After the PSG, how can the Sleep Study Dr write a prescription before you see a DME?

[antinatalism]

I quote from [this post](viewtopic.php?p=1273718#p1273707).

Yes, a prescription for a CPAP device is required in Ontario.

It's also a requirement to be eligible for OHIP's 75% assisted devices coverage.

I think it's very strange that her Dr. didn't give her a prescription and cut her loose so abruptly. The process for me (also in Ontario) was:

1. Family Dr referral to Sleep Clinic
2. Sleep Study
3. Consult with Sleep Study Dr - given prescription
4. Referral to DME for equipment testing and purchase
5. Ongoing support with both Sleep Study Dr and DME

My 65 y.o. mom completed Step 2, but we're bewildered why Step 4 isn't Step 3? Shouldn't she see a DME first? if she doesn't, how can the Sleep Study Dr know which machine to prescribe in his Rx?

[chunkyfrog]

The DME is equivalent to a pharmacy--they only SELL the cpap.
It would be a conflict of interest for the seller to order the product.

[Dog Slobber]

I quote from [this post](viewtopic.php?p=1273718#p1273707).

Yes, a prescription for a CPAP device is required in Ontario.

It's also a requirement to be eligible for OHIP's 75% assisted devices coverage.

I think it's very strange that her Dr. didn't give her a prescription and cut her loose so abruptly. The process for me (also in Ontario) was:

1. Family Dr referral to Sleep Clinic
2. Sleep Study
3. Consult with Sleep Study Dr - given prescription
4. Referral to DME for equipment testing and purchase
5. Ongoing support with both Sleep Study Dr and DME

My 65 y.o. mom completed Step 2, but we're bewildered why Step 4 isn't Step 3? Shouldn't she see a DME first? if she doesn't, how can the Sleep Study Dr know which machine to prescribe in his Rx?

I was diagnosed with Sleep Apnea.

I then consulted with the Clinic's sleep Dr. She referred me to the DME who gave me a loaner APAP machine, and titrated me. Through the titration period, a machine type (CPAP, APAP, BiLevel) is determined and a prescription written up.

[palerider]

I quote from [this post](viewtopic.php?p=1273718#p1273707).

Yes, a prescription for a CPAP device is required in Ontario.

It's also a requirement to be eligible for OHIP's 75% assisted devices coverage.

I think it's very strange that her Dr. didn't give her a prescription and cut her loose so abruptly. The process for me (also in Ontario) was:

1. Family Dr referral to Sleep Clinic
2. Sleep Study
3. Consult with Sleep Study Dr - given prescription
4. Referral to DME for equipment testing and purchase
5. Ongoing support with both Sleep Study Dr and DME

My 65 y.o. mom completed Step 2, but we're bewildered why Step 4 isn't Step 3? Shouldn't she see a DME first? if she doesn't, how can the Sleep Study Dr know which machine to prescribe in his Rx?

How can you go to the dispenser of equipment before you have an RX so that they know what to dispense?

[TropicalDiver]

I quote from [this post](viewtopic.php?p=1273718#p1273707).

Yes, a prescription for a CPAP device is required in Ontario.

It's also a requirement to be eligible for OHIP's 75% assisted devices coverage.

I think it's very strange that her Dr. didn't give her a prescription and cut her loose so abruptly. The process for me (also in Ontario) was:

1. Family Dr referral to Sleep Clinic
2. Sleep Study
3. Consult with Sleep Study Dr - given prescription
4. Referral to DME for equipment testing and purchase
5. Ongoing support with both Sleep Study Dr and DME

My 65 y.o. mom completed Step 2, but we're bewildered why Step 4 isn't Step 3? Shouldn't she see a DME first? if she doesn't, how can the Sleep Study Dr know which machine to prescribe in his Rx?

US perspective here. The doc doesn't need to specify the brand/model but they do need to describe the capabilities. A lame analogy: The doctor prescribes you a pickup truck that can tow at least 4,000 pounds and has 4WD. You go to the dealership and select your truck.

So, two typical approaches: a) doctor diagnoses apnea (often based on a home study) and writes a script with some basic information (auto machine, mask of patient choice, and the initial settings). The DME dispenses the machine. The doctor looks at the results and may adjust the settings or order a more advanced machine (bilevel is one example); or b) Doctor diagnoses apnea and notes information from the titration part of the in-lab sleep study (assuming it had a titration component) -- this will guide them in determining whether a more specialized machine is appropriate and the initial settings. The DME dispenses the machine.

So what does a good quality DME typically do? They dispense the machine you want provided it is consistent with the script. They show you how to use and care for the machine. They set the machine according to setting prescribed by your doc. They provide the opportunity to try a variety of masks -- to get the one that works best for you. They handle any compliance reporting required by the insurance. They provide supplies to you when necessary/appropriate.

The last thing I want is the DME telling the doctor how to write the script. And the ideal script (from a patient perspective) gets me the best possible machine appropriate for my treatment and otherwise gives me flexibility. As others have notes, auto and full data is what you are looking for. (I understand there is a strange wrinkle in OHIP that allows the AUtoset For Her to be dispensed as a CPAP. So if my script was for a plain CPAP, that is what I would target.

The DME is essentially a chemist for hard goods.

[Cpapian]

There are basically four machines types and most patients only require one of the first two.

There is CPAP where the machine operates on a fixed pressure somewhere between 4 and 20.

Then there is the APAP where the machine operates on a range of pressures in a range somewhere between 4 and 20.

The next machine has different names by different manufacturers. Some call it a Bi-PAP. Some of it's features include a higher range (maybe 25) and the ability to offer a higher range of difference between the inhale and the exhale than the 1st two machines. This machine may be chosen for specific conditions.

The fourth machine might be called a ASV which has more intricate abilities needed for certain conditions.

All machine could have oxygen added if required.

The third and 4th machines you will notice I have been pretty vague about because I don't use or need anything above the APAP.

The Rx will specify which of the 4 types of machine be provided, the settings and oxygen if required.

The sleep study will give the Respirologist the necessary information to determine what type of machine is required and they will indicate the machine setting to be used.

It's possible the Dr has an opinion about which machine manufacturer is better. Your mom can choose to listen to him or not. However, the doctor's Rx for the type of machine (CPAP, APAP, etc) your mom has no choice here. The ADP program has specific criteria for when an APAP or higher is required over a CPAP. The dr is audited to ensure compliance with the criteria.

[palerider]

There are basically four machines types and most patients only require one of the first two.

There is CPAP where the machine operates on a fixed pressure somewhere between 4 and 20.

Then there is the APAP where the machine operates on a range of pressures in a range somewhere between 4 and 20.

The next machine has different names by different manufacturers. Some call it a Bi-PAP. Some of it's features include a higher range (maybe 25) and the ability to offer a higher range of difference between the inhale and the exhale than the 1st two machines. This machine may be chosen for specific conditions.

The fourth machine might be called a ASV which has more intricate abilities needed for certain conditions.

And then, there's the ST, and the *VAPS, and the..... more than four.

[Cpapian]

There are basically four machines types and most patients only require one of the first two.

There is CPAP where the machine operates on a fixed pressure somewhere between 4 and 20.

Then there is the APAP where the machine operates on a range of pressures in a range somewhere between 4 and 20.

The next machine has different names by different manufacturers. Some call it a Bi-PAP. Some of it's features include a higher range (maybe 25) and the ability to offer a higher range of difference between the inhale and the exhale than the 1st two machines. This machine may be chosen for specific conditions.

The fourth machine might be called a ASV which has more intricate abilities needed for certain conditions.

And then, there's the ST, and the *VAPS, and the..... more than four.

Welllllll........ I felt I covered that by saying "basically" ...... and for the OP since her mom will probably be prescribed a CPAP or APAP I didn't want to introduce irrelevant (for her purposes) information. But hey .... knock yourself out.

[palerider]

There are basically four machines types and most patients only require one of the first two.

There is CPAP where the machine operates on a fixed pressure somewhere between 4 and 20.

Then there is the APAP where the machine operates on a range of pressures in a range somewhere between 4 and 20.

The next machine has different names by different manufacturers. Some call it a Bi-PAP. Some of it's features include a higher range (maybe 25) and the ability to offer a higher range of difference between the inhale and the exhale than the 1st two machines. This machine may be chosen for specific conditions.

The fourth machine might be called a ASV which has more intricate abilities needed for certain conditions.

And then, there's the ST, and the *VAPS, and the..... more than four.

Welllllll........ I felt I covered that by saying "basically" ...... and for the OP since her mom will probably be prescribed a CPAP or APAP I didn't want to introduce irrelevant (for her purposes) information. But hey .... knock yourself out.

You might as well say "There are basically two machine types, single pressure and bilevel". *shrugs*

[Cpapian]

There are basically four machines types and most patients only require one of the first two.

There is CPAP where the machine operates on a fixed pressure somewhere between 4 and 20.

Then there is the APAP where the machine operates on a range of pressures in a range somewhere between 4 and 20.

The next machine has different names by different manufacturers. Some call it a Bi-PAP. Some of it's features include a higher range (maybe 25) and the ability to offer a higher range of difference between the inhale and the exhale than the 1st two machines. This machine may be chosen for specific conditions.

The fourth machine might be called a ASV which has more intricate abilities needed for certain conditions.

And then, there's the ST, and the *VAPS, and the..... more than four.

Welllllll........ I felt I covered that by saying "basically" ...... and for the OP since her mom will probably be prescribed a CPAP or APAP I didn't want to introduce irrelevant (for her purposes) information. But hey .... knock yourself out.

You might as well say "There are basically two machine types, single pressure and bilevel". *shrugs*

Palerider

[palerider]

Welllllll........ I felt I covered that by saying "basically" ...... and for the OP since her mom will probably be prescribed a CPAP or APAP I didn't want to introduce irrelevant (for her purposes) information. But hey .... knock yourself out.

You might as well say "There are basically two machine types, single pressure and bilevel". *shrugs*

Palerider

What is it with people who blather erroneous information, then get their panties all in a bunch when they're corrected?

[Cpapian]

[zonker]

datalaughing.gif

[chunkyfrog]

Boys!
Put away the ruler--and please WASH IT!
This nonsense should have stopped in SIXTH GRADE.

[JayDee]

"...how can the Sleep Study Dr know which machine to prescribe in his Rx?..."

It's akin to going to the pharmacy without an Rx and asking to try different drugs. It is as irrational as something like... "anti-natalism".
-JD