Wildly Different Numbers

[e39f10]

I kind of fell off the horse with CPAP after a couple nasal surgeries seemed to have done the trick. But things went downhill again and back to the dreaded sleep center.

Before I had a script of 12 for a REMstar Auto but as luck would have it I had some pet issues that did in the mask which is really what I needed replaced more than the machine. But I have good insurance at the moment and the old machine was about 6 years.

Sleep study came back with needing a 16 which blew my mind. AHI was in the high 60s which scared the patooey out of me but didn't make sense because the surgery DID help but did make sense cause I felt like crap.

Without paying attention (and I'm really mad at myself for this) the inhouse DME (which is something everyone should run from, there's at least an appearance of a conflict of interest) slipped me an PR One WITHOUT CFLEX. It never dawned on me a DME would do this and no one ever tried that on me before. While It was my fault for not paying attention, I not only felt victimized but felt so sorry for all the new patients that didn't know what they were getting into because I knew they could have more effective treatment with the technology that is out there that only costs a few bucks more. I think that's what made me the most depressed.

Anywho, I also found a major flaw in the insurance where my company decides ahead of time what they will pay for a machine regardless of the market or retail which discourages competition. They PROMPTLY cut a check for $2100 for the PR One (did I mention it didn't have CFLEX?) but I figured something was wrong when I got the machine home.

Basically I refused to use it. I took the new crap mask ($250 for a $90 mask on CPAP.COM) and used it on the old machine. Leaks leaks leaks but the number did adjust to 16 but I think this was because of the leaks and not what was really needed.

The DME side of the sleep business (I REALLY liked the doctor so I was becoming angrier and angrier that I was going to have to loose him if I had a problem with the DME side) basically said tough caca since I took the machine home. By the way they forgot to have me sign anything except the payment plan on the deductable.

Wanting to keep a good relationship with the doctor, I talked them in to upgrading to a PR One Pro but they would have to order it because they never heard of the thing. And since it was a "special order" they would void the payment plan on the deductible and insist I pay the original $350 deductible plus $125 more for the Pro upfront even though they got $2100 from the insurance company already.

I was ready to make a scene on a follow-up visit but they surrendered when they saw an easy out because the machine showed 0 hours. They referred me to another DME just to get rid of me but was nice enough to let me keep the useless mask and tubing for $300.

Now, my mind was completely blown by the new DME. These guys are smart and I'm not used to that. Putting my loyalty to the old REMstar aside, I LISTENED to what they had to say about the machines they prefer and agreed on an S9.

Before the tech showed up at my house I called back to verify the machine. They said it was an S9 without Autoset but with EFR. We talked a bit (imagine a DME willing to do that) and they said they could send out an auto AT NO EXTRA CHARGE as long as the script got changed.

I called for that but wouldn't you know it, the doctor would need more than a couple days to change it and of course I took business away from them by returning their machine. I called the DME not wanting to cancel the appointment but seeing little choice. I also had given up on offering any clever solutions of my own. I was going to pretend I was calling an offshore call center that couldn't deviate from a script and wouldn't have any idea what I was talking about.

To my second surprise their reaction was "no problem we'll just send an Autoset out set to CPAP only and then send a new card later". This astounded me because that was the clever solution I wanted but decided it was easier not to get mad by not suggesting it.

So, without any guarantee that they were going to get the updated script, they sent the top of the line S9 out with heated hose (which is AMAZING!).

Tech comes out and I notice that he was also smart. He came up to my level as far as recognizing that I knew my stuff and wasn't an idiot. We talked for ONE HOUR AND FORTY MINUTES. I told him what masked worked for me but also said I appreciated the fact that he wasn't an autonoman and would listen to what's changed in the last few years. Now, I have tried three different pillows and never could get satisfaction. The Activa worked and even though all that extra gyration frightens most small children and adults, it gives a good seal.

But I took the Swift FX and have been tickled pink. So in this case I didn't try to tell them what to do, and they didn't try to tell me what to do. We had an actual productive conversation.

My worries:

Q: I already took delivery of a mask from the other DME
A: We'll bill it in six months

Q: I'm worried I won't get used to the mask so I should stick with what I know
A: If it doesn't work out, I'll drive back out with a new mask and we'll repeat it until it does work. A secret in the business is that all they have to do is tell the manufacture that the mask didn't work for the patient and they just replace the lost stick. There's no reason to get stuck with a crap mask.

(I'm not saying everyone retailer or high volume website should do that since they are aimed at lowest costs)

Q: I'm worried that my insurance company is hyper paying for these things and my deductible is going to be WAY higher than estimated
A: Don't worry about it. We have a hardship department that will lower your copay in order to foster a long term relationship

(WHAT????!?!??!)

Q: Do you take Visa?
A: We don't take any money upfront. Enjoy your top of the line machine. I'm going to leave now with no money upfront even though the last DME wanted $425.

Was I dreaming?

OK, that's the experience leading up to the actual question.

I SWEAR the Remstar was set to 16 but I never used it for therapy once I saw that it was the basic model. But the old Remstar Auto was also going up to 16 on its own so I thought that the script was right. But now I'm not sure. I think there's a real good chance that the number is off because the mask was crap. I guess I could try the crap mask on the new machine but I can't be bothered right now.

When the S9 showed up the script was for 12. Funny how that number is the original number from my first test at this clinic. Kinda freaking me out. No matter I have an Autoset now.

With auto turned on, heated hose with Swift FX the AHI is hovering around 1. I feel tired but it's a different kind of tired. The pressure though has been less than 9 which is what I expected after the surgery three years ago.

So now I am suppose to believe that I started at a 12 six years ago, went to 9 three years ago after surgery and now am magically at 16. Yet, when the script is actually written I'm at 12 again but the machine titrates to 8.1.

I'm getting a LOT of sleep. It doesn't feel magically refreshing but I feel that most likely I'm paying back some deficit. I got in a huge conflict with my last job (massive lawsuits cause we say mean things about each other) and I've been having nightmares pretty much since November. So getting 4 or 6 hours sleep in one night is a big change.

The pressure is there if I pull the FX off and of course the machine seems to think everything is fine so I think everything IS fine.

The actual question is, since I don't feel "great" yet, is my thoughts about the mask from the original DME being so incompatible with me that it skewed the sleep study so bad into thinking I needed 16 when I only needed half of that?

I will test with the crap mask and when I see the S9 software I'll get detailed reports. The machine is happy, I'm pretty happy just still tired but it feels a "good" tired if that makes any sense.

I think for everything above, autoset machines should be the rule and not the exception. Cheap ass DMEs and doctors that avoid these newer features should realize that success = repeat business and happy, healthier patients.

My experience and hard knock education is rare and with therapy failure rates so high they should be doing a lot more than relying on a single sleep study and then telling you "see ya" for two years.

Did I mention my unhappiness with the sleep study process? Let me tell you. . .

[mars]

Did I mention my unhappiness with the sleep study process? Let me tell you. . .

Hi e39f10

It's ok - you really do not have to tell me about the sleep study process. It has taken me half an hour to read up so far.

It sounds like you are doing well, but just need the usual settling in, experimenting, and finding out what is best for you.

No doubt all that messing about is quite a challenge, but it really does sound as though you have sorted a lot out and that things are probably as good as to be expected at this stage.

I do not have your machine, so cannot comment further, but best wishes on your continued improvement.

cheers

Mars

PS - By the way - what was the question