HELP HELP HELP. CPAP prescription for Auto CPAP.

[quote="judys02"]Hi- My DME problems aren't quite as bad as yours, but I have found what seems to be another SECRET trick to limit the patient-- I hope someone can help me get around it. You might also need this info.

I have the Remstar M Auto with Cflex. Originally the DME disabled the AUTO part. After a lot of argument, I got a new prescription and had it set so that it auto-titrates. But they set it at 4-20 somehow. I know I should be able to use the + key to make it start at 6, but they seem to have disabled that!!!! (I gasp at 4 and it is taking forever to get to 9).

I also (on my own) bought the Encore sw and card reader. So, I wrote a new DEVICE PRESCRIPTION with a 6-20 range. When I put the card back into the apap, it beeps continuously and flashes the card symbol.

So there is something set in the machine at 4-20 that I can't change. ( If I take the card out, it works at 4 again, but without any recording capability).

The card isn't "corrupted" as the manual says. I can read it on my PC and all the data is still there and it specifies 6-20.

Does anyone know how I can make it start at 6? AND read my card again?

And yes, I've called my DME, gotten voicemail on all choices, and no call backs. I haven't tried Apria, but Pulmonary Solutions in Santa Clara is not very responsive either.

The DME can only set the machine to what the DR ordered. They cannot make up settings. Not to say that they would not make a mistake, but it may be your DR that ordered that setting, not the DME that decided what to set the APAP at.

Maby this will help.

http://cgi.ebay.com/Respironics-RemStar ... dZViewItem

CRMW

judys02,

I am the original poster. Don't worry! Read "bdp522"'s response in this subject on Page #1. It will tell you how to reset the machine to the proper range.

I got the machine with the range wide open from 4 to 200. I followed bdp522's intruction and was able to get into the clinician setup mode and narrow the range to 6:12 as suggested by Rested_gal. I have the smart card but don't have the SW yet and still don't know how to play with it yet.

My first experience last night was better than normal but I still woke up a few times mainly because of the mask (not used to it yet) and the machine noise.

My comment on the noise is as follows.

In the middle of night, that faint pumping noise (not the air leak around the hose or gap) is quite ennoying. If it's in SYNCHRONIZATION with my breath like the LITTLE (just little, not much) air leak, then it might have the hypnotizing effect if one can go along with it (like counting 1,2,3...)
Howver, the pump sound is lagging about 1/2 second behind my breath. As I reach the end of my exhalation phase and my breath intensity reduces, the pump continues in this "noise" phase with constant intensity. It kind of trying to invite me to "SING ALONG" with it and "CONTINUE EXHALE SIR". I was mis-guided to extend my exhale. Then, I realized that I must reverse the course to breath in and then I can hear the machine pump turns to a different "noise phase". By doing that, I felt like I am the one who broke the "SING ALONG" game. The feeling is just not pleasant. The pump noise is actually not bad if it follows my breath closely. But when it lags behind a little bit and you have to be the "bad singer", then this noise is quite ennoying. I guess I have to get used to it and then will slowly ignore it.

My email is pc91770a@yahoo.com. You could email me if you like. Since we are new users of this PAP world, I think it's constructive to be able to exchange ideas and answers. The Auto PAP will be my very companion from now on.

During the CPAP training last night before I was allowed to take it home, I realized that I was the only one getting an Auto PAP and the rest of them got the Plus or basic model. No heat, no auto. Another lady didn’t even get a humidifier (I can’t see how one will leave without it because your throat will be extremely dry and soar. I felt sorry for her and told her later that she should ask her doctor for that). Later in the session, I peeked at two absentees’ invoices (who has the machine ready but didn’t come) on the table near me; I realized that my Auto CPAP price was not much different than his/her CPAP Plus model, some thing like 100 difference. Knowing that how the CPAP functions now, I believe that every first user should be prescribed with an Auto CPAP at least once to double check and to fine tune the pressure around the sleep lab pressure number. (For my personal case, I realized this morning that I spent 90% around 6.5 cm and my sleep lab number was 8cm. I am glad that I can use the machine at 6.5 instead of 8cm. However, it’s only one night experience here)

Regarding the quality of the DME instructor, I really have no comment at all. At one point, he was telling everyone in the room about how to use ramping feature. I then asked what does the “ramping feature do in my Auto CPAP setup mode?” He looked at my machine (wide open from 4-20) and told me that “it is the time it takes to ramp from 4 to 20cm”. I am not sure that is true but I believe the 4/20 are to define the min/max limits of the pressure setting, the machine will start from the MIN pressure, work upward until it finds the optimal pressure setting and stop there. How long will it take to reach from MIN to the optimal setting? Anyone can help answer this? However, I don’t think “ramping time” is used to control this as the instructor said.


Thanks a lot for everyone's inputs and comments here. We are the world!

Regards.

pcisuser wrote:Regarding the quality of the DME instructor, I really have no comment at all. At one point, he was telling everyone in the room about how to use ramping feature. I then asked what does the “ramping feature do in my Auto CPAP setup mode?” He looked at my machine (wide open from 4-20) and told me that “it is the time it takes to ramp from 4 to 20cm”. I am not sure that is true but I believe the 4/20 are to define the min/max limits of the pressure setting

The DME instructor was wrong. You're correct about 4 - 20 defining the minimum and maximum pressure range for the machine at the time you were picking it up and the instructor was looking at it. His explanation was not correct.

A side note: "traditional" Ramp cannot be used with the older Respironics REMstar Auto in auto mode, but can be used in the newer M series auto in auto mode.

A very important thing to be aware of - if you go into the setup menu of the M series Auto, be sure to leave the "split night time" at the default setting of "Off." I think it is unfortunate that a drawing of the "split night time" menu item in the Provider Manual shows the arrow pointing at a setting of two hours (120 minutes) instead of pointing at "Off" which is the way it would appear on the machine screen itself the first time a person goes through the setup menu.

The Provider Manual does not explain well what would happen if a DME instructor as clueless as the one you had were also the person setting up your machine according to an Rx of 4 - 20. He might (just might) think that what was pictured in the Split Night Time window shown in the Provider manual was probably the way that item should be set.

The hapless user would get two hours of nothing but 4 cm pressure no matter how many apneas/hypopneas were hitting. Only after the 120 minutes were up would the machine finally start auto-titrating and actually "treating" the user.

Perhaps the Quick setup card shows it differently, but the picture in the Provider Manual could lead to a mistaken setup, imho. Less likely to happen if they had simply shown the arrow pointing to "Off". Oh well.

KansasRT wrote:The DME can only set the machine to what the DR ordered. They cannot make up settings.

Not to pick on you, but I realize that and that is a pretty good point.

If the doctors don't know how these machines work then they shouldn't be prescribing pressures for them.

Either that or as an RT, you are allowed to question the script settings for the machine with the doctor (and/or suggest to the patient they call and ask about it).

Maybe it is as simple as a setup card that gets sent back to the doctor that has a REMARK section: Suggest using a higher Minimum starting pressure at 5.0cm as we have seen patients starve for air at the default setting.

You would only have to do that a couple times and I think the doctor would get the hint.

It is no different than a oral medication they would prescribe to the patient, if they don't know what the effects of the medication are they are prescribing they shouldn't be prescribing it, same for the machine.

If alcohol causes adverse effects with a medication, my pharmacy puts a fluorescent warning sticker on the prescription bottle filled.

There is a Warning section in the User Manual for the machine, it lists out contradictions that the patient might have, maybe they need to include something along the lines:

Warning: After you start using your new machine and feel you are not getting enough air to breathe while falling asleep and/or the incoming air feels stuffy contact your doctor to have the Minimum pressure checked or increased.

At least this way the patient doesn't go 3-4 weeks suffering while they wait for their next follow up doctor's appointment. If they come here they find out about it much quicker, but can you imagine the number of patients that think it is normal to use that pressure that are not even aware of sites like this.

You end up hearing: I'm so claustrophobic I cannot use it. In reality they are not getting enough air to breathe normally, have difficulty falling asleep and overall a much rougher time at tolerating cpap therapy when it could be made so much easier for them.

When I go to my pharmacy to get a prescription filled and the pharmacy didn't have the particular drug in stock or seen a drug interaction with another medication I may be taking do you think they would still fill the script and send me on my way because that was the way the doctor wrote it?

Not my pharmacy anyway, they call the doctors office to either confirm or okay any change from the script.

If it is very well known that 4.0cm pressure is way too low for a majority of patients, as a professional you already know that.

This is one of the reasons I think compliance is so bad and patients have such a miserable time starting out, they are given machines set to 4-20 ranges, or a cpap with no Ramp enabled. I remember when I got my first machine the doctor didn't put a humidifier on the script so I didn't get one. that lasted about a week, I went to my PCP and he rewrote the script on his own pad and I ordered the humidifier myself. I haven't seen that sleep doc since, so his stubbornness with this patient didn't get him much in the way of repeat business with me.

Same goes for Ramp feature with a straight cpap, patients don't have that feature enabled because it wasn't prescribed. Every cpap user will tell you Ramp makes it so much easier to fall asleep especially when first starting therapy instead of starting at the highest pressure.

I don't expect every doctor to know how these machines work, but if the RT's are the experts then they should be the ones that pick up the phone to the doctor and suggests a higher starting pressure if 4.0cm is seen.

This is why I say the script should always just have the PSG titration pressure listed on the script. Then as a RT you can look at that single pressure and set up the machine the correct way. Maybe the script has Rx: CPAP, Auto 8.0cm.

I don't know of any sleep lab that starts off a titration at 4.0cm. Nearly every one I have ever been to or seen on a titration PSG starts off at 5.0cm or higher.

As an RT I can pick up the phone and call, and I do everytime I get a starting pressure of 4cmH20. Whether or not the physician will change the order is another story. Dr's can be very nasty when you question their orders, sometimes I think that it clouds the patients treatment. If I don't get anywhere with the patients DR I arm the patient with how to approach the DR themselves.

This is my first post and hopefully will not be considered thread crapping. I have had my CPAP for one week and went back for my first follow up with a technician at the Brigham & Women's Sleep Health Centers in Brighton, MA. I have a REMStar Plus M Series with C-FLex (no smartcard/software) and a heated humidifier and the ComfortClassic mask. After a couple of days I got a half dollar-sized sore on my forehead but I put moleskin, band aid, and some foam around it and some cream and continued to use it for an average of 7.2 hours every day. I also had air leaks and water problems (but thanks to this forum I have some ideas on how to address the water problem). So I was interested in a different mask. I have HMO Blue. My tech said I was not eligible for a new mask for six months. So I said Ok I 'll just buy one. She said the cost of the two I was interested in (ComfortGel and Fisher Paykel HC405) was $280 each, so I said I would have to do some checking first. (I looked at them and said to myself, these can't really be almost $300 each.) (Up to this point I had been basically flying blind and trusting to the medical experts.) So I ordered both of the masks online for a total of $110 for both and have continued checking and found this forum. I guess if I buy the CPAP machine from them now my cost will be about $484 but if I rent it will be $22 till the end of the year and then next year I have another $750 durable equipment allowance (after I meet my $1,000 deductible, I think.) But from my initial reads of this forum, it seems like it would be better to get an auto adjusting one. Should I continue to rent for a while, or try to get them to switch my machine to the auto M and buy it from them. i don't know what my sleep study calls for by I think my primary care physician would give me a prescription for what I want, CPAP.com sells the auto M with heated humidifier for $937. Is it that much better than what I have?

You are in the typical situation lack of research BEFORE jumping in. Seems you are in good company. Now what can you do?


You can get the Auto M series online here at CPAP.com with the prescription you currently have. Just need to make sure it is in your hands hardcopy. Then scan it in and upload for CPAP.com and you can buy any CPAP or APAP. Even the Plus you have now I believe would be $516 ($414 without humidifier (see below) (about what you would owe the DME or less.) Take it back now and purchase whatever you want. It is your life and your money.

Your deductable next year at $1000 is more than the cost of the machine online (unless you have other medical devices that would cause you to meet all or part of your deductable anyway, you have to figure that out). Buy it yourself and take what you have back to the DME.

If you can convince your Insurance company to reimburse you for some of the cost, great. But even with cash you are money ahead.

You don't need to convince your doc you want or need an auto if you are buying cash and have the prescription. Just do it. If you don't, go get that preseciption and copies of the sleep studies for future reference.

You will get both manuals with your CPAP.com purchase as opposed to the DME holding the important manual back.

You may find (most likely, that the humidifier was an outright purchase that the insurance company already paid for. Check your paperwork.) That humidifier I believe will fit all M series machines, so you can just buy the machine and keep the humidifier you have. Lower cost. $610 +$185 (card reader and software) = $795 may be what you need. Auto, and $414 + $185 = $599 for the plus (something inbetween for the pro2.

Good luck with whatever you decide.

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CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, cpap.com, CPAP, DME, Prescription, auto, APAP

Hi,
This is my first post to any forum, ever. I hope I do not offend protocol, if I do, it is not intentional.

To contribute to the discussion of A-CPAP. I have used CPAP for 7 years - and what a change it has made to my life.

I also have the Remstar with memory card & heated humidifyer,for 1 year now. It is much better than the Solo CPAP I had for the previous 6 years. My prescription was for '8' on the cpap. The DME set the Apap at 5-12. The software tracks your experiences. After 2 weeks I took the card to the DME who downloaded it and 'read' it. This gives them a lot of infomation, which they display in charts.

In my case, they were able to tell that at certain periods of sleep I needed more pressure (than 12), and at other times I could do with less than 5. So, they set the machine to 4-15. When checked a few week's later, that range suited me fine.

It is an individual thing - that is the point of the software, to track experience so adjustments can be made. Altogether, the apap, with adjustments has made a significant difference for me. With the cpap only, none of that variation was possible, so I'm glad I spent the extra to upgrade when I replaced it.

I have the instructions to set the machine, but find it better to let the professionals do it, so as not to screw up. The DME does not charge e for theis service - and they were not the ones to sell me the machine. I did buy my new mask and filters from them.

So, I think the advice others gave about your initial settings 6-10 is right on. After a few weeks, have your card ead and ask them to show you the results and make the adjustments to the settings.

Best of luck with this.

I don't know what you mean about letting the professionals set up the machine so you don't screw it up. I have an auto and it is far far easier to set up than putting a message on my telephone answering machine, programming my vcr and many many other daily activities most people do.

If you are happy letting the DME do it fine do that, but it is so much eaiser to deal with it yourself and quicker too. No wasted time driving to DME (for some of us that is an hour or more). And for some of us the DME makes more mistakes than we ever could or would.