Okay, now I'm fightin' mad!

[OscarFraley]

But for a few dollars, if you had an AUTO with C-flex right from the beginning you would have avoided many months of grief and anger and had EXACTLY what you needed from the very first day. Even if the titration was wrong, the AUTO would have given you exactly the right amount of pressure to keep you breathing, and nothing more.

What a lot of bother to maximize the profit for your DME. I'm sure you are happy that you will now have EXACTLY the lowest priced equipment that will just barely meet your minimum requirements and not one penny more. I believe in not being wasteful, but the working assumption of the story you relate is that YOUR time and loss of effective treatment for these how many months are FREE!

The important thing is that your DME made the maximum profit under the circumstances. Their policies and procedures reflect that. As GUEST suggested, that is cause for rejoicing.

[Guest]

Umm, did you folks actually read her posts?
Not only has her DME done nothing wrong, they've even gone out of thier way to help her and provide her with anything she has asked for.
They even gave her a different machine after her insurance company bought her old one!
Please don't go on a witch hunt when it's not needed. Save it for those times it is needed!

[DME_Guy]

To me it sounds like the DME has done a great job. They don't have to switch out your machine and are doing so at their cost. Not many companies in any industry would do that.

There is a difference between C-flex and EPR. For you, I think it's important that you get an auto machine with C-flex. First of all, if it is the high pressure that is causing your problems, an auto machine will only be at the highest pressure when needed. For me, my machine only goes above a pressure of 9 for about 20 minutes per night.

C-flex is flow based technology. EPR is mechanical. C-flex lowers the pressure based on two things. The first is what the machine is set at. It can set at three different settings, 1, 2, 0r 3. The higher the setting, the greater the pressure relief. I have mine set at 3 because I hate breathing against high or moderate presssure. The second thing C-flex does is match your breathing pattern. If you take a large breath, C-flex will further decrease the expiratory pressure relief to match your breath volume. EPR is not flow based. It will lower the pressure based on 3 settings as well but the expiratory relief is alwasy the same, regardless of how hard you exhale.

More importanly for you, EPR will shut itself off if the machine detects Apneas. It has to, because it's not based on flow. In your case, you'll be right back to a basic C-PAP machine and you will probably be ripping your mask off again.

My feeling is you'd be much happier with a Remstar Auto. I think you need lower pressure most of the night with consistent expiratory relief. The S8 Vantage does have EPR but not in auto-mode. The reason is the algorithm of the machine is based on flow rate, but EPR is not based on flow. Respironics has the patent on flow based expiratory pressure relief so I'm guessing whey EPR is mechanical, rather than flow based.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, C-FLEX, DME, auto

[ladytonya]

The DME says that the CPAP was "called in" to them by the sleep center, which they say means that they would have provided the equipment before they actually saw the sleep study. Now, there is a copy of my sleep study in my file and they see the notes regarding the use of c-flex, but they also admit that I received my machine before they received my study. I have not spoken with anyone at the sleep center yet to verify what they are telling me, but I did physically see my file at the DME. The sleep center called in a CPAP with a pressure of 9 on December 24 and I received my ResMed Escape on December 26. The date stamp on when they received my actual sleep study is December 27. It seems fairly clear that the sleep center called in a CPAP, not c-flex. I spoke to my doc about getting an auto and he is completely against it so I don't think getting an auto and getting it paid for by insurance is even a possibility.

Since the DME is going to trade out my Escape for an Elite, I am not going to complain too loud, at least not to them. When I get someone on the phone from the sleep center besides the receptionist, I may raise a little hell, but at this point I don't feel it is the DME's fault. The main reason I am okay with trying the Elite is I won't need a new humidifier and I am familiar with the operation of the machine. Plus, if I understand correctly, the Elite will give me some data on the display. I like the idea of that because I have no idea where my stats are at this point.

Thanks for all the great advice and suggestions you all have given me! In this particular instance, I actually don't believe that I have an evil DME as I did when I made my initial post. If I find out otherwise from the sleep center, then I'll change my opinion. At this point, I am happy that the DME is willing to switch equipment. I was advised that it will be new and that they will simply switch it out with no additional charge. If it was the sleep center's error, I definitely can't complain, at least not about my DME.

I'll definitely let ya'll know what I find out from the sleep center when and if I can ever get someone there on the phone!

[rested gal]

To me it sounds like the DME has done a great job. They don't have to switch out your machine and are doing so at their cost.

I agree. I think they are trying very much to be helpful.

There is a difference between C-flex and EPR. For you, I think it's important that you get an auto machine with C-flex. First of all, if it is the high pressure that is causing your problems, an auto machine will only be at the highest pressure when needed.

I also think that would be a wise choice -- the REMstar Auto with C-flex.

The second thing C-flex does is match your breathing pattern. If you take a large breath, C-flex will further decrease the expiratory pressure relief to match your breath volume. EPR is not flow based. It will lower the pressure based on 3 settings as well but the expiratory relief is alwasy the same, regardless of how hard you exhale.

I'm not sure I follow here. DME_Guy, did you mean to say that if you exhale a large breath? I think of "take a large breath" as drawing it in.

I don't think I'd say C-flex "matches your breathing pattern". I think of that as the kind of thing a true bi-level machine does...maintaining pressure reduction of the exhale UNTIL you inhale again. C-flex lets the regular pressure back in before the exhalation is finished. EPR holds the exhale pressure reduction throughout the entire exhalation bi-level style, and waits (at least a certain amount of time) until the user takes another breath.

And I guess that's where I think there's more to consider as to which one -- C-Flex or EPR -- would give better relief across the board. I think it would depend very much on the person and the strength of that person's normal exhalations.

For example, I normally breathe out rather lightly. Not very forceful exhalations. C-Flex, even set at 3, doesn't drop a lot for me. It's enough of a drop to be more comfortable than breathing against full pressure, but I don't get the kind of drop that someone with more forceful sustained exhalations would experience.

When I experimentally tried straight pressures of 14 or more, my exhalation is too light to cause C-flex to do more than a brief blip at the beginning. The full pressure rushes back in almost immediately for me at anything above 13. EPR, on the other hand, always delivers a 3 cm drop if set at 3 no matter how high the regular pressure. And keeps that drop in place throughout my entire exhalation, no matter how lightly I'm exhaling.

Fortunately the pressures my REMstar Auto used rarely went above 13; and touched that only briefly, occasionally. Usually stayed around 9 to 11. The 1 - 2 cm drop I experienced with C-flex set at 3 was pleasant. Several times I sat there trying out different exhalation "forces" while watching the pressure. With my normal exhalation, a drop of 1 cm or a fraction more was the most pressure reduction C-flex gave me -- set for the most drop possible. Only if I deliberately blew out very hard could I get C-Flex to drop 3 full cm's against my usual pressure of 9 coming in. So, if I really needed a very definite pressure reduction, EPR would have suited me better. As it was, the one or two cm drop I got from C-flex was good enough to be noticeably comfortable for me.

So... while I do think the pressure that ladytonya will be using would let C-flex be comfortable for her even if she exhales as lightly as I do, I don't think C-flex is necessarily better in general than EPR because one is flow-based and the other mechanical. I think the question of which one would give more comfort for each individual would depend greatly on the pressure prescribed and an individual's natural exhalation strength. Trying both would be the only way to know.

More importanly for you, EPR will shut itself off if the machine detects Apneas. It has to, because it's not based on flow. In your case, you'll be right back to a basic C-PAP machine and you will probably be ripping your mask off again.

Maybe, maybe not..as far as ripping her mask off. True, EPR will suspend under certain circumstances, but it will also resume EPR operation after the breathing normalizes again. It's just as likely, in my mind, that a sleeping person could sleep right through an occasional pause in EPR operation, as not.

My feeling is you'd be much happier with a Remstar Auto. I think you need lower pressure most of the night with consistent expiratory relief. The S8 Vantage does have EPR but not in auto-mode.

And that is the #1 reason I agree with choosing a Respironics machine, if a person is going to get an autopap and wants pressure relief when exhaling. The ResMed autopap can't do both at the same time. The Respironics autopap can.

As far as autopaps go, I'd want the Respironics REMstar Auto/C-flex. However, if ladytonya has to settle for straight cpap, then either brand with their own expiration relief would be fine, imho.

Except that I'd not ever buy a ResMed machine on general principles...period.

viewtopic.php?t=10666

[NightHawkeye]

In this particular instance, I actually don't believe that I have an evil DME as I did when I made my initial post. If I find out otherwise from the sleep center, then I'll change my opinion.

Ladytonya, you're far more patient than I would be. While it's good that your DME is willing to trade out your machine, please don't reject the advice given to you by the most knowledgeable people on this forum.

My first inclination would be to simply fire the whole bunch you're dealing with, because they're operating a deplorable scam. They've each got a built-in escape mechanisim; each can claim it wasn't their fault that you didn't get good equipment. Physicians are often tightly allied with their suppliers, and I'd suggest to you that is true in your case. That's why the sleep center started you on the cheapest possible equipment, to maximize everybody's profits - and not just the DME's profits either, because you have to go back for more visits.

Anyway, if it were me, I'd demand the DME, because of the pain and suffering they'd put me through for no reason whatsoever, other than simple greed, that they provide me with what I wanted - an APAP with C-flex. And I'd tell 'em I didn't give a damn about whether the good doc liked APAP's or not. I'd tell 'em an APAP is the same billing code as CPAP, so it doesn't make a bit of difference to insurance.

Ladytonya, if your DME had been any good, they'd have swapped you out for the right machine as soon as they received your complete report. I'm sorry, I'm not buying the part about the DME being the good guy here. I think they stink.

Regards,
Bill

[ladytonya]

Unfortunately, I can't change DMEs midstream. My insurance company won't let me. I have no choice on the sleep center, either, unless I want to drive a long way. I have been very happy with both my sleep center and my DME until this incident. Additionally, I don't buy into the conspiracy theories about the DME and sleep center being tied together because I had my choice of like 3 or 4 DMEs. I chose the one I am using because they are the same one my husband uses for his bi-pap supplies and we used them for both my grandmother and my great aunt when they needed similar services.

I've been doing a lot of reading about the whole c-flex vs. EPR thing and I'm not sure which will work better for me. I really don't care about getting an APAP as long as I have either c-flex or EPR for the exhalation relief. I've been offered the Elite with EPR and that's what I will try next. If I'm still ripping my mask off in the middle of the night, then I'll go from there. Again, I really appreciate all the great advice you guys are offering. I just wish that I would have found this site before I got my equipment! If that would have been the case, I probably would have asked more questions and would have known that when they gave me the Escape they were giving me the bottom of the barrel, cheapest machine thay had.

[Arizona Willie]

The S8 Elite with EPR should work just fine for you. I didn't have mine turned on at first and didn't think I needed it .. and could have gone on forever without using the EPR really.

But, just out of curiousity, I turned it on and was amazed at the difference. Really much easier to use with EPR on set at 2.

I haven't used the other machines so I can't really compare but the concept of EPR and C-Flex seems to be the same, they both put out lower pressure during your exhale.

Right now everyone is mad at Remstar for their pricing policies but their equipment is excellent.

[cpapjack]

Right now everyone is mad at Remstar for their pricing policies but their equipment is excellent.

I think you mean ResMed, not Remstar.

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed

[NightHawkeye]

Additionally, I don't buy into the conspiracy theories about the DME and sleep center being tied together because I had my choice of like 3 or 4 DMEs.

I hope you're right about your DME being good, ladytonya. Don't forget though that they conveniently forgot about the little item of C-flex early on which apparently would have saved you grief. As for your sleep clinic prescribing the cheapest possible machine, after they'd already proven it wasn't going to work for you, it seems obvious to me that the sleep clinic is humoring the local DME's (who prefer to see prescriptions written this way), rather than tending to the unique and individual needs of their patients (i.e., thereby putting money before healthcare concerns).

Sounds like a clear cut case of plausible deniability to me. I still think your initial reaction of being fightin' mad was entirely justified. Hopefully though, this new machine will work out better for you.

Regards,
Bill

[Guest]

Additionally, I don't buy into the conspiracy theories about the DME and sleep center being tied together because I had my choice of like 3 or 4 DMEs.

I hope you're right about your DME being good, ladytonya. Don't forget though that they conveniently forgot about the little item of C-flex early on which apparently would have saved you grief. As for your sleep clinic prescribing the cheapest possible machine, after they'd already proven it wasn't going to work for you, it seems obvious to me that the sleep clinic is humoring the local DME's (who prefer to see prescriptions written this way), rather than tending to the unique and individual needs of their patients (i.e., thereby putting money before healthcare concerns).

Sounds like a clear cut case of plausible deniability to me. I still think your initial reaction of being fightin' mad was entirely justified. Hopefully though, this new machine will work out better for you.

Regards,
Bill

[ladytonya]

That's exactly why I can't be mad at the DME, Guest. They gave me what my sleep center ordered. Period. I have seen my file at the DME and you can tell when they received each phone call and each fax. The machine was called in to them as a cpap on December 24 and I received the cpap on December 26. They didn't receive the fax from the sleep center until December 28. That tells me they were on the ball in getting me the equipment as fast as they could even with the delay in getting the study and the prescription from the sleep center. When I first posted, I was mad because I thought the DME ignored the c-flex and just gave me the cheapest machine, but how can they ignore something that they haven't even seen yet? The RT thought it was interesting that the sleep center called in for a straight cpap after they made the note in my study that I did better with c-flex, but she said that since the order was called in by the sleep center they had no reason to review the study. They just filed it away when they received it.

I still haven't gotten an answer from the sleep center as to why they ordered cpap when I did better with c-flex in the sleep study, but that's an argument that I need to have with the sleep center, not the DME. You guys that don't like DMEs are very persuasive with your arguments against them, and sometimes you are right. This time, however, I think the fault lies with my sleep center. If I don't get an answer from them in a day or two, I'm going to make an appointment because I do want to find out who dropped the ball. Luckily, even though the ball was dropped at the beginning of my treatment, it has now been recovered and I am on my way to hopefully getting the therapy that I should have been getting all along.

[birdshell]

Lady Tonya, you certainly seem to be fair in your assessment of the DME provider and the sleep lab.

IMHO, the sleep lab had someone call the DME provider and the CALLER made the mistake; when calling in a C- it became a CPAP instead of a C-flex. Especially if the caller was new, and was not a sleeping disorder sufferer, this might be an easy mistake to make.

This caller could have been a 20 year old medical assistant or something similar; or it could have been a sleep technician. This doesn't make it better, but with the efforts to cut costs in medicine today it is not too surprising.

Remember how doctors' offices used to have RN's to show you to your room and take your temperature and give you injections? Now, unless the doctor is a specialist, just go ahead and TRY to find an RN in the office (who is not a patient).

[NightHawkeye]

Luckily, even though the ball was dropped at the beginning of my treatment, it has now been recovered and I am on my way to hopefully getting the therapy that I should have been getting all along.

We all certainly hope that is true now, ladytonya. You deserve good treatment. If, however, things don't go quite as well as expected, keep on their case.

Regards,
Bill