Interesting talk with the DME

[nedi]

So after posting a few posts regarding my settings, an overwhelming theme keeps coming up: ditch the S9 Escape Auto for the S9 Auto Set.
I spoke to the folks at the sleep lab and my fave representative said she'd speak to the owner of the place that provided me with the equipment and let him know I wanted an exchange.
I called her back and she told me said that "it does the same thing. just measures leaks." So I called him myself. Every time I said I just wanted the detailed data, he kept saying in a real friendly manner that it wouldn't be any different, the only thing you get is leak data, and my tech gave you a proper fitting (which he didn't). I asked him what the issue was. Do they not do exchanges? Is it a money issue? What it came down to was that he assumed i didnt want to pay the extra couple hundred bucks and didn't want to see me "wasting" my money. I quickly took hold of the conversation, told him to send it, here's my CC info, address, etc. Told him I'd send the old one back after receiving the new, etc.

I just thought it was odd because he didn't understand the importance of the data. Honestly, I'm not totally sure of the scope of data provided, but there's nothing better than more data!
He was also an APAP user. He told me to keep the settings ranged from 4-20 like he does. In the end the fellow was more than accomodating. I just don't know how much he knows about this stuff himself.
Thought I'd post it as part of my journey.

Also was happy to be able to get my hands on my sleep lab report! My awfful, tired, non-productive day is turning out to be pretty productive.
Cheers

[teknomom]

I'm glad you got some good results. When you download your data, print out a copy and show him that it's more than just "leaks". He may truly not know! Scary! Some owners are really just the business people and may not understand what they sell. But... they should!

[nedi]

I'm glad you got some good results. When you download your data, print out a copy and show him that it's more than just "leaks". He may truly not know! Scary! Some owners are really just the business people and may not understand what they sell. But... they should!

I will definitely do so. I don't think he knows either. He said they don't even stock the Auto Set.
Odd.

[Janknitz]

There is a world of difference between the S9 Autoset and the S9 Escape.

The escape provides only usage data--hours of use. After that is proved up to your insurer, WHO CARES??? You already know if you are using it or not. It's your body!

If what you have is the Escape Auto, I think the only EFFICACY data it shows is number of AHI's. I'm not sure if it breaks down that data into types of events (hypopneas, Clear airway apneas, and obstructive apneas), how long they were and what the pressure was when they occurred--someone who knows the Escape Auto may be able to tell you. I'm pretty sure the Escape auto does not have flow data, that can help you pinpoint what might be going on if you are waking or having clusters of apneas.

The S9 provides DETAILED AHI information broken down into hypopneas, clear airway apneas, and obstructive apneas. It tells you how many events you are having, how long the events were, and the pressure when you were having the events. It provides information on flow data. It records snoring. It provides useful leak data (how much leak, when, for how long).

Not everyone does well with a wide open auto setting (4-20) and your DME's suggestion that you keep it there becuase it works for him is pure baloney. A wide setting forces your machine to take too long to respond to apneas and can cause it to go to higher pressures than necessary. It may miss apneas because it doesn't adjust instantaneously. Some people just do better on a fixed CPAP setting. With the data, you will be able to dial in YOUR optimal settings for YOUR best treatment, NOT HIS!

[nedi]

Yes, in the end it seemed like a batlle between what he thought was right for me and what i thought was right for me. I think that most people, in most situations, would rather be taken care of poorly rather than take care of themselves well. I think that was where he was coming from; a generic, washed down version of all-around service. Still, I'm the one paying the bill. Give me what I want, dammit! lol.

All's well that end's well, and in the end, he was a fantastic rep.

[DrBucky]

There is a world of difference between the S9 Autoset and the S9 Escape.

The escape provides only usage data--hours of use. After that is proved up to your insurer, WHO CARES??? You already know if you are using it or not. It's your body!

If what you have is the Escape Auto, I think the only EFFICACY data it shows is number of AHI's. I'm not sure if it breaks down that data into types of events (hypopneas, Clear airway apneas, and obstructive apneas), how long they were and what the pressure was when they occurred--someone who knows the Escape Auto may be able to tell you. I'm pretty sure the Escape auto does not have flow data, that can help you pinpoint what might be going on if you are waking or having clusters of apneas.

The S9 provides DETAILED AHI information broken down into hypopneas, clear airway apneas, and obstructive apneas. It tells you how many events you are having, how long the events were, and the pressure when you were having the events. It provides information on flow data. It records snoring. It provides useful leak data (how much leak, when, for how long).

Not everyone does well with a wide open auto setting (4-20) and your DME's suggestion that you keep it there becuase it works for him is pure baloney. A wide setting forces your machine to take too long to respond to apneas and can cause it to go to higher pressures than necessary. It may miss apneas because it doesn't adjust instantaneously. Some people just do better on a fixed CPAP setting. With the data, you will be able to dial in YOUR optimal settings for YOUR best treatment, NOT HIS!

Second the warning about such a wide setting. If you haven't had a sleep study it is okay to start with though. Use the S9 auto set's data to figure out what the actual low is and set yours to that. For example, while I was initially prescribed a 6.8 (from my sleep study), I noticed that my APAP always stayed above an 8.6 once it ramped up. Thus it didn't make much sense to have my APAP always start 6.8 only to have to ramp up higher later (and possibly miss an OA).


Messing with the top number isn't too important with the S9. In previous APAP's the point of the max was basically to stop it form ramping above a reasonable pressure due to Clear Airway events. Since the S9 is able to identify these (fairly well, though can't tell the whether they are Central Apneas or not) you don't really have to worry that it's going to go nuts and ramping the pressure up. I've never had my APAP go above 12, but still don't see the point of restricting the top end.

[Emilia]

Well, it will be all's well when you actually have the machine in hand. Another reason the DME is reluctant to support patients having control of their own therapy is a loss of business. When cpap users ask for help adjusting thing, they can bill for that. When you ask them to print out data from a machine, they can bill for that. It is a business.... and they really are all about the bottom line.

Glad you stood your ground. I hope you get the Autoset soon and you can rein in your pressure range to a reasonable one based on your titrated pressure. For example, if you were titrated at 10 you would want your pressure range to be set +/- 2 -----so, 8-12. This is the general rule used, but other tweaking can be done....even in half notches of .5

You will get it all worked out soon enough....your pro-activity and eagerness to learn ensures you will be on your way in no time. Good luck!

[Janknitz]

The OP is in another country (Dutch Carribean), so they may or may not be able to bill for consultations there?

I know it can't be fun to have to pay for your own machine, but at least you get EXACTLY what you want without having to fight people who are more concerned about their bottom line than your needs. If you are willing to pay, there's no excuse for not providing you with exactly what you want. Would you settle for a cubic zirconia when you want and can afford a diamond?

[DoriC]

Your Rep may be a nice guy but he really wasn't being honest with you or he just doesn't know his machines. But you're a nice guy for saying he was a nice guy! Good luck and keep us posted.

[Sheriff Buford]

Not everyone does well with a wide open auto setting (4-20) and your DME's suggestion that you keep it there becuase it works for him is pure baloney. A wide setting forces your machine to take too long to respond to apneas and can cause it to go to higher pressures than necessary. It may miss apneas because it doesn't adjust instantaneously. Some people just do better on a fixed CPAP setting. With the data, you will be able to dial in YOUR optimal settings for YOUR best treatment, NOT HIS!

Dr Bucky: keep in mind that the Resmed autoset will not start increasing pressure to treat an apnea event until 7 seconds. That means your body has experienced an event and is not treated until 7 seconds occurs. This is the autoset vs straight cpap controversy. It's a comfort thang, also. Food for thought.

Sheriff

[rocklin]

Hi,

I would post about your serial problem with centrals, even when you are up and about and wide awake.

That is too an important a wild-card not to mention.

Glad the FFM is now working out.

roc

[archangle]

It's sad how many "professionals" think Auto CPAP means "Auto 4-20 cm pressure" and don't realize it can be set to a lesser pressure range to deal with any problems that arise.