How do you find a good DME/Lab?

I've been using a CPAP for about three years, and now finding this forum and hearing others' experiences, I find I got almost no care at all. Yes, I got tested, and I got hardware, but they didn't talk about maintenance, or replacement parts, or followup visits, so all my hardware is old and almost never cleaned (because I didn't know to) .

I just got over a corneal abrasion from my CPAP mask, and can no longer get it to NOT leak air into my eyes. Clearly it's time to get retested and upgrade my old hardware and try on different masks, but how do I know I won't run into the same experience?

There was talk in another thread about starting a list of reviews of DMEs/labs, but having just found and joined this site today, I don't feel it's my place to start one. I will say the place I had problems with was Sleep Health Center in Newton. Maybe I fell through the cracks, or got a bad Doctor, but they only have one chance for a first impression if they don't schedule a followup I'm in the greater Boston area, if anyone has specific recommendations for me.

Thanks for listening.[/b]

Unfortunately, what you have experienced is quite common. And probably why most of us are at this forum.

Here is a link for sleep clinics, etc. that would be in your area. There is no guarantee that they will be better or worse than what you experienced already.

viewtopic/t15652/DME-Sleep-Lab-Doctor-S ... cator.html

You can also do what most of us have done, and that is pretty much handle our own therapy. If you have insurance and have to use them, you can find out if our forum host affiliate handles your insurance. The site is;

billmyinsurance. com

You can purchase equipment very inexpensive compared to DME offices, through cpap.com (our internet host).

Most of us have been in the same boat you are - and support and help one another. Welcome aboard.

Linda3032 wrote: You can also do what most of us have done, and that is pretty much handle our own therapy. If you have insurance and have to use them, you can find out if our forum host affiliate handles your insurance. The site is;
billmyinsurance. com

But how do you know what to set your unit to if you do it all yourself? I suppose you can buy a bunch of masks to see which works, but how do you know if the machine is configured right?

Thanks in advance.

dj_segfault wrote:

Linda3032 wrote: But how do you know what to set your unit to if you do it all yourself? I suppose you can buy a bunch of masks to see which works, but how do you know if the machine is configured right?
Thanks in advance.

I'm brand spanken new to OSA, so any . . err. . . old hands feel free to jump in and correct me if I'm wrong.

Here's how things worked for me:

I knew I had sleep apnea for some time, and finally went to a sleep doctor. He set me up for a sleep study where I went into a lab in the evening, they strung 800 miles of wire around me and several dozen sensors (OK, I might be exagerating just a bit), and watched me sleep. Since I clocked 70-80 events/per hour right off the bat, they hooked me up to a cpap and played with the pressure to see what worked best for me.

So that gave me a starting point, 9 cm/h2o of pressure. But my DME was the same group that did my study, and my DME contact isn't the sharpest tool in the shed. The reality is, if I am going to control my OSA, I need to do a lot of research on my own, and this board is part of it. Read a bunch of the posts, you'll learn a lot.

There are posts that talk about places to go to try different masks. CPAP.com even offers return insurance on some (at additional cost) allowing you to return a mask if you do not like it.

Hopefully your sleep study calibrated a CPAP to let you know what kind of pressure you need. That's the main concern. The rest is mostly a comfort sort of thing. It helps a lot if you have some sort of sensor capability on your machine so you can tell if you are getting events or not. Then you can make changes and see if they make things better or worse.

Many of us use software which records apnea events. Of course that's an extra expense and likely you'll also have the added expense of getting another machine which supports the software.

A less expensive option is using an oximeter overnight. Many folks have indicated they can get one free for a night or two from their DME's if their doc will write a prescription for it.

Studies have also proven that people are quite competent to adjust pressure themselves even without benefit of any objective measurement. After all, most of us know when we've had a "good" night vs when we've had a "bad" night.

If you'll fill out your profile listing the equipment you have, folks will be better able to respond to any specific questions you may have.

Oh, and one other thing; Welcome to the forum.

Regards,
Bill

Thanks for the welcome.

When I did my overnight sleep study, they had me sleep, and woke me up after just 45 minutes saying "OK, we've seen enough! Let's hook up the CPAP unit!"

I'm a very geeky and proactive person, and solving my lack of quality sleep (and air leakage issues) is worth good money to me. I wouldn't have a problem with a more DIY solution. I just never knew about these options before.

So even if I buy the unit myself I still need to get tested in a sleep lab, right? I got my first unit about three years ago, with no followups, so my confidence that the setting is currently optimal (if it ever was) is pretty low.

These units you hook up to a computer: Do they need to be hooked up to a computer while in use, or do you periodically connect it for a tuneup?

I checked with my insurance company and was fortunate to find out that my equipment and supplies are covered 100% w/no deductable or co-pay. As long as I go through network, darn it. So first you should consider checking with your insurance company to see what coverage you have (if any).

My default DME is the same place that did my sleep study, but I'll be switching in five years (or sooner) when I get a new machine. Meanwhile, I simply think of them as my clueless supply company. I don't expect to get any treatment help or information from them.

If you want to take charge of your therapy - even if you get your equipment from your DME, then you need to get a "good" machine.

Ask for a Remstar Auto with cflex, or a Remstar M Auto with cflex.

dj_segfault, tell us what machine you have now -- we can tell you how to find out what pressure you are currently at.

I'm pretty sure it's set to 14.

It's a Tranquility Quest 7300 from Respironics. It was NOWHERE on their products pages. I finally found a link to a PDF for the user manual (I never got one), and the (C) date on the manual is dated 1999! It must have been long discontinued even when I got it.

Check out these specs:
CPAP Pressure Approx. 3 to 20 cm H2O
Weight 4.5 lbs., (2.1 kg)
Height 4.5" (11 cm)
Length 9.5" (23.6 cm)
Width 7.75" (18.9 cm)

Altitude Compensation
If you should travel or move to a location that is at a different altitude than that at which the pressure was set by the Homecare Dealer you
may need to have the pressure reset on your unit. All nasal CPAP units, except those which have a pressure transducer (such as the Tranquility
and the Tranquility MP r) will produce less pressure as altitude increases. These lowered pressures may cause a return of symptoms. Contact your Homecare Dealer to have the pressure reset at or to reflect the new altitude that the unit will be operating at.

There's no way for me to see, let alone change, the settings on this unit.

Well, lol, maybe I shot my big mouth off too soon. That is an oldie. But I'm sure someone on this forum will know about this machine - and how to change the pressure on it.

But, what would you change the pressure too? -- that's the big question.

If you or your insurance will pay for a new one, you would be much better off with a new Auto (see post above).

dj_segfault, I agree with Linda. Old CPAP machines are like old computers in some ways. Technology has moved on and the new machines are inexpensive. For most of us it's not worth wasting time playing with an old one, especially when you want to enjoy the benefits that the newer monitoring software offers.

Deciding between a CPAP and APAP might be the hardest decision, although from the way you talk, it sounds like that's a no-brainer, too. You can read reviews about the various machines on CPAP.com, but don't be afraid to come here and ask any questions you may have.

Regards,
Bill

dj, did you read the light bulb / our collective wisdom yet?

The article on building your CPAP support team, cpaptalk-articles/building-CPAP-support-team.html , has a list of what to look for in doctors and DMEs and ways to find them. Unfortunately, you have to pick one before you can evaluate them.

You could phone your insurance and find out what DMEs are available on your plan. Then ask a lead sleep tech at a local hospital sleep lab, or a sleep doctor, for their opinions on some of the better DMEs in the area.

Also see the article on CPAP machines and the article on reasons for APAP.

dj

Fellow geek here. IMHO, the best thing you can do for yourself is get an APAP, or an auto BiPAP & the corresponding software & card reader.

From that point you have armed yourself with the knowledge & capability to treat yourself without having to be at the mercy of others, who may, or may not, have your best interest at heart.

That's the road many of us here have taken, and I don't know of anyone that regrets doing so.

Best,

Rick

Well, for starters, a lot can change in 3 years. I'd be inclined to write a letter to that sleep lab and request a copy of your full sleep evaluation and titration study results, graphs, the whole ball of wax, including the final dictated report AND a copy of the equipment order (script). Send it Certified Mail, Return Receipt Requested just in case they try to snowball you. With written proof of your request you have them by the short hairs. You have a legal right to a copy of your medical records and these are part of your medical records. Even if all you get is the final dictated reports of each at least you have a starting point. After 3 years passing the full data may no longer be available. Maybe. My guess is it still would be.

Since you have insurance, because a lot CAN change in 3 years, I'd go ahead and have another sleep study. They may or may not be able to do just a titration study, that will depend on your insurance.

Call your insurance and ask when you are eligible for a new xPAP machine and what sleep labs and DME suppliers they are contracted with. Get the full list. Call or visit each one. Explain you received your sleep studies and equipment 3 years ago and then were dropped off the map and you do NOT intend to be "dumped" like that again! Visit each sleep lab during the day and ask to see the sleep facilities, relate your experience of 3 years ago and that you don't intend to be passed off like that again! (Just drop in, none of this making (and paying) for an appointment). Ask who writes the equipment orders, the sleep lab doctor or your family doctor.

Then, WHEN you are ready to accept ANY new equipment INSIST that you WILL have some say in what equipment is scripted and that it WILL be mutually agreed upon by YOU and the sleep doctor. If your insurance will pay for another machine make sure the script is written for the EXACT make and model machine you and your doctor agree upon. Be sure to get a copy of that script! If you have a new sleep study and/or titration study be sure you get copies of the full data, each should be some 5-6 pages at least, plus the dictated results report.

Meanwhile, check out the various machines and prices at cpap.com. If you are not eligible for a new machine via insurance and must self-pay for a new one, shop around, cpap.com will meet any online DME's advertised price.

I can tell you that I've been seeing the RemStar Auto w/C-Flex, new and complete in the box w/humidifier and data card, going for $450 pretty regularly at yahooauctions.com At least 4-5 of them in the last few months.

dj_segfault, here's what I'd buy -- "if it were me":

Respironics REMstar Auto with C-flex and heated humidifier. Either the older model that we refer to on the message board as the "tank" ('cause it's slightly bigger) or get the Respironics REMstar Auto M series with heated humidifier (slightly smaller.)

You don't need a new Rx to buy that machine online. A copy of your original Rx (if you have it or can get it from the doctor) need only have the word "cpap" somewhere on it, to buy an autopap from cpap.com. Doesn't even have to say "autopap". The machine will come pre-set from the factory at 4 - 20 cm H20. That auto-titrating range will encompass any single cpap pressure you were originally prescribed.

You can change the range after you get the machine. You can also set it to operate as a straight cpap single pressure machine, if you wish.

Or, buy the Respironics BiPAP Auto with Bi-flex. But that would involve getting a doctor to write you a new prescription with the word "bipap" or "bi-level" on it. So, it's easier to get just an autopap with your current prescription. An autopap would very likely be all you'd need, since you're already exhaling ok against whatever straight pressure your HealthDyne machine is using.

Anyway, that's just a suggestion...if you want to take an active role in your own treatment. Sounds like you do. I did.