New User: Dumb Question: Do I need a Dr. Prescription to try

[BigNortherner]

Those claiming a prescription is not needed to buy a CPAP machine in Canada should explain these claims:
- http://www.lung.ca/diseases-maladies/ap ... ndex_e.php
- http://www.cpapneacentral.com/tips/faq.htm "Do I need a prescription for a CPAP? (Back to top)
Yes, U.S. and Canadian Federal law require a physicians' prescription for this item."

It would be good news, but claimers need to substantiate where it can be done.

[Wulfman]

This is an interesting forum and thread topic. I may have OSA. My wife has bugged me for years to get into a sleep study. But, I worry that I'll never be able to get affordable life insurance the moment an OSA diagnosis enters my medical records. So, I'd rather NOT jump through all the hoops of a paper trail if I can get help without it.

Based on the posts I'm reading, having insurance won't necessarily save me any money and will tend to push me toward a lower quality machine. Well, I'd rather purchase something quality on my own if that's the case.

I guess I have a ton of research to do. Can anybody give me a ballpark idea of what I should expect to pay for a quality, data capable, cpap, humidifier, mask and software?

You have justifiable reasons to worry about that one. It'll put the kibosh on you being able to get it.

Keep reading this forum and asking questions. Here are some places to start.

Copied from "rested gal's" list of lists......

http://www.smart-sleep-apnea.blogspot.com/

viewtopic.php?p=307168#p307168

Here's her whole list.

viewtopic.php?t=17435

Also, don't forget to read some of the "stickies" in the upper sections of the forum.


Den

[Mary Z]

Just what symptoms are you having that make you sure you have sleep apnea? Some of the machines on Amazon do not mention a prescription, but that doesn't mean they won't require one. Do you have a family doctor that will help out? Otherwise I suggest what has been suggested before- Craigslist, newspaper, rummage sale, flea market, word of mouth- you would be surprized how many machines are stuck in closets. Good Luck.

[jrockbridge]

In my case, I think I know I have OSA due to extremely loud snoring, but there are other signs as well. My nose seems to close up at night. I awake with my nose obstructed most mornings. I often feel exhausted in the morning. It takes me a long time to get going in the morning. I often feel very grump in the morning.

I think I know that I want a full mouth + nose mask because I suffer from hay fever and other allergies. My nose just doesn't work very well at night. Also, I'm pretty sure I want a heated humidifier. I live in a dry climate.

[rested gal]

Too high of a pressure can lead to central apneas. Sleep techs see it all the time while titrating patients.

It can, but I doubt it's thaaaat common.

Here's what an RRT, RPSGT, manager of an accredited sleep lab wrote:

viewtopic.php?t=14225 on page 2

"The phenomena of pressure-induced central apneas is tossed around far too freely. The vast majority of people do not get centrals because of ultra-therapeutic CPAP levels. BiLevel, Pressure Support (PSV) and Proportional Assist (PAV) Ventilation are another matter. You need some mechanism to drive the pCO2 below the sleeping apneic threshold, and plain old CPAP rarely is able to do that. OK, if you wanna argue that CPAP increases base lung volume (Functional Residual Capacity)(FRC), and since that increases gas exchange, some people can generate centrals that way, fine. But it's not as many as you might think.
SAG"

The small (imho) possibility that a few people might have a few central apneas due to high pressure is far outweighed by the possibility of an untreated OSA sufferer having a motor vehicle accident, or having a heart attack/stroke, or losing a job, or ... the list goes on and on... due to excessive daytime sleepiness from plain vanilla Obstructive Sleep Apnea.

A problem that is solved by a fan pushing room air into a mask that keeps the pressurized air contained so it can push/hold the airway open while the sleeper breathes.

Sure, it would be best to have a formal sleep study. OSA isn't the only sleep disorder. But it's one of the most common. And one of the most easily treated if a person is determined to do it.

Link to a study that concluded, "yes."
"Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?"
http://www.tnlc.com/Lara/laura/osa/CanP ... wnCPAP.pdf

Link to a Powerpoint presentation by board certified pulmonolgist/sleep doctor (Dr. Barbara Phillips) at a meeting of the American Lung Association of the Central Coast - November 2004:
"Not Every Patient Needs to Go to the Sleep Lab"
http://www.tnlc.com/Lara/laura/osa/Barb ... t_0830.pdf

[roster]

I guess I have a ton of research to do. Can anybody give me a ballpark idea of what I should expect to pay for a quality, data capable, cpap, humidifier, mask and software?

$1000. You can get suggestions on machines from forum members.

You may want to start looking at https://www.cpap.com/cpap-machines-all. ... Range=1000

[roster]

The small (imho) possibility that a few people might have a few central apneas due to high pressure is far outweighed by the possibility of an untreated OSA sufferer having a motor vehicle accident, or having a heart attack/stroke, or losing a job, or ... the list goes on and on... due to excessive daytime sleepiness from plain vanilla Obstructive Sleep Apnea.

And I will add that a newbie trying to titrate themselves, if they have properly educated themselves, will start out at a low pressure (7 cm is my suggestion). This further reduces the possibility of pressure-induced central apneas.

As far as self-titration, despite three nights in certified sleep labs my diagnosis was incomplete and the pressure titration was never correct. I ended up titrating myself after getting educated about sleep apnea and CPAP. However, the software should certainly be used in the process.

[rested gal]

My list of machines that record "full data" (AHI and leak info) and those that don't -- updated February 2011.
You'll want a machine that can record leak and AHI info. The ones in blue do that; the ones in red do not:
viewtopic.php?p=307168#p307168

[jrockbridge]

I'm thinking that maybe I should go through my United Health Care insurance. It may save me some money....or not. What do y'all think about insurance?

[Janknitz]

Insruance CAN save you a lot of money, but it depends on your insurance. You need to understand what your total out of pocket cost will be for a machine and supplies. It helps if you decide first what machine you want, or at least what features you want, and whether your doctor (if you use insurance you MUST have a documented case of sleep apnea and your doctor MUST prescribe the machine) will prescribe what you want.

Consider whether a CPAP machine will be an outright purchase or a "rent to own" (capped rental). If its' a rental, you may cover more than one deductible period, so be sure to factor that in.

Consider how much your deductibles and co-pays will be for the machine AND supplies.

Contact your insurance company to find all this out and more: you want to know if they reimburse by HCPC's code or by specific make and/or model of machine (for a more thorough explanation, see "What you need to know BEFORE you meet your DME in my signature line). Do they limit the price the DME can charge you or do they permit the DME to charge you more than the allowable amount for machines withint the same billing code? Do they require you to use specific DME's or give you a lower co-payment or a limited out of pocket cost with certain providers.

Once you know all of the above, you can calculate your out of pocket costs, factor in the aggravation of dealing with DME's and insurance companies, and decide if it's worth using your insurance. You pay for your insurance, so you should be able to benefit from it, but sometimes it's just not worth it.

[BigNortherner]

I read a couple of the articles/papers on self-"titration", and I comment:

Point made in “Not Every Patient Needs to go to the Sleep Lab” by Barbara Phillips is that un-necessary CPAP is low risk. Claims that auto-titrating machine is adequate (but advice elsewhere in this forum is to set machine base pressure high enough to eliminate most events, that requires data analysis). Much ado about definition of OSA/HS. Appears to claim that there is “CPAP responsive disease”, seems to say that may not meet normal OSA criteria. Says polysomnography is not a perfect tool, though identifies one of its deficiencies as a matter of the equipment used (e.g. using thermocouples instead of pressure sensors to measure flow). (Unfortunately the slides don’t communicate well, they were prepared to accompany a talk rather than stand on their own.)

Can Patients with OSA Titrate their own CPAP? by Fitzpatrick et al is an extensive study comparing sleep lab and manual CPAP with auto CPAP, but with a small sample size (18 persons). I have to think about its method, which rotates the same persons through all configurations. That gives consistency of bodies, and minds - except for the experience of prior configurations.

[GLIDERGIDER]

I started this thread and I thought I'd follow up with my condition.

I did go to a sleep lab. Very interesting process. I learned a lot. Glad I went. I was diagnosed with Apnea. My Dr. prescribed flow setting is 11. I forgot the units. I'm having a horrible time adjusting to the mask. I only use the machine about 2 hours on average per night. Then I wake up, take off the mask and sleep the rest of the night. I've been on the machine for about 1.5 months now. Only one night on travel did I fail to use the machine, (or try to use the machine).

I'm wondering if a reduced flow setting of say 9 would be more comfortable to me and allow me to sleep through the night. I have a quality machine. It has a reduced pressure (4 units) on a timer to help get to sleep.

Thoughts?

[archangle]

I started this thread and I thought I'd follow up with my condition.

I did go to a sleep lab. Very interesting process. I learned a lot. Glad I went. I was diagnosed with Apnea. My Dr. prescribed flow setting is 11. I forgot the units. I'm having a horrible time adjusting to the mask. I only use the machine about 2 hours on average per night. Then I wake up, take off the mask and sleep the rest of the night. I've been on the machine for about 1.5 months now. Only one night on travel did I fail to use the machine, (or try to use the machine).

I'm wondering if a reduced flow setting of say 9 would be more comfortable to me and allow me to sleep through the night. I have a quality machine. It has a reduced pressure (4 units) on a timer to help get to sleep.

Thoughts?

Welcome to the hosehead collective.

Please go into your profile for this board and enter your equipment.

You really need to wear the machine all night. Apnea is probably damaging your body and organs, even if you're only sleeping a few hours a night without CPAP. Also, if you're not getting 4 hours a night, your insurance may refuse to pay for the machine.

You may want to check one of the many threads about keeping your mask on. Or start your own new thread.

[codinqueen]

I have UHC insurance, and there are many different plans, and many different policies through employers....I am not sure if UHC insures privately (without an employer-based plan.) My UHC (UHC Choice Plan through my employer) plan dictated that I MUST get my CPAP machine and supplies through Apria, and my equipment, as listed in my signature, cost me and insurance as follows:
Insurance paid:
ResMed S9 Autoset CPAP machine $528.08
ResMed H51 Humidifier $166.45 - this is the tub that has to be washed and is not dishwasher- safe, disposable and replaced every 6 months
ResMed Swift for her Nasal Pillow Mask Frame $54.99 - replaced every 6 months
ResMed Swift Fx Headgear $18.58 replaced every 6 months
Climateline tubing $?--- I can't find the original bill- they did not have it priced out when I picked up my machine & supplies- must have been $240.00 for insurance, because I pay 10% after meet annual $500. 00 deductible and I have the EOB of payment (I forgot to write down the billed amt)- replaced every 6 months




My co-pays :
S9 Autoset CPAP $52.81
Humidifier $16.64
Mask frame $5.50
Swift headgear $1.86
Climateline tubing $24.00

Besides that you will need to buy:
Power strip/Surge protector- I got 9 feet (about $15.00)
White vinegar for cleaning supplies (about $1.00)
Mask wipes $3.00 (unless you want to wash it every day, then you need mild soap, about $2.00)
Hose management system (My Cozy Hose Boss from Pur-Sleep was about $15.00)
Essential Oil from Pur-Sleep if you want the air that is blowing into your mask fresh-smelling ($15.00 for 30 cc bottle)
Lansinoh Ointment for nasal pillow users- $8.00 at grocery store/pharmacy in baby supply aisle.

Per UHC rules, The nasal pillows can be replaced 2 per month, and the CPAP machine filter for S9 is replaced 1 per 6 months, & the Climateline tubing replaced every 6 months. I don't know how much this stuff is, I just ordered some of my replacements, because I was a little bit late getting my order in since I started CPAP in Feb 2011. I needed to have the money to pay the co-pay before I could buy the supplies, and money is very tight with unemployed hubby.

I have seen some really good deals on Craigslist, but caution you to know which machine you are getting, if it is fully data- capable, before you get one, so you will have info you can analyze to see how you are doing. OSA is so prevalent now, I'll bet there are more machines tucked away in closets than ever, because a lot of people are diagnosed, but they don't follow through on treatment for one reason or another, although CPAP can save our lives if they have OSA. I suggest you ask family and friends if they know anyone with a machine gathering dust in the closet, and see if you can make a deal, but only if you can't convince them to treat their OSA.

Good luck! I know how hard paying for medical care is- my health insurance is almost no help because I can't pay the deductible and co-pays when I need to, because the high premiums whittle my paycheck down so much!!!! But with my medical history, I can't "go naked" instead of being insured either.

[rested gal]

Good to see you back, Glider.

And glad to hear you did go for a sleep study. You know for sure what you're dealing with now.

Usually, it's the mask (rather than the machine or the pressure) that bothers people and causes them to take the mask off during the night.

What's the full name of your machine? And the full name of your mask?