Not sure about DME

My son(adult) just started CPAP therapy two weeks ago. He is on a BiPap. I went with him to get his machine from his DME as I am also getting a CPAP and I wanted to see how it all works.

It was odd right away to me as there was a very small area in the front, right when you walk in the door that everything takes place. They said that regulations said no one could go back in the rest of the office. So another client came in at the same time and we were all shoved together with another DME talking to the second client while my son's DME discussed his information. It was a bit off putting with no privacy. (And the place was pretty dusty as well.)

The DME person came out and brought my son's machine and showed him how it worked, but didn't know anything about to get data from it. I believe my son has a PR Respironics System One ASV. The service person really didn't show my son how to clean it - but he did say clean it every two weeks. I also later heard that the CPAP should be lower than the patient, but that wasn't mentioned.

My son has taken to his BiPAP surprisingly well, and his wife says she is actually sleeping better as well. But he is having difficulty with a very dry mouth. He wakes up during the night with a dry mouth and has to take off mask to go back to sleep.

I had posted earlier and got some great advice to go visit a couple of DME's and then make a decision. So I found someone that seems really knowledgeable and I will get my CPAP today. When I ordered, my new DME told me that I needed a heated hose. At the time I asked him about my son's dry mouth, and he said that he should try adjusting his humidifier, but if that didn't work, to get a heated hose. He said that for my son's BiPap to get a Hibernight tubing. My son called his DME and was told that he needed to drink more water before bed (which he was already doing). They said that patients rarely needed a heated hose except up north. (We live in Texas). If my son still wanted one, that he would have to pay for it with his own money. We both have the same special Medicaid program, just with different providers. My hose is covered, so I'm not sure why his wouldn't be. In the meantime, my son doesn't have the money to buy a hose, and he is not using his BiPap as much as he would like.

Another question, is that in the last couple of days he says he is waking up really tired and exhausted. When he went for his titration with the BiPap he came home and was really surprised how well he felt after one night. He was feeling pretty good other than the dry mouth, but now is complaining about his tiredness in the morning. I'm thinking his DME should help with that, but they just said to keep at it.

I like my DME a lot as he seems very knowledgeable and helpful. I suppose it's too late for my son. Does he have to stay with this DME for four or five years?

It's not too late to change DMEs. DMEs can always be changed. Explain the situation to your DME that you like and they can help get things rolling. Just because a person gets a machine from one DME doesn't mean that they can't use another DME for masks and other supplies.

What model Respironics machine did he get? Model numbers are on the bottom of the blower unit...a 3 digit number.

If he got a model 960...there is a heated hose option for it.
If he got a model 950...no heated hose option for it but there are options to help. More on those later if that is what he has.

If he got the much older discontinued 900 might be 910..looks like this
https://www.cpap.com/productpage/remsta ... chine.html
Then he got royally screwed and I would return it and switch everything over to the current DME that you like.

If the DME you like takes your Medicaid then they most likely will take Medicaid from your son.

Thanks Pugsy! I think he has a newer model, but I'll have to check to see which one. I had mentioned to my DME that I wish my son had gone to him. He said that since my son's DME had already given my son his BiPap, it couldn't be returned. He wouldn't be able to collect any commission off of it, so it wouldn't be beneficial for him to now take my son on.

Do you think that there are legitimate issues with my son's DME? If so, perhaps my son can go to the people he had his sleep study with and see if he could transfer to them (as they are a DME as well), if my DME won't take my son.

Welcome to the forum.

It would help if you could post / register the equipment that your son has.
I have a link in the signature block on how to do it.

If he does have an ASV machine, you should put that in your post subject line so ASV users will notice and provide commentary. I also have a link to my post on being new to Respironics CPAP machines that may be helpful.
With the humidifier tank removed from the machine, look on the bottom of the unit. There will be a model number that will look like 760 or 960 preceded by some alphabetic characters. If it is an ASV machine, the number will be 960.

The description of the DME space with talking about medical information in the presence of other than the patient seems as if it violates the HIPAA law.

If he has a good newer technology machine there is no reason to return the machine anyway but there's nothing preventing him from using a different DME for other supplies.
The new DME would need to do some paperwork though and sometimes they don't want to do it but it can be done.
It may be that your DME doesn't want to take him on since he can't make the big bucks on the sale of the machine but he could still make money off the sale of masks and supplies...maybe that amount isn't enough to suit them.

If you don't feel good about your son's DME....by all means change. It doesn't mean you have to return the machine to do that....but machine's can always be returned and dispensed from another DME... He's on Medicaid...I bet he is in a rent to own situation where he has to prove compliance for a certain period of time before the machine is his. Rent to own is real easy situation for returning a machine.
Lot's of paperwork involved though and a bit of a hassle.

Dry mouth - the first thing to check is for mouth breathing. If he is using a nasal mask then he is losing air pressure and his therapy is ineffective.

If he has either the 950 or 960 machine SleepyHead software will work. See the new thread on the forum's main page regarding the testing SleepyHead builds...it mentions Mac but in that thread is also Windows version update links and information.

Using the software you can see if leaks (no matter what the cause) are a potential problem.
Dry mouth is normally associated with mouth breathing but it takes very little mouth breathing to dry out the mouth so dry mouth doesn't automatically mean the entire night's therapy is lost due to mouth breathing. Might be as little as 15 minutes. Always best to evaluate any potential leaks using the software before assuming the worst case scenario.
Mouth breathing/opening leaks will show up on the leak graphs as a leak...the machine doesn't know what kind of leak..just a leak.

If he is using a full face mask already dry mouth is still likely from mouth breathing and while sometimes increasing the humidity setting will help...it doesn't always. Again...once we know which model we can maybe offer ideas to help.

Okay - my son's machine is PR, System One; BiPap AutoSV Advanced (960P)
System One Heated Humidifier, DOM
Respironics Amara gel full-face cushion

I'm hoping to get my machine shortly, and I will post my equipment on my profile.

Thanks!

With the 60 series machine (and the 960 is a 60 series machine) there is an optional heated hose that allows for greater customization of the humidity that is delivered. It might or might not be enough added moisture to help with dry mouth when using a full face mask and probably wouldn't help at all if a lot of mouth breathing is going on and a nasal mask is being used.
It's an option though and not always supplied...to check on the heated hose...if the hose has a black end where it attaches to the humidifier then it is the heated hose and the necessary lid on the humidifier and the 80 watt power supply is already likely in place.
If it is a hose that is gray/white on both ends then it isn't a heated hose. Sometimes the humidifier supplied is already heated hose capable and if it is the power supply brick will say 80 watts and if it isn't it will say 60 watts.

If no heated hose available...there is a way to change the default humidification system so that it adds more moisture to the air. This is done in the clinical setup mode and the change is to Classic humidity mode. It adds more water to the air than the default humidification system mode does. Chances of rain out also increase (condensation in the hose or mask or both) but may not be an issue until winter arrives.

Thanks Pugsy! What a treasure of advice! Well, in the meantime, my son bought some biotene spray, and says it helps. He really has surprised me how happy he is with his BiPap.