Switching to an Auto Adjusting Machine - No help from DME

[RosemaryB]

You should definitely get more than your prescription. You should get your complete sleep study and complete titration study, too. By this, I mean, the study with all the graphs, charts, not just the doctor's interpretation of those graphs and charts.

Thanks, I believe I will get these at my next appointment with my P.A. We pushed the appt. out a couple of months so I can get used to my machine, but she did say she would go over the results of the sleep study at that time.

Appreciate the response!

[neillebo]

Sorry if i am posting in multiple places. I am a newbie here and obsessed (as i believe we all are.. in a good/right way)... I decided to do some research here and then just ignore my doctor (not willing to give the apap, etc) and call the online providers AND my insurance company directly. I have United Healthcare. They put me in touch with the right department who told me that i had to give them the exact name of the company i was going to buy from and the insurance codes/cost etc BEFORE I buy.. then i can order it and send the claim to the insurance company. Yes, a DME would be in network and would have to meet my deductible (in my case $300) and then would pay 80%... for online, once they have the "Purchase authorized", they will reimburse me after i meet a $600 out of network/in network deductible (lucky me i had surgery this year and met it) and then only 65%... of course, that will still cost less than what the in network would cost due to the high dme cost. .I also dont have to get a darn apap rx from my doctor as they accepted my cpap rx.. All of that said, it seemed a bit too easy and a) i dont have my apap shipped yet- who knows maybe they call my doctor and she interferes or something and b) i dont have my money back from insurance of course.. they documented my call, including the fact that i already have a covered cpap machine from my dme that i will return, so anything can happen and, who knows, maybe they give me a hard time. I did ask the question every which way but sunday (i love that expression but dont know how it applies or what it means) to make sure that i would be covered as long as i return the dme one. but who knows. my dme provider was very upset and told me that isnt allowed.. but that's what they do.... Not even sure that i was going to tell my doctor. but my dme says they wont pick up my machine unless the doctor sends an rx discharging the unit for pickup. what a racket.. And i love this thread more than most... they really are in it for the cash. My doc has no interest in talking to me about any of the results. i just get her PA.. A friend of mine works in mktg for a sleep clinic and it's all big bucks. OF COURSE they hate apap. i'll never have to go back to her.. anyway, if anyone knows of a reason why I am wrong, pls tell me.. but so far, so good... ciao

[goose]

Hey 62Chev,
Welcome to the clan of hoseheads.....
You have received excellent advice here and it appears you are learning and listening -- that's precisely what we all did and most of us are far better for it. You have questions?? We have answers!!!!

Beware of those posts listed as "Guest" with no other identification -- especially those that make seemingly irrational statements......Most are what we call "trolls" or "hit and run" or "drive by" posters and I would venture to say this one was a DME or rep that doesn't appreciate the advice to purchase online. If you purchase online, they can't rip off your insurance company for 3 times the $$$!!!! They pop in, stir the pot and leave, not having the guts to identify themselves -- you'll see 'em every now and then.....

That said, I do use a brick and morter DME. I have a fairly good one, but I did have to train them.
They tried to deny my request for APAP, so I asked my doctor for a machine specific prescription which she wrote ( I also have a very good doctor!!!). I had to remind them that I was concerned about my health and treatment and didn't give a hoot about their profits.....
I also mentioned to them that I had the software to control my machine and already knew the "procedure" to set the machines pressure etc., and that I would do so when I consulted with the doctor......In saying that they now understand that every time I need a 60 second change to my treatment they're not going to be able to bill my insurance company for a "service call" -- probably $100+ they really didn't earn.
I do get my new masks every 3 months, my supplies (new humidifier water tank, filters, hoses) from them also. I have ordered online and I have also used a different DME and just paid out of pocket.....
Having a good DME and doctor, I also seem to have pretty good insurance as well -- I haven't paid a dime for any of my DME supplies, machines etc. Only my chosen out of pocket items.
I consider myself extremely fortunate in that!!!!!!

DS - I really like your new avatar!!! Also, well said post!!!!!

Take care Chev -- keep us up on how you're doing
cheers
goose

[62chev]

Hey 62Chev,
Welcome to the clan of hoseheads.....
You have received excellent advice here and it appears you are learning and listening -- that's precisely what we all did and most of us are far better for it. You have questions?? We have answers!!!!

Here is an update. I finally received my machine (M seriers Auto CPAP with A-flex) from my local DME. I tried to purchase online, but the fact I already had a month worth of rental processed on a machine from my local DME made me ineligable to go through insurance with the online provider.

My machine was left at the factory settings (4-20) by the DME (so much for their assistance) fortunately I was able to set my machine myself with instructions received in this forum (you guys are great). I increased my low pressure to 7 (doesn't feel like I'm starving for air now).

I still have not made it through the night without tearing the thing off (because it is so uncomfortable etc) but I'm still trying..... My keeper (wife, bed partner, better half) is about ready to ask me to find alternate sleeping arrangements.... at least this time it isn't the garage! She refers to me as Sir Hiss! (robinhood)....

I ordered the software & reader online so am anxious to see what is actually happening during the night.

Just a 'funny' about my DME, the gal that 'trained' me on the the Apap machine was the same one that gave me so much grief about returning my CPAP machine. She asked me (as if she had forgotten) why I chose to go with the APAP with a-flex machine. I told her I couldn't stand the CPAP machine and the feedback online was very positive for the APAP machines....

She said she was surprised that more people didn't order the APAP machine, since the few that they have sold, the people really like them. HELLO!!!! excuse me, is this the same DME, employee that read me the riot act just last week when I dared to question, much less request a different machine...... go figure.....

Anyway - lessons learned:
1) be persistant
2) listen to others advice on this forum
3) go to lesson 1

Thanks again to everyone for helping a newbie.

Hopefully I will make peace with my machine (and wife) and sleep through the night with both......

ZZZZzzzz

[rested gal]

Just a 'funny' about my DME, the gal that 'trained' me on the the Apap machine was the same one that gave me so much grief about returning my CPAP machine. She asked me (as if she had forgotten) why I chose to go with the APAP with a-flex machine. I told her I couldn't stand the CPAP machine and the feedback online was very positive for the APAP machines....

She said she was surprised that more people didn't order the APAP machine, since the few that they have sold, the people really like them. HELLO!!!! excuse me, is this the same DME, employee that read me the riot act just last week when I dared to question, much less request a different machine...... go figure.....

ROTFL!!!

[Karyn526]

But it drives me crazy. I can't get to sleep fpr the life of me. At least the sound was somewhat constant when he was on cpap. He wanted to try the using the straight c flex features but found out it is disbaled. We have checked the settings and the pressure is set to 9 so we are wondering if it is configured for straight cpap only. The c flex feature is disabled and it just angers us that the insurance company/dme will allow him to have this but then disable the features making this such a great unit. Anybody got a clinicans guide to PM me???

[cflame1]

Karyn,
In simple terms... unplug the machine and while you're plugging it back in, press the left and right buttons. To get through the menu, use the up and down buttons.

Before you make any changes, write down everything in case it needs to be changed back or something.

[Wulfman]

But it drives me crazy. I can't get to sleep fpr the life of me. At least the sound was somewhat constant when he was on cpap. He wanted to try the using the straight c flex features but found out it is disbaled. We have checked the settings and the pressure is set to 9 so we are wondering if it is configured for straight cpap only. The c flex feature is disabled and it just angers us that the insurance company/dme will allow him to have this but then disable the features making this such a great unit. Anybody got a clinicans guide to PM me???

Which machine? (specific model)
If it's the machine in your profile, it's a low-end "Legacy" model that doesn't have C-Flex. Respironics made two models of the "Plus" machine.....one with C-Flex and one without. If yours looks like the one below your post, look on top of it to see if it has a purplish-blue sticker with white letters on it that would say "C-Flex Feel the difference". If it doesn't have that sticker and only has 3 buttons......Ramp, Heat and On/Off......then it's the model without C-Flex. The model WITH C-Flex has two additional (grey) "User" buttons below the LCD screen.

Den

[ozij]

Karyn,
Could you perhaps start your own thread?
And tell us who is "he", and why you have this machine "REMstar Plus CPAP Machine" on your profile? I find your post very confusing: This REMstar on your profile doesn't even have c-flex - it's as basic as basic can get. And a straight pressure of 9 is just that - straight 9.

O.

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, C-FLEX

[Wulfman]

Here are the instructions for BOTH machines:

Den




REMstar Plus CPAP w/C-Flex

1. With the machine plugged into a wall outlet, unplug the cord from the back of the CPAP. Then, press and hold down the two user buttons below the display screen while plugging the cord back into the CPAP, and continue to hold the buttons down until the CPAP beeps. This will indicate that the CPAP is in the Therapy Setup Menu.

2. The display will first show the number of hours the machine has been used. To erase this total and begin again at zero, press and hold the ramp or humidifier button. An “X” will appear on the display. Hold the button down until the time change to “0” and the “X” disappears.

To skip this setting or continue, press the right user button.

3. The elevation setting will appear next. To change this setting, press the ramp or humidifier button until the correct setting appears. Here are the elevation settings: 1 = less than 2,500 ft.; 2 = 2,500 to 5,000 ft.; 3 = 5,001 to 7,500 ft.

To skip this setting or continue, press the right user button.

4. The therapy mode will appear, either CPAP or CFLEX. To change this setting, press the ramp or humidifier button until the correct setting appears.

To skip this setting or continue, press the right user button.

5. The CPAP pressure will appear. To change this setting, press the ramp or humidifier button until the correct setting appears.

To skip this setting or continue, press the right user button.

6. The CPAP fine adjustment setting will appear. This setting allows you to calibrate your CPAP pressure to a manometer. We suggest you do not try to adjust this setting.

To skip this setting or continue, press the right user button.

7. The CFLEX setting will appear if you selected the CFLEX mode in number 4 above. A setting of 1 offers the least drop in pressure, 3 offers the most. To change this setting, press the ramp or humidifier button until the correct setting appears.

To skip this setting or continue, press the right user button.

8. The ramp time will appear next. It may be set for 0 to 45 minutes in 5 minute increments. To change this setting, press the ramp or humidifier button until the correct setting appears.

To skip this setting or continue, press the right user button.

9. The ramp starting pressure will appear. To change this setting, press the ramp or humidifier button until the correct setting appears.

To skip this setting or continue, press the right user button.

10. The patient disconnect setting will appear. This sounds an alarm when there is a mask leak and turns the airflow off. 1 = On; 0 = Off. To change this setting, press the ramp or humidifier button until the correct setting appears.


There are no other settings available. Press the pressure start/stop button to exit the menu or press the right user button to scroll through the settings again.


-----------------------------------------------------------------------------------------


REMstar Plus wo/C-Flex Setup

IMPORTANT!
When the device is in the Therapy Setup Menu, the humidifier and ramp buttons operate as up and down keys to change the settings and the pressure on/off button will take you to the next screen.

Therapy Setup Menu
1. Plug the pronged end of the power cord into an electrical outlet. To enter the Therapy Setup Menu hold the ramp and pressure on/off buttons down while plugging the power cord into the device. The airflow will automatically turn ON and the display screen will show the current elevation setting and the unlock symbol.

IMPORTANT!
Prescribed therapy settings can be set only using the Therapy Setup Menu.
To prevent patients from tampering with the settings, the directions to access the Therapy Setup Menu should not be revealed to the patient.

Elevation Setting
a. The elevation setting and symbol will be displayed.
The patient also has access to this setting in the Patient Setup Menu.
Lo = less than 2,500 ft. (<762 m.)
M = 2,500 to 5,000 ft. (762 m. to 1524 m.)
Hi = 5,000 to 7,500 ft. (1525 m. to 2286 m.)

Note: Altitudes of 7,500 ft. (2,286 m.) may affect the accuracy of the pressure. Verify the pressure settings with a water column manometer.

To change the elevation setting, press and release the ramp or humidifier button until the correct setting is displayed.
Press and release the pressure on/off button to go to the next setting.

Pressure Setting
b. The CPAP pressure setting will appear.
To change the setting, press and release the ramp or humidifier button.
Range: 4 to 20 cm H2O (in 1 cm. H2O increments)
Press and release the pressure on/off button to go to the next setting.

Fine Adjustment Setting
c. The CPAP fine adjustment setting will appear. This setting allows you to calibrate the device so that the pressure setting can be verified with a manometer.

If you DO NOT want to calibrate the device, press and release the pressure on/off button to go to the next setting.

If you DO want to calibrate the device, follow the directions below:
1. Connect the patient circuit to the REMstar Plus. Make sure there is an exhalation leak in the circuit.

2. Zero the manometer and connect the manometer at the patient mask. Make sure the pressure has stabilized (let the manometer sit for at least 60 seconds).

3. If the pressure setting is not the same as the manometer reading, press and release the ramp or humidifier button to change the setting.
Range: -0.9 to 0.9 H2O (in 0.1 cm H2O increments)
Press and release the pressure on/off buton to go to the next setting.

Ramp Time Setting
d. The Ramp Time symbol and setting will appear. The patient also has access to this setting in the Patient Setup Menu.
To change the setting, press and release the ramp or humidifier button.
Range: 0 to 45 minutes (in 5 minute increments)
Press and release the pressure on/off button to go to the next setting.
Note: If the ramp time is set to "0" minutes, or if the CPAP pressure setting is 4 cm. H2O, the following ramp setting will not be displayed. Go to Step f.

Ramp Starting Pressure Setting
e. The Ramp Starting Pressure symbol and setting will appear. To change the setting, press and release the ramp or humidifier button.
Range: 4 to Prescription Setting (in 1 cm. H2O increments)
Press and release the pressure on/off button to go to the next setting.

>4 Setting
f. The number of times this device has been used for more than four consecutive hours (>4) will appear. To erase the total and go back to zero, press and release the ramp or humidifier button.
An "X" will appear in the upper left corner and the total will change to "0000". (Pressing the button again will restore the original count)
Press and release the pressure on/off button to go to the next setting.

LED Setting
g. The LED on/off symbol and setting will appear. This setting allows you to have the lights behind the button turned on or off.
The patient also has access to this setting in the Patient Setup Menu.
1 = ON
0 = OFF
To change the setting, press and release the ramp or humidifier button.

Exit Settings
h. To go back to the beginning of the settings, press and release the pressure on/off button.

To exit the Therapy Setup Menu, hold the pressure on/off button down and press the ramp button one time. Release the on/off button. The airflow will turn off.

[Guest]

I was diagnosed with Sleep Apnea in 1978, cpap wasnt developed until 1985. I bought the first cpap <respironics> in 1985. It was big as a truck and sounded like a 747 taking off.
Many Machines later, It was recommended that i get an auto titration machine. Respironics makes one and Resmed.
After trying both machines, I chose the resmed, in my humble opinion the resmed is far superior to the respironics.
After so many years of forcing a hurricane up my nose. Ive developed some issues, which can change my pressure needs often. Well none of us can go for a sleep study every couple of months..I was in a quandary...the auto machine has solved alot of the problems for me.

[drummergirl410]

I hope that you're able to get a machine you need. I was given a ResMed s8 AutoSet Vantage for a two week trial and absolutely loved it! I had no problems exhaling. The auto setting for me is effortless to breathe with. After that, my DME tried to play the ol' switcheroo and give me an s8 Compact, which is a straignt cpap with no EPR, no data, no nothing. I used it for an hour and felt like a balloon! I had a very acute case of aerophalgia (gas in the stomach caused from the air being swallowed) It was like breathing against a brick wall! I called the emergency number for my DME and subsequently spent the rest of the night without the machine and a serious case of gas that it took another day to get rid of. After a lot of fuss with my DME RT and finally agreeing to pay the difference in price from what I was told "the insurance would not cover", I got my auto machine back. It was totally worth it!

I have tried the Vantage in cpap mode with EPR. I found the best setting for me was an EPR of 3. Running it in this seting is much more comfortable than straignt cpap, but a shade shy of the comfort I get in auto mode. RestedGal is right, the EPR only works on straignt cpap mode with the Autoset Vantage, however, I wouldn't feel the need for EPR in auto mode anyway because it's so comfortable as it is. I say all this from personal experience and everyone's response is different. My pressure is relatively low compared to some and there are folks with higher presures that like the option of exhale relief in auto mode.

Keep fighting and don't give up! Don't settle for less when it clearly doesn't meet your needs, and don't let the DME push you around, should you still decide to use one.

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, CPAP, DME, auto