Just diagnosed...no machine yet!

[Gaga58]

Okay, talked with the insurance and was told my coverage is 70% after deductible with in-network, 50% with out of network. When I asked for the names of the DME's in network I was told that would be up to my doctor. They would take the readings from my study and based on those would determine what machine I would need and he would order that for me. I was also told that it would use a smart card to determine whether I was using it and if I was, if it was working correctly and any changes would be read and made by my doctor. There is a 3 month "trial" in which any changes or returns can be made and the insurance will also pay as a rental up to the coverage price. So, what do I do now? I thought it would be me going to pick out my own equipment, but not according to what I was told. Is this a norm or this something only us rural folks "with not much to choose from" options get?! I'm not actually working with a "sleep" doctor...they're sending their recommends to my family physician and I'm assuming he will write the script from there. Should I just wait til after the titration thing and then talk with my dr. to see what they're giving me, or do I need to be questioning the gals at the sleep center who are going to be trying masks and setting pressures?! Any thoughts/advice appreciated!!

[Pugsy]

If your doctor will be making the order or RX based on sleep center suggestions (which is usually pressure and in rare instances cpap vs apap vs bipap) then just call your doctor and ask who your choices are that will work in network.
It is rare for a family doctor to dictate DME.

Then check with the choices to see what they routinely supply. Some good DMEs actually do it right and start off with full data machines. Some go even further right and supply full data APAP machines.

Having a family doctor who writes the RX can actually be a very good thing because you can probably request more specifics to enable you to get the machine you want. They are usually more amenable to requests.

So don't panic yet.. Find out what is going to be offered before you want to turn it down.

Also do the math. If your deductible is satisfied by the sleep studies then found out how much your 30% out of pocket costs are going to be. Sometimes it doesn't cost all that much more to buy online, to heck with insurance and have the peace of mind to know you have what you want. If you have a high deductible do the math there as machine costs will lessen deductible.

I did fire my first DME because they refused my requests and were general buttheads. I am in rural area. I had one other choice or I would have been driving an hour to DME instead of 15 miles. I did decide to get my machine from a private sale. I did the math. My out of pocket was the same plus I got exactly what I wanted. I do use the second DME for other supplies. I have 3 machines, none of which went through my insurance.

[Gaga58]

Pugsy...just realised we're "neighbors"!! I'm in central MO, and yeah, not a lot to choose from here. Closest to me that I am aware of is Jeff City or maybe the Lake, which either way is about an hour drive. We do have Lincare, which my daughter uses for her oxygen/asthma equipment and they have always been so good and nice to her. I had hopes I would be able to use them as well and possibly still can. I think I will call them direct and find out if THEY know whether they are an in network provider. I will also call the girls at my dr's office and ask them, we all know each other pretty good so if they know the info they will tell me before I even get to Doc. He is VERY good to work with and I'm not worried about that part as much as I am in how much they will tie his hands. And what about buying private...as in a quitter machine...I guess I will still need someone to do the settings or are these things pretty much self explanatory? But guess has to be someway to know whether or not the thing is working correctly (all those charts and software things in prior posts!!!) I don't want to pay out of pocket and then not have a clue if or when anything is not doing what it's supposed to be doing! Well, at least not til I have a little more experience with all this stuff under my belt!

[Pugsy]

Pugsy...just realised we're "neighbors"!! I'm in central MO

OMG we are totally neighbors. I am just outside Mount Vernon.
I have to go get my hair done right now so no time. I will be glad to help. Send me a PM and perhaps we can chat via phone. I have broken wrist and my typing sucks with one hand. You can get my crash course in understanding all this.
I can figure out how to set up just about any machine.
I can also watch local craigslist for hot deals....I know what to look for.

[soundersfootballclub]

Pugsy and everyone else who responded to this thread thank you so much for sharing your expertise. I too am a newbie. In fact I haven't been officially diagnosed yet with OSA since my sleep study is next week but I am pretty sure that is going to be my deal so I am already starting to get edudated on various machines and masks to get a head start. This thread and the included links are really wonderful. Based on what I read here I am already convinced to just go and buy direct online since my insurance will not cover equipment.

Pugsy I looked up your machine and was wondering if that is the defacto machine you would recommend based on functionality and price for someone diagnosed with mild to moderate OSA? My doc had a Resmed S9 (not sure the exact model) and the one that looks like a clock radio in the room as examples and I was thinking about checking those out initially but your suggestion looks more affordable. I am definitely curious about the humidifier component. Usually I don't like being in a room that has a heated humidifier running in it but I do tend to get dry nose and mouth especially in the winter months. I am assuming the CPAP humidifier will pretty much feel like breathing in air processed by a room humidifier or can I fine tune it so it is not really noticeable??

I also wanted to throw out a question on mask choices if I could. I am hoping to go with the nasal pillow like the Swift™ FX Nasal Pillow CPAP Mask, but I am not sure if that is appropriate for my situation or not. I say this because I tend to wake up with dry mouth in the morning so does that mean I should be looking at a mouth mask since I favor mouth breathing?? My other concern is I tend to have some nasal congestion at night due to allergies and was wondering if any nasal congestion would block the effectiveness of the CPAP air potentially or will it actually potentially address both the congestion by keeping both the nasal passages open with pressurized air AND address OSA episodes simultaneously???

Phew. Sorry to bud in and write a long post but trying to avoid adding a new topic all together.

Cheers!

[Pugsy]

Pugsy I looked up your machine and was wondering if that is the defacto machine you would recommend based on functionality and price for someone diagnosed with mild to moderate OSA? My doc had a Resmed S9 (not sure the exact model) and the one that looks like a clock radio in the room as examples and I was thinking about checking those out initially but your suggestion looks more affordable. I am definitely curious about the humidifier component. Usually I don't like being in a room that has a heated humidifier running in it but I do tend to get dry nose and mouth especially in the winter months. I am assuming the CPAP humidifier will pretty much feel like breathing in air processed by a room humidifier or can I fine tune it so it is not really noticeable??

Okay, here's the deal why I have Respironics machines. Strictly related to data despite the lack of data on screen with the Repsironics machines. Back when I was doing my research Respironics software showed a couple of things that ResMed machines didn't. I knew I was going to use the software and I wanted access to a couple of minor things (snored and flow limitations) even though I had no clue what they meant. Then I happened upon a M series APAP on craigslist that had zero hours on it. Price was just about what my co pay with insurance would have been and I didn't have to fight with DME to get what I wanted. If I had found a ResMed machine back then I probably would have got it. But I had already decided that the M series APAP was number once choice.

Both brands (and others) will give very effective therapy at all levels of OSA severity.
Respironics is a bit more affordable if using online supplier or no insurance.
I am a bit miffed at ResMed for its sales restrictions (no shipping outside of US by US suppliers and no ResMed products allowed at the cpapauction). So I probably won't ever be buying a ResMed machine unless it is private purchase and too good of a deal to pass up. I will use their Swift FX mask because I have tried enough of the other masks to know that I am not going to cut off my nose to spite my face. It is the most comfortable mask I have ever tried..
If you want to try it, then try it. I thought I was mouth breather bad but I found out I wasn't. There are ways to deal with minor congestion and mouth breathing. Unless you simply cannot ever breathe well through your nose, there is no reason not to at least try it.

Regarding how the humidified air feels....It actually feels a bit cool to me, not warm, not sticky, not like what I would have expected. I use a setting of 3. It isn't cold air, but it isn't warm air either. On my arm the vented air is slightly cooler than what goes up my nose. I wouldn't like warm air at all. I have enough hot flashes and added heat as it is.

Welcome to the forum. I am bad, I often zero in on questions and forget my manners.
Feel free to ask any questions that come up. Huge learning curve right now. I know it is overwhelming. Been there myself.

[Dojers]

Okay...sure hope that figuring out that whole software/data thing is not a requirement anytime soon!! I couldn't make heads or tails of any of what I looked at!! I'll get back to that part later!!

Just be aware that as you get more and more interested in what this wonderful world of hoseheads is all about you're going to want to learn more and more. And having the software and the data will become important. If you can get started with the proper equipment right off the bat that does what would be necessary down the line there'd be no hassle when you decide you want to know what all those numbers are you are hearing tossed around and start wondering what YOURS are. Maybe it's not something you really care about now but it may be something you want down the road. Better to be ready and not want it than to now have it but want it.

Good luck! And welcome to the HoseHead Brigade

[robysue]

I am definitely curious about the humidifier component. Usually I don't like being in a room that has a heated humidifier running in it but I do tend to get dry nose and mouth especially in the winter months. I am assuming the CPAP humidifier will pretty much feel like breathing in air processed by a room humidifier or can I fine tune it so it is not really noticeable??

I've never liked being in a room with a heated humidifier, but I wouldn't give up the heated humidifier on my xPAP for anything. To my nose it's not at all like a room humidifier. Of course, I've got nasal pillows and what the humidified xPAP air does is keep my nasal passages from getting dried out from the breeze. Also helps with keeping my lips from getting dehydrated and chapped.

My other concern is I tend to have some nasal congestion at night due to allergies and was wondering if any nasal congestion would block the effectiveness of the CPAP air potentially or will it actually potentially address both the congestion by keeping both the nasal passages open with pressurized air AND address OSA episodes simultaneously???

Many people find breathing the filtered air helps the night time congestion. But others find breathing through a CPAP seems to make their congestion worse. Sometimes the fix is as simple as playing with the humidity setting. But for a few people the problem seems to be the fact that air is blowing into their nose. If you tend to get more congested when sleeping under a fan or if you get more congestion on windy days even when the pollen count is way down, then chance are you may indeed find that congestion may be a problem.

But the real fix for CPAP&Congestion problems is getting serious about dealing with the nasal congestion FULL TIME. In my case, I've had to develop a zero tolerance to nasal congestion in order to be comfortable sleeping with the mask AND in order for my BiPAP Auto to not be quite so prone to increasing the EPAP every night. So now that I'm in allergy season, I find that I have to (a) take an OTC antihistamine every day---regardless of whether my nose feels stuffy or not, (b) do a nasal rinse a couple of hours before bedtime every night, and (c) use Flonase at bedtime. A side benefit from working to eliminate my nighttime congestion is that this is the first summer I can remember where I'm breathing through a clear, unstuffy nose during the daytime. And I quite like that.

You can learn more about nasal hygiene and CPAP by visiting these two links:

http://sleeptreatment.com/allergy-video-series
http://doctorstevenpark.com/unstuff-your-stuffy-nose

[JointPain]

I am assuming the CPAP humidifier will pretty much feel like breathing in air processed by a room humidifier or can I fine tune it so it is not really noticeable??

Welcome to the forum. On the Redmed S9 (only one I know personally) you can easily adjust the amount of humidification (*). Without humidification I was having sneezing fits all day long. I gradually increased the humidification until the sneezing fits went away. I don't notice the humidification at all when using it, but I think I'm relatively insensitive to such things. I haven't slept in a humidified room, but I can't stand being sticky. I like to run the AC occasionally not principally for cooling but to get rid of the moisture in the air (Houston is pretty humid).

(*). Given the way CPAP machines prevent normal users from even seeing so many other pieces of really useful information, this is actually a bit of an anomaly. Aren't they worried we'll turn the humidifier up to maximum and drown ourselves? (sarcasm mode off)

[Gaga58]

Sounders...I, for one, am glad to have you butt in...as you've read, I'm diagnosed just waiting on the titration thingy, so we can (hopefully) learn as we go here. I can say this much, I've only been on here a few days and already these folks have jumped in and offered support and advice...kind of makes you think this thing is do-able!??!!

Dojers...I am hoping to get a machine that will do everything I need it to do even if I don't have a clue what that is at the present! lol! I had already thought (and have been looking and reading) that whether or not I'm understanding half of this stuff, one day I might...best to be prepared and not out here trying to buy a whole new machine. I will say, the quitter I mentioned in an earlier post is supposed to be sending me their machine and masks...no charge. I have no idea what kind it is, let alone what it does, but will post all that once it's here and see what you all think. Perhaps it can be a starting point, or trial version until I get my own...we'll see.

Pugsy...will pm you when I get another few free minutes...I am canning pickles and am between batches right now...also take full time care of my mother who has severe dementia, so not always easy to set down and type. I've tried to get on here all day!! Also tough to make phone calls, but I definitely want to pick your brain if you'll allow me to do so!!

Thanks again everyone!!

[Pugsy]

Pugsy...will pm you when I get another few free minutes...I am canning pickles and am between batches right now...also take full time care of my mother who has severe dementia, so not always easy to set down and type. I've tried to get on here all day!! Also tough to make phone calls, but I definitely want to pick your brain if you'll allow me to do so!!

No problem. As you have time.
Pickles huh? I love sweet pickles and sweet pickled beets are my all time favorite.
Let's see what the quitter is sending you. Heck, may get lucky.

[soundersfootballclub]

Okay, here's the deal why I have Respironics machines. Strictly related to data despite the lack of data on screen with the Repsironics machines. Back when I was doing my research Respironics software showed a couple of things that ResMed machines didn't. I knew I was going to use the software and I wanted access to a couple of minor things (snored and flow limitations) even though I had no clue what they meant. Then I happened upon a M series APAP on craigslist that had zero hours on it. Price was just about what my co pay with insurance would have been and I didn't have to fight with DME to get what I wanted. If I had found a ResMed machine back then I probably would have got it. But I had already decided that the M series APAP was number once choice.

Pugsy thank you for the warm welcome and also than you so much for the clarification! So I think I will put the auto ResMed back at the top of my list. It sounds like I should take the leap and give the nasal pillows a shot and also order the humidifier unit for my ResMed.

Feel free to ask any questions that come up. Huge learning curve right now. I know it is overwhelming. Been there myself.

Thanks again for your time. I'm sure I will have many questions.

[soundersfootballclub]

Sounders...I, for one, am glad to have you butt in...as you've read, I'm diagnosed just waiting on the titration thingy, so we can (hopefully) learn as we go here. I can say this much, I've only been on here a few days and already these folks have jumped in and offered support and advice...kind of makes you think this thing is do-able!??!!

Good luck Gaga! I'm actually not too worried about any of this so far. I'm sure it will become habit after a while. I already wear a nightguard (grinding) and goggles at night (dry eye from LASEK) and my wife has given me enough grief over my already weird bedroom get up. This will just give her more material I guess. But....If we sleep better from this CPAP machine it is going to be well worth it!! There are far worse medical maladies to be cursed with!

Cheers!

[nanwilson]

Sounder and Gaga I can't believe how positive both of you are....I am amazed..you will both do wonderfully as a hosehead.
Welcome to both of you I expect to hear more good things going on with your therapy soon. I got ding'd with a non data machine and finally after about a year of not knowing what was going on, I had the opportunity to buy an M series from a fellow hosehead here. The difference has been a boon to my health.....and I can only attribute it to the wonderful folks here that got me on the road to good therapy. Good luck to you both and again welcome to the world of hoseheads .
Cheeers
Nan