First Sleep Dr. visit after starting CPAP

This is where a lot of the "new" items found on Craigslist come from. Also...people try a mask and 3 months later they get another, and another, then they find that they need to change masks and it starts all over again. About 5 years ago a friend told me he had a closet full of hoses from automatic shipments.

Sonnyboy wrote:

palerider wrote:

klm49 wrote:Sonny Boy, Thanks that pretty much echoes the ones I had found on the internet.
The list my Dr. gave me says FFM cushions every 4 wks, max. of 8 weeks and hose every 3 months, max 6.

just because you CAN go buy new tires for your car every month, doesn't mean you SHOULD!!!

same with cpap supplies. there's no reason to throw away money replacing perfectly good parts.

my first mask *frame* lasted for a good four years... I had to replace the headgear three or four times, and a couple parts of it.... but replacing a mask every few months, just because I *could* or because someone trying to sell me stuff said I should? that's crazy.

Palerider you are absolutely right but you never know when your DME is going to foul up an order or how long it will take them to get it fixed so I recommend accessing backups early in the game and then you don't need to continue reordering just because you can.

I agree *completely* get a couple extra everything, put 'em in the closet (or the cpap bag) and you're ready for surprises.

Pugsy wrote:
Up to you to decide what you are comfortable doing or not doing but at the very least...change it to apap and set minimum to maximum to see what the FLs show.

Pugsy, Sorry been busy this week. I finally managed to get APAP turned on with both pressures at 12 so we can see Fl's. I'll probably try varying the pressures as we discussed later this week. Here is last nights results:


I didn't sleep well last night and woke up several times as I had to drive to the big city today to see a Neurologist at Sleep Dr.'s recommendation. (He said he saw a couple of unusual spikes during my Sleep test and my Titration. Neurologist said it is probably nothing, but we will do a formal EEG, then likely a 72 Hr. Ambulatory EEG.)
Looks like I need to work on the snoring. I think I do that on my back. I know I snore when I am in my recliner on my back.

RogerSC wrote:Yeah, my DME originally tried to follow the Medicare list. I ended up with a lot of backup nasal pillows, cpap filters, and so on. It wasn't too long before I told them to ask me what they should send and not just send the maximum that Medicare will reimburse. Once I have a couple of backups, I'd rather the DME store the rest for me in future instead of having a closet full of unused cpap supplies here *smile*. This has been an ongoing process, involving me sending stuff back occasionally when I already have backups...I mean, how many hose and humidifier tanks, etc. do you need, anyways?

It pays to keep an eye on those DME's *smile*. They'll send a lot of stuff that you probably don't need, since they make a profit on everything that you keep. And if you see what they bill Medicare as opposed to what Medicare pays them, it is ridiculous...but that's a whole other issue. I've speculated in the past that they take those differences as tax losses, otherwise why bother to bill what they know Medicare (or other insurer) won't pay?

well so far the DME is giving me the runaround on giving me a new cushion. There supposed "your insurance covers" list doesn't even show me able to get cushions. I'm o n Medicare with a good supplemental and every list I have seen shows cushions as an available item. Since I just started CPAP on 4/8 according to there list I don't get anything till July 8th. I'm not finished haggling with them yet! I wonder if it is possible to switch DME's during the first year and what would happen to the machine I have/ I live in a fairly small town but I know there is another DME, maybe I should pay them a visit. My Dr. told me there list is set up for them to make the max. $$$$$'s. As a last resort I will call him.

Thanks to everyone for all the comments.

You have cut off the events graph on the top and included the respiration and snore graphs on the bottom and the events graph is more important than the snore graph (we can see the snores on the events graph) and more important than the respiration rate graph which really has no value to speak of.

You don't have to re do this image...since you slept poorly anyway let's see what tonight shows and hopefully you will sleep better. Just try to include that Events graph and omit the unneeded graphs on future reports.

You probably are correct about the snores and sleeping on your back but it also could be REM sleep or even a combination of REM sleep and sleeping on your back. Whatever the cause you need more pressure during those times and having apap with a little bit of range could maybe help. Sometimes we just can't stay off our backs and we have no control over REM so sometimes it pays just to let the machine do its job in apap mode. I wouldn't be surprised if you had some FLs in close proximity to the snores...they sort of go hand in hand often.

Cushions for a full face mask like the Simplus you are showing in your profile are indeed allowed one per 30 days. The DME is incorrect...and if you want to switch...you are certainly able to do so.
There's no requirement that you get your masks from the same place you got the machine. Call up the other DME and explain your situation and what you want. They probably will be happy to have your mask business. Now, they may need a RX or information from your doctor...but it can be done.

A7031 is the HCPCS code for that cushion.

klm49 wrote:

well so far the DME is giving me the runaround on giving me a new cushion. There supposed "your insurance covers" list doesn't even show me able to get cushions. I'm o n Medicare with a good supplemental and every list I have seen shows cushions as an available item. Since I just started CPAP on 4/8 according to there list I don't get anything till July 8th. I'm not finished haggling with them yet! I wonder if it is possible to switch DME's during the first year and what would happen to the machine I have/ I live in a fairly small town but I know there is another DME, maybe I should pay them a visit. My Dr. told me there list is set up for them to make the max. $$$$$'s. As a last resort I will call him.

Thanks to everyone for all the comments.

As I understand the medicare requirements, if you decide to switch DME suppliers, your rental period will start over Under medicare you rent the machine for 13 months, then it is yours. The mask and other items are yours since they were paid for. My DME carries cushions for most of the masks they stock. Sometimes they have to special order them which takes a few more days to get to me.

Okie bipap wrote: As I understand the medicare requirements, if you decide to switch DME suppliers, your rental period will start over Under medicare you rent the machine for 13 months, then it is yours.

That's only if someone gets a new machine from the new DME. There is no requirement that a new machine be involved for a DME to simply supply masks and cpap accessories.
Getting a mask from a different DME doesn't negate the original machine contract and it stays in place.
Now the new DME might like to sell a new machine but Medicare doesn't require it.
I use a DME for masks and supplies and they have never sold me a machine. ...and I have Medicare.

Thanks all for responding. Thr DME issue will get resolved, all this info. really helps.
Pugsy, sorry about the graph. Will repost in the morning.
FWiW - I was a little leary of making my 1-2 hr. Trip to the big city because of how I have been feeling because of the Sleep Apnea. Even after having a not so ideal night of sleep as I was driving home from the Dr. visit I realized how much better I felt than before CPAP!

Pugsy wrote:You have cut off the events graph on the top and included the respiration and snore graphs on the bottom and the events graph is more important than the snore graph (we can see the snores on the events graph) and more important than the respiration rate graph which really has no value to speak of.

You don't have to re do this image...since you slept poorly anyway let's see what tonight shows and hopefully you will sleep better. Just try to include that Events graph and omit the unneeded graphs on future reports.

You probably are correct about the snores and sleeping on your back but it also could be REM sleep or even a combination of REM sleep and sleeping on your back. Whatever the cause you need more pressure during those times and having apap with a little bit of range could maybe help. Sometimes we just can't stay off our backs and we have no control over REM so sometimes it pays just to let the machine do its job in apap mode. I wouldn't be surprised if you had some FLs in close proximity to the snores...they sort of go hand in hand often.

Pugsy, Here is last night's graph. I can not for the life of me figure out how I made the events graph disappear. I messed around this morning and finally made it reappear. Now I can't get the Flow Limits graph to appear, I have it checked in the waveforms but the graph doesn't appear.

Respironics machine show FLs up on the events graph...not on a separate graph (ResMed machines will do a separate graph). So if you look up on the Events graph and make the events graph taller so that the legend on the left isn't so squished together you will see where FL is shown.
It's right below RE and it shows some FL flagging. Not a huge amount of FLs but a few.

Do you know how to resize the graphs so you can look at the events graph without it being squished?
Just hover the mouse cursor on the bottom line of the graph until you see a little short double line....when you do see that short double line then click and drag the mouse cursor down and the graph will get taller.
All the graphs are easily resized to make for better viewing and it moves unneeded graphs out of sight.

Pugsy wrote:Do you know how to resize the graphs so you can look at the events graph without it being squished?
Just hover the mouse cursor on the bottom line of the graph until you see a little short double line....when you do see that short double line then click and drag the mouse cursor down and the graph will get taller.
All the graphs are easily resized to make for better viewing and it moves unneeded graphs out of sight.

yes, I had made them smaller trying to get more to appear Sorry!
Try this:

That works. As you can easily see there are some FLs going on. Not a huge number but when looked at in conjunction with the RERAs...might point to possibility of some low level arousals going on that you may or may not remember. It's not screaming out "fix me" though...but it points to maybe something that could be improved upon and maybe help if someone is having a lot of wake ups or not sleeping well.
The fix is easy...usually just a little more pressure during the times where you see the RERAs and FLs either with a little more minimum if using apap mode or a little higher overall pressure if using cpap mode.
Something to think about...not anything that is standing out as urgent though.

If it is solely related to supine sleeping then maybe doing something to help stay on your side would be enough. I haven't been too keen on adding something to cause me to wake up (like the tennis ball trick) due to discomfort because I see no sense in adding something to cause more wake ups when my sleep is already fragile enough. I prefer to just let the machine do its job no matter what sleeping position I am in or if my pressure needs change because of REM sleep (which we can't control anyway).

I notice the number of RERA's, it reminds me of my wife's SH data. I was, perhaps mistakenly, thinking that CPAP therapy had no effect on RERA's. I thought RERA's were a result of a COPD condition. Is this incorrect?