Newly diagnosed with questions and DME problems

nachofoot · Post by **nachofoot** » Tue Dec 25, 2007 12:35 pm

Hi,

I'm newly diagnosed with sleep apnea and have been lurking around for about a week. I was recently given a prescription for an auto-pap setting of 5-15. I was then sent to a DME.

At the time, I was changing jobs and moving so I had about 2 days of insurance left. Originally, they offered payments when I talked to them over the phone but they changed their story when I drove there. They gave me a run-around about not wanting to deal with me even though I offered to rent the equipment myself. They said it would be too much hassle to try to collect. They then offered me a used Resmed S8 Vantage for $600 which I refused.

So now I'm buying online and I see used ones mixed in with new ones. Do the Resmed S8s have a screen stating the usage hours? Is it resettable so that someone could try to pawn off a used one as a new one? Is it possible for me to set the machine myself to 5-15?

Thanks for any help!

sleepycarol · Post by **sleepycarol** » Tue Dec 25, 2007 12:41 pm

I won't be able to help you with the Resmed question.

Just wondering if you will insurance at your new place of employment. If you get a letter from your old insurance company and give it to the new insurance company they should waive any pre existing conditions. I am in the same boat but have had my apap since the end of August. I gave the new insurance company a letter indicating I had coverage, the dates of coverage, the name of the coverage, etc and was told the preexisting clause would not pertain to me since I was moving from one company to another.

I will have to meet the deductible but would have had to with the old insurance once Jan. 1 came.

Purchasing on line is cheaper in many cases that going through a DME. If you purchase from cpap.com you are given a new machine set at your pressure. To bid on a cpap from cpapauction you will need to have your script on file. If you have an apap script (which is what I have) you can only bid on apap's. If you have a cpap script you can bid on either cpaps or apaps. Buying from auctions are buyer beware (I purchase a lot off from auctions so am not knocking them).

Wulfman · Post by **Wulfman** » Tue Dec 25, 2007 1:03 pm

When you consider deductibles, copays, and other things, a person is just about as well off purchasing a new machine out-of-pocket if they have their prescription (and they SHOULD have it).

My insurance provider reimbursed me 80% of my out-of-pocket costs on my first CPAP and equipment, but I've since purchased several others from CPAP.COM and one from an individual (another forum member) whom I felt that I knew well enough (and I was not disappointed).

Den

Slinky · Post by **Slinky** » Tue Dec 25, 2007 2:31 pm

The Resmed S8 Elite w/EPR (straight CPAP) and the Resmed S8 AutoSet Vantage both have good size, easy to read, LED screens w/access to lots of data via the Advanced Patient menu. This is easily accessible by pressing the Left and Right buttons and holding them for 3-4 seconds, Efficacy Data will appear in the LED screen. From there it is a matter of the Left button to Enter, Right button to Exist, Up button to return to the previous screen and Down button to progress to the next screen.

The one caveat is that you must do this before noon to access that night's data as these CPAPs run on a 24 hour, noon to noon, internal clock. After noon the data rolls over into the total averages (also accessible: previous week, month, 6 months and year). You cannot alter your therapy accidentally or intentionally from the above menus.

The available data is the pressure at or below which you spent 95% of the night, the Leak rate at which or which you spent 95% of the night (minus the accepted leak rate for that mask setting), your apneas/hypopneas per hour thru the night, the number of hours you've used the machine, the number of nights you've used the machine, the number of nights since the machine was first used and the number of hours used that night.

Yep, we can tell you back channel how to change the pressure settings. And yep, you can see how many total hours the machine has on it. In addition, the serial number is composed of the 4 digit year it was built and the 2 digit month it was built as well as its production number.

I bought my Resmed S8 AutoSet Vantage, used w/505 or 550 hours on it (I've forgotten now), complete w/User and Clinician manuals, hose, extra filters, carrying case, humidifier - complete, everything except a mask for $550 including shipping from a fellow forum member.

Gerald · Post by **Gerald** » Tue Dec 25, 2007 2:45 pm

Nacho.........

If you can possibly swing it, buy your own machine online....from CPAP.com.

I would suggest that you stay away from Resmed....because they jacked up their prices recently....to hold down the screams of the DME's....because too many of us were purchasing online.....at much lower prices than the DME's wanted to charge.

I suggest that you purchase a Respironics "M" series machine with humidifier and AFLEX. You can run that machine in (3) different modes....straight CPAP (one pressure).......AUTO with CFLEX.....or AUTO with AFLEX. (I'll be purchasing one of these machines tomorrow....for backup.)

This machine is fully data capable....and can be used with software (Encore Viewer or Encore Pro 1.8) so that you can monitor and manage your own progress. Without software, I think it's very, very difficult to get good results. You don't have to get software immediately, but I highly recommend that you do so if you can possibly afford it.

The biggest problem you face is determining which mask is best for you.
Expect for this to be a sort of "do-it-yourself" project. There are so many variables and subtleties in this treatment....that it becomes a series of ongoing "tweaks and adjustments". I've been a hose-head for over a year....and I'm still tinkering with my systems. I don't think you can purchase these "tweaks & adjustments" from a DME....because it is so time consuming......and requires a certain mechanical ability that is hard for them (the DME's) to hire. They just don't want to spend the time and money on you if they can get out of it.

Decide if you want your hose to "arrive" from over you head....or from below. Decide if you want a nasal mask that covers your entire nose.....or one that delivers air just to your nares....or one that covers your nose and your mouth at the same time.

Expect to go through up to half a dozen masks before you find one that fits you "just right".....and delivers the best treatment to you. Software is vital in figuring out which mask is best.

Finally, when you can do so, I'd suggest a PulseOx 7500 recording Oximeter. It's good to check your O2 uptake every month or so....just to be sure that you're doing OK.....and that your treatment is effective.

Gerald

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, humidifier, hose, cpap.com, cflex, Encore Pro, CPAP, DME, auto

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, humidifier, hose, cpap.com, cflex, Encore Pro, CPAP, DME, auto

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, humidifier, hose, cpap.com, cflex, Encore Pro, CPAP, DME, auto

nachofoot · Post by **nachofoot** » Sat Dec 29, 2007 9:23 am

The receptionist at the doctor's office gave me a run-around about how the local suppliers would "check up" on you to see if your machine is working for you. I found out from the DME that "check up" was just going to be a phone call that asks how everything's going. I finally got them to fax it in though...

I looked at the M Series Auto with A Flex and I was torn between that one and the Resmed S8 Vantage.

Someone suggested to me that the Resmed S8 Vantage was more successful at picking up and adjusting to events as they happen. Both clinics reported that I had about 14 events per hour and my oxygen level was 88% at the lowest. Does exhaling against the machine cause undue pressure against your lungs and heart?

Panhandler · Post by **Panhandler** » Sat Dec 29, 2007 10:03 am

nachofoot wrote:...Both clinics reported that I had about 14 events per hour and my oxygen level was 88% at the lowest. Does exhaling against the machine cause undue pressure against your lungs and heart?

I use an "old" Respironics Auto with C-Flex which eases off the pressure when I exhale, as does ResMed's EPR feature. The A-flex feature is a more sophisticated adjustment of the pressure, timed to your breathing. There is some issue I've heard about with ResMed not having some features available in auto mode, but I don't recall the details.

As to breathing against the pressure having an impact on heart or lungs, it's not unusual for me to wake up in the morning wondering if the machine has failed, since I don't feel the pressure anymore. And there are well documented negative effects of untreated apnea on the heart.

By the way, 5-15 seems like a pretty wide range, to me. When I was "playing" with my pressures, I had it narrowed to 8.5-11. The sleep study titration was 9. It's a good place to start, but I'd sure want to be able to see the data and make adjustments. Many people who are set at 5, or have a ramp which starts at 5 report that they feel they're not getting enough air. That was my case. I had the ramp starting pressure set to 7 and the duration of the ramp set down to 5 minutes, just long enough for the machine to get in sync with me. Now I don't use ramp at all. Ramp, by the way, is just a gradual increase in pressure, designed to let you fall asleep before the pressure comes up to the full setting. It didn't really work for me.

It's good you found the forum. There are a lot of good people here who can really help you through the early, frustrating stages of becoming a hosehead. Welcomd aboard!

Slinky · Post by **Slinky** » Sat Dec 29, 2007 10:54 am

About the only "advantage" to a local DME supplier is if they have a good (reasonable) mask exchange policy. And that totally depends on whether you find a good local DME supplier. They are fewer and further between than should be the case given all the touting they hand us about the "service", "support" and "education" they supposedly provide. There are some good ones around tho and it is worth checking them out. Keep in mind their prices are almost always higher than buying a mask online but, with a good mask exchange policy until you find the "right" mask it can be well worth it to utilize a good local DME supplier. THEN WHEN you have found the "right" mask for you, you can just order new ones of that type online.

snoregirl · Post by **snoregirl** » Sat Dec 29, 2007 11:09 am

I would forget the local overpriced DME and go with a new machine from CPAP.com.

I would also question the 5 - 15 setting. I would start at not less than 6 so I could breath.

Do you have a titration pressure? If not, I would go with 6-15 briefly and then try to narrow it down to a spread of 6 or so.

The local DME as stated above buys you basically nothing unless they will exchange masks. And even then the masks are overpriced and you can buy a couple of the more popular ones online for a reasonable price online.

ozij · Post by **ozij** » Sat Dec 29, 2007 11:40 am

The Remed Auto mode does not have exhale relief aka EPR.

O.