My first trip to the DME

[Made_in_1960]

Four months after asking my primary care doctor about sleep apnea, and a seemingly endless wait for various appointments and sleep study results, I will be getting my CPAP and related gear Thursday (3/4/10) afternoon. I am so tired of being tired all the time. I can't wait to finally get a treated. According to the DME's website, they carry Respironics and ResMed machines. I've armed myself with Rested Gal's list of data capable machines at viewtopic.php?p=307168#p307168. I don't know if my HMO will let me get a data capable machine. But, I'm going to try. If anyone has any other tips for me, especially regarding masks, I'd love to hear them. Wish me luck!

[tattooyu]

I have Anthem (Classic) HMO, and I got a ResMed S8 Autoset II. Remember, the insurance company pays the exact same amount regardless of brand or model for data-capable vs. non-data-capable. I forgot the insurance code, but it's something like "E0601", which covers all CPAP/APAP machines.

[JohnBFisher]

I would wish you luck, but 9 tenths of "luck" is being prepared. And you clearly have done your homework. But sure... Good luck on your visit. Hope you proceed quickly toward effective therapy and wonderful sleep!

[rested gal]

Welcome to the board, 1960.

I do wish you good luck. I'm betting on you.

[DreamStalker]

First of all, as Tatoo said, the insurance pays one set price to the DME regardless of whether it is data capable or not. Likewise, your copay is the same regardless of the machine you get (some DMEs will try and make you pay the difference in their costs ... just say no and take your business elsewhere).

In other words, the battle will be decided upon the greed level of the DME and your desire to have the best equipment to treat your condition ... ie. their profit margin vs your health.

If your Rx only states CPAP at such and such pressure, the DME can and usually does give you the cheapest machine they have in order to maximize their profits. However, in the end, they do have to give you the machine that your doctor prescribes. So if you can get your doc to write the Rx to specifically state a machine that provides full efficacy data, the DME must swallow its profit margin in lieu of your health.

[aroche]

I agree with Dreamstalker, and will supplement with 'Don't be afraid to push for what you want." I didn't, and I had live with a compliance only system for a few months while I figured it out. Start out getting what you want and need instead.

Don't be afraid to go to a different DME if need be. Some are not that good to or for you.

[Made_in_1960]

I got a ResMed S8 AutoSet II. Although this is an auto-tritating machine, it has been set up to run in CPAP mode. This machine is fully data capable. It has been set up with a GSM (cell phone based) transmitter that will send compliance data back to my insurance company and and therapeutic data to the DME. The respiratory therapist told me that she will be remotely monitoring my data, primarily looking at leak numbers. The machine was provided on a 10-month rent-to-own arrangement. At the end of the rental contract, I send the remote transmitter back to the DME, the machine is mine, and I don't have to provide compliance data. I have a data card that I can use to download my data from the machine.

I also have an H4i humidifier.

After discussing various mask options with the RT, I selected the Mirage Swift LT. I went in thinking I wanted a mask that covered my entire nose. The RT said, because my prescribed pressure is relatively low at 8 cm, I could use a mask with nasal pillows. It seemed counter intuitive, being more comfortable with something stuck in my nostrils. But, she pointed out that the nasal pillow type masks require fewer straps and less hardware to hold them in place. In addition, I'll need less tension on my straps to prevent leakage. I asked if I could return the mask for another style if I wasn't working for me. She said yes. With that, I was convinced.

In addition, I have a travel bag, hose and some other related paraphernalia.

When I got home tonight, I set up the machine on my nightstand, donned the mask, turned it on and laid down on my bed for a few minutes, just to see how it all felt. I am amazed at how quiet this machine is. My girlfriend's Respironics M Series Pro sounds like a jet engine compared to my machine.

I'll post a follow-up in a couple days to let you all know how things are working out for me. Thanks for everyone who responded to my posts. Thanks to this forum, I was well prepared and knew which questions to ask.

All things considered, I think I did pretty well at the DME today. I am glad that after months of waiting, I am finally getting treatment. I haven't been this excited about going to bed since December 24, 1967!

[DreamOn]

Good to hear that you were able to get a good machine! Your preparation paid off. Sleep well tonight!

[roster]

Excellent machine. Good luck.

[carbonman]

It has been set up with a GSM (cell phone based) transmitter that will send compliance data back to my insurance company and and therapeutic data to the DME. The respiratory therapist told me that she will be remotely monitoring my data,

'60, please keep us informed on this aspect.
I will be very interested to hear how this works out.

[Made_in_1960]

As promised, here's an update on my progress with my new CPAP. I got my equipment one week ago today. It's been an adjustment for sure. I am starting to notice significant improvement in my alertness and mood during the day, especially at work. But, I'm still waking up 3-4 times per night . I'm hoping that once I get used to the machine and address some of the issues below, I'll be able to sleep through the night. I notice that I'm dreaming a lot more. I've had some very BIZARRE dreams this week. Not nightmares, but very weird stuff.

This forum has been a wonderful source of information.

The first night, I set my humidifier midway between the lowest and highest setting. I woke up three hours later with water running down my face and a gurgling hose. Thanks to the forum, I knew what is was; It was the dreaded "rain-out". So I wiped off my face, lifted the hose to let the water drain back in to the reservoir and turned the setting down. That seems to have solved the problem. I've placed an order on CPAP.com for a hose cover along with a 12V converter for use in my camper.

I've woke up a couple of times with my mouth open and dry from sleeping with it open. During one of these episodes, my girlfriend said I was snoring. I left a voice message for the RT at my DME requesting a chin strap. When I got my machine, she promised to send me one, if I decided I needed it. But, I have not heard back from her yet (I called on Monday). I've read here about some folks taping their mouths shut. But, I want to try the chin strap alone first.

One of the biggest puzzles has been how to get my data from the machine. The RT wouldn't tell me. After scouring the manuals that came with the machine to no avail, I found the answer here 3 days ago. Here's the numbers, I've retrieved so far:

3/9/10 Leak .22L/s, AHI 3.5, AI .4, HI 3.1
3/10/10 Leak .32, AHI 3.6, AI .1, HI 3.5
3/11/10 Leak .30L/s, AHI 4.8, AI .7, HI 4.1

My impression is these number are below limits, especially for leaks and AHI. Again, I'm hoping they'll improve once I get my chin strap.

I'm not using the software. For now, I am content to just retrieving the data each morning and writing it down in a notebook.

I got a call yesterday from the company that's monitoring the compliance data on behalf of my insurance company. The representative wanted to know if I had any questions or issues with my machine. She said they were getting good data from the GSM transciever unit on the back of machine and it showed that I've been using my machine for 5-9 hours each night.

The only other issue, I'm having is dryness in my nostrils. I'm hoping that once I get my hose cover, I can turn my humidifier back up.

I am very happy with the quietness of the machine. My only complaint is the reservoir is a one peace unit. I can't take it apart to dry it out.

So, this has been my experience so far. Thanks again to everyone for all the useful information you all have posted here.

[roster]

The dryness in your nostrils might improve if the chin strap keeps you from mouthbreathing.

My impression is that chin straps are not effective for the majority that try them. So if you give a strap a good trial and it fails, the next trial should be a full face mask.

[rested gal]

Thanks for the update, 1960. Very interesting.

You got an excellent machine!
Best of all, you're doing a very good job educating yourself and monitoring your own treatment.

Hope all continues to get better and better for you.

[JohnBFisher]

... As promised, here's an update on my progress with my new CPAP. ...

Thanks for coming back with an update.

... I notice that I'm dreaming a lot more. I've had some very BIZARRE dreams this week. Not nightmares, but very weird stuff. ...

You are getting more REM sleep than you probably have in years. You will probably find that you will feel more creative and better able to remmeber things. That's a great side effect of CPAP.

... Here's the numbers, I've retrieved so far:

3/9/10 Leak .22L/s, AHI 3.5, AI .4, HI 3.1
3/10/10 Leak .32, AHI 3.6, AI .1, HI 3.5
3/11/10 Leak .30L/s, AHI 4.8, AI .7, HI 4.1

My impression is these number are below limits, especially for leaks and AHI. ...

As you note, the leak rate could be better. But your AHI value is *wonderful*. Keep up the good work!

... My only complaint is the reservoir is a one peace unit. I can't take it apart to dry it out. ...

Why? Fill it with distilled water and then you don't have to empty and dry it. Nothing will grow in distilled water. Okay, every now and then (once every 3 or 4 months) I will wash out the humidifier tank. But it's just not a big deal.

Anyway, I agree with Rested Gal, you are doing a great job of learning and monitoring your therapy.

[Slinky]

I agree w/the others. You done good and are doing great. Try some Ayr Saline Nasal Gel in those tender dry nostrils. And a little of that Ayr Saline Nasal Gel on the bottom of your nostrils will help w/the Swift LT nasal pillows sitting well in your nostrils and reducing leaks. Hang your hose above your head, that should eliminate the "rain out". It will also reduce the tugging of your hose on your mask and help to reduce any mask leaks.