First post-study Dr. visit coming up

BReece · Post by **BReece** » Wed Jun 20, 2007 9:59 am

Hi All,

Great forum! I've been reading lots for the last few days (since I had my sleep study). I'm excited to have found such a vibrant, friendly, knowledgable community.

I had my sleep study last Thursday and it confirmed sleep apnea. I have an average of 24 interruptions per hour.

My (GP) doctor e-mailed me yesterday offering to just set me up w/ the needed equipment, but thanks to the reading I've done here, I'd much rather go in for a visit and make sure that I get the right equipment rather than the default. My doctor is open to a pre-prescription visit, so I'm hoping he's also open to my input.

I'm wondering what equipment I should push for. APAP vs. CPAP, for example.

Also, do I need a machine that will let me monitor my treatment? I'm a computer geek, so that sounds interesting.

Should I get a full face mask, or just the nose thing? If I get one, how difficult will it be to get the other if/when I decide I need that?

Any other information I should take with me? Any other advice?

Sorry for the novel, but I just want to be as prepared as possible. Feel free to point me to any links that answer these questions if you'd like. Any insight will be much appreciated.

Thanks,
Bret

JimInAL · Post by **JimInAL** » Wed Jun 20, 2007 10:33 am

Welcome to the forum! If you are like most of us, you'll learn more hear than you will from your Dr.

BReece wrote: I'm wondering what equipment I should push for. APAP vs. CPAP, for example.

There are advantages to an APAP, but some people do fine with just a CPAP. You might need different pressures at different times of night, or when sleeping in different positions - a CPAP can't do that, but an APAP can automatically adjust. If your prescribed pressure is high (mid-teens or more), you might even need a BiPAP.

BReece wrote: Also, do I need a machine that will let me monitor my treatment? I'm a computer geek, so that sounds interesting.

As a fellow computer geek, I agree it sounds interesting. Now at 3 months into my treatment, I can say that if I hadn't gotten such a machine and the software to go with it, I might would have given up by now. For example, the data from the machine told me that my first mask leaked so badly that the treatment was ineffective - I could tell it was leaking, but since I was new at this, I had no idea how much leakage was OK.

BReece wrote: Should I get a full face mask, or just the nose thing? If I get one, how difficult will it be to get the other if/when I decide I need that?

Many (most?) people end up trying both. When you get your equipment, you should have a trial period for the interface during which you can get a different one at no additional cost. Every face is different. A mask that works great for one person will be terrible for someone else.

BReece wrote: Any other information I should take with me? Any other advice?

Many people also find a humidifier to be essential. If the Dr. doesn't automatically recommend one, ask why not.

Slinky · Post by **Slinky** » Wed Jun 20, 2007 1:45 pm

Assuming you have insurance, may I suggest you strongly consider the Resmed S8 Elite CPAP w/Humidaire 3i integrated heated humidifier OR the Resmed S8 AutoSet Vantage w/the above humidifier.

They are good sturdy, efficient machines AND you will enjoy the data you can easily access via the good size, easy to read, LCD screen. Since both Resmed AND Respironics have decided to make it difficult to obtain their software and reader cable you will appreciate access to that data until such time as you are able to obtain the software & cable.

If you don't have insurance and are self-pay OR have high deductable/co-pay insurance then I would suggest the RemStar Pro2 (pre M series), RemStar Pro M Series or the Remstar Auto w/C-Flex (pre M series) or RemStar M series Auto w/C-Flex or even the Respironics M Series Auto w/A-Flex. (If not the M series INSIST on the Pro2, not the Pro).

Another to consider is the Puritan Bennett GoodKnight 420E and its Silverlining software.

tangents · Post by **tangents** » Wed Jun 20, 2007 2:04 pm

Slinky, that's so cute that you added the 420E as almost an addendum...

That's the one I bought last month, and I'm quite happy with it. Cost-wise it's the cheapest, and you can still buy the software for it. The ONLY problem with it is that PB has no exhalation relief, (and an occasional whistle) , so if your pressures are high, that would be a consideration for you.

If your doctor is hesitant to give an APAP right off the bat to a newbie like yourself, my advice would be to explain that you will be operating it in CPAP mode, and will only use the APAP in the event of future problems or concerns.

Mask interface? Very personal choice. Consider your sleeping positions and how often you move around at night. Consider whether or not you mouth breathe. Consider the distances between your nose and upper lip and between your lower lip and chin for fitting. Try the masks on while lying down, and with the hose connected. Dreamstalker has some wonderful writeups on mask selection (nasal, mostly, I think). Wulfman has some good writeups on full face masks.

Let us know how you make out!
Cathy

snoregirl · Post by **snoregirl** » Wed Jun 20, 2007 3:19 pm

I agree that what you get may depend on your insurance.

If you can get an auto, nothing is lost and everything to gain. You can use it like a cpap if you want, but have the option to use it in auto to check your titration results. Resmed auto doesn't have exhale relief in auto mode.

If you titration pressure is high you may like the APAP in auto mode as you will spend less of the night at that really high pressure

If you have insurance, and it is worth using, and you don't want to fight, then any of the popular data recording machines that are not auto are good. If your pressure is high, then exhale relief is beneficial.

If you are really high pressure bipap is needed.

You don't tell where you are pressure-wise so it is hard to say what you need.

Even if you agree to let your doc fax your prescription to a dme, get a copy for yourself. Also get a copy of your sleep study.

Double check what your copay is and what your insurance will cover (not with the DME but with the Insurance co).

And study the specs of the different machines on CPAP.com. There are people here who like and do well with all the major brands. Cost and features could be the deciding thing.

Slinky · Post by **Slinky** » Thu Jun 21, 2007 7:04 am

Cathy, I only always mention the Puritan Bennett 420E GoodKnight last simply because I've had NO experience w/it or any P&B machine and only know that those who have this particular machine love it, it has software easily available and it is an auto.

BReece · Post by **BReece** » Thu Jun 21, 2007 11:52 am

Hi All,

Thanks very much for the welcome and all of the information.

I feel like I'm prepared to go in, and if necessary, fight for what I need.

I'll update my profile when I get going w/ my equipment.

Thanks again,
Bret

Slinky · Post by **Slinky** » Thu Jun 21, 2007 1:34 pm

Bret, just keep in mind that an autoPAP isn't necessarily the best machine for you. Since they are billable at the same reimbursement rate as a straighht CPAP the DME suppliers do NOT like to provide them. It really is up to your sleep doctor whether to script an auto or not. You don't need an auto to have a fully data capable xPAP. It is worthwhile to fight for a fully data capable machine but whether it is an auto is hardly worth fighting for.

Two important issues are 1] to call your insurance yourself and ask what local DME suppliers they are contracted w/and hope that you will have more than one to select from and 2] check w/the DME supplier(s) what their mask exchange policy is.

How did you do w/the mask you used during your titration study? If it was comfortable and you didn't have much of a leak problem it may be your best choice. You might want to ask to see and select from a variety of both full face masks, nasal cushion masks and nasal pillows to at least try one of each at the DME suppliers to see which seems to be the better selection to actually try at home.

Be prepared but don't walk in expecting problems w/the local DME supplier. You just might be very pleasantly surprised! If you go in expecting problems you will probably encounter them. Keep an open mind and we'll cross our fingers for you.

BReece · Post by **BReece** » Thu Jun 21, 2007 1:46 pm

Thanks, Slinky. I'll heed your advice.
Bret

BReece · Post by **BReece** » Thu Jun 21, 2007 1:50 pm

Oh, I missed the question.

I don't think I had a big problem w/ leakage, but I was pretty out of it during my sleep study. They ran out of time before getting me to no interuptions, but they got me down to four per hour. I don't know how they're going to decide what pressure to prescribe. I just figured I'd see what my Dr. says tomorrow morning.

My Dr. has been very good at letting me participate in my care, so I'm hopeful that he'll be open to my wishes with all of this, but we'll see.

The only thing that I'm still a little confused about is whether to go w/ a full mask or a nose thingymajig. I used a mask at my study. I just thought that I'd start with whatever my doctor suggested since changing head gear seems much easier than changing machines. I'll definitely check to see what my DME's mask exchange policy is.

Thanks again,
Bret

Linda3032 · Post by **Linda3032** » Thu Jun 21, 2007 3:08 pm

Depending on the exchange policy via your DME, and also whether the sleep lab determined on if you were a mouth breather or not:

Get a good fitting for a full face mask with your DME -- because it is the most expensive. But also try on as many nasal masks as you can. Make notes on which ones you hate and which ones you might like to try.

Then, further down the road, when you are tempted to buy out-of-pocket, you can get a nasal mask or pillows which are less expensive than full face masks.

Also, be aware that many here on the forum are open to swapping masks that don't work for them. It's an inexpensive way to try other masks.

BReece · Post by **BReece** » Thu Jun 21, 2007 9:43 pm

Thanks Linda.
Will do.
Bret

First post-study Dr. visit coming up

First post-study Dr. visit coming up

Re: First post-study Dr. visit coming up