Had first trip to DME today

Guest · Post by **Guest** » Mon Sep 19, 2011 5:31 pm

Brief history. Wife says, "you snore like a freight train, and I can't sleep." I get kicked to the couch until sleep study. 8/17 first sleep study shows OSA with AIH 14, longest is 69 sec with desat to 82% and "you snore like a freight train". 9/13 sleep study and cpap titration. All went well, resolved snoring and AIH very low. Received prescription (cpap setting 7) today and went to DME. After reviewing here, 1st choice was Resmed S9 AutoSet (like the idea of auto, climate control, and gets great reviews), 2nd choice Respironics PRS1 auto (also well respected and reviewed, with auto, less complex humidifier system +/- ). DME helpful and informative, will get me S9 if that's what I really want, BUT... DME shows me PRS1 cpap (not auto). States MD's in this area don't really like the apap machines very well, auto function will be unnoticeable at low settings of 7, humidifier will work fine for me and wouldn't make any difference.

I reluctantly accepted the PRS1 cpap with the understanding I can exchange if I don't like it. I also have access to PRS1 apap to demo for a couple weeks (another source, long story). I plan to use apap for 2 weeks, then cpap for 2 weeks and compare treatment. I still feel like the DME is trying to talk me out of the machine I want, but they may have valid points. I won't have any experience with S9 to compare so input from the board would be greatly appreciated. Any other features you feel are advantages for 1 machine over the other? Is the auto function really a non issue with a cpap setting of 7?

Thanks for all your help,
New Hose Head
Jason

Pugsy · Post by **Pugsy** » Mon Sep 19, 2011 5:40 pm

Guest wrote: Is the auto function really a non issue with a cpap setting of 7?

Well.....let me share my story. Prescribed 8 cm cpap.
Got the software and found out at 8 cm I was still having AHI in double digits (10 to 12). I had bought APAP out of pocket just because that was what I wanted. Come to find out that not only did I need more pressure sometimes I need as high as 18 cm. Not all the time, just some of the time. So I use minimum 10 cm as it keeps the AHI less than 3 and maximum of 20 to handle the nights when I simply need more pressure.

Which PR System One CPAP machine did they give you? I hope it wasn't the Plus as it is not fully data capable.

DocWeezy · Post by **DocWeezy** » Mon Sep 19, 2011 5:42 pm

The DME is just trying to make more money off you. Get the auto and make sure it is one that records full data, NOT just compliance data (I don't know all the permutations of the names, but I think with the S9 make sure it doesn't have the word "Escape" anywhere). You can run any machine in straight CPAP mode OR auto mode--basically two machines in one. If your doctor doesn't like the auto mode, you can run it in straight CPAP. Don't settle for less than what you REALLY REALLY REALLY want because you'll have the machine for a minimum of 5 years. The DME just wants you to choose a cheaper machine so that they can make more money.

Bottom line: Their reason for not getting an auto is pure unadulterated baloney!

Weezy

DoriC · Post by **DoriC** » Mon Sep 19, 2011 5:58 pm

Guest wrote:I reluctantly accepted the PRS1 cpap with the understanding I can exchange if I don't like it. I still feel like the DME is trying to talk me out of the machine I want, but they may have valid points. I won't have any experience with S9 to compare so input from the board would be greatly appreciated. Any other features you feel are advantages for 1 machine over the other? Is the auto function really a non issue with a cpap setting of 7?

Thanks for all your help,
New Hose Head
Jason

The only valid point they're not mentioning is the profit margin! Insurance uses the same payment code for cpap or apap but the DME pays more for the auto so less $$ in their pocket. Insist on the auto, it's like 2 machines in one and if your pressure needs change you can self-titrate. The sleep study is only one night in the lab and may not always be accurate. You may also need different pressures if you have more positional or REM events. There's a lot to learn here so keep us posted.

tattooyu · Post by **tattooyu** » Mon Sep 19, 2011 6:00 pm

^
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What they said!

Pugsy · Post by **Pugsy** » Mon Sep 19, 2011 6:03 pm

Forgot to add... Given what I experienced what do you think would have happened if I had just got a straight cpap machine?

If you truly want APAP to have "just in case" and to satisfy "what ifs"...then push for what you want. You are the one who will use it every night. Make sure it is exactly what you want. You can always use Auto machine in cpap mode or the apap mode. Straight cpap machine... one mode only. Plus the little fact that the DME makes more money selling a straight cpap than they do selling apap. Don't let them wear you down so that you feel like you are "just settling".. you won't be happy if you feel that way.

archangle · Post by **archangle** » Mon Sep 19, 2011 6:20 pm

Guest wrote: DME shows me PRS1 cpap (not auto). States MD's in this area don't really like the apap machines very well, auto function will be unnoticeable at low settings of 7, humidifier will work fine for me and wouldn't make any difference.

.....YOU.....
.....GOT.....
.....SCREWED.....

Let me guess. He gave you a PRS1 "Plus" machine, didn't he? Check next to the display where it says "REMstar blahblahblah". Tell us what it says.

The PRS1 Auto will do everything the PRS1 PRO or Plus machine will. If you set it to manual CPAP, it will do exactly the same therapy the manual CPAP machine will do. There is absolutely no reason any patient would want the manual CPAP machine instead of the auto.

The S9 AutoSet will work fine in manual mode as well.

Don't be surprised if the promised return policy isn't there if you take it back.

If you go back, be careful he doesn't try to give you an S9 Escape Auto or an S9 Escape.

"auto function will be unnoticeable at low settings of 7" - Bald faced lie. Auto works fine at low pressure. Actually, it works BETTER at low pressure. If you set the machine to be manual, you won't get the auto function.

"States MD's in this area don't really like the apap machines very well". Who gives a rat's mask? The auto machines will function very fine in manual mode. If it's ever determined that you should try an auto machine, the function will be there. If you buy the manual CPAP, and decide you need auto, you're screwed.

Bald faced lie #3 that he will probably tell you. "I can't give you an auto machine because your prescription specifies a manual pressure." Yes, he can. The auto machine can be set to give you a single pressure, thus properly fulfilling your prescription.

There is no reason to do a trial of the manual CPAP machine to see if you like it better. Get the Auto if you can and then set it yourself to manual CPAP and try manual. If you like manual better, leave it on manual.

When you go back, remember. PRS1 PLUS - don't take it. PLUS is a big MINUS.
S9 Escape or Escape Auto - don't accept. Stand up, start and run screaming from the room trying to ESCAPE.

Carl LaFong · Post by **Carl LaFong** » Mon Sep 19, 2011 6:22 pm

+1 on the profit theory. My DME is charging the insurance company more than $1800 for a machine with an *MSRP* of about 600 bucks. (Click my equipment link below to check.) My out of pocket expense is nearly $300. So there's lots of room for negotiaton. Get the machine you need/want.

Janknitz · Post by **Janknitz** » Mon Sep 19, 2011 6:56 pm

Take a look at my blog post in my signature below: What you need to know BEFORE you meet your DME. It will explain a lot.

Call your insurance company so that you have a good understanding of what they cover and how. Don't take the DME's word for it.

And be sure to read my other blog post "Don't pay that upcharge" because if they do cave and give you what you want, they may try to charge you more for it.

taberge · Post by **taberge** » Mon Sep 19, 2011 7:15 pm

Guest wrote: States MD's in this area don't really like the apap machines very well, auto function will be unnoticeable at low settings of 7, humidifier will work fine for me and wouldn't make any difference.

This sounds like a line of BS to me. Besides, a competent doc should not have a problem with APAP's.

snoringmountain · Post by **snoringmountain** » Mon Sep 19, 2011 9:22 pm

Thanks for all your responses... very helpful. Just reinforcement to get what I want. To my DME's credit, I did check the machine I received and it is the Pro model with full data. Only thing it is not is the auto. DME did also say he was willing (just not motivated) to get apap for me if I wished. I will be leaving everything but mask in packaging and call again in morning to order S9 autoSet as I wished. I'll use my loaner PRS1 auto while I wait. Thanks again for all the support.

Jason

rested gal · Post by **rested gal** » Mon Sep 19, 2011 10:26 pm

snoringmountain wrote:I will be leaving everything but mask in packaging and call again in morning to order S9 autoSet as I wished. I'll use my loaner PRS1 auto while I wait. Thanks again for all the support.

Jason

Good advice from everyone...and good decision by you, Jason!

Had first trip to DME today

Had first trip to DME today

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