newbie needs help on the process

[oldgeezer]

I just got diagnosed a week ago, and am awaiting for the approval of insurance. Here are my thoughts and questions regarding the process. I may be jumping the gun but am trying to figure out how much input I really have.
I haven't see the script, but I know the Doc. doesn't like auto CPAP machines. He says they are not reliable
He also mentioned Cflex, which I believe is a brand name rather than a feature
After some research, I decided I want the Resmed S9 elite or autoset with humidifier and climate tube. I don't know if its the best choice, but my feeling is that I'm going to have this machine hooked up to me for a third of my life, so I simply want the best.
So, can I get what I want, or does the Doc and DME decide? I'm sure they know better than me, but I don't want to be bullied into something just because it is more convenient for them.
Seems to me other brands have something like cflex, and even if the doc doesn't like auto machines, is it reasonable for me to insist on it, even if the auto setting is disabled at first. As I said, I'm going to have this thing on my face for a long time, why not get all the bells and whistles?
Any thoughts and comments are welcome

[NotSleepingBeauty]

Welcome!

I am also a newbie. I have been on CPAP for about a month. There are folks here that will have great answers for you. First you need to read the sticky thread above for is for newbies and the one about what to know before you go to the DME.
NSB

[Sheriff Buford]

Tell your Doc that the autocpap... either resmed s9 or Philips Respironics are the top of the line. With both machines, you can use either straight cpap or autoset mode. Also... these machines are data-capable. Research which one you want and educate yourself on the machine. Make sure he writes exactly the machine you want on the script, the humidifier, the climateline hose (resmed s9 autoset only) and a mask - to your comfort.

Dang, I wonder where he is getting his info from... he is way off.... but try telling him that...

I'll go with you. If he gives you any lip,, I'll taze the rascal...

Sheriff

[Janknitz]

Please take some time to look at my blog in my signature below, and pay special attention to the page called "What you need to know BEFORE you meet your DME". That's important information that will help you get what you want, and to anticipate the roadblocks the DME is going to throw in your pathway.

Then you have some homework to do:
1. Do you want the REsmed S9 autoset (NOT Escape Auto!!!) or the PRS1 auto or does it matter to you?
2. Do you understand how your insurance compay covers these machines and what your out of pocket costs will be (my blog tells you what info you need directly from your insurer--don't take the DME's word for anything)?
3. Do you know which DME's in your area work with your insurance company?

Now, tell the doctor you want the script IN YOUR HAND--you do not want it forwarded to the DME. Then you can go to any DME YOU choose and work with them, instead of hoping your doctor chooses a DME you are going to be comfortable being "in bed with" so to speak, for the next 5 or so years. Choose a DME that wants your business and is willing to bend over backwards to see that you get your machine of choice.

If the script specifies a CPAP with a fixed pressure and Cflex, the DME is only going to want to give you a PRS1 Pro or Plus machine. You definitely do NOT want the Plus, it has no data, but just to confuse you the PRS1 Pro is called the “Pro with cflex plus”. But you want the auto anyway so neither is acceptable.

You have two choices. You can call around to DME’s that your insurer covers to ask if they will give you a PRS1 Auto (NOT AutoIQ) anyway. If none will, then ask your primary care physician (or any other doctor you know, even your dentist) to rewrite the prescription for exactly what you want. Either:
1. “PRS1 Auto with A/flex, patient access to AHI, leak and periodic breathing data set at X pressure with ramp and flex enabled for patient comfort, integrated heated humidifier, and mask of patient’s Choice.” OR
2. ResMed Autoset with patient access to AHI, leak and periodic breathing data set at X pressure with ramp and EPR enabled for patient comfort, integrated heated humidifier, climate line or slimline hose of patient’s choice, and mask of patient’s choice.”

Ask the doctor to add "Dispense as Written" and then insist the DME do so.

Make sure you calculate your out of pocket costs and compare those to online. If you have a big deductible you may be happier just buying your own online and getting exactly what you want with no arguments.

[Mary Z]

Good luck. It's smart to think ahead. I think many of us don't use many of the bells and whistles like EPR, ramp, settling, A and C Flex after we become used to the machine. The most important thing is data capable.

[Kilgore Trout]

Welcome to the forum! You've found the best resource for xPAP questions and support!

C-Flex is a feature of modern Philips Respironics machines; it lowers pressure when you exhale so you're not fighting the current. Resmed S9 series machines have this feature too, but they call it EPR (exhalation pressure relief).

Rule 1: Regard your DME as you would a used car salesman. If you bring a healthy dose of skepticism with you to apply liberally to anything they say, you'll be alright.

[oldgeezer]

Thanks to all for your insights. It's only a week since my diagnosis, and already I've learned so much about the inner workings of the process. Like anything, knowledge is power. In a twisted way, I sort of hope the DME screws with me a little, so I can use some of the wonderful information I have gained here.
If you're interested, I'd be happy to share my experiences as I move forward.

[josh73]

Hi Oldgeezer. I'm very new to this too, just completing my 4th night on cpap. My DME tried to give me the S9 Escape and I asked for and received the S9 Elite based mostly on what people were saying about it on this board. It's the best straight CPAP machine Resmed offers. My prescription didn't call for an auto machine and I didn't push it, as long as I got the Elite, I wa happy. the EPR makes. Big difference in my opinion. You can feel it working while you're breathing with the mask on. Like I said, I'm VERY new to this but I like the Elite so far. good luck!

[oldgeezer]

So, I'm not going to have the opportunity to test drive these machines. I'll have nothing to compare them to, no adjustment period for different algorithms. So simply put, if money is no object, which machine should I get? Also, in your opinions, if the doc prescribes a level pressure, so I be a pain in the butt and ask for an auto machine even if that feature is disabled. They don't seem to cost much more, and I thought it would give me more options down the road.
But then again (as I openly admit), I really don't know what the heck I'm talking about yet!

[BlackSpinner]

So, I'm not going to have the opportunity to test drive these machines. I'll have nothing to compare them to, no adjustment period for different algorithms. So simply put, if money is no object, which machine should I get? Also, in your opinions, if the doc prescribes a level pressure, so I be a pain in the butt and ask for an auto machine even if that feature is disabled. They don't seem to cost much more, and I thought it would give me more options down the road.
But then again (as I openly admit), I really don't know what the heck I'm talking about yet!

You get the manual online and do it yourself. It is your machine, your health. You don't ask your mechanic to put gas in your car do you? You don't allow your dealership to dictate where you get your gas? They are no more difficult to understand then an old VCR - easier in fact. They try to fake you out with babble but it is basically like a machine to inflate tires or a compressor for a nail gun and a lot less dangerous.

TELL your doc what you want. You pay his salary, he is your employee.

[Pugsy]

CFlex is Repironics form of exhale relief. EPR is ResMed's exhale relief. While they are both forms of exhale relief...after than no real similarity...they go about it entirely differently. EPR is a simple cm drop in pressure during exhale. How much of a drop depends on EPR setting. A setting of 3 equals a 3 cm drop in pressure. If your straight cpap RX is 10..a setting of 3 will drop the pressure down to 7 during exhale.
There is also a setting for how fast do you want this to happen. If your RX pressure is already at the cut off line where if you go below that pressure some events might sneak past the defenses then it is possible that if someone uses a 3 cm drop during exhale that some events might not be prevented. Easy enough to fix though. Either reduce EPR if you can or increase the pressure just a bit to compensate. It doesn't happen with everyone though. I mention it only for educational purposes.

Respironics Flex options are flow based and not based on a per cm setting. If you happen to breathe more forcefully during your inhale and exhale cycles the pressure will drop a little more but it doesn't come close to a 3 cm drop that ResMed has if you are going by just the setting numbers.
You can read about how Respironics does things herehttp://cflexplus.respironics.com/ though I will admit...poorly worded explanation. From my own personal experience (with both brands) the Flex feature offers a minimal actual reduction in pressure but they do it in a manner that is fairly easy to get into your own natural breathing rhythm so that if feels like a larger drop in pressure than it is.
So I usually tell people it is more of a rhythm thing than a set per cm drop sensation. I setting of 3 in the Flex options made me feel like I was breathing too fast trying to stay in sync with the machine. A setting of 1 was a bit slow and a setting of 2 was pretty close to my own rhythm and more comfortable. Since it is a flow based relief...it depends on the person how they perceive it.

In all honesty, while EPR and Flex are different, either one was comfortable and fairly easy to adjust to.
My Resmed use was just a trial. A forum member loaned me their ResMed so that I could explain how the 2 machines "felt". Not many people get a chance to use both brands. The DMEs usually stock one brand and don't have both brands for you to test. Some people may do better with one brand over another but I think most people will do just fine with either. I know that I did. I had the software for each and my results were pretty much the same with either. Different algorithms but both effective.

APAP vs CPAP...well the APAP is 2 machines in one since it can be used in cpap mode and apap mode.
APAP isn't for everyone. Some people find that variable pressures disturb their sleep. It is nice to have the option to change though and sometimes having APAP mode available comes in handy. I found that APAP suited my own needs because I discovered that sometimes I had some events that needed around 17 cm of pressure but most of the time I did quite well at 10 or 11 cm. Obviously I sure didn't want to use 17 cm all the time just to be able to kill some rare stubborn events. I was lucky that the pressure variations from 10 to 17 never bothered me. Slept right through them.

There are pros and cons to all machines. Seems like some of the doctors that dislike APAP might be basing their assumptions on when APAPs are used in a wide open setting...like 5 minimum and 20 maximum. That works great if you only need 9 cm to deal with the apneas...not so great if you need 13 cm..the apaps can't get to 13 cm quick enough to be completely effective. Set up properly APAPs are just as effective as cpaps. Set up wrong an they don't work well at all.

If you can get an APAP...by all means go for it. You never know when it might be useful. If the DME and doctor won't budge and you have to use your insurance because finances don't permit you to buy out of pocket..getting a straight cpap machine isn't the end of the world. If adjustments in pressure needs happen to be needed...just might take a wee bit of time to get them dialed in.

Is ResMed "better" than Respironics? Not really. Both will give very effective therapy. They just go about it differently. There are some minor differences in features and how they go about things but the end result is they both are very good machines. Now if you happen to be one of those people who happen to do better with one machine than another...at this point you have no way to know if you would or not. Playing the odds...you would likely do very well with either.

[Kilgore Trout]

If you have your say, I think you'd be in great shape with either of these:

• Philips Respironics REMStar System One Auto
• Resmed S9 AutoSet

They're both fully data capable and they're good modern machines. However, if you need BiPAP, someone else will need to chime in.

[oldgeezer]

One last question, I promise. Practically speaking, how important is it to have a local DME? I only have 1 within a reasonable driving distance (Apria).
On a day to day basis, is physical proximity that important? Without any experience in this, I'm guessing it's more important in the beginning as I adjust to this new fact of life.

[NotSleepingBeauty]

I like having my DME local, that way I can go there to get what I want/need and not need to wait for them to mail it to me.

[archangle]

One last question, I promise. Practically speaking, how important is it to have a local DME? I only have 1 within a reasonable driving distance (Apria).
On a day to day basis, is physical proximity that important? Without any experience in this, I'm guessing it's more important in the beginning as I adjust to this new fact of life.

Despite how much we complain about the bad ones, a local DME can be a big help, especially on startup. Even the bad ones often give out good advice and assistance between their screwups and outright lies.

Being able to exchange masks easily is also a good thing about a local DME.

If your DME is not local, it's extra important to have a spare mask, filters, cushions, hose, water tank, etc. It's good to eventually get a spare CPAP. Watch for friends with unused CPAPs, garage sales, Craigslist, etc. and see if you can snag a workable backup.

Insurance will usually have a replacement schedule. Order parts as often as you can until you have enough spares, then only order as needed.