S8 verses REMstar Auto

[hayeswildrick]

My doctor, somewhat at my insistance, prescribes a REMstar Auto @ 9. She added to the prescription, "or" Resmed S8 with EPR.

With no surprise, the DME is insisiting that they will sell me an S8, since the prescription calls for a set pressure. It also, she admitted, is a function of the fact that they get the same reimbursment for either machine and don't want to eat the difference.

I've already asked "Bill My Insurance" to give me a price for the REMstar, but I'd really like to get specific feedback as to when/whether I should settle for a non-Auto machine. The S8 looks like a good machine, just not auto. Do I really need auto, or am I just going for bells and whistles?

Jeff

[Slinky]

Very few of us really NEED an Auto, BUT - they sure can come in handy when we haven't quite yet found "the" pressure, "the sweet spot" that gives us our best results and most restful sleep via our original titration study and they "can" be used in place of an additional sleep study from time to time.

That being said: Resmed makes a GOOD machine AND the data available vie their nice size, easy to read LED screen if given access to the Advanced Patient Menu is really, really nice.

I would take your script back to your sleep doctor and tell her that the "or Resmed S8 Elite" is NOT what the two of you agreed upon and ask her to re-write the script for the Resmed S8 Vantage which IS an AutoPap or RemStar M series Auto w/C-Flex? Now you ARE talking comparable machines and your DME has his/her choice of which profit difference to swallow.

The Resmed AutoScan 5.7 software and card reader "are" available online. You just need a little "help" looking for and finding it which is readily available via a PM from any of several members in this forum so that shouldn't hold you back from accepting the Resmed S8 Vantage if that is the way your DME opts to go.

There's more than one way to skin a cat and get what you want. Good luck.

[TGregg]

Like you I was scripted for 9cmH2O and wanted a Remstar auto. And my DME wanted to provide a ResMed S8. I was able to talk them into upgrading to an S8 Elite which has the smart card. It also has Ramp, Smart Start and EPR.

I was pretty dissapointed, and thought long and hard about it, but finally decided to give it a try.

And I've very glad I did. Turns out I don't need EPR, nor smart start nor ramp (although I may enable those some day). I do great on my S8 Elite. In my case the smart card is definately worth it, but I don't need all the other bells & whistles.

When I was in the lab, the CPAP I tried there sucked. Or blew, rather. Exhaling against it made me question this whole idea and whether therapy would work for me. "I'm gonna have a heck of a time getting used to this" I thought as I exhaled.

But my S8 Elite even with EPR disabled is WAY better to exhale against than whatever nasty thing they had at the lab. I can hear the machine spin up when I breathe in, and decrease when I exhale, even though EPR is off.

When I read this forum before starting therapy, I was sure I would need APAP and a stand alone humidifier, and I've have rainout to deal with. Thing is, problems get much more attention than successes. That's a good thing because everybody is trying to help with problems, but one has to realize that when one reads this board. But my therapy has been great!

My DME is pretty much standard fare though, LOL.

So I wouldn't get too excited about APAP, the main thing in my case is to have the ability to see how well treatment is working by monitoring my stats (which I can do with the S8 Elite). Perhaps you can try the S8, then if compliance is a problem go to APAP.

[Catnapper]

Your question is do you need an auto. You will have to answer that.

My answer is what worked for me and may not be your answer. I started with the straight cpap. I was one miserable person. A home titration with an auto made a huge difference for me, as I seldom need the high pressure prescribed by my study. At lower pressures, I have fewer mask leaks and I am more comfortable with the breathing. The deal breaker for me was that I could (with software and cardreader) see daily that my compliance was paying off with low AHI, and few minor leaks. That helped me continue when I was tempted to quit.

Having said that, some people are happier with constant pressure. Some people don't care to look at overnight data, but judge success based on how they feel. All of those possibliities exist for you and are excellent ways to go about your therapy if they make you feel like you want to feel. However, you can do all the options with an auto. Leave it at constant pressure, and ignore the data. The machine will last usually for several years. If you change your mind after the initial purchase, the insurance, if you go that route, won't pay again for probably 5 years. In 5 years, your needs can change based on other health issues, like weight or problems with heart, diabetes, or whatever. An occasional check with the auto can give you a clue about what is happening.

Another thing that I like is the C-Flex, an option that not all people like. The RemSTAR has that as an option while using Auto, but the other maker you mentioned does not in auto mode. That is another thing to consider.

Will they let you try both? Some people have said they sleep better with one machine than another. That sounds important to me. I had that option and it made a big difference to me.

I think that what you want is a big part of your question, not just what you need. Do you want to "settle"? What I wanted were the most options I could get for treating this serious health issue.

Best wishes,
Catnapper

[NightHawkeye]

Jeff, since you asked . . .

. . . I'd really like to get specific feedback as to when/whether I should settle for a non-Auto machine. . . . Do I really need auto, or am I just going for bells and whistles?

All things being equal, it would be a no-brainer, you'd simply want to insist on the Remstar-auto. The difference in machine capabilities is not minor. There are major differences; from the ability to auto-titrate, to data collection and C-flex, which is much smoother than EPR (OK, that's a comfort thing).

Of course, all things aren't equal are they, so this is where your own judgement comes into play. I'll list the reasons why I recommend that it's worth your while to go with the Remstar-auto at this point.
1) Auto-titration is a plus, you can find your 90% pressure in a single night.
2) If you're like most of us, your 90% pressure will vary from night to night, sometimes by a lot. You might benefit a lot from running in APAP mode every night. Lots of folks here believe that they do.
3) If you're like some of us, you will experience aerophagia. An APAP can really make a difference if this is a problem for you.
4) If you're like some folks here that do a tad better on CPAP, then you still have that capability, but you also have the APAP to fall back on if your weight changes, or for other reasons you need to re-titrate yourself. (No worrying about enduring another sleep lab titration)
5) C-flex - OK, it's a comfort thing, kind of, but lots of folks still swear by it.
6) The data collection and monitoring capability of the Remstar-auto is as good as it gets. There's also that thing about not being able to get ResMed software in the U.S.

Having said all that, what are the advantages for the ResMed machine?
Hmm . . ., not much that I see.

Guess I still see it as a no-brainer. If it were me, I'd be back on the horn begging, pleading, demanding, or whatever else it takes, to have the doc rewrite the prescription for the Remstar-auto exclusively. It's your therapy. Give it the best chance for success - to me that means using every tool at your disposal. (I'd ask bluntly, if necessary, whether your doc has any financial ties to your equipment provider. If not, then why the heck does your doc care a whit about what machine is prescribed.)

Just remember, lots of folks can't tolerate this therapy, largely because of the equipment they're provided with. Good luck.

Regards,
Bill

[Wulfman]

AND......
It's YOUR health

It's YOUR insurance premiums that are paying for this stuff.

It's YOU who will be sleeping with this stuff every night.

Get the BEST!

YOU deserve it!

Den

[hayeswildrick]

Then how should the doctor write the prescription:

Her current prescription specifically states a pressure of 9. The DME says that since she's prescribed a specific pressure (as opposed to a range of pressures), she's basically saying that she wants a CPAP functionallity, rather than an APAP functionallity.

Does an APAP prescription need to say something along the lines of 5-12?

Jeff

[DreamStalker]

1) you could respond back to your DME that the range is to be set from 9 to 9 and that the doc specifically wrote a script for an "AUTO". In addition, all APAPs can function as a CPAP.

2) Call your doc and tell her that your DME is refusing to give you the "AUTO" that the doc prescribed and ask that you be given an origianl script clarifying that you are to be treated with an "AUTO" set from 9 to 9 ... if that is the doc's recomendation.

[NightHawkeye]

Does an APAP prescription need to say something along the lines of 5-12?

No, the easiest thing would be if your script had no pressure at all on it. If the doc writes the script without any pressure, then I would think it'd be really hard for your DME to pawn a regular CPAP off on you. (How would they set the pressure? (Might be fun to watch you DME's reaction. )

Regards,
Bill

[Linda3032]

Like someone said, if they want to sell you a Resmed, ask for the S8 Vantage.

Or the Remstar Auto set at a straight cpap pressure of 9.

If you want an Auto (and I did), then don't settle for anything less.


And, be sure to let us know what happens.

[hayeswildrick]

OK, This is long, so I'll understand if some folks skip this. Based on all of your input, here's the letter I'm faxing to my doctor tonight.

PRESCRIPTION REVISION REQUEST by Jeffrey ***
March 5, 2007

Dear Dr. _______________,

Thank you for your thoroughness and continuing care in the treatment of my sleep apnea. I appreciate very much the time and attention you and your office staff (especially Sharon) are spending to see that I get the best care possible.

When faced with a major purchase or life change (such as I’m facing with the start of CPAP therapy), I tend to do exhaustive research so that I can have the fullest possible understanding of my condition and options. Since my last office visit I’ve spent many hours reading and speaking to other patients – learning everything that I can learn as a layman about sleep apnea and CPAP treatment options.

I hope that you’ll take a few minutes to understand why I’m asking for the particular equipment below, and consider re-writing my prescription so that it will be possible for me to get it. Ultimately, of course, you are the doctor! If you don’t think that this equipment is the best for treatment of my apnea, I would be eager to speak with you so that I can come to a better understanding and we can work well together for long-term success in my therapy.

As I understand it, you’ve prescribed either:
1) REMstar Auto C-Flex CPAP machine with REMstar heated humidifier
Or
2) Resmed S8 Elite with heated humidifier
And that the prescription specifies a pressure of 9.

I spoke with the representative from XXX Medical Equipment, and understand that they are requesting an additional form from you before they can process my insurance. XXX also said that since your prescription calls for a fixed pressure, they will not supply an APAP machine. She was candid in explaining that their insurance reimbursement would be identical with either machine, so it was in their best interest (not necessarily mine) to supply the least expensive alternative.

Would you consider rewriting my prescription to specify only the REMstar Auto C-flex with heated humidifier, or the REMstar M Series Auto C-flex with heated humidifier, but with a range of pressures for auto-titration, rather than one specific pressure?

RATIONALE:

1) Auto-titration is a plus that will allow us to determine my ideal titration in at-home sleep conditions over a period of weeks and months. With the smart-card and Encore software, I can bring you a complete report so that you can have the maximum information to direct my care over an extended period of time.

2) The REMstar machine can be used in 4 modes:
a. Auto with C-Flex
b. Auto without C-Flex
c. CPAP with C-Flex
d. CPAP without C-Flex
The Resmed S8 has only two modes, with and without EPR.

As I understand, it’s impossible to know at this point which of these four modes will provide me with the best combination of comfort and therapeutic value. Since my insurance company will only purchase one machine every 5 years, there will be no chance of changing to a different therapeutic mode if I purchase a less flexible machine.

3) The data collecting ability of the REMstar is, I’m told, as good as it gets. In addition, it has Encore Pro software available for patient use so that I can participate with you in the data collection process. The more understanding, input, and control I have over the course of my therapy, the more likely that I’ll be able to maintain compliance.

4) Patients I’ve spoken with who are using APAP technology indicate that they have lower incidence of aerophagia. Of course I have no idea whether this will be an issue with me, but it would seem beneficial to lower the possibility at the outset.

The Resmed S8 is clearly an excellent machine – among the best of pure CPAP design. I’m sure that’s why you chose it. Nevertheless, it seems to me that the wider array of options and features on the REMstar Auto is most likely to lead to a balance of comfort and therapeutic efficacy that will enhance my chances for successful long-term therapy.

Sincerely Yours,

Jeff ***

--------------------------------------------
I'll let you know how it goes!

[Linda3032]

Jeff,

Depending on the doctor and his valuable time - the fax might be too long. And it might not be absolutely necessary. Here's my thoughts:

Did your DME absolutely refuse to give you an Auto? They can set it at cpap 9 and still meet the prescription requirements.

I would speak again with the DME -- tell them you want an auto, and ask what you need to do to get one from them.

Indicate that you are willing to go elsewhere to get it.

Let them make the decision to give you one or not. They can always call your doctor's office and request a revised prescription -- one to meet their needs to get you the machine you want.

If all else fails, then fax your doctor.

Do you have the original prescription? Keep it or a copy for future use.

[taterbug]

[quote="hayeswildrick"]I've already asked "Bill My Insurance" to give me a price for the REMstar, but I'd really like to get specific feedback as to when/whether I should settle for a non-Auto machine. The S8 looks like a good machine, just not auto. Do I really need auto, or am I just going for bells and whistles?

Jeff

[NightHawkeye]

Nice letter, Jeff. Hope it works for you. It will probably put your doctor on notice that you already know a lot more about the machines than she does. I'm betting that she won't even protest your request. Let us know how it goes.

Regards,
Bill

[Slinky]

I would just like to clarify one thing as you are ruling out one darn good machine that provides EXCELLENT data and EASY TO INSTALL AND USE SOFTWARE when you rule out a "Resmed S8".

There is more than one Resmed S8. The Resmed S8 VANTAGE is an AutoPAP and as good as ANY AutoPAP on the market. It is every bit equivalent to the RemStar Auto w/C-Flex, classic or M series. It has an easier to read LED screen, and more information available easier via the LED screen than the Respironics. And this may or may not make up for its EPR not being available in Auto mode whilst the C-Flex is available in Auto mode on the Respironics since you don't seem to have a need for the expiratory relief given your scripted pressure is a straight 9 cms.

And if you look around in the right places, I bought my AutoScan 5.7 software and cable reader CHEAPER brand new out of the box than any prices I saw for the EncorePro and cable reader.

As far as your FAX. I don't think I would make any mention of my having access to and use of the software. The full data capabilities are what is important FOR YOUR DOCTOR TO MONITOR AND TO ADEQUATELY TREAT YOU. Like the data will help HER to better treat you.