Going for CPAP setup on Thursday - have some questions

jweeks wrote:

fsmitty wrote:Also, they said that the unit will ramp up to my sleep level which is 9. Is that a high number? I am new to this and still don't understand the terminolgy.

Smitty,

A pressure of 9 is on the low side of middle. Anything less than about 6 or 7 isn't really enough air for most people to breathe. About 14, and it gets hard to exhale, so folks often go to a Bi-Level machine. Most of the entry level machines max out at 20, but the mid-grade machines and Bi-Level machines typically go to 25. If you are above 25, then you are into the upper tier of very expensive machines.

CPAP doesn't work on a sliding scale. For example, someone with a pressure of 18 doesn't have twice as bad of OSA as someone with a pressure of 9. Rather, what the air does is "stent" open your airway. Once there is enough pressure to keep your airway open, you can then magically breathe. Someone can have very bad OSA and only need a pressure of 9, and others can have a comparatively mild case but need a pressure of 20. That was the deal with your titration study--to find that magic pressure level that works for you.

-john-

How does one know if the setting of 9 is really the number that I should use? I know that is the number they decided would benefit me in the lab. Last night, was my first night, it felt to me that the machine was not giving me enough air. How does one decide if the CPAP is really helping me? It was a rough night with the machine as it was hard to get comfortable and fall asleep. I am hoping that I can get used to this thing.

fsmitty wrote:Not too sure if sleep apnea can be in your genes as my father has it also.

It's generally acknowledged that every disease has two components: genetics and opportunity (e.g. lifestyle). One of the very annoying things about OSA is that the vast majority of doctors out there tend to solely focus on the latter when genetics play such a huge role. Think of it this way: your overbite and the size of your tonsils aren't exactly something that you have a choice about, and both of those play huge roles in your preponderance towards OSA. Hence, not a surprise at all that it passed down to you.

fsmitty wrote:How does one decide if the CPAP is really helping me?

This is basically why we urge you to get a data-capable machine.

Some people get really lucky. The titration (the in-lab pressure of 9 they settled on is the lowest pressure that splinted your airway open and eliminated sleep events, to answer that question) works, the machine works, they feel great, and happily ever after.

For the rest of us, it's really hard to tell if a machine is helping you or not if you're still not feeling great. While you're on night 1 (or 2 now, I guess) and everyone takes a while to feel better, if you can't see the events and pressure and leak rate, it's almost impossible to titrate and adjust your machine yourself since you'll have no idea how you're doing. That's where a lot of the members of this board can give you a hand in terms of helping yourself.

I'm a bit disturbed you're being forced to use your sleep doctor's choice of machines, but I vaguely remember something about rural sleep doctors being allowed to do stuff with DMEs that those in larger areas can't.

old64mb wrote: This is basically why we urge you to get a data-capable machine.

I have to go back to the doctor on Oct 21st for my follow-up. Do you think that I should call the doctor and tell them that I want a "Data Capable Machine"? I have Blue Cross and Blue Shield and found out that in 30 days they will charge the insurance company $1900. This system on the internet only costs about $354 so why are they charging $1500 more?

My doctor, who is attached to the sleep lab, is also acting as the DME. Not too sure, if it will annoy them if I ask them that I want to change machines to one that provides more data. Do you think that I need to call the insurance company to found out my options? I don't want to cause any bad feelings with my sleep doctor.

fsmitty wrote:I have to go back to the doctor on Oct 21st for my follow-up. Do you think that I should call the doctor and tell them that I want a "Data Capable Machine"? I have Blue Cross and Blue Shield and found out that in 30 days they will charge the insurance company $1900. This system on the internet only costs about $354 so why are they charging $1500 more?

My doctor, who is attached to the sleep lab, is also acting as the DME. Not too sure, if it will annoy them if I ask them that I want to change machines to one that provides more data. Do you think that I need to call the insurance company to found out my options? I don't want to cause any bad feelings with my sleep doctor.

Yes you should call the doctor and tell them that you want a "Fully Data Capable Machine". After all it's not the Dr that'll have to deal with it (money and impact on life) if you have a problem, it's you. It's not the Dr that'll have to pay for more trips to the sleep lab, it's you.

fsmitty wrote:It is lunchtime and after doing some research it does appear that the Sleep Style 234 that they gave me is not full data. My sleep doctor, who is attached to the Alabama Sleep Clinic, only gave me one choice of machine. They said that it is on loan for 30 days and then my insurance company will get billed to full purchase price.

Is the Sleep Style 234 a bad CPAP machine to have? Reviews on the internet seem to show that people like it mainly due to it's low noise and integrated humidifier. My doctor is also the DME so I don't really know if I have any choice in the matter. I will give this unit a try and see how it goes.

Also, they said that the unit will ramp up to my sleep level which is 9. Is that a high number? I am new to this and still don't understand the terminolgy.

You're gettin' screwed.......BIG TIME! Check out the prices on the links I've listed below. It's not that the machine they gave you is "bad", it's just not data-capable......and it's much cheaper than something better.

https://www.cpap.com/cpap-machine/fishe ... -cpap.html

Your insurance will pay the EXACT SAME AMOUNT for whatever CPAP you get.......and will be billed at least $1900 (as you noted). The difference is in how much profit your doctor/DME is going to pocket.

Having a sleep doctor who is also a DME is a big "red flag"........and as I understand it, it either is or will be forbidden/illegal under the recently adopted Medicare/CMS rules.

That machine has been on the market for several years and the manufacturer has come out with newer models that DO have more data capabilities.

https://www.cpap.com/cpap-machine/fishe ... ifier.html

https://www.cpap.com/cpap-machine/fishe ... ifier.html

Just a few words of warning..........it's YOUR money (insurance premiums, deductibles and co-pays).


Den

I wish I had read all this prior to my visit to the DME. The nurse asked me if I had a preferred DME and I had no clue so I took whomever they recommended me. When I got their they gave me a SleepStyle 234 and a ResMed mask. I returned the mask after a week because I was getting the red marks around my nose that are indicative of a mask that is too tight (so I learned much later). I then was issued a ComfortFusion mask that works good most of the time, but leaks into my eyes quite often. It is now well past my 30 days, and so I can do very little about it. Fortunately, my overall experience thus far has been very positive and I enjoy the clarity to my day that wasn't there before.

My lesson that I would pass on? Take the time to learn and be informed, it will make your equipment choices better, and you won't feel like you were handled poorly later on when you o learn.