Have an Autoset for Trial....I'm having problems

[Windmill]

Hi windmill,
I'm waiting for approval for a new auto cpap from Ontario Assistive Devices (OHIP). The DME sent my application on March 25th, and still have not been approved!
I called last month and they told me that there is a backlog of 2 months. I called the technician of the sleep lab where I was diagnosed with severe sleep apnea, to call OHIP but she has not heard from them. In the meantime, I have an old Remstar Auto CPAP machine that my DME rented to me. I've been having some occasional problems with it, such as the suffocation feeling when I wear it with my Quattro mask. My min. setting is: 7cm and the max is set to 16. I ordered the Resmed S8 Autoset II and will have a new Quattro mask, it seems that this machine is specifically designed to work better with the Resmed masks and if you have another mask like a Respironics or other brand, the sleep technician has to modify the pressure settings so you get maximum benefit. I agree with paul56, many DME's don't know how to set up these machines correctly. Every case is different, I still get the occasional bloating, since I've been also diagnosed with GERD, sleep apnea is deadly if left untreated, but also frustrating to deal with at times!!!
I hope that you will get approval soon of your new auto CPAP!

I know that it can take a long time to get approval for an auto CPAP. My DME told me IF I qualify it could take up to 6 months to get the approval,(sure does seem like a long time ) and that the sleep Dr. would have to write a letter to explain why I would need an auto and possibly have another sleep study using the machine. I have had 2 heart attacks in the last three and a half years so they want me to use this machine no matter what. I did mention to the DME that ADP probably doesn't care about my other health issues, they are only interested in the numbers, so it won't be for lack of trying if I don't qualify. By using this auto for a couple of weeks I am hoping that it shows a variance of at least 4 between pressures that I need in order to qualify. If I do qualify it would be a Resmed S8 Autoset II that I would get. I can't use EPR on the machine I have right now in the auto mode and I really miss that. They give you whatever they have there at the time to use. I am lucky so far I'm not paying for anything, it is all a "trial" basis.

[anotherRandy]

I will call the DME in the morning and hopefully she will tell me how to change the settings. I don't want to have to drive to the office just for that when I know it is just a matter of pushing a couple of buttons... I certainly know how to do that.

Anyone can push buttons. It's knowing which buttons to push that is the key!!!!!!!!!!!!!!!!!!!!

[Windmill]

Here's hoping I have all the right ones

Thanks for all the input.

Marlene

[billbolton]

Your DME is sticking you with an outdated piece of equipment.

What was it about "The DME was willing to let me have this machine to try" and "returning it" that was unclear

For the purpose of trialling whether an APAP is more suitable than a CPAP in the circumstances described, there is no significant difference between an S8 Autoset and an S8 II Autoset

Cheers,

Bill

[spitintheocean]

What was it about "The DME was willing to let me have this machine to try" and "returning it" that was unclear

For the purpose of trialling whether an APAP is more suitable than a CPAP in the circumstances described, there is no significant difference between an S8 Autoset and an S8 II Autoset

My Ontario DME also let me "try" an APAP machine until they received the completed ADP form from the sleep doctor. When that didn't show up after a month or so they asked me to pay for it while they completed the ADP forms as though it was a cpap unit. The provincial support for a cpap unit is hundreds less than for an auto. The DME doesn't care since the patient pays the difference.

You managed to link a reference to returning with the unit so the DME could take readings as though the "borrowing" and returning were inextricably linked. What do you think will happen when this patient returns with the unit to download the data and the doctor's prescription for an apap has not been received? We regularly hear of patients that have been passed off cheaper or older units because they didn't know better. Would you prefer that I had not alerted Windmill to be on her guard to avoid something similar occurring with her?

As for the difference between the older and newer units, EPR has been shown to have the greatest impact on new patients ..... why wouldn't she want to trial the unit that has the greater potential to do her the most good? Wouldn't you first need to try out EPR before you decide it isn't nececssary?

[billbolton]

You managed to link a reference to returning with the unit so the DME could take readings as though the "borrowing" and returning were inextricably linked. What do you think will happen when this patient returns with the unit to download the data and the doctor's prescription for an apap has not been received?

Conspiracy theories are down the hall!

[spitintheocean]

Bill,

I thought that you were better than that last remark.

Please don't confuse cynicism for paranoia.

[rested gal]

I ordered the Resmed S8 Autoset II and will have a new Quattro mask, it seems that this machine is specifically designed to work better with the Resmed masks and if you have another mask like a Respironics or other brand, the sleep technician has to modify the pressure settings so you get maximum benefit.

The Autoset II is a good machine, but whoever told you that a sleep tech has to modify the pressure settings for maximum benefit if you use a brand of mask other than ResMed's... I'm not so sure that's the case. Might be for some people.

I'd think that any mask which fairly closely matches the expected vent rate of an equivalent ResMed mask would do fine for most people, without any adjustment of the pressure settings for "maximum benefit."

Every manufacturer is going to test their own machines with their own masks...and recommend that their own masks be used. I doubt if many (any?) bother to test their machines with other manufacturers' masks. Why should they, when they can recommend their own masks and be done with it?

I could be entirely wrong, but I'd use whatever brand of mask was most comfortable to me. Finding a mask a person can actually sleep comfortably in is of the utmost importance, imho. If that means using a different brand of mask with a particular autopap, that's what I'd do.

Now, if the DME were talking about a VPAP Adapt Servo machine and using only the recommended masks for that particular machine, I'd agree.

[Velbor]

I could be entirely wrong, but I'd use whatever brand of mask was most comfortable to me. Finding a mask a person can actually sleep comfortably in is of the utmost importance, imho. If that means using a different brand of mask with a particular autopap, that's what I'd do.

I agree with you that comfort (and acceptable leak patterns) must be the primary drivers underlying selection of a mask. However, I have posted data demonstrating that under identical conditions, different masks can have significantly different therapeuctic performance characteristics -- different respiratory event indices, time in apnea, and pressure responses from AutoPAP algorithms.

My testing has not been sufficiently wide that I can state confidently that the principal consideration is the "type" of mask -- nasal vs. full-face, though that would be my conjecture -- since I have so far collected data for only one mask of each type, and both from the same manufacturer. (I have recently begun using a second FF from another manufacturer, but it will be a more than a few weeks before adequate data is collected and analyzed.)

So, while comfort and leak management are primary, I would urge caution to avoid the suggestion that there are no other considerations, or that there might not be appropriate "adjustment" of machine settings when switching masks. Velbor

[cycloman2005]

I called my DME and the sleep lab technician yesterday, Ontario Assistive Devices rejected my application because my doctor did not fill out the prescription correctly according their new rules when submitting an application for a new Auto CPAP. The doctor originally wrote my min. and max. titrated pressures when I sleep on my side and my back, but forgot to put 8cm@ sleep on side and 16cm@ on back. The doctor wrote the word: "at" instead of @, is that not silly or what! Just for that technicality, I've been waiting for almost 3 months! They did not even contact the sleep lab or my DME, what incompetence! The sleep lab technician and doctor re-submitted my application and I should be getting my auto CPAP in the next couple of weeks. The sleep lab technician called back Ontario Assistive Devices to clarify, thank God she was so helpful and competent! I also found out that I do have some apneas @ 16cm pressure, the technician told me that I avg. 30 events/hr, compared to 55 events on my initial sleep study. I increased my max. pressure to 18cm, I slept very well last night, feeling well rested this morning! My min. pressure is currently set @ 6cm and my max.@ 18cm on my Remstar Auto and the ramp time to 0.
I'm anxious to see if the Resmed 8 Autoset II that I ordered with the EPR technology, will help alleviate my GERD and asthma symptoms compared to the Resmed Auto that I've been using for the last 5-6 months. I guess it takes time to become a expert of CPAP therapy! This board has been a valuable source of information to help me better understand!

[cycloman2005]

Another update, I called Ontario Assistive Devices yesterday about my approval for a Auto CPAP machine, I finally managed to speak to the program manager regarding my application. She said she would call back in the afternoon, to my surprise they pre-approved my application and my DME would get paid in 4-6 weeks. Yipee! She also explained that the doctor forgot to wrote my fixed titrated pressure on my prescription, part of their new policy, that's why my application was rejected initially. The DME specialist told me earlier, but were not very helpful. I've been waiting since March, I hopefully will get my new machine soon! The DME seem only to care about profits and not patient care. i learned from this experience that you have to ask questions and follow-up and be persistent.

[Windmill]

I had so much trouble with the auto that I went back to regular Cpap, I needed to get some sleep. We were going camping so didn't want a whole lot of issues. I am still using a loaner, a Resmed S8 Elite. The pressure is set at 8 for the time being. Today I am going for a Cpap clinic at the sleep Dr.'s office. I don't know what this involves but will find out this afternoon, I have to take my equipment with me. I still have a hard time falling asleep even with meds and wake up very early. My numbers don't look too bad so I guess it will just take some time. I have been playing around with the EPR and I really like it at 3. The particular auto I had didn't have any EPR to use in the auto mode, don't know if that would have made a difference or not.

[Slinky]

I would have kept that APAP and just reset it in CPAP mode!!!! As much as I liked my Resmed S8 Elite I woud NOT have given up my Resmed S8 AutoSet Vantage to get it back!!!!!

[ricochetv1]

Another update, I called Ontario Assistive Devices yesterday about my approval for a Auto CPAP machine, I finally managed to speak to the program manager regarding my application. She said she would call back in the afternoon, to my surprise they pre-approved my application and my DME would get paid in 4-6 weeks. Yipee! She also explained that the doctor forgot to wrote my fixed titrated pressure on my prescription, part of their new policy, that's why my application was rejected initially. The DME specialist told me earlier, but were not very helpful. I've been waiting since March, I hopefully will get my new machine soon! The DME seem only to care about profits and not patient care. i learned from this experience that you have to ask questions and follow-up and be persistent.

And I thought American medical care w/insurance was ridiculous... supply govt. beaurocracy to the mix and it becomes a true nightmare. More affordable, but a freakin' nightmare, none-the-less.

[cycloman2005]

I called my DME this morning, they will order a Resmed S8 Autoset II, new Quattro mask and hose, they will call me when it arrives hopefully in a week or two!
I'm anxious to try the EPR feature that windmill mentioned in her post, it should relieve some of the bloating and reflux issues, I've been experiencing at the high pressures due to my severe sleep apnea.