Some things I've learned about CPAP

[DME_Guy]

I've been using it for about 6 weeks now and through this forum have learned a lot. I've also learned a lot from talking with my Dr and my sales reps. Here's a few things I've learned.

1. Sleep techs in sleep labs don't always use the best mask for the patient. They use the mask that is easiest for them to titrate the patient on.

2. I used to assume the MDs knew all there was to know about CPAPs. My Dr wasn't even sure what an APAP is. I had to explain it to him.

3. APAPs are somewhat of a mystery in how they work. Each manufacture has a different algorithm. I never really thought about it before I started using one.

4. People who haven't used CPAP have no idea what we go through. CPAP techs, MDs, and DME staff are all "sold" on a certain machine type and mask and often expect that to work for every patient. They make their decision on what they see. We make our decision on our personal experience. Experience is an excellent teacher.

5. Heated humidification should be mandatory.

6. C-flex is a great technology! I liked it before I used it but as a user, I love it.

7. There really should be separate biling codes for machines with expiratory relief and another code for APAPs. I don't believe a straight CPAP will work for every patient.

8. Tracking your own progress through the machine such as the Remstar Auto and Pro should also be mandatory. The patient should know how they're doing.

9. The heated hose is great! Never heard of it before I started using CPAP and reading this forum.

10. And finally, there are a lot of very knowledgeable people on this forum! Thanks to all of you for your help and input.

[Bingo]

Certainly an interesting post.

Thank you DME Guy!

Bingo

[ozij]

You said it, DME_Guy:

Experience is an excellent teacher.

O.

[dllfo]

Thanks DME_Guy---

I think you hit the nail on the head....the more we learn, the more we understand the situation and the better off we are. That sounds awkward,
but is still true.

I have always thought if all doctors underwent their own treatments, they would have a lot more empathy for the patients. Undertakers, MEs and Coroners excepted of course.

Seriously, what a great bunch we have. He is right, we have a large body of
knowledge here and this is what I told the Apria Customer Service Mgr here
in Sacramento. How can Respironics or Chevrolet or Apria know what their
customers need if they don't listen to them? Or at least listen to the customers opinion of the results. DME_Guy must be a pretty decent person, he has been ripped by a few people....just for being a DME person. Grossly unfair, but he seems to be pretty smart and understands it is just someone "venting".

The more contact we have with the industry, the better off both groups are.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, DME

[dllfo]

OK computer experts...look at my first paragraph above. WHY are the
sentences 3 different lengths?

Like this:

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxx

I went back to edit it and the sentence length was "correct". I noticed on some
of my other posts they are the same way.

Any suggestions? I do use two separate computers....laptop right now and
a desk top at other times.

Thanks.....

[Bingo]

OK computer experts...look at my first paragraph above. WHY are the
sentences 3 different lengths?

Elves.

Bingo

[NightHawkeye]

OK computer experts...look at my first paragraph above. WHY are the
sentences 3 different lengths?

Dave, I've been wanting to talk with you about that. (Just kidding, Dave.)

Actually, I've noticed this in your posts previously when I've quoted you. Your posts contain carriage returns at the end of the lines.

When you compose your posts are you hitting the ENTER key when you reach the end of a line. If so, then instead just continue to type when you reach the end of a line and the carriage returns will not occur.

Regards,
Bill

[chdurie2]

dme guy:

correct me if i'm wrong but aren't you a dme or otherwise in the cpap industry? now this may be my naivete, but i was told five years ago when i got my machine that neither my doctor, dme or insurance company would even think about giving me a cpap machine without a heated humidifier--that it is, essentially, standard equipment even if not written down in some rule book somewhere. i think i even read that on the internet back then. so did i mis-read, have a luxurious insurance company/dme or what? i guess i'm just surprised that you don't think a heated humidifier is standard equipment. and obviously, i could be wrong.

now that we've got that out of the way, what sorts of patients is a straight cpap machine not good for? and that an autopap would be most suitable for? the reason i'm asking is that i want an autopap, and i will soon be asking my doctor, insurance company and dme to trade me up to autopap after five years of owning a cpap (a month or so of first using the machine, giving up, 4 and a half years of non-use, and now three months of full compliance.) i'm pretty sure my doctor won't know autopap from cpap and will write autopap if i tell him to, but i may have to justify it to even him. i plan to tell them bluntly that a cpap forces me to take charge of my own therapy in ways they may not like (adjusting my own machine) because i can't be calling them every time the pressure isn't right, that initially this time around the pressure was fine, but within a month or so, the maximum pressure felt like nothing, i'm waking up in the middle of the night, and i'm tired again. i have a deviated septum, which may or may not affect things.
so i was curious if there were other factors , factors that i might not be aware of, that i could bring into my pitch that might make the cpap powers that be agree more readily to buying me an autopap. i wouldn't lie or anything, but say, if a hypothyroid condition (which i have) is one factor that might change their decision, i should certainly remind them about that. another factor is that i have a heart murmur. these are just things i am throwing out. can you tell me what the parameters for autopap desirability from the dme/insurance/medical point of view are that would make them say, give this lady an autopap?

thanks.

caroline

[brasshopper]

[moved to its own topic by author]

[DME_Guy]

Yes, I do work for a DME company. And no, a heated humidifier is not standard equipment. If it was, it would come in the box with every xPAP. It has a separate billing code from the xPAP machine. I would say I only order about 3 or 4 heated humidifiers for every 10 xPAPs I order. A large local medical group will not pay for heated humidification without first letting the patient suffer without it.

As for APAPs, I view sleep apnea like high blood pressure. If a Dr prescribes blood pressure medication, he typically has the patient come in to have it checked and adjusts the medication as needed. Our pressure is our medication. It's not realistic to go in for a sleep study every couple of weeks to make sure we still need the same pressure. An auto machine adjusts the pressure throughout the night, every night. I know for me personally, I'm usually fine at a pressure of 7, but sometimes I need 11 and rarely 13. There are a lot of things that affect sleep apnea - sleeping position, illiness, meal size, alcohol intake, weight change, stress, among other things. A straight CPAP can't adjust for these things. At the very least, a CPAP that records data should be used so the patient knows how they're doing. The problem with those machines is it just points out a problem. An auto machine will prevent the problem from occuring in the first place. Also, when you had your sleep study, you'd have to hope you needed your peak pressure that night because that's all you're going to get every night. How would you know?

Some patients can't tolerate their peak pressure throughout the night but can tolerate it while in a deep sleep or for a protion of the night. For those patients, a straight CPAP won't work. In general, it's more comfortable to breath against a lower pressure and only be at your peak pressure when necessary. IMO, this should improve compliance for most users of CPAP.

In your case, I would think if your doctor prescribes an auto machine, you should get it. DMEs don't like to give them out because they cost more but the reimbursement is the same as a straight CPAP. However, if the Dr prescribes it, I would hope they won't give you a problem. I know where I work, the RX is king as it should be. It doesn't sound like straight CPAP is working for you. That should be enough for you Dr to prescribe an Auto.

[quote="chdurie2"]dme guy:

correct me if i'm wrong but aren't you a dme or otherwise in the cpap industry? now this may be my naivete, but i was told five years ago when i got my machine that neither my doctor, dme or insurance company would even think about giving me a cpap machine without a heated humidifier--that it is, essentially, standard equipment even if not written down in some rule book somewhere. i think i even read that on the internet back then. so did i mis-read, have a luxurious insurance company/dme or what? i guess i'm just surprised that you don't think a heated humidifier is standard equipment. and obviously, i could be wrong.

now that we've got that out of the way, what sorts of patients is a straight cpap machine not good for? and that an autopap would be most suitable for? the reason i'm asking is that i want an autopap, and i will soon be asking my doctor, insurance company and dme to trade me up to autopap after five years of owning a cpap (a month or so of first using the machine, giving up, 4 and a half years of non-use, and now three months of full compliance.) i'm pretty sure my doctor won't know autopap from cpap and will write autopap if i tell him to, but i may have to justify it to even him. i plan to tell them bluntly that a cpap forces me to take charge of my own therapy in ways they may not like (adjusting my own machine) because i can't be calling them every time the pressure isn't right, that initially this time around the pressure was fine, but within a month or so, the maximum pressure felt like nothing, i'm waking up in the middle of the night, and i'm tired again. i have a deviated septum, which may or may not affect things.
so i was curious if there were other factors , factors that i might not be aware of, that i could bring into my pitch that might make the cpap powers that be agree more readily to buying me an autopap. i wouldn't lie or anything, but say, if a hypothyroid condition (which i have) is one factor that might change their decision, i should certainly remind them about that. another factor is that i have a heart murmur. these are just things i am throwing out. can you tell me what the parameters for autopap desirability from the dme/insurance/medical point of view are that would make them say, give this lady an autopap?

thanks.

caroline

[chdurie2]

DME Guy:

Thanks for correcting me on the heated humidifier.

And thanks for your positive opinion that I'll likely get an Apap. I guess I'm just uneasy because five years ago I had individual PPO insurance that was pretty generous and now I have HMO, which is not--although I haven't tested it in the CPAP arena. Hopefully I can persuade my doctor that I do not have the time and money to hunt down the DME or an MD sleep specialist every time there needs to be a pressure adjustment.

You're terrific!

Caroline

[dllfo]

Brasshopper, I couldn't wait to read the rest of your great post.

I get so upset with the sleep clinics. They say we don't get enough sleep in
one night??? Well DUH...don't wake us up at 5am....if the so called mgt would
ASK us when we want to report and most of all, when do we want to get up?
They might get better info.

Maybe I am wrong, but I don't think most people will get into a strange bed,
in a strange place, wired up to boot, then sleep 8 hours. It would seem most
of us "pass out" from exhaustion about 2-3am. Maybe not.

Bill, I am not hitting the enter key on this paragraph. I am being very careful not to do that. I am letting the program move my words down to the next line when they exceed the normal limits. I know I probably do hit the enter key from habit, but I did not hit it in this paragraph. Sorry folks, but some of my earlier posts were all over the place. One sentence is 4 inches long, the next sentence is two inches long. Please bear with us. Bill, I noticed the sentence in my last paragraph has split just now. On my screen
it says "It would seem
most
of us "pass out" from .....

Now I did hit the enter key as I repeated myself, but the paragraph before that I don't remember what I did. I was just typing. Apologies to brasshopper....trying to clean up my posts.

EDIT....this is weird. What I see as I type is nothing like you see after I post it. Not hitting the enter key seems to take the irregularities out of it. Thanks again Bill. Maybe I can quit making messes.
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CPAPopedia Keywords Contained In This Post (Click For Definition): clean

[dllfo]

Caroline, the PPO for the wife and I was about $500 a month 3 years ago. Our share was about $250, then within two years our PPO went crazy. Our share
went up to about $775 a month. We dropped it and I went to Tricare's PPO.
It is more expensive for us, but with all my medical problems I want to be able to go anywhere I need to go.

And my machine did NOT come with a heated humidifier. My doctor somehow
omitted it. His office sent over another prescription and I got it a week or so later, but it SHOULD be standard issue. I sleep much better with it.

And as DME_Guy said, the Rx is king. No one will move until the see the Rx.
I got my doctor's office to fax me a copy of the prescription. By the way, if you do not have a fax, you can get one at Office Max, Stapels, etc. for $39.95 or less.

[brasshopper]

I meant to make that a new topic - somehow it got put into this as an answer. I'll move it and edit it out here. Sorry.

[Bonnie]

Great post, DME_Guy....we strive to change the world, one DME at a time.