Ok folks, gotta jump into the fray!
It is being repeated over and over in this thread, by the RT guys, that a patient should do their home work before taking a xpap machine from the DME.
BrainRT suggests googling (going to the library if you don't have a computer) to learn all you can about sleep apnea treatment. I agree we all need to educate ourselves but some cannot. IMHO there is a large population of my peers (60+) that use xpap and of that population, many are confined to nursing homes, don't have access to a computer, have no knowledge to use the computer, are home bound and can't get to the library, are illiterate, were raised to believe that the doctor is always right and believe that the medical community has your best interest at heart. What do you do with those persons? Do they not deserve the best care they can get? Should they have to suffer with inferior treatment because they cannot google?
IMHO, I will go a step further and say that all xpap machines should be auto's. I was titrated wrong and I would suggest there are others who have been too. And I think all machines should come with an intergraded humidifier.
To suggest that we need another "cheap" xpap machine is not taking the patients interest to heart. IMO, if you want to be a good DME or RT and put the patients needs first, then another basic xpap is not what we need.
Just my 2 cents,
Gilda
ResMed Tango CPAP Machine
[quote=BrianRT]Most people don't go to dealerships without doing research so why does it happen with medical equipment?[[/quote]
In addition to everything mommaw said:
Because they didn't plan to be ill an need the equipmnet
Because their energy and thinking ability are affected by their illness
Becasue they need the medical equipment to make them feel better now, and to help them function like a healthy person.
Because the first car you drove is rarely the first car you've ever seen or used, and you've been taught how to research for cars.
O.
In addition to everything mommaw said:
Because they didn't plan to be ill an need the equipmnet
Because their energy and thinking ability are affected by their illness
Becasue they need the medical equipment to make them feel better now, and to help them function like a healthy person.
Because the first car you drove is rarely the first car you've ever seen or used, and you've been taught how to research for cars.
O.
_________________
| Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
| Additional Comments: Machine: Resmed AirSense10 for Her with Climateline heated hose ; alternating masks. |
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.
Antoine de Saint-Exupery
Good advice is compromised by missing data
Forum member Dog Slobber Nov. 2023
Antoine de Saint-Exupery
Good advice is compromised by missing data
Forum member Dog Slobber Nov. 2023
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
Great points, mommaw and ozij.
Over in another thread viewtopic.php?t=21414
I wrote:
I think there are several reasons newly diagnosed people don't "research" the equipment they are going to receive:
1. Many are under the assumption that "cpap" is "cpap" -- that there's one machine called a "cpap" machine to treat sleep apnea. Different brands, maybe, but all just "a cpap machine."
2. A general assumption that the doctor is "the expert" in all health matters. And that whatever the doctor prescribes is exactly what we are supposed to have for our treatment. Especially if it's a doctor specializing in "sleep disorders."
3. A general assumption that the doctor (especially a "sleep doctor") knows ALL about the machines and has actually directed the DME to give the person the exact machine the doctor knows is best for that person. Of course we know that other than prescribing "cpap" or "bi-level" the doctors usually leave the actual choice of machine up to the DME, and the DME usually gives the most basic of "whatever" to the person, for maximum profit.
4. An expectation on the part of the newly diagnosed that not only has the doctor chosen the exact machine they are to have, but that the DME is also an "expert" health care professional who knows all about the machines, too.
In other words, complete trust in all the medical professionals involved. Sometimes well placed trust. Sometimes not.
People expect to do their own research before buying the usual consumer product like a camera or a TV...or a toaster. They forget that a piece of medical equipment is also a "consumer product" and that there can be choices.
They think the doctor is making a choice for them. They don't realize that more often than not the doctor has left it up to the DME to make the choice. People don't realize that more often than not, the DME pushes only what makes the most money for them, and that many DMEs are too often ignorant about comfort issues with the various machines. And masks!
Add into the mix, "Well, insurance will pay for it." Plus a fatigued brain and body that just wants relief as soon as possible....
If the doctor and the DME say, "This is what you need...." there it is.
Over in another thread viewtopic.php?t=21414
I wrote:
I think there are several reasons newly diagnosed people don't "research" the equipment they are going to receive:
1. Many are under the assumption that "cpap" is "cpap" -- that there's one machine called a "cpap" machine to treat sleep apnea. Different brands, maybe, but all just "a cpap machine."
2. A general assumption that the doctor is "the expert" in all health matters. And that whatever the doctor prescribes is exactly what we are supposed to have for our treatment. Especially if it's a doctor specializing in "sleep disorders."
3. A general assumption that the doctor (especially a "sleep doctor") knows ALL about the machines and has actually directed the DME to give the person the exact machine the doctor knows is best for that person. Of course we know that other than prescribing "cpap" or "bi-level" the doctors usually leave the actual choice of machine up to the DME, and the DME usually gives the most basic of "whatever" to the person, for maximum profit.
4. An expectation on the part of the newly diagnosed that not only has the doctor chosen the exact machine they are to have, but that the DME is also an "expert" health care professional who knows all about the machines, too.
In other words, complete trust in all the medical professionals involved. Sometimes well placed trust. Sometimes not.
People expect to do their own research before buying the usual consumer product like a camera or a TV...or a toaster. They forget that a piece of medical equipment is also a "consumer product" and that there can be choices.
They think the doctor is making a choice for them. They don't realize that more often than not the doctor has left it up to the DME to make the choice. People don't realize that more often than not, the DME pushes only what makes the most money for them, and that many DMEs are too often ignorant about comfort issues with the various machines. And masks!
Add into the mix, "Well, insurance will pay for it." Plus a fatigued brain and body that just wants relief as soon as possible....
If the doctor and the DME say, "This is what you need...." there it is.
ResMed S9 VPAP Auto (ASV)
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
Gilda,
What I was referring to was the people who CAN research, but just don't. Of course there is a number of people who, for whatever reason can't. And for them, I don't know what the answer is. I wish I did, but I don't. I wish life was a lot more fairer than what it is, and people were more honest and altruistic, but they aren't. But then again, not ALL DME's and RT's are the devil either, meaning, not everybody gets shafted and there are some good experiences.
Unfortunately, anytime that little concept called a "profit margin" is added into anything, there's gonna be people looking at how to maximize it.
As I've said before in this thread, an inexpensive XPAP would be most beneficial to someone without insurance for example who couldn't afford the Cadillac. Some therapy is better than no therapy right?
I DON'T think it should be used for DME's to maximize their profit margin any further than what it already is. I hope I've cleared that up before everyone that knows me thinks I've taken leave of my senses in this thread.
I feel like ALL of the DME corruption in this capacity stems from the fact that E0601 is a catch-all for ALL CPAPs. If this was ever changed, with extra HCPCS codes to diffrentiate basics from datas to autos, then you wouldn't see DME's trying to dump the most basic models left and right and practically outright refusing to give an Auto out unless the doc (or patient, if their knowledgeable) demanded it.
Willsucceed, let me start off by saying that, upon review, my phrasing was a bit inflammatory and let me humbly apologize. We all have bad days, though it seems mine almost stretched into half a week. The last thing I want to do is hop on the forum and let outside events influence the way I treat people. It's rare when I compromise my professional decorum so again, I am sorry that I didn't approach this thread with my usual tact.
Basically, I didn't understand why auto leak compensation was such an important factor to you. That's why I asked you to explain it. I personally don't look at it as a big deal because I don't believe in it. I've always thought this feature was "gimmicky" at best.
Now, in theory, it's a great concept. Automatically adjusts for leaks to make sure you still get your set pressure. I wish it was that simple. Here's the way I see it, when you have a mask leak, it's because of pressure, naturally. The pressure is like water, it tries to find the path of least resistance. When it finds a weak point in the mask seal, poof, you've got a leak. So the thinking is, (according to the..ahem...manufacturers....who have a vested interest in selling the priduct of course) the machine will increase the pressure to make up for this. In practical application, this is flawed because as you increase pressure, the leak rate isn't static, it's dynamic. The leak is simply going to increase as more pressure is applied to it. Now this isn't even factoring in the fact that intentional leak rates will increase also, so that, added to the unintentional leak rate, your total leak (intentional + unintentional) will increase.
Theoretically, if the machine increased pressure again, because now we have a larger leak, the same thing happens a little highwe up the pressure range. Now, I know this isn't the way these machine are set, or else everyone would top out at 20cmH2O. So then, where does the machine limit this increase? It would be at a minute amount at best and stop, else you WOULD top out the range of the machine.
So basically, that's why I'm not a big believer of auto leak compensation. Sure the reps come by our DME and tell us about all of these great and wonderful features, but I take it all with a grain of salt because I know where their interests lie (sell product, make $$)
But now, here's the kicker......a little leak is OK anyway. Yes, I'm talking about unintentional leak. By definition of unintentional, it's not to mean 'avoid leak at all costs', it means leak not related to the air that escapes out of the exhaust ports on all masks (intentional leak).
So let me go in detail why a little leak is ok. Obstructive apneic/hypopneic events are more prone to happen on inhalation. The reason being that when we breath in, a negative pressure situation is created throughout the airway, from the alveoli to the nares (or lips if your a mouth breather) this is draw air into the lungs. Think of it like a bellows if you will.
When your upper airway is predisposed to constriction for whatever the reason (large tongue, tonsils intact, extra tissue or just a narrow airway) this negative pressure on inspiration will draw the tissue together. In a true obstruction, the tissue, being moist from saliva and mucous will stay stuck together, making exhalation impossible.
This is where PAP comes in. We all know how it works, but the thing to keep in mind is that PAP works mostly during your inspiratory phase. The full set pressure is not that important on exhale because we generate our own positive pressure when we breath out. THIS is the principle that bipap operates on.
When we breath out, our exhaled pressure meets the incoming CPAP pressure (because it is constant) and creates a pressure spike in the mask. The pressure spike will be the one finding the path of least resistance so if a part of the mask isn't sealed up all that great, that's where it goes. But it's OK. It's on exhalation. It's about a 1-2cmH2O loss at best, which is nothing compared to the spread of most bilevels.
I suppose I've timed out with this lengthy reply, lol. Didn't mean to write a book (oh wait....I AM writing a book....I'll just cut and paste this then )
But all of this talk about leaks is making me have to go to the bathroom.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, CPAP, DME, seal, auto
What I was referring to was the people who CAN research, but just don't. Of course there is a number of people who, for whatever reason can't. And for them, I don't know what the answer is. I wish I did, but I don't. I wish life was a lot more fairer than what it is, and people were more honest and altruistic, but they aren't. But then again, not ALL DME's and RT's are the devil either, meaning, not everybody gets shafted and there are some good experiences.
Unfortunately, anytime that little concept called a "profit margin" is added into anything, there's gonna be people looking at how to maximize it.
As I've said before in this thread, an inexpensive XPAP would be most beneficial to someone without insurance for example who couldn't afford the Cadillac. Some therapy is better than no therapy right?
I DON'T think it should be used for DME's to maximize their profit margin any further than what it already is. I hope I've cleared that up before everyone that knows me thinks I've taken leave of my senses in this thread.
I feel like ALL of the DME corruption in this capacity stems from the fact that E0601 is a catch-all for ALL CPAPs. If this was ever changed, with extra HCPCS codes to diffrentiate basics from datas to autos, then you wouldn't see DME's trying to dump the most basic models left and right and practically outright refusing to give an Auto out unless the doc (or patient, if their knowledgeable) demanded it.
Willsucceed, let me start off by saying that, upon review, my phrasing was a bit inflammatory and let me humbly apologize. We all have bad days, though it seems mine almost stretched into half a week. The last thing I want to do is hop on the forum and let outside events influence the way I treat people. It's rare when I compromise my professional decorum so again, I am sorry that I didn't approach this thread with my usual tact.
Basically, I didn't understand why auto leak compensation was such an important factor to you. That's why I asked you to explain it. I personally don't look at it as a big deal because I don't believe in it. I've always thought this feature was "gimmicky" at best.
Now, in theory, it's a great concept. Automatically adjusts for leaks to make sure you still get your set pressure. I wish it was that simple. Here's the way I see it, when you have a mask leak, it's because of pressure, naturally. The pressure is like water, it tries to find the path of least resistance. When it finds a weak point in the mask seal, poof, you've got a leak. So the thinking is, (according to the..ahem...manufacturers....who have a vested interest in selling the priduct of course) the machine will increase the pressure to make up for this. In practical application, this is flawed because as you increase pressure, the leak rate isn't static, it's dynamic. The leak is simply going to increase as more pressure is applied to it. Now this isn't even factoring in the fact that intentional leak rates will increase also, so that, added to the unintentional leak rate, your total leak (intentional + unintentional) will increase.
Theoretically, if the machine increased pressure again, because now we have a larger leak, the same thing happens a little highwe up the pressure range. Now, I know this isn't the way these machine are set, or else everyone would top out at 20cmH2O. So then, where does the machine limit this increase? It would be at a minute amount at best and stop, else you WOULD top out the range of the machine.
So basically, that's why I'm not a big believer of auto leak compensation. Sure the reps come by our DME and tell us about all of these great and wonderful features, but I take it all with a grain of salt because I know where their interests lie (sell product, make $$)
But now, here's the kicker......a little leak is OK anyway. Yes, I'm talking about unintentional leak. By definition of unintentional, it's not to mean 'avoid leak at all costs', it means leak not related to the air that escapes out of the exhaust ports on all masks (intentional leak).
So let me go in detail why a little leak is ok. Obstructive apneic/hypopneic events are more prone to happen on inhalation. The reason being that when we breath in, a negative pressure situation is created throughout the airway, from the alveoli to the nares (or lips if your a mouth breather) this is draw air into the lungs. Think of it like a bellows if you will.
When your upper airway is predisposed to constriction for whatever the reason (large tongue, tonsils intact, extra tissue or just a narrow airway) this negative pressure on inspiration will draw the tissue together. In a true obstruction, the tissue, being moist from saliva and mucous will stay stuck together, making exhalation impossible.
This is where PAP comes in. We all know how it works, but the thing to keep in mind is that PAP works mostly during your inspiratory phase. The full set pressure is not that important on exhale because we generate our own positive pressure when we breath out. THIS is the principle that bipap operates on.
When we breath out, our exhaled pressure meets the incoming CPAP pressure (because it is constant) and creates a pressure spike in the mask. The pressure spike will be the one finding the path of least resistance so if a part of the mask isn't sealed up all that great, that's where it goes. But it's OK. It's on exhalation. It's about a 1-2cmH2O loss at best, which is nothing compared to the spread of most bilevels.
I suppose I've timed out with this lengthy reply, lol. Didn't mean to write a book (oh wait....I AM writing a book....I'll just cut and paste this then )
But all of this talk about leaks is making me have to go to the bathroom.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, CPAP, DME, seal, auto
To know even one life has breathed easier because you lived. This is to have succeeded. -- Ralph Waldo Emerson
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WillSucceed
- Posts: 1031
- Joined: Sun Nov 07, 2004 7:52 am
- Location: Toronto, Ontario
BrianRT:
Thanks for the apology, but, in all honesty, there is no need for one. I'm quite OK with differing opinion and, I'm certainly no stranger to sarcasm myself.
Your explanation of the theory behind leak compensation makes good sense and I can understand that if there is a leak happening (other than the intentional leak of the exhaust port) and you increase the pressure to compensate, you are likely to get even MORE leak. I'd hope, however, that the increased pressure would help to keep the pressure that the patient is getting at, or close to, the prescribed pressure.
While I agree with you that some treatment is better than no treatment, I still think that it is inexcusable for manufacturers to produce machines that don't TRY to optimize therapy.
As I fessed-up to earlier in this thread, I'm not an RT nor an expert in OSA treatment. I'm also certainly not an engineer (grad school stats almost killed me) so I have no idea what it takes to put leak compensation technology in a CPAP -I'd like to hope that this technology cannot make that big a price difference compared to a non leak-compensating CPAP machine.
Perhaps I'm really naive... I just think that the manufacturers and the equipment suppliers should have a shred of morality; this bare-bones Tango is mutton dressed as lamb.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, CPAP
Thanks for the apology, but, in all honesty, there is no need for one. I'm quite OK with differing opinion and, I'm certainly no stranger to sarcasm myself.
Your explanation of the theory behind leak compensation makes good sense and I can understand that if there is a leak happening (other than the intentional leak of the exhaust port) and you increase the pressure to compensate, you are likely to get even MORE leak. I'd hope, however, that the increased pressure would help to keep the pressure that the patient is getting at, or close to, the prescribed pressure.
While I agree with you that some treatment is better than no treatment, I still think that it is inexcusable for manufacturers to produce machines that don't TRY to optimize therapy.
As I fessed-up to earlier in this thread, I'm not an RT nor an expert in OSA treatment. I'm also certainly not an engineer (grad school stats almost killed me) so I have no idea what it takes to put leak compensation technology in a CPAP -I'd like to hope that this technology cannot make that big a price difference compared to a non leak-compensating CPAP machine.
Perhaps I'm really naive... I just think that the manufacturers and the equipment suppliers should have a shred of morality; this bare-bones Tango is mutton dressed as lamb.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, CPAP
Last edited by WillSucceed on Sat Jun 30, 2007 8:56 pm, edited 1 time in total.
Buy a new hat, drink a good wine, treat yourself, and someone you love, to a new bauble, live while you are alive... you never know when the mid-town bus is going to have your name written across its front bumper!
ozij wrote:
In addition to everything mommaw said:
Because they didn't plan to be ill an need the equipmnet
Because their energy and thinking ability are affected by their illness
Becasue they need the medical equipment to make them feel better now, and to help them function like a healthy person.
O.
Again, I'm talking about the ones who can educate themselves, but don't.
What with a possible large number of weeks between your first night sleep study and getting the equipment, there is ample time for those who have the capability.
To be fair though, you're making it sound like most people are practically incapacitated by the time they are diagnosed. While there are exceptions to everything, this isn't really the standard cross-section of SDB patients.
I agree mostly with Laura. People are just too trusting of the medical community. I know I'm not.
To know even one life has breathed easier because you lived. This is to have succeeded. -- Ralph Waldo Emerson
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billbolton
- Posts: 2264
- Joined: Wed Jun 07, 2006 7:46 pm
- Location: Sydney, Australia
No doubt the 47 Million people in the US that have no health insurance (not to mention another additional non-trivial number that are under insured for whatever reason) will be an "interesting" demographic for your research.WillSucceed wrote:More interesting would be to look at which machines sell and which don't and, the demographics of the purchasers.
Cheers,
Bill
_________________
| Machine | Mask | |||
 |  | |||
| Additional Comments: Airmini, Medistrom Pilot 24, CMS 60C Pulse Oximeter, ResScan 6 | ||||
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WillSucceed
- Posts: 1031
- Joined: Sun Nov 07, 2004 7:52 am
- Location: Toronto, Ontario
My apologies Bill. Perhaps I should have been more specific.
I'd look at a broad range of demographics INCLUDING knowledge and information/training received BEFORE first purchase of equipment.
At risk of getting myself into trouble, I think that it is a sad state of affairs that any of your citizens go without funding assistance for life-saving equipment.
I'd look at a broad range of demographics INCLUDING knowledge and information/training received BEFORE first purchase of equipment.
At risk of getting myself into trouble, I think that it is a sad state of affairs that any of your citizens go without funding assistance for life-saving equipment.
Buy a new hat, drink a good wine, treat yourself, and someone you love, to a new bauble, live while you are alive... you never know when the mid-town bus is going to have your name written across its front bumper!