Need Machine advice

[coldair]

My sleep doctor has requested me to get a new cpap machine which will be able to download info. The cpap I have now is the Resmed 7 which I have had for 18 months, my pressure is 14 but I am still very sleepy during the day and I am very good about using the system every night.. I have a lot of
air leaking out of the mask which is a HC403 and am having a hard time finding a FF small enought for me. When I asked which machine I would receive they stated that it would be the Everest 2. Is this not just a travel machine or can it be used every night with my pressure. My Doctor is trying to advoid having to break my jaw since I seem to have a very small mouth and jaw. (My husband wants a second opinion on the small mouth..LOL)

[Slinky]

Hi, coldair. I'm not the brightest candle on this birthday cake but you have me wondering if this "Everest" is the CPAP your doctor specifically suggested or if this "Everest" is the device the local DME supplier is trying to foist off on you.

You are so right to question the wisdom of going to the expense to replace your current Resmed S7 with an Everest on the basis of "data ability"!!! There has to be a mistake or a misunderstanding here somewhere. Your momma didn't raise no fool.

Its a good thing you are questioning the choice of machine now before you accept it 'cause to the best of my knowledge, the Everest is not capable of providing any more than compliance data only. Which completely negates the reason your doctor stated that he wanted you to get a new CPAP.

UNLESS the only data he is interested in is whether you really are using your CPAP and if so how often and how long. And if THAT is all he is interested in then I'd be inclined to find another sleep doctor. Is this doctor selling you this machine? IF so, I KNOW I'd find another doctor!

Why not ask whoever is trying to sell you this machine to show you a copy of a download printout from this machine?

Look on the top of your Resmed S7 and tell us which Resmed S7 model you have. Some Resmeds are fully data capable and some Resmeds are not. Maybe this supplier just doesn't have the Resmed software.

If you've only had your Resmed S7 for 18 months did you get it from this same business that is trying to sell you the Everest?? The S8 models have been out since at least mid 2006.

To my knowledge the only fully data capable CPAPs and autoPAPs are:

Straight CPAPs
1] Resmed S8 Elite w/EPR
2] Respironics M Series Pro w/C-Flex
3] one of the Puritan Bennet GoodKnight models but I'm not sure which

Auto PAPs
1] Resmed S8 AutoSet Vantage
2] Respironics M Series Auto w/C-Flex
3] Respironics M Series Auto w/A-Flex
4] Puritan Bennet GoodKnight 420E

As far as a full face mask small enough .... whew! I've had enough problems finding a nasal cushion mask small enough for me and I don't think I have that small of a face! Or nose!

[Slinky]

coldair ... the Everest 2 is capable of providing compliance data only ...

https://www.cpap.com/cpap-machine/evo-A ... chine.html

The AEIOmed Everest 2 is the latest model by AEIOMed and replaces the original Everest Aura Polaris TR CPAP machine. It is essentially the same machine as before but has optional DataRest Software reporting capabilities. Also the power supply has been modified from the original Everest Aura Polaris TR CPAP, as well as some slight modifications to the optional heated humidifier.

HOWEVER: that is somewhat misleading because:

https://www.cpap.com/cpap-compare-chart/CPAP/2496

You could call cpap.com's toll-free number to specifically get answers about this.

[coldair]

This is the same DME that sold me the Resmed on 18 June 2006, my Doctor
did not request a particular machine just one with download ability and a humifier and a FF mask.. The DME is the one pushing the machine. My doctor is worried because I was in the hospital for 9 days last month and was hooked up to a heart and breathing monitor and using my machine, and they had to come in several times at night to tell me to breath. I can not get in for another study for several months and he wants this done for 30 days prior to me going back in the hospital in Feb. I feel that since I will be using the machine every night I should not settle for one that is a travel
machine.

[dieselgal]

As far a a full face mask that runs small you should consider the Soyala. I believe that even comes in XS but they already run small so you may not need one that size.

BUT my question is......WHY WOULD THE DR. NEED TO BREAK YOUR JAW?

[Slinky]

Is this meant as a one month loaner? Or are you or your insurance supposed to be buying this Everest?

Either your DME supplier is totally misunderstanding your needs or they could give a rat's rear about you or your life and just wanna pawn off the cheapest machine that has a slot for a "smart card" they can.

Given your situation, I wouldn't accept ANYTHING LESS than a fully data capable autoPAP if it is to be just a one month loaner. Altho you did say "buy".

Do you have good insurance? Why not call your insurance company and ask them what local DME CPAP suppliers they are contracted with. Hopefully you will have the option of more than just this one 'cause this one isn't sounding any too impressive!! Also ask what your DME CPAP benefits are.

MOST insurance companies do not pay for a specific brand or model of xPAP but rather by an insurance (HCPCS) code. Bare-bones not even compliance data capable CPAPs thru fully data capable auto PAPs are classed under the SAME HCPCS code, E0601, so the profit margin for the DME supplier is greater if they can foist off the bare-bones Everest than if they have to provide you w/a fully data capable autoPAP. Far too many DME suppliers will tell you that your insurance won't pay for an autoPAP or will insist that your equipment order (script) specifically state an autoPAP.

By all means, you should make your ordering doctor aware of the device this DME supplier is trying to foist off on you, that it is ONLY compliance date capable and will not be able to provide him w/ANY other data. In fact, I would ask him to write your equipment order in one of the following ways:

1] Respironics REMstar M Series Pro w/C-Flex (w/heated humidifier if you prefer)
2] Pressure ---- cms (whatever your pressure is)
3] C-flex setting 3 (or whatever your doctor suggests)
4] Ramp off (unless you prefer it on)
5] Show AHI/Leak feature On
6] Fisher & Paykel HC 150 heated humidifier (unless you prefer the integrated heated humidifier. If so just add "w/heated humidifier to the REMstar Pro)
7] Nasal mask, Full Face mask, or Nasal Pillows mask of patient's choice.

1] Resmed S8 Elite w/EPR (w/heated humidifier if you prefer)
2] Pressure ---- cms (whatever your pressure is)
3] EPR setting 3 (or whatever your doctor suggests)
4] Ramp off (unless you prefer it on)
5] Efficacy & Usage Data access
6] Fisher & Paykel HC 150 heated humidifier (unless you prefer the integrated heated humidifier. If so just add "w/heated humidifier to the Resmed S8 Elite)
7] Nasal mask, Full Face mask, or Nasal Pillows mask of patient's choice.

1] Respironics REMstar M Series Auto w/A-Flex (w/heated humidifier if you prefer)
2a] Minimum pressure (whatever your doctor has determined)
2b] Maximum pressure (whatever your doctor has determined)
3] A-Flex setting 3 (or whatever your doctor suggests)
4] Ramp off (unless you prefer it on)
5] Show AHI/Leak feature On
6] Fisher & Paykel HC 150 heated humidifier (unless you prefer the integrated heated humidifier. If so just add "w/heated humidifier to the REMstar Auto w/A-Flex)
7] Nasal mask, Full Face mask, or Nasal Pillows mask of patient's choice.

1] ResMed S8 AutoSet Vantage (w/heated humidifier if you prefer)
2a] Minimum pressure (whatever your doctor has determined
2b] Maximum pressure (whatever your doctor has determined
3] EPR setting 3 (or whatever your doctor suggests)
4] Ramp off (unless you prefer it on)
5] Efficacy & Usage Data access
6] Fisher & Paykel HC 150 heated humidifier (unless you prefer the integrated heated humidifer. If so just add "w/heated humidifier to the Resmed S8 AutoSet Vantage)
7] Nasal mask, Full Face mask, or Nasal Pillows mask of patient's choice.

You will notice the similarities to each suggestion.

1] Exact brand and model of machine
2] Scripted pressure (the autoPAPs have a pressure range rather than a set pressure)
3] Scripted amount for lower pressure at exhalation
4] Starts w/4 cms of pressure and ramps up to your set pressure after you get to sleep
5] Allows you to access your nightly data via the LCD screen
6] While the integrated humidifiers are most convenient for travel and take up less space on your nightstand, in really dry situations sometimes they can't provide as much humidity as you might need or want. For many the integrated humidifiers are more than satisfactory).
7] This ensures that you can try several masks, including a Full Face mask (sometimes they insist on a script specifying full face if the script just says mask, or will only provide the exact mask mentioned in the equipment order).

The humidifier you probably have is the Resmed Humidaire 2i. Unfortunately, the Resmed S8s all require a Resmed Humidaire 3i OR a stand alone humidifier.

A lot of sleep doctors aren't really aware of just all the options these newer CPAPs can provide so I'd go to cpap.com and print out the info page on each of the above CPAPs and discuss w/you which his preferences are whilst you explain to him what your preferences are so the two of you come to a mutuall agreement on which he will write the order (script) for.

And, if you DO have the option of other local DME suppliers beside this current one I'd shop them all for the best deal, ESPECIALLY asking what their mask exchange policy is and explaining the problems you've been having w/full face masks.

Also, be aware that your insurance company may refuse to purchase another CPAP so soon. If that is the case, at least have your doctor write one of the scripts above as a one month loaner. Your insurance "should" pay for the loaner and if not you will only be out of pocket for one month's rent. And if that is the case, then the script should DEFINITELY be for one of the 3 suggested autoPAPs and that can be used as a "home titration" in place of or until a new sleep/titration study can be scheduled and done.

To help matters along and speed up the process it would also be very helpful if your doctor would include a Letter of Medical Necessity w/the new equipment order.

Are you by any chance covered under Medicare as your primary insurance?

[coldair]

First, per my Doctor I am not a candidate for the other surgery for OSA, and my jaw is pushed back, he stated that it was a grade 4, explaining that when I sleep on my back my tongue has no where to go but down my throat. And the surgery they are thinking about will bring my jaw forward.
Funny but when I was in the hospital last month, the anesthilogist (sic) asked if I had OSA as my jaw line was very small and had my sleep doctor discussed the jaw surgery with me.

Second, yes I would own this machine for good and the doctor did write a letter for the insurance company (Military Tricare). I have been in touch with them about this and they stated that as long as I have an RX from my doctor they would pay. The DME is the one who insisted on the letter. They have been very good in the past on the mask with me, but too tell the truth I come here to review and then tell them which one I want.

[Slinky]

Well then, TELL them which of the xPAPs I suggested you want. These are fully data capable xPAPs which will provide the data your doctor needs and wants.

Every night you use it any of these xPAPs will provide the data on what pressure you spent most of the night, what leak rate you experienced during the night, how many apneas/hypopneas you experienced per hour in addition to how many nights you used it and how many hours you used it each night and other information as well.

[RosemaryB]

Slinky gave you some very thorough, very good advice. Nothing to add here, to repeat what she said: don't let this DME give you a bum machine again. Most of the DME's will do this. They don't care about anything but $$$$$$$$. See if your insurance will let you get it from our host's sister site BillMyInsurance.com. If I had it to do again, this is what I'd be doing.