Long time user new to the board

[wellshooter]

I was prescribed a bpap in 2004 I think. I had the Phillips M series. My sleep study in 2004 set my pressure at 18. After 6+ years of use on that machine I heard rumors that the M series had faulty logic and did not always hold pressure. My insurance would not replace it without another sleep study and I didn't have the time or feel the need so I replaced it out of pocket with a System One. No one was very knowledgable or helpful and I don't recall all the instructions I was given with the first one. But machines wear out and I have heard that they can be tested but can find no one around here that can do that. So I set the new machine, I expensed out of pocket with no support, to 18 and went on with my life.

About 10 years ago I moved 300 miles to be closer to the Grandkids, have gone onto Medicare and supplement, and have a new Dr. (or different Dr than the one who originally prescribed). My wife is severely disabled and I am her care provider so going out for a new sleep study is not something I want to do. My Dr. has proposed an "at home" sleep study which to my way of thinking will only demonstrate my need for the CPAP so that he can write a prescription that Medicare will honor. My objection is that I can't sleep without the CPAP now and I am afraid that I am risking my life doing this test.

I pulled the card on my current machine thinking the data would be all that is needed to validate my prescription. But I can't read the data. Can someone point me to a downloadable software program for MAC that will allow me to display the data ? The card has data on it, I just can't open it.

I will have many more questions later if I can't find the answers by searching the board.

[Julie]

https://sleep.tnet.com/resources/sleepyhead
https://sleep.tnet.com/resources/sleepyhead/shorganize

[Pugsy]

Which model System One do you use? Model number is a 3 digit number on the bottom of the blower unit.
Depending on model you may or may not have much data at all anyway.

Medicare will require more than the doctor writing a RX for the machine before they will pay for it. They will require sleep study results and it has to be a sleep study done per their requirements and if you don't have access to your old sleep study records that proves need and is one of their approved types of tests you will have to have a new sleep study. There is no way around it that I am aware of.
The old study would probably be sufficient but you have to have those records first. There's a lot more to it than just the doctor saying you need cpap and writing the order.

Medicare does allow home sleep studies as long as they meet certain criteria....so a home study is an option if those other records aren't available or if they happened to not be the kind of sleep study that Medicare approves.

[D.H.]

To the OP:

Please fill in the equipment in your profile. Assuming that you do it correctly, we will know exactly what type of equipment you have.

[Julie]

But if it's incorrect, he'll go to jail?

[Pugsy]

But if it's incorrect, he'll go to jail?

Maybe there's a new law that we don't know about that he's found with all his reading and dreaming up weird stuff.

The only reason I asked about model was to maybe save him some time messing with the software. If he's got a brick it's a waste of time even getting the software.
Even if he didn't have a brick the machine being used doesn't prove need. Just might prove the machine is being used effectively.
Medicare won't give a hoot about what the reports say about using the machine until it is first proven that it is needed...and the only way is a sleep study. Even if it was chocked full of untreated apnea events which points to sub optimal therapy Medicare wouldn't care.

Medicare has some rules/criteria in place for cpap users who were diagnosed prior to Medicare age....those rules must be met and one of those rules is the sleep study requirements. Now the old sleep study might be sufficient but one would have to get it and submit it to certain. Without it there is no chance of getting Medicare to pay for anything cpap related without a sleep study proving diagnosis. A doctor saying so isn't enough.

[wellshooter]

Thank you Julie. I downloaded the app and read the card and the app reports that all that is on it is compliance data. Rather useless I suppose.

Pugsy - It is a 250P if I am reading the right number. Old enough that when I filled out my profile I couldn't find it listed.

D.H. Equipment profile attempted. Cannot find my machine listed.

Pugsy - Obviously it is a "brick", however that is new information to me.

On to other topics. I will either do the test or purchase a new machine OOP.

I have a nasal type mask. At my high pressure I have to keep it quite tight to keep a seal. I have found that a little vaseline on the end of my nose will keep the seal through the night. Face type masks, and I have tried on several, always leak around the bridge of my nose. I have a very thin nose bridge and they won't seal there. Current Brand and type is Phillips but otherwise unmarked. I buy replacement head gear and consumables usually off of Amazon about every 6 months.

I have the heated humidifier. I also recently purchased a SoClean machine. Seems to be a great investment.

My problems with the current setup.

Problem 1 - Occasionally lose some seal during the night and wake up with my nose very cold. This leads to severe sinus drainage during the day. A major irritant. Boosting the humidifier setting helps some but leads to congestion in my lungs. I attribute that cold nose to the Bernoulli principle. Am I right ? Would a heated hose help ?

And the closely related Problem 2 - I live in the edge of the desert Southwest. This means that the humidity can swing wildly in Fall and Spring. I have taken to watching the dew point very closely to adjust my humidifier. As the dew point drops below 30 degrees (it can go all the way to 0) I raise my humidifier setting to 3 , as it comes up above 50 (it can get as high as 90) I lower it to 1 or even 0. In 24 hours I have seen the dew point swing 80 degrees. It is very difficult to stay ahead of because dew points are not commonly forecast. I need a machine that can track and adjust for dew point for me while I sleep.

If this is confusing its because of the way its written. Sorry, I have difficulty explaining it to non cpap people. Maybe users will understand.

[Julie]

No - it's not all compliance data by a mile! SH is a comprehensive program used (not on phones tho') on the computer and has the most data of any results based one around... it's what most here use and post their data through Imgur (as explained in the links) so we can all see what's what and help you get set up - but, you do need a computer that isn't a brick (hadn't realized that's what you had).

[Pugsy]

I need a machine that can track and adjust for dew point for me while I sleep.

Actually this is very doable. The machines have come a long way since you got the 250 model. The newer Respironics and ResMed machines have humidity sensors built in to the machines and they take into account the ambient humidity and adjust the heat to the water so that the humidity delivered is constant and consistent with the humidity selection you select. On nights where there is less moisture in the air the machine might use quite a bit of water and on the nights where there is more moisture in the air (like when it is raining or whatever) it might use little to none water because it doesn't need to add any more moisture.
It's nice to pick a setting and then forget it and let the machine do the work for you. I pick what I like and the machine uses the water if it needs to and doesn't if it doesn't need to. I don't have to do anything or worry about it. The night's when it rains and I might have the windows open...won't use much if any water but on the nights where the air is less humid it will use more water and all the time the humidity delivered to my nose never varies and I don't have to mess with it.

The heated hose affects the hose air temp. Comfort thing. I use one year round...crank it up in the winter because my bedroom gets cold and I don't like the cold air in my nose. Turn it way down in the summer because I don't like air that is too warm.
All the while the humidity stays constant because the hose air temp and the humidity can be set separately.

If you got a newer machine that had full data you might find you don't need that 18 cm pressure to keep the OSA under control.
It's easy to manage yourself. There is even free easy to use software available for you to monitor things yourself.
Also there are machines that will auto adjust the pressure so you don't have to use higher pressures all night if you happen to have times when you could get by with a lower pressure. That's what I use because in REM I need higher pressures than I do in non REM...and REM only makes up about 20% of the night so I only have to use the higher pressures 20% of the night and I am asleep and never notice the changes. The machines that can auto adjust are called apap machines. They are actually cpap machines that have 2 modes of operation...the fixed cpap mode like you are using now and a mode where the machine can auto adjust as it needs to within the parameters you might set. So 2 machines in one.

Based on what you have said so far I would suggest that you maybe look at a ResMed APAP machine.
Either the slightly older and now discontinued S9 AutoSet or the newest model the AirSense 10 AutoSet. Both have the humidity sensing I mentioned above. Both have heated hoses available if you want to use one without adding anything special to the machines in terms of power requirements...or you can use a regular hose if you wish. The S9 can sometimes be found a little cheaper because it has been discontinued but it's pretty much the same thing as the AirSense minus some minor setting choices that aren't critical.
Someone had one not long ago for sale here on the forum that was brand new zero hour. I don't know if he still has it or not but could find out if it interest you. I think a little less than $400 and that included shipping...I can find out for sure it you are interested. Humidifier was included.
The AirSense 10 machines have the humidifier built in...no more separate units to deal with.

Up to you if you want to do the sleep study needed to get Medicare to pay for stuff. What you could do is buy your own machine and do your own thing and still go through the hoops later to get Medicare on board. They get you a machine and the one you bought on your own can become a back up or travel machine if you wish.

I use an AirSense 10 AutoSet for Her...it is like the regular AutoSet with the auto adjusting mode and cpap mode but it also has an additional auto adjusting mode that is a little different...so it's 3 machines in one.
See the link in my equipment profile to get an idea what these machines are like.

Software to see what the machine can offer...see this thread for some examples
viewtopic/t158560/How-to-post-images-for-review.html

and go here and see what is offered.
https://sleep.tnet.com/equipment
and more examples of what you can see with SleepyHead which will work just fine with either the S9 AutoSet or the AirSense 10 Autoset.
https://sleep.tnet.com/resources/sleepyhead/shorganize

[wellshooter]

Thank You Pugsy. You are very helpful. I have a lot of reading to do.

I have to decide between the PR Dreamstation and the ResMed 10 I guess.

My main wants are a heated hose and auto adjusted humidity.

If there are others that can do these things I need to find them and learn about them.

I have read your summary of the PR 60 and ReMed 10 and learned much.

If anyone has any info or comments on the PR Dreamstation I would like to see that too.