Janknitz]

Even the "good" DME may not be as great as your friend thinks. Most people don't take the time to educate themselves and understand what is good care from a DME (although the fact that your friend got a ResMed Airsense Auto for Her means she may very well be an exception to this rule).

But you need to educate yourself so you know if you are getting what's best for YOU. Does the good DME work with your insurance (you mentioned Medicare--does it work with your Medi-gap policy??). Read my "What you need to know BEFORE you meet your DME" so you will know what to look out for. The machines mentioned are outdated, but the rest of the info is still good.

[chunkyfrog]

Sorry, PR, there is a "smart" RAMP, whatever they call it, that starts the ramp when it thinks you are asleep,
which might work for someone overly sensitive.

[palerider]

Sorry, PR, there is a "smart" RAMP, whatever they call it, that starts the ramp when it thinks you are asleep,
which might work for someone overly sensitive.

ah, right, Auto ramp... you had me confused for a bit

I couldn't figure what condition smartstart could help with, other than not being able to reach the start button from the bed.

[Jeanne Ellen]

Dear Janknitz, what a great, informative article! That was just what I needed to read, and I'm so glad I read it before I stepped into the DME office. Thanks so much.
As for the Wisp mask--it did have a heated humidifier. It seemed fine at first, but as the night wore on l had the impression that my nose was just sort of closing up. Plus, it was really starting to hurt around the top and I didn't like the way air was blowing from the exhaust. When I complained, the tech brought me a mask with nasal pillows that I liked much more. However, by that time there was no way I was ever getting back to sleep. I came home with both masks, but I have no intention of using the Wisp again unless I'm on death's doorstep.

[Jeanne Ellen]

I got my prescription and see that my doctor has specified a pressure setting of 8-12 on my machine. I also found out that the good DME doesn't work with Medicare, so I've decided to buy the equipment myself. I really want to get started on the road to success with cpap. The machine my doctor's chosen is the DreamStation Auto Cpap with heated humidifier DSX500T11 and modem. The mask I originally chose was an Eson nasal mask, but since an awful titration experience, I think I'd be happier with nasal pillows. On the prescription, it specifies the Eson or "mask of choice." I called the DME to get a quote, and they priced the above equipment at $900 and $120 for the nasal mask. This seems close to the price that's quoted on cpap.com, so I think the DME sounds fair, plus they offer a good support team, so I'm planning on buying from them.

I would go forth and purchase this machine today except that I'm hesitant to do so because I had such a hard time using Cpap on the night of the titration study. The tech said she'd never been able to raise the pressure above 5 because I would immediately awaken. I don't know how I could sleep at all if we start off at a setting of 8, so I have a sense of doom about my success. My question to you is, would you go ahead and get the machine and just start in, or would it be better to wait and talk to the doctor? I have an appointment with him next week. Do sleep doctor's offer as much help to people starting out with cpap as a good DME technician?