Newly Diagnosed and Overwhelmed

[harpo029]

Hello all. I was just recently diagnosed with sleep Apnea. I actually go for my second test Monday and then I guess starts the process of finding a machine. That is what has brought me here. There are a lot of different options out there and I am feeling a bit overwhelmed. I don't want to make a wrong choice and end up with something that makes things worse or that I wont want to use. So I a reaching out for suggestions please!!! I am a side or belly sleeper so that has me a bit freaked out with having to wear a mask to sleep. Also wanting to see if anyone has suggestions on that part of it as well. Also does anyone know if I have some kind of grace period to get different equipment? any help would be appreciated!!

[Julie]

First it's important to know what your insurance will and won't cover, so you'll have to get in touch with them. There are a few different types of machines used for slightly different diagnoses, but the basics are Cpap (one set pressure used for obstructive apnea) and the same type of machine but with an automatic feature and it's called an autopap, also used for the same thing but using two pressure settings. It's definitely preferable to plain Cpap as it will also do cpap if you want it at some time (a minority of people do better on those) but Cpaps can't do auto, so it's best to go for the auto to begin with... and don't let them tell you they're more expensive because they're not... it's just that the dealers can make more money on the plain ones sometimes. Also, you want a machine that allows you to track your progress with (free) software overnight... it doesn't come with the machines, but most have a place for an SD card that you then can use with your computer, and they give lots more info (which we can then help you interpret and if necessary, tweak things) than machines with only 'compliance' data (that's the stuff insurance co's want to prove you're using the machine so they'll continue to pay for it).

Some machines are either too old or just wrong for using the software, but it all requires a bit more info than I'm giving you here, so depending on what your MD's prescription says, you'll get one of the relatively few useful machines or you won't... but if we let you know which ones you want, you can ask your MD to write the script for one of them and then you can worry about the software. So when you have a report on results, come back to this thread with whatever machine you've been told you'll get and we can help getting the right one if it's not one of those.

[SleepyEyes21]

Hello all. I was just recently diagnosed with sleep Apnea. I actually go for my second test Monday and then I guess starts the process of finding a machine. That is what has brought me here. There are a lot of different options out there and I am feeling a bit overwhelmed. I don't want to make a wrong choice and end up with something that makes things worse or that I wont want to use. So I a reaching out for suggestions please!!! I am a side or belly sleeper so that has me a bit freaked out with having to wear a mask to sleep. Also wanting to see if anyone has suggestions on that part of it as well. Also does anyone know if I have some kind of grace period to get different equipment? any help would be appreciated!!

Hi harpo029, welcome to the forum

If your insurance cannot tell you what machines they cover (mine didn't know), find out from your insurance who your Durable Medical Equipment (DME) provider is. (The DME is the company that will deliver all of your CPAP supplies, if you have insurance.) Call the DME and they will tell you exactly what machines, masks, and supplies are covered by your medical insurance. Tell the DME what you want is a "data-capable" machine; (that's what Julie is trying to say in her reply.) You do not want a machine that is NOT at least data-capable.

Since you are a side or belly sleeper, a good mask to try is the Airfit P10.

Ask your DME about grace periods. I doubt you'll get one on the machine, so you may want to post your choices here for advice before you choose. You might get one on the mask, but again, you will need to ask the DME.

Also, since it is close to the end of the year, here are some insurance things to think about:

1. In general, any payments you make toward your machine for 2016, may not count towards your number of payments needed in 2017. (You usually make a certain number of monthly payments before you 'own' the machine.) Ask your insurance about this;

2. If you are changing insurance plans for 2017, then nothing you pay for 'rental' fees for any machine in 2016 through your current insurance, is reimbursable and/ or goes forward into a new plan;

3. If you've met your maximum out of pocket for medical expenses for 2016, then all of your cpap supplies should be covered 100%.

4. If you haven't met your 2016 deductibles, and your monthly 'rental' fee is going to be high, you might want to consider buying a machine out of pocket. You can get new data capable machines for under $400.00.

It can all be overwhelming at first, however you are on the right track with knowing you need to focus on the mask and machine for now- great job! Hang in there- we are all here to help. Happy Thanksgiving

[harpo029]

Thank you!!! That information does help some!! I have reached out to my insurance company. I know my plan states that DME is covered at 80% after I have met my yearly deductible (which I will have met once I start shopping for a machine). I did ask to see if for some reason the cpap would be different and would be covered at 100%. Once I get the prescription and find out the DME supplier (I asked that in my email to the insurance company as well) I will definitely get with them for more specifics on what all is covered and any known grace periods. And then I will be back for help!! So far really glad I found this site!!

[robysue]

harpo029,

Take anything that your DME says with a grain of salt. Many DMEs will claim that your insurance only covers the most basic CPAP machine that records compliance data or perhaps a bit of summary data, but that does not record full efficacy data. But all CPAPs and APAPs have the same billing code, and so they are all technically covered by your insurance. It's just that the DME will make more money by setting you up with the cheapest machine they can get you to accept.

So when you are calling DMEs, have a list of machines and model names or numbers that are acceptable to you. And politely ask something along the lines of: "My insurance company tells me you are an in-network DME and I've been diagnosed with obstructive sleep apnea. Will you be willing to set me up with any of the following specific models of CPAPs/APAPs?" Then read the list of acceptable machines. If the DME says no they only set people up with cheaper machines, then thank the person for their time and hang up and call the next DME on the list." Chances are you will find a DME who will be willing to set you up with the correct equipment.

In my opinion the follow are acceptable, full efficacy data machines:

APAPs:
Resmed AirSense 10 AutoSet
Resmed AirSense 10 AutoSet for Her
Philips Respironics DreamStation Auto CPAP

Straight CPAPs:
Resmed AirSense 10 Elite CPAP
Philips Resprionics DreamStation Pro CPAP

In general APAP is a better choice than a straight CPAP since an APAP can be set to run in CPAP mode, but a CPAP cannot run in APAP mode. The one exception is the Resmed AirStart 10 Auto which only records the most basic summary data. If the choice is between the AirStart 10 Auto and the AirSense 10 Elite, the Elite is the better choice.

[harpo029]

I FINALLY got a script in hand and here is what is reads

Pt needs a CPAP Machine: A flex over range 7-13 cm H2O z fisher and paykel eson 2 nasal interface, sixe small of her choice

Can someone interpret that..lol

[Okie bipap]

It says you are to get an auto adjusting CPAP machine (APAP) and an Eson 2 nasal mask of what ever size you want. The two most popular auto adjusting machines are the Philips Dream Station auto and the ResMed Air Sense 10 auto or the Air Sense 10 auto for her. Your pressure should be set to 7 to 13 cm H2O.

[Pugsy]

A flex over range 7-13 cm H2O

Pressure RX of 7 to 13 range...this mean an auto adjusting pressure machine (apap). APAP machines are cpap machines with 2 modes of operation. Setting would be 7 cm minimum with a maximum of 13 so the machine could auto adjust to whatever if feels it needs is needed
fixed single pressure...that's cpap mode
auto adjusting single pressure...that's apap mode

AFlex is a term for exhale relief that is only available on the Respironics apap machines. Other brands will offer exhale relief but they call it something else.

fisher and paykel eson 2 nasal interface, sixe small of her choice

The ESON is a nasal cushion mask make by Fisher & Paykel (F & P). Not sure what the number 2 means.
"of her choice" may just mean you can choose whatever mask you want. It's a bit odd the way they worded things.

Have you read this
https://maskarrayed.wordpress.com/what- ... me-part-i/

Be very careful with the brand and model of machine you get.
While the RX sort of points to Respironics APAP your DME might try to give you something else.
Used to be that all APAP machines were full data machines but that's not the case now since ResMed just recently released it's brick AirStart model line. Avoid anything with AirStart in the model line.
AirSense is okay but AirStart isn't okay.

The most current apap machines in the Respironics and ResMed line which is the only brands I would consider if it were me.
Respironics apap machine.....the DreamStation Auto cpap machine

ResMed apap machine....the AirSense 10 AutoSet or even better yet the AirSense 10 AutoSet for Her

[Taxmantoo]

I was issued an Eson in October, but on F&P's website you will see that they're now advertising the 'new and improved' version, the Eson 2.

[reolhlains]

I FINALLY got a script in hand and here is what is reads

Pt needs a CPAP Machine: A flex over range 7-13 cm H2O z fisher and paykel eson 2 nasal interface, sixe small of her choice

Can someone interpret that..lol

Hey Harpo - welcome!!
I'm not that much further down the track on my journey - I started CPAP probably 6 or 7 weeks ago.
I went to a Philips provider and obviously was given the Philips machine to trial - I haven't had any other experience - but I can say the Philips machine is just amazing. I'm probably on about the same setting as you - well, my max is set at 18, but it's never got above 14 and that was only once.
When I wake up, I don't even know the machine is on - actually most of the time it's on for about 20 mins after I wake up while I check emails and stuff and then think, hmmm, I guess I should take this off! I am also a side sleeper - didn't have much problem getting to sleep on my side with it.
Good luck - and please keep us updated as to how things are going. I'm sure you'll feel amazing for it!!!!
Reo.