help me pursuade Dr/DME trade Elite to Auto

[SaltLakeJan]

I'm new to CPAPTALK & CPAP (1-16-09) I realize I found a Gold Mine of information here, and after pouring over old & newposts, I realized I could monitor my apnea treatment as I do my diabetes. And I want more than the LCD I have on my ResMed 8 Elite ll.
I'm 5ft 8, but have small nares, have to use the small size pillows for ResMes Mirage Swift mask. After 24 days of compliant therapy, my nares feel scorched , irritated & have formed cracks not on the bottom of the nostril, but strangely on the top. I've done the Gel, nasal irrigation plus saline spray. but their insides have gone from bad to worse. The fact that the H3i humidifier rarely works may have added to my problem. I notified DME about humidifier. His answer, "You just have to learn to work with it." I called the dr. She sent pres. for me to have mask of my choice and to. FIX HUMIDIFIER.
I have an appointment with him at 9am tomorrow. He didn't sound excited to change/fix humidifier. It kinda sounds like he isn't going to be to easy to work with.
Do I tell him because of the lack of sleep trying to ease the nares I feel worse than when I started, & both my BP and heart beat has increased. And I think his earlier suggestion that i may need another type of machine, is something I want to know now ( Do I tell him I want to upgrade to new ResMed Auto.Or, should my first approach be with the dr, I don't have an appointment until 2-26, Should I tell her the DME said I might have to have a different type machine?
IWhile I have these problems is probably going to be my best chance to change, and I don't want to flub my chances. Having never tried to convince a DME or a Dr to change equipment. I don't have the faintest idea how to go about it. My dr is brisk, and I don't want to irritate her. Those of you who have done the steps to make the change - please give me some suggestions. Thanks for all the information here on this site - what did newby's do before for help?

[RipVW]

I think the ultimate argument is simply, "I cannot continue to use this machine." Of course, you have to add the "why" you can't use it (e.g. don't know what your pressure is set to, but if it's relatively high, an auto might be more comfortable since it would not have to run at the higher pressure constantly). Be tough—it's your machine and your health! Good luck!

[Wulfman]

What's your pressure?


Den

[SaltLakeJan]

Thanks to RVW you mean I've now gone from patient to purchaser (with full purchaser rights) that sounds good to me.

Den, my sleep study "exhibited moderate sleep apnea" My pressure is 7.2. The sleep Dr has not discussed the polysomnograpaphy with me. I got my abbreviated copy from DME. I had UPP surgery in 2002 which took out the previous diagnosis of "severe" with 99 apneas per hr of sleep & central apneas of 84 per hr. I don't recommend the surgery, I wound up with more problems than it solved. (choke on food constantly, have to have Heimlich Maneuver 3 times in an emergency.)

The current report shows some things that disturb me, Average heart rate 52, low heart rate 16, high heart rate 150.
The Respiratory Analysis had 16 obstructive apneas, apnea index of 2.7. 97 hypopneas with Respiratory disturbance index (AHI) of 18-9. Supine AHI of 32.6.

Thanks for your interest, I appreciate every response I get.Jan

[alnhwrd]

It sounds to me after reading your post that your primary problem is the mask. Is there a reason why you are using that specific mask, or is it just the one they gave you? Lots of people have reported success with the next generation of that mask, the Swift LT. I use a nasal mask, the Ultra Mirage II, mostly because I haven't been able to get used to sleeping with things up my nose . Rip and Den both use Full Face masks. Some people have found that using a nasal or full face for a few days will give their nares a chance to heal up so they can try again. Each type of mask has its plusses and minuses.

If you are having problems with the humidifier for your unit, one option would be to purchase a stand alone unit, like the F&P HC 150 that is shown in Rip's profile. Lots of people prefer this unit as it has more surface area to provide better humidification. You could ask your Dr. to write a specific RX for this unit if he/she is willing.

I hope things work out for you. Congrats on sticking with it for almost a month, and keep it up!

[Wulfman]

Thanks to RVW you mean I've now gone from patient to purchaser (with full purchaser rights) that sounds good to me.

Den, my sleep study "exhibited moderate sleep apnea" My pressure is 7.2. The sleep Dr has not discussed the polysomnograpaphy with me. I got my abbreviated copy from DME. I had UPP surgery in 2002 which took out the previous diagnosis of "severe" with 99 apneas per hr of sleep & central apneas of 84 per hr. I don't recommend the surgery, I wound up with more problems than it solved. (choke on food constantly, have to have Heimlich Maneuver 3 times in an emergency.)

The current report shows some things that disturb me, Average heart rate 52, low heart rate 16, high heart rate 150.
The Respiratory Analysis had 16 obstructive apneas, apnea index of 2.7. 97 hypopneas with Respiratory disturbance index (AHI) of 18-9. Supine AHI of 32.6.

Thanks for your interest, I appreciate every response I get.Jan

At a pressure that low, I have a hard time believing that an Auto/APAP would be of any benefit. And, the changing pressure of an APAP may also disturb your sleep. The Elite machines are data-capable and have exhale relief. You should be able to monitor your therapy with what you have.


Den

[SaltLakeJan]

Alnhwrd, I think you'r right, it is the mask, it may be because of the nasal pillows. I originally had the Swift - for a week- I couldn't keep it on. As soon as the ramp finished, it blew right off my face. I had no idea why it came off, and I'd put it back on. Repeat until about 5 am, when I quit for the night. Went that routine for 3 nights before I called the DME. I went down, the pillows on the Swift were too big for my nose. Gave me the Swift for Her. After a few nights of the mask popping off my head, I called, & DME gave me Mirage Swift ll.

When I go tomorrow, I'll leaving the pillows, at least for now. But I don't know what kind of mask to get. What works for you? Jan.

[SaltLakeJan]

Hey Wulfman, I appeciate your advice. I would be lost without this site. When I was diagnosed in 2002, I didn't have a clue and when my sleep dr mentioned I could have UPPP surgery, I jumped at it.
The reason I was interested in an Auto was that I read in advice to new users: "Get an "auto" if at all possible. More comfortable to breathe on, etc and to get data capable."
Also, my leaks go up to .058, & since my machine notifies me if my mask is off for a few seconds when I am trying to get myself more comfortable, I'm not sure what the leaks mean. Initially I taped my mouth, the leak rate stayed about the same. Sometimes my mask starts making a bzzzzing, sound, I awaken and adjust it - but the leak alarm hasn't made a sound. Does that make any sense to you?
If my leaks have nothing to do with getting an auto - It would save me a lot of hassle to keep what I have, and get the ResScan 3.7 and data reader, does anyone know if I need a prescription for that? I plan to get it from CpapTalk because of their efforts here. (I noticed they were getting a shipment of ResScan 2-13-09.
This whole apnea experience is beginning to seem like a giantic onion-you peel off a piece, & your eyes start tearing, but your determined to keep going. Instead of an onion, the beginners post their questions - & someone more knowledgeable will answer. Thanks again, Jan

[Wulfman]

Jan,

I should also mention that leaking will also drive an Auto crazy (and the user, too) with pressure changes. If a person has problems with leaking, the straight pressure will at least keep a constant pressure.
I'm not a ResMed machine user, so I'm not completely familiar with their alarms or with the Swift masks and why they might "buzz". Maybe some of the other users who have the ResScan software can comment on it. Personally, I've never been able to make heads or tails of the reports that have been posted on the site, so I can't tell you if it's worth the money......and I'm usually all for users getting the software to see what's happening during the nights.
You do not need a prescription to purchase software.

Good luck.

Den

[SaltLakeJan]

Hey there Wulfman, glad you let me know how an auto would react to leaks. I don't want any more whistles & bells waking me - it's enough already. So,the REMstar and ResMed products are not related in any way. I thought the names were similar & one might have been a spin-off.
Many thanks for the pointers. Jan

[n9yty]

I'm a newbie, so forgive me if this is a stupid question, but...

I thought that all you needed to get the equipment was a letter of "Medical Necessity", not strictly a prescription for a particular machine spelled out. Sure, the doctor can recommend one, but do they really lock you into one and only one? I thought the online vendors would sell you whatever you wanted as long as you had the LMN.

If that's the case, then can you tell the DME to take their machine back and buy one online and submit it to insurance yourself?

[Wulfman]

Nope. The two "R" companies are separate entities and no connections.

I should probably add a little information that I didn't before, but APAPs/Autos can all be run in straight pressure (CPAP) mode. However, I still believe that at your pressure level, it wouldn't be necessarily advantageous to use an Auto.
I have several Autos and a CPAP but use straight pressure exclusively for my night time sleep. Occasionally I'll set one of them to a range of pressures for some experimentation during naps, but it hasn't been "necessary" to determine my pressure needs.....I did that a long time ago with my data-capable CPAP.

Den

[boston]

I'm a newbie, so forgive me if this is a stupid question, but...

I thought that all you needed to get the equipment was a letter of "Medical Necessity", not strictly a prescription for a particular machine spelled out. Sure, the doctor can recommend one, but do they really lock you into one and only one? I thought the online vendors would sell you whatever you wanted as long as you had the LMN.

If that's the case, then can you tell the DME to take their machine back and buy one online and submit it to insurance yourself?

depends on the insurance. some wont reimburse online purchases.
but if your deductible/copay is high enough, you could still save money going through cpap.com

[Wulfman]

I'm a newbie, so forgive me if this is a stupid question, but...

I thought that all you needed to get the equipment was a letter of "Medical Necessity", not strictly a prescription for a particular machine spelled out. Sure, the doctor can recommend one, but do they really lock you into one and only one? I thought the online vendors would sell you whatever you wanted as long as you had the LMN.

If that's the case, then can you tell the DME to take their machine back and buy one online and submit it to insurance yourself?

With online sellers, you don't even need a letter of medical necessity......just a prescription. You can purchase an APAP/Auto with a simple CPAP prescription. However, if your prescription is for an APAP/Auto, you will not be able to purchase a straight CPAP from an online seller......only an APAP.

Den

[SaltLakeJan]

n9t ty, I became a member on CpapTalk one day after you, but you may know more than I do. What turned out to be my DME called me, said they had received a prescription from my dr for my apnea equipment, please arrange to come in. When I went in the ResMed 8 Elite ll, was sitting there with a Swift ll Mask. I asked about other machines and masks, and the snot nosed "kid" acting as my Respiratory Therapist, told me that's what the dr ordered, you're not getting anything else. He told me to put the mask on and tighten it if I felt any leaks, and it was time for his next appointment. I was out the door before I realized I had come in. Someone asked me if my dr got a kickback -
When I get other equipment, I will buy online. J.