A great mask-fitting experience with a hospital sleep lab!

RosemaryB · Post by **RosemaryB** » Fri May 25, 2007 8:48 pm

Earlier this week I went to a hospital in a nearby city where they have a sleep lab that seems to be excellent. I know someone who went to it and have looked at his reports and they are much better than mine. He really appreciated them, despite the fact that he had a horrible time sleeping there and was pretty claustrophobic about the mask.

The techs were very knowledgeable about the masks and I got to try on several, though they would have let me try on more if I'd asked. They had the hybrid, which I wanted to try, though not yet the new ResMed Liberty. I took a list with pictures and the tech was interested in that one and the Bravo, which he hadn't seen yet. I got to try the Breeze which seemed doable and also the Opus. I liked the Opus, but it seemed to come too far down on my lip.

I also located another hospital within an hour's drive that did this as well. When I spoke with them on the phone they also seemed excellent, though they said there was a fee (she didn't know what it was, but thought insurance might pay for it). However, she answered a bunch of questions on the phone and I didn't feel brushed off.

The hospital also had a DME rather loosely associated with them. The tech said that they made sure that people who got the mask through their DME got the whole "kit" in other words, all the different sizes of nasal pillows for the Swift, etc. (My DME RT insisted that "insurance doesn't pay for more than one size" when I asked for all of them). Next time, I'll have the doctor write the script for the "entire kit" when I get a replacement mask.

It took a good bit of searching to find these resources, and I had to drive a ways to get there, but well worth it. I encourage others to try to find these "Mask clinics." We have a bigger hospital with a good sleep clinic nearby, but they didn't have this service, so just because one doesn't have it, doesn't mean others won't. I plan to go back one more time before I get my 6 month mask replacement.

This was free and open on a walk-in basis.

momadams · Post by **momadams** » Sat May 26, 2007 7:46 am

Please tell us where you live and where you went.
Shari

Joethespy · Post by **Joethespy** » Sat May 26, 2007 8:09 am

Rosemary,

I'm glad to hear that you had a good experience. Some good labs do allow patients to do what you did.

Good Luck...Joe

tillymarigold · Post by **tillymarigold** » Sat May 26, 2007 8:25 am

Mine was excellent too, at the time they had every mask out except the OptiLife but there were some that weren't out yet (the two new Resmed Mirage ones, the Swift II, the Bravo). They were loaning me the mask and told me I could have any one of the ones they had on hand, unfortunately they ended up not having the Pillows Cushion for the ComfortLite 2 so they could only give me the Direct Seal Cushion (which I like better for comfort, but it doesn't fit my nose--my nose hooks under very slightly, and since the Direct Seal Cushion is more J-shaped than horizontal, the tip of my nose always presses against the tube ... that said, with the Pillows Cushion, I had to really fight with it to get it to turn under as much as it needed to, and it still won't seal properly sometimes).

'Scuse me for being bitter, had a bad night last night. But yeah, my sleep center (which is AASM accredited) was awesome with the mask fitting, it was free and I got to keep the mask! Hope the replacement cushion on my Hybrid gets here before I have to give it back.

BrensTiredMom · Post by **BrensTiredMom** » Sat May 26, 2007 9:15 am

My sleep lab just called on Friday afternoon to remind me of my appointment with the sleep specialist on Tuesday and to let me know the results of the titration study were in. And then they went on to say that the Dr. wrote a CPAP Rx and they wanted to schedule a home care company to come out. She also asked which of the 2 masks I wore for the study did I want them to write the Rx for. I said neither...I want to try on some others first. And I was insistent. It was only then that they said I can discuss with the Dr. having a 45min-1hr mask fitting appointment with a resp therapist. Good thing I knew from all of you to stand up for myself and say 'YES, I want that!' instead of just letting them write a Rx for something that might not be the best for me. I also declined letting the home care agency come until I've spoke with the Dr. so I don't end up with a machine that doesn't do what I know some of them CAN do for me. I hope my fitting appointment goes as well as the ops!!

RosemaryB · Post by **RosemaryB** » Sat May 26, 2007 1:59 pm

momadams wrote:Please tell us where you live and where you went.
Shari

Garden City Hospital in the Detroit, Michigan area. If anyone is getting a sleep study in S.E. Michigan this might be one place to consider.

RosemaryB · Post by **RosemaryB** » Sat May 26, 2007 2:06 pm

[quote="BrensTiredMom"]My sleep lab just called on Friday afternoon to remind me of my appointment with the sleep specialist on Tuesday and to let me know the results of the titration study were in. And then they went on to say that the Dr. wrote a CPAP Rx and they wanted to schedule a home care company to come out. She also asked which of the 2 masks I wore for the study did I want them to write the Rx for. I said neither...I want to try on some others first. And I was insistent. It was only then that they said I can discuss with the Dr. having a 45min-1hr mask fitting appointment with a resp therapist. Good thing I knew from all of you to stand up for myself and say 'YES, I want that!' instead of just letting them write a Rx for something that might not be the best for me. I also declined letting the home care agency come until I've spoke with the Dr. so I don't end up with a machine that doesn't do what I know some of them CAN do for me. I hope my fitting appointment goes as well as the ops!!

Joethespy · Post by **Joethespy** » Wed May 30, 2007 8:26 am

Rosemary,

Most masks only come with one size in the package. Recently some devices like the Swift have all of the sizes packaged with the mask. From an tech and a manager (inventory) this is a good trend. Hopefully other types will follow this trend.

You are right when you say that the first fit may not always be the best. Technologists (even the best ones) have their own preferences and use those to narrow the selection process. This is why our policy is to give the mask used on the titration to the patient. When the DME sets the patient up with CPAP at home, we ask that the DME replace the mask to us(sleep lab). If for some reason, the patient decides that that the mask first used is not working and the DME provides another mask, we will just absorb the cost of that mask. Sleep labs usually get a better price on masks than DME's do but it is illegal for a sleep lab to sell a mask. Even without this setup a good DME will usually absorb the cost of one or two masks.

Another issue is that most masks are only designed to be in use for about a year. The materials they are made from are designed for comfort and seal not to last forever. Medicare will pay for a new mask, tubing and filters every 6 months. Most private insurance companies will pay for this about once a year. When this time comes due, this is a good opportunity to go to your DME and see if there are any new masks available that may suite your needs better.

Good Luck....Joe

rested gal · Post by **rested gal** » Wed May 30, 2007 1:11 pm

I believe Medicare is quite a bit more generous than every 6 months for masks, tubing, and filters:

From cpap.com's sister company (billmyinsurance.com), this is the Medicare replacement schedule they show:
http://www.billmyinsurance.com/cpap-faq/Medicare.html

HCPCS Code....Description.......Allowed Replacement Frequency

A7030NU.....Full Face Mask..........1 every 90 days
A7031NU.........Full Face Cushion......1 every 30 days
A7034NU.....Nasal Mask..............1 every 90 days
A7045............Exhalation Port with or without Whisper Swivel...Span Not Yet Released By Medicare
A7032NU........Nasal Mask Cushion.....2 every 30 days
A7044NU........Oracle......................1 every 90 days
A7033NU........Nasal Pillows..............2 pairs every 30 days
A7035NU....Headgear..................1 every 180 days
A7036NU........Chinstrap..................1 every 180 days
A7037NU....Tubing......................1 every 30 days
A7039NU....Non-Disposable Filters..1 every 180 days
A7038NU....Disposable Filters........2 every 30 days
A7046...........Humidifer Chamber.......Span Not Yet Released by Medicare

E0601NU........CPAP...Varies Greatly - Call For More Information
E0470NU........BiPAP...Varies Greatly - Call For More Information
E0562NU.......Heated Humidifier...Varies Greatly - Call For More Information
E0561NU.......Passover Humidifier...Varies Greatly - Call For More Information

Medicare does not cover accessories. Examples of accessories are non-essential items such as snuggle hoses, software and card readers and battery packs.

RosemaryB · Post by **RosemaryB** » Wed May 30, 2007 1:54 pm

Joethespy wrote:Rosemary,

Most masks only come with one size in the package. Recently some devices like the Swift have all of the sizes packaged with the mask. From an tech and a manager (inventory) this is a good trend. Hopefully other types will follow this trend.

You are right when you say that the first fit may not always be the best. Technologists (even the best ones) have their own preferences and use those to narrow the selection process. This is why our policy is to give the mask used on the titration to the patient. When the DME sets the patient up with CPAP at home, we ask that the DME replace the mask to us(sleep lab). If for some reason, the patient decides that that the mask first used is not working and the DME provides another mask, we will just absorb the cost of that mask. Sleep labs usually get a better price on masks than DME's do but it is illegal for a sleep lab to sell a mask. Even without this setup a good DME will usually absorb the cost of one or two masks.

Another issue is that most masks are only designed to be in use for about a year. The materials they are made from are designed for comfort and seal not to last forever. Medicare will pay for a new mask, tubing and filters every 6 months. Most private insurance companies will pay for this about once a year. When this time comes due, this is a good opportunity to go to your DME and see if there are any new masks available that may suite your needs better.

Good Luck....Joe

_________________

Joe, for my titration study I was given a choice of nasal masks only. I told the tech that they all hurt my sinuses and showed her where they pressed but one was better than the others, but she said those were the only choices they had. Nasal pillows weren't mentioned at all, and I didn't even understand what they were at the time. When the sleep study was over, she said that this was the mask the DME would give me and that I didn't have a choice.

I woke up with a sinus headache that lasted all day. I don't have a lot of sinus headaches, so was sure the mask had caused it.

Luckily I found this forum and went to the DME with a list of masks, mostly nasal pillows that I wanted to try. Fortunately, I found the Swift which is working well enough for now.

However, if my sleep lab had given me the mask I used, and I hadn't had the benefit of this forum (which many people don't) I would have struggled with that mask, assuming it was the best I could do.

I'd opt for having the patient be able to try on masks at both the lab and the DME in case the tech's biases prevent a good fit. Since compliance is only 50%, it seems that this is the least that can be done.

Joethespy · Post by **Joethespy** » Wed May 30, 2007 5:57 pm

Thanks for the info rested gal. I had not recieved an update on this in a while.

Humidifier

Additional Comments: Pressure 16 cm H2O at altitude 6550ft