French Nurse Expert in Apnea's Treatment, don't understand..

[Yannou971]

Hi, (Sorry about My English, it's not perfect But I'm from Paris..I want to talk you You, the CPAP Patients.
Cause in France the system is different,.

I've heard, after your Diagnosis, there is two ways :

First One : You Insurance guide you to a DME as (Line Care, Apria, etc...)
The DME give to you an apoitment. You go and they give to you the machine ( like Airsense S10 autoset), try with you a mask, then you come back at home.

In this case,
who put the right settings in the Machine?
if you have problem of leaks or dry mouth, who help you to fix it ?
You can call them but is there anybody coming to your house to help you?
Did they read the SD card you give a feedback to your Doctor ?
How Many time you see the DME in the first year ?
Do you have charge to paid to the DME ?
Do they change your mask many times in a year ?

The Second way is : You Prefer to selfpaid and you go on website as "h t t p s ://w w w . c p a p m i a m i . c o m /"
How you choose your stuff ?
How you choose you mask and try it ?
Is there anybody doing a feedback of the results of the treatment to you or to your doctor ?
Do you think many people going to selfpaid for the treatment .

I hope you understand my poor English and you could Answer to my questions

Have a good day/night

[BlackSpinner]

who put the right settings in the Machine?

The DME. The setting will depend on a sleep study where they try the machine at different settings. OR they will put you on an auto machine for 2 weeks (or less or more) to see what happens.

Some machines have a kind of cellphone which sends the data to the DME which sends it to your doctor. Others you have to bring the SD card in.

Sometimes you are lucky and you get a good DME and they help you with mask problems, most don't know what they are selling.

If you go your own way you are totally on your own however people here will help you. Our host cpap.com is also a good supplier.

There is software available free of charge (but please make a donation) on this site called Sleepyhead which will let you track your therapy.

[Okie bipap]

In the first scenario, you would have a sleep study. The study may be in your own home, or at a sleep clinic. A doctor reviews the results of the sleep study and writes a prescription for the appropriate cpap or bipap machine. The prescription is then sent to a DME who sets up the machine with the prescribed settings. The DME then notifies the patient to come in and pick up the machine and a mask. Normally, the prescription is written so the patient can choose any mask that works for them. Once the patient leaves the DME office and gets the machine home, the patient usually uses the machine at the prescribed settings. Most insurance companies require the patient to use the equipment two thirds of the time. They require a follow up meeting after thirty days and before 90 days with the prescribing doctor to verify the patient is using the equipment and it is properly treating the sleep apnea. Once this requirement is satisfied, if the patient finds the setting are not providing proper treatment, they often start making changes to the settings on their own.

In the second scenario, the patient purchases the equipment without having a sleep study or meeting with a doctor to obtain a prescription. People normally purchase an automatic machine which will self titrate and decide what the necessary pressure is. They use software such as sleephead or ResCan to monitor their treatment and make changes to their settings as necessary. Many of the people on this forum have taken this approach to their treatment and offer suggestions to others that have questions on the effectiveness of their treatment.

[Frencgy Nurse]

Its really different of France.
In France: Dr Call a compagny, Compagny take appoitment with patient and go to the patient's home in 72 hours.

The Nurse or Thecnician : spent 2 hours to explain what is Diseas apnea, how the treatment work. How to put correctly mask etc...

2 days Afters, the Compagny call the Patient, 8 days after, the compagny go to patient home and take result from SD card and change settings if it's necessary, send the result with a comment to the doctor.
30 days afters, go agains to patient home, and again and again until patient have more than 5 hours of using, less than 5 apneas per hour, and acceptable leaks....

Thats the result we need to be paid buy our French Social Security.

That "savoir-faire" bring us to a high level of expertise (over 90% of our patients are above 4hours of use / night.

For the patients in the second way ( They selfpaid their traitment)
Do you think they would be ready to pay monthly fee to be personaly followed-up ?

[Julie]

Only if they had not found this forum! We help each other with every step, from finding a place to buy the right equipment (sometimes Cpap, sometimes Apap or ASV, Bipap, etc) as inexpensively as possible, which means making sure the machine is clean, that it will give useful data (much more information than 'compliance' hours) to help titrate the right pressure settings, and how to read the data - usually using Sleepyhead software (designed by one of our members), how to choose the right mask (including advice on 'full face' masks if patients are mouth breathers). We help interpret results after they are posted on the forum and then make suggestions about changing pressures if necessary and how to do that, plus give more advice on proper sleep habits, special pillows, and discuss medication the patient might be taking that could affect how Cpap works, etc. etc.

There are many people here with lots of experience and knowledge about apnea and Cpap, and when we feel it's necessary we advise others to see a doctor - sometimes their medical problems are not due to Cpap of course, but other things.

But whether or not it would be accepted in France is up to the French people - we have had members from France in the past of course, just as there are members from all over the world, and because we are all just patients too, no one charges anyone money for helping.

[herefishy]

If you have had a sleep study, be sure to get a copy of the results, then you will know what you need in the way of a starting place for your therapy if you buy your own machine.

[Julie]

I think she may be more interested in starting her own advice business...

[ChicagoGranny]

Do you think they would be ready to pay monthly fee to be personaly followed-up ?

No! It's best to take care of yourself.

Some have used the analogy of the best treatment for a diabetes patient. The patient makes sure to get educated about his condition and the treatment. By himself, he checks his blood-sugar levels a few times per day. Then he adjusts his medication, insulin and diet.

It's the same with CPAP. Get educated and take control of your CPAP therapy. No need for someone to hold your hand.

[BlackSpinner]

Do you think they would be ready to pay monthly fee to be personaly followed-up ?

No! It's best to take care of yourself.

Some have used the analogy of the best treatment for a diabetes patient. The patient makes sure to get educated about his condition and the treatment. By himself, he checks his blood-sugar levels a few times per day. Then he adjusts his medication, insulin and diet.

It's the same with CPAP. Get educated and take control of your CPAP therapy. No need for someone to hold your hand.

A lot of people need help the first few months. For a lot it is a dramatic life style change and they need hand holding. Diabetic patients have that. There are lots of groups that help diabetic patients. Just in my drug store there are pamphlets, there is a trained diabetic specialist you can talk to free of charge, and there are monthly drop in sessions where you can talk to people. There are walks to raise funds for various research and support projects. Where ever you turn you can get help. Sleep apnea? There is one poster in my doctors office.

[Frenchy Nurse]

i totally agree about the fact that help coming from other patients or forum is a good thing.

But professionnals have solutions to some troubles other persons don't have.

One exemple, one of you talk about mouth breather and facial mask. Do you know less than 1% of population is mouth breathing, and you can re-educate someone to breath by nose with a good humidifier/nasal mask combo?

That means long term economy for the patient who have to buy his mask, nasal and facial are not same price.

We can detect open mouth just by looking at leaks curb, and with the teleobservance we can adjust settings at distance to match perfectly to the patient's needs.

[The Choker]

Do you know less than 1% of population is mouth breathing, and you can re-educate someone to breath by nose with a good humidifier/nasal mask combo?

1. I would like to see a reference to the 1% statistic, please.

2. Reeducation claim is wrong. 85% of mouth breathing is due to some of several types of nasal obstruction - viewtopic.php?f=1&t=112138&view=unread#unread

[chunkyfrog]

. . .

But professionnals have solutions to some troubles other persons don't have.

. . .

NOT ALL OF THEM.
Besides, our insurance model in the USA has very little provision to pay for "support "
This is where WE are.
It may be different in France, but "stuff" and "help" are separate, and only "stuff" gets paid for,
at least in the cpap realm.
---I gather you are unemployed . . . Lot of that going around. Tough for anyone.

[Julie]

Good luck getting people to pay for what we provide free. And a humidifier is not the answer to mouth breathing even if it helps with some patients.

[Pugsy]

For the patients in the second way ( They selfpaid their traitment)
Do you think they would be ready to pay monthly fee to be personaly followed-up ?

Not here in the US.
Now there may be a really small number of people who would/could be willing to pay for one on one personal care but not enough to make much of a living off of it.
A couple of years ago we had a RT come here to the forum promoting this sort of business in the Dallas, TX area. Pretty much got laughed off the forum but I went to the website just to check out the pricing and I about choked at what I saw. Mask fit was $75

Now maybe in France people who self pay would be more agreeable to paying out of pocket but here in the US self pay people are usually the people who don't have insurance and are of limited income and paying for one on one care simply is cost prohibitive. Maybe the ultra rich.....but how many of those type would you gather as clients?

[Frenchy Nurse.]

You look aggressive I don't know why. I was here to have some informations . . .

I have still an job in my compagny SOS Oxygene . . . You can check it on Internet.

The difference between a forum and a professionnal is ... Experience . . .

I follow up for many years more than 500 patients . . .and for sure the extrem majority of them didn't need a full face mask . . .

Do you know why humidification help to close the mouth ?
nasal obstruction most of the time (not ALL of the tim) by a Dry air congestioning the inside noose. . . so you open your mouth to breat... I don't talk about nasal septum deviation for sur. . .
I read hundred repports of divices . . .

I don't say what you say is bad . . . I just say you talk about what you know by your experience of yourself, and you know every patients are different and the solution for one is maybe not for another . . . .

You look to be a great comunity. . . But don't be aggressive when help can come from outside . . .

I know YOU will not paid cause YOU have a great comunity, my question was, do you think some peoples with less time than you could pay for a expert advice and maybe a good follow up with "teleoservance" . . .?