Introduction and a questions

[Steviemain]

Well....after umpteen years of thinking that being tired all the time and losing my wit and mind were all parts of getting older (turned 50 last year) my Doctor convinced me to do a sleep study. Results as best as I can tell were; AHI of 54, which I guess means I was slowly creaping into a slow, oxygen deprived death.

I am anal by nature and research as much as possible to ensure I'm getting the latest and greatest information on whatever I'm doing at the time...and behold...I found cpap.com and cpaptalk.com.

I've read multiple threads and am convinced most people on this site are "on the ball" and as an old mentor once told me, "there is no knowledge greater than the wisdom of experience", which this site oozes!

So....I haven't even started on a CPAP machine yet, but it will be delivered on Tuesday, 2/17. I was told that I'll be receiving a Remstar M-Series with C-Flex and Heated Humidifier to use with a Mirage Micro nasal mask. My research revealed that these are all good items and I feel as if all should be well in the world.

All the above will be delivered by a Home Health Care specialist and my question to the forum is; What should I ask to ensure I get the best out of this visit?

P.S. I feel like a kid in a candy shop in anticipation of sleeping well and regaining my wit and mind again!

Thanks

[ozij]

You should ask which model it is exactly, compare it to Den's recently posted list, and insist on a machine that has full data capability.
Don't let anyone fool you wiht a machine that only records compliance (i.e. hours of use).

Welcome to the forum!
O.

<snip> I'm going to post (again) the full list of Respironics machines, just in case someone else is wondering, too.
The "Basic" and the "Plus" machines are NOT data-capable.

Den





REMstar Basic (no SmartCard) - DS100*, DS100H*
REMstar Plus with C-Flex (no SmartCard) - DS200* DS200H*
REMstar Plus with C-Flex and SmartCard - DS200S DS200HS

REMstar Pro with C-Flex - DS400S, DS400HS

REMstar Auto with C-Flex - DS500S, DS500HS
REMstar Auto with A-Flex - DS510S, DS510HS

BiPAP Plus with Bi-Flex - DS600*, DS600H*
BiPAP Auto with Bi-Flex - DS700S, DS700HS

BiPAP autoSV - 1038917, 1040716
Noninvasive Ventilation Systems
BiPAP AVAPS - 1029744, 102970
BiPAP S/T - 1012885, 1014248

*These models only offer phone-in compliance data.

[bap40]

Agreed.... be sure to get the best machine and the one YOU WANT right off the bat. I did plenty of research on machines before I got my first one. The DME basically laughed when I told her what I wanted and her reply was basically that I didn't KNOW what I needed. She talked me into "her" machine.. Before my first month was over and I had done a lot of reading on this board, I fired them and went to a place that had no problem with my choice. It also helped that I asked my family doc to write a new script for the exact machine I wanted.. The sleep doc would not do that. Any doctor can write a script for treatment.

[DoriC]

We were lucky to have found this forum about 2wks before my husband's sleep study. The Sleep Center faxed the report to our Internist the next day,DX=Moderate Sleep Apnea. He agreed to write the RX exactly the way I was told here,(he had no clue), REMstar M Series APAP w/AFlex, Humidifier, FF Mask of Patient's Choice, Pressure @11-15. Hubby was titrated at 13 but I followed the recommendation here of the 2up,2down setting to start with. The DME brought the equipment the next day with a ComfortGelFFmask,the one he used for his titration but I quickly asked for the UltraMirage thanks again to this forum. We saw a Sleep Specialist after a month and he suggested a setting of 8-18 "since we had an auto and we should let it find the right setting". I just smiled when he said he'd see us again in 3months. I realized then that education is so powerful and the truth is I'm learning everything I need to know right here. When will the medical community ever catch up with me! BTW, we have an appt with our Internist next week and he wants me to bring some reports and explain them to him! Don't get me wrong, he's been our Dr for 15yrs and really knows his stuff but he admits he doesn't have the time to really research sleep apnea even though he was the first one who diagnosed my husband and sent him for the sleep study.

[MidnightOwl]

Saying Remstar M series is like saying late model ford. It doesn't tell you anything. I agree with the other posts that you DO NOT want the "basic" and you DO NOT want the Remstar "Plus" (I have that one and regret it). But these are cheap and if you don't call up to request something else that's almost certainly what will arrive on Tuesday.

All the Remstar M series have a fairly small humidifier tank. At a high pressure in dry air it will run out of water before your 8 hours of sleep is up. I use a pressure of 14 and it only happens when the air is dry. But if your air is very dry and you use a high pressure you might want to look at a different brand. Of course you can always add a stand alone humidifier later.

By the way make sure they give you the little part that lets you use the Remstar M series CPAP without the humidifier. If you take the humidifier off there is a big hole in the cpap where it was attached. Without that piece you won't have the option of leaving the humidifier home when your travel or sending it for repairs or replacing it with another model.

A good mask is whatever fits you. I see the ads claim this fits anyone. Maybe it really does. Is this the same one you used during your study? And did that mask work well for you? If not I hope you can try some others.

Make sure you test the mask fit with the cpap's "ramp" feature turned off. . (Ramp is a function on most cpaps that starts the pressure out low and gradually raises it over 20 minutes or so). You don't want do discover at bedtime that the mask leaks as soon as you get to your prescribed pressure. Don't worry if it feels like you are getting blasted in the face when you are fitting the mask. Those first few minutes are the worst.

Some people try the mask lying down. I'm sure it's a good idea but it just wasn't something I was going to do with a stranger in my living room.

Wash the oil off your face before trying on the mask. It will fit better if you do.

Make sure you are shown how to adjust the mask later even if it seems perfect while trying it. Ask what parts come apart for cleaning and ask for a demonstration (the same for the cpap machine). Then, make sure you have the same information in writing, just in case you immediately forget it all (I did).

Ask what all the buttons on the cpap do and how to look at/adjust whatever you're allowed to look at/adjust. Don't waste your breath asking about adjusting other things - you get can that here in minutes.

Don't sign any paperwork with blanks and make sure you have a copy of anything you sign. Don't sign anything that says you are agreeing to terms in an attached document that the company convenient forgot to attach. You can always draw lines thru the blanks or cross out any clause that says, for instance, that you are agreeing to the terms on the missing page 2.

Write your questions down ahead of time - then remember to look at the list. I forgot that part and forgot at least half of them.

This is all I can remember right now. I hope others come back with more.

Good luck

midnightowl

[Steviemain]

First off....this site is incredible!! I enjoy reading the posts and find myself laughing at the quips of many....There seems to be a direct correlation to OSA, intelligence, and wit...perhaps a direct result of the sleep deprived to subconsciously compensate for being tired all the time...could be? But enough of that....

Thank you for the quick responses to my initial question of what to ask the DME when they arrive at my house this Tuesday.

MidnightOwl---your detailed response blew me away....thanks for taking the time to enlighten me! I have written all your questions down and will have them ready.....and yes, the Mirage Micro was the mask I used at my sleep study.....it seemed to work fine, but then again I'm ignorant at this time to what is "fine" and what is "good".

Bap40 - I'll be calling my Doctor Monday to request a machine of my liking.....my wife calls me an electronics snob (home theater, stereos, etc) so why wouldn't I want only the best in CPAP equipment, ha!

Ozij - the info about getting a machine with full data compatability is HUGE!! Based on the members of this forum's preferences I'm pretty sure I know what to get....but I'll be asking that question in a minute.

DoriC - thanks for letting me know that all Doctors and DME's are not created equal when it comes to OSA....this site will surely teach me to ask the right questions.

So....I perused many forums to get info on the machines that people post at the bottom of their comments and these two seem to be "tops" on the list so I plan on getting one of them (not that there aren't other great machines, but my research time is running out). I realize the masks are a "whatever works best for you" item.

The machines;
1. The RemStar M-Series Auto CPAP with C-Flex, heated humidifier, Encore Viewer Software and card reader.
2. The RemStar M-Series Auto CPAP with A-Flex, heated humidifier, Encore Viewer Software and card reader.

The questions;
1. What exactly is/are the benefit/differences between the C-Flex and the A-Flex? I've read about them, but am still unclear between the two.
2. Do these units travel well, i.e. airlines?

Thanks again and as MidnightOwl stated, "saying only M-Series is like saying late model ford"...love it!

[Wulfman]

Both C-Flex and A-Flex are "comfort" settings to aid in breathing relief. With the Auto with A-Flex, a person can pick and choose which features they want to use......it's a multi-mode machine.
The options are:
CPAP mode (single pressure and no exhale relief)
CPAP mode with C-Flex
APAP mode (no exhale relief)
APAP mode with C-Flex
APAP mode with A-Flex

You can read about the Flex technologies here:

http://aflex.respironics.com/

http://cflex.respironics.com/

There's only one machine that has the A-Flex technology.
As far as insurance billing, there's only one CPAP billing code - E0601 (covers everything from the basic CPAP to APAP)

The M Series was designed to be more "travel friendly". There are others that are now smaller and lighter, but not as full-featured as the M Series APAP w/A-Flex. If you do a LOT of traveling, you might want to pick up another less-expensive machine for travel purposes. It doesn't hurt to have a spare machine, anyway.

Den

[SharkBait]

If you're okay with Respironics, I wonder if anyone has tried telling their doctor, "Would you please specify A-Flex? I've done some research and people find that provides great exhalation relief, some say it's MUCH better than C-Flex...".

Then you got it all -- APAP, full reporting, the works...

I know the machine doesn't look as cool as the Resmed, and yeah, there's that brick thingy. But I'm traveling today and taking the APAP machine and the brick's no biggie...

[ozij]

Is there any chance at all you may have loaner? (Do you get to audition home theater equipment at home?).
The reason I think it may be worth it to trial a machine is that automatice algorithms are different, and some people respond better to one algorithm that to the other.

I had a Respironics Auto on trial when I started - there were major misundersting between it and me. The PB on the other hand (whith help from member of this forum) turned out much more adaptable, and therfore better for me.

We recently had two members (Browser and Mindy) who discovered they preferred the treatment given to them by the Covidien Sandman than the Respironics.

A trial run would let you find that for yourself if a machine is good for you.

O.

[rested gal]

Welcome to the board, Stevie. You've already gotten lots of good info in this thread, so I'll reiterate what Midnight Owl said:

you DO NOT want the "basic" and you DO NOT want the Remstar "Plus"

When people are told that their DME is going to give them a Respironics M series machine, the DME almost always plans to give them the "Plus" model.

If it's a "Plus", I'd refuse it. I'd ask for at least a "Pro" in the M series line.

There are other equally good brands of CPAP machines, too, which record more than just hours of use.

My list of machines that record "full data" (AHI and leak info) and those that don't -- as of October 2008:
viewtopic.php?p=307168#p307168

[Steviemain]

Well, well, well.....as I slowly drift off into analysis paralysis on how exactly to get the best machine and not knowing how flexible the DME is...happens at work too....too much to do and too little time.

Anyway, you all are just AWESOME in helping me get set-up at the front end; incredible amounts of great information....sounds as if many folks have had some extensive trial and error runs and want to help others to not have the same experiences...how refreshing and unselfish.

I will defintiely take everyone's advice and see what happens when I "do" ask my Doctor to change my prescription...hope it goes over better than a lead zeppelin.

I love the idea of the "loaner" program, but have no idea if the DME (Lincare, by the way) has such a thing. I just had a telecon with them on Friday and I had no idea what to ask them.....now they need to be afraid, ha! And yes, home theater equipment can be test driven prior to purchase at the higher end stereo shops.....ahhh, the joy of clean sound and great movies, but I digress.

Now I have three more questions...go figure, ha!

1. Wulfman stated that there is one insurance code (E0601) that covers all CPAP machines....do I need to tell that to the Doctor or DME. I would assume (shame on me) they already have this information, but after reading the multiple threads (and thank all of you for your links to info and other threads) it appears that many people assumed that DME's were all educated and up front...not necessarily the case.
2. And I read on one of the other threads that insurance does "not" cover the software and devices. If that is true do most people buy them at CPAP.com or other DME's?
3. I also read that insurance companies need proof (thus, data from the machines) before they will continue to pay for products. Can someone please elaborate a bit on how the insurance works throughout this process?

I apologize if I'm being overly enquisitive...it's the anal thing I mentioned when I started this thread.

Again, you all are just AWESOME!!!

Steve

[Gerryk]

Well....after umpteen years of thinking that being tired all the time and losing my wit and mind were all parts of getting older (turned 50 last year) my Doctor convinced me to do a sleep study. Results as best as I can tell were; AHI of 54, which I guess means I was slowly creaping into a slow, oxygen deprived death.

I am anal by nature and research as much as possible to ensure I'm getting the latest and greatest information on whatever I'm doing at the time...and behold...I found cpap.com and cpaptalk.com.

I've read multiple threads and am convinced most people on this site are "on the ball" and as an old mentor once told me, "there is no knowledge greater than the wisdom of experience", which this site oozes!

So....I haven't even started on a CPAP machine yet, but it will be delivered on Tuesday, 2/17. I was told that I'll be receiving a Remstar M-Series with C-Flex and Heated Humidifier to use with a Mirage Micro nasal mask. My research revealed that these are all good items and I feel as if all should be well in the world.

All the above will be delivered by a Home Health Care specialist and my question to the forum is; What should I ask to ensure I get the best out of this visit?

P.S. I feel like a kid in a candy shop in anticipation of sleeping well and regaining my wit and mind again!

Thanks

Ask questions! The only stupid question is the question I uhm I mean you didn't ask.
First off did you try this mask and others and is this the one that fit you best and had the least leaks?
If not ask about trying other masks if this one doesn't work for you.
If you don't understand something when they are explaining or setting something up stop them and ask them to clarify.
Ask how they recommend cleaning your equipment.
Ask about replacement supplies. When you can get them according to your insurance schedule.
Most insurance has a chedule they follow for replacement items such as the mask cushion,
My insurance will pay for two a month and a completel mask every three months.
Ask how to read what the machine is telling you about your use and if you are having any events.
If things work out for you and this works, I suggest getting a card reader and software so you can track your status.
Other things you may run into such as dry mouth ask on the boards or do a search.

Good luck.

[Wulfman]

#1. The doctor usually doesn't put that code anywhere......that's usually done at the DME level when they bill the insurance provider. That information is "ammo" for you to use if the DME balks at giving you a machine you want. Too many DMEs try to claim (to the patient) that there will be an up-charge for getting a better machine than the plain-Jane one they want to give their customers. They get the same amount from the insurance provider regardless of which CPAP they hand out.....consequently, they make less profit from a higher-end model and then they try to con the customer into forking over more money. That's the sign of a shady DME.

#2. Yep. We've all bought our own software and readers. Insurance (except in a couple of rare instances) won't pay for it.

#3. All depends on your insurance provider and the DME. Minimum requirements for "compliance" are at least four hours per night for 70% of the nights. I always advise new users to get their insurance providers to buy the machine outright as soon as possible (if possible). In my case, I purchased all of my (initial) equipment from CPAP.COM outright and then billed it back to my insurance provider and got reimbursed for 80% of it (except for the software and reader). I didn't want to go through a local DME and this way made it less expensive for my insurance provider and me. By doing it this way, it showed my insurance provider that I was SERIOUS about this therapy and consequently there was no "compliance" issues that I had to prove to anybody.


Den

[ozij]

And yes, home theater equipment can be test driven prior to purchase at the higher end stereo shops.....ahhh, the joy of clean sound and great movies,

... I thought as much... but then, my experience of that is with hi-fi stereo in another country...
O.

[Steviemain]

Wulfman - fantastic information; I really appreciate your responses.

I've learned so much from this forum in the past two days that I'm thinking I may cancel my DME visit this Tuesday. What the heck, I've been sleeping poorly for years so another week or two delay won't make too much of a difference. Of course, some of you may find delaying the DME visit as a bad idea...please feel free to hammer me if this is poor judgement. Or perhaps I should keep the visit and see how they handle all the questions to determine whether they are on the light or dark side....Typing away as I contemplate the mysteries, ha!

Speaking with my insurance provider now that I know "things" is a great idea. I found all the insurance codes on CPAP.com so now I can provide them to see how it's handled and just what type of machines I can really get (as well as do a bit more research). Hopefully, they'll be as appreciative as yours was about taking this journey seriously.

GerryK - you added several more important aspects to my questions. Replacement equipment hadn't even entered my mind...thanks

Well, I can't think of any more questions at this time, but figure that I will get some feedback regarding canceling my DME visit.

I didn't know what I didn't know and now I've got enough information to be dangerous....

Thanks,
Steve