Questions for DME - Machine delivery at 3PM EST

[cappy]

Sorry about waiting until the last minute here! I will be receiving my S9 Auto, heated humidifer and heated tube at 3 PM eastern TODAY! I have read just about all I can about the machine, etc. There are a couple things on my mind right now. First is should I start on Auto or on my prescribed CPAP = 10? Will I be able to adjust the auto settings myself? If so, is it appropriate for me to ask the DME to show me how? What other questions should I be asking?

Chris

[chunkyfrog]

If it says "Escape" on top, boot them out until they bring an AutoSET.

[BlackSpinner]

Sorry about waiting until the last minute here! I will be receiving my S9 Auto, heated humidifer and heated tube at 3 PM eastern TODAY! I have read just about all I can about the machine, etc. There are a couple things on my mind right now. First is should I start on Auto or on my prescribed CPAP = 10? Will I be able to adjust the auto settings myself? If so, is it appropriate for me to ask the DME to show me how? What other questions should I be asking?

Chris

Don't bother asking. They will hide the manual away from you - clients are considered to stupid to handle that dangerous thing called AIR! You can find it online and do what ever you want.

I would set it to auto starting at 7 and open at the top for a few night to see what you really need in your own bed and then narrow it down.

[Pugsy]

They will set the machine at straight cpap of 10 cm...they won't show you how to do anything unless it is how to change EPR or humidifier settings.

I would recommend that you start your first night at the suggested 10 cm cpap and give yourself a few nights getting used to things before adding the variable pressures of APAP into the mixture.
You will likely use EPR at some setting and that varies the pressure also (during exhale).

Just because you can change to auto mode....doesn't mean you have to change it immediately
but if you feel you must....just be aware that varying pressures add another thing to get used to and I would suggest a very tight auto range if you want to do that.

Give me a minute and I will send you a private message with the provider/clinician manual pdf link so you can read up on how to do all the ultra secret stuff the DME won't even tell you exists.

[Heavylids]

If it says "Escape" on top, boot them out until they bring an AutoSET.

Well, I'm no data monger yet but I did see the light when it comes to being able to see more than even the newer Escape Auto will display or show in ResScan. My DME (Lincare) was only too happy to order an S9 Autoset to replace the new Escape I started with on 4/09. I should have it next week.

In my case it is the Dr. (Sleep Specialist) who decides the settings and if I use CPAP or APAP. I need APAP. I don't think the DME should be deciding that. When I asked teh DME initially about lowering thepressure setting until I got used to the machine he contacted my sleep doc and asked. She said ok and to that and now, two weeks later, after my follow up visit with the doc the setting is back to where she initiall wanted it. 4-12. This has my AHI average at 2.2.

[Janknitz]

I agree with Pugsy--start out at your titrated CPAP pressure of 10 and see how you feel and how the data looks. Don't start tweaking until you know what you're doing and why, that doesn't make much sense. You will have enough to do getting used to sleeping with it all. After a few nights you can see what's working and what isn't and then start teeming by changing ONE THING and one thing only at a time to learn what works for you.

Tweaking is ok, but blindly doing it just because you can makes no sense.

[cappy]

All, thanks for the responses. Very helpful! My DME was early...imagine that! I have my machine and look forward to getting cozy with it tonight! It is the S9 AutoSet (not the escape) with H5i humidifier, and ResMed Quattro FX full face mask. I do have questions about the SD card though.

The DME wanted to set the pressure on Auto from 4-18. Based on what folks are saying, this is too broad a range to try to get used to. My prescribed level is 10 (straight cpap). I had to argue with him to set it at 10 with a ramp starting at 6. I won the battle! The DME will send two more SD cards, one for Auto and one for straight cpap. Will I be able to re-program the data card to say 8-12 when I am ready to do that?

Thanks again to all who responded.
Chris

[Pugsy]

After your 30 day compliance thing is met...if the DME has used ResScan and the SD card to adjust your machine and the machine won't let you adjust it because of what is on the SD card, you can either get your own SD card or erase the one that has the ResScan ordered changes on it..and start fresh.

They may or may not use ResScan to make modifications to your machine...no problem though...we have ways of bypassing all that when the time comes.

Since you only need a 30 day compliance report to satisfy your insurance....once that is over with your DME won't even care because once they get paid for the machine they won't be nearly as interested in what you do.

I do think giving your RX pressure a good trial is a smart move. Just because we can change something doesn't mean we always should. Best to make changes when clear goals are seen.

[DoriC]

What's surprising to me is that the DME wanted to use his own auto settings when the RX called for cpap at 10cms? They're usually pretty strict about changing the Dr's prescription. Glad you won and good luck.

[Janknitz]

Don't worry about "getting in trouble" if you change the pressure setting. The compliance check is just to see if you are using the machine, the DME has to show that to the insurer so the DME can get paid. Nobody except you (and the occasional doctor) cares if it's working for you or not. Do what works for you.

[Slartybartfast]

[snip] My prescribed level is 10 (straight cpap). I had to argue with him to set it at 10 with a ramp starting at 6. [snip]
Chris

Glad they didn't try to leave you with an Escape auto. You have a good machine. But what's with their trying to set it wide open like that? That's what you'd do if you had no idea of what was the appropriate pressure for you. You underwent an expensive titration study in order to determine that setting. And they appear to have simply ignored that. I see you followed that logic and insisted they set it to 10. Good for you. Based on the titration study, that's the best starting point. Now, sleep on it at 10 for about a week before you start to fiddle with the settings, so you can get an idea of what 10 feels like. Then, when/if you want to explore the Auto features, set the lower pressure to about 7 or 8 and leave the upper setting way high. In the past, more primitive machines needed to have a lid placed on the upper pressure so that the machine wouldn't run away. Your S9 won't do that, so an upper setting shouldn't be necessary.

FWIW, my titration study resulted in a recommended pressure of 11 cm. I have been running at 9 (low) and 20 (high) for 15 months and the data shows my pressure never exceeds 12, and tends to average around 10.5, so the titration study was pretty accurate.