First Night!

I am a Medicare beneficiary, so I have Kaiser Advantage. Excellent coverage. I didn't pay a penny for my new Resmed AirSense 11 Autoset or any of the associated paraphernalia

Ummm, unless you have Kaiser as a supplement under an Employer Group Health Plan or a retirement plan, you are going to have a monthly co-pay FOR LIFE plus an annual deductible. Sorry to be the bearer of bad news.

This is the "Evidence of Coverage" (EOC)for Kaiser Sr. Advantage 2022 in the Northern California Region: https://healthy.kaiserpermanente.org/co ... e-ncal.pdf The EOC is the actual contract between you and Kaiser, even if you never saw it before, signed it, or knowingly agreed to it.

See this on page 52 of the PDF (section 7.1, Rules for Ownership of Durable Medical Equipment):

In Original Medicare, people who rent certain types of DME own the equipment after paying
copayments for the item for 13 months. As a member of our plan, however, you will not acquire
ownership of rented DME items no matter how many copayments you make for the item while a member of
our plan. Even if you made up to 12 consecutive payments for the DME item under Original Medicare
before you joined our plan, you will not acquire ownership no matter how
many copayments you make for the item while a member of our plan.

Medicare permits HMO's to do "perpetual rentals" instead of capped rentals for DME. Your machine is considered "Durable Medical Equipment".

Some people have Kaiser as a supplement to Medicare through an "Employer Group Health Plan" (EGHP--Medicare loves acronyms) or through a retirement plan that continues coverage into retirement on the company plan. In such a case you may be correct that you won't have a monthly co-payment or deductible with Kaiser for DME. But the vast majority of people on Kaiser Senior Advantage do.

Original Medicare patients (Part A &B, not C) still have to pay an annual deductible and monthly co-pay for their DME, but these rentals are capped at 13 months, then they own the machine. Some supplemental plans pick up some or all of the out of pocket costs. But for Kaiser patients, you will NEVER own your machine.

BuckarooBanzai wrote: ↑

Mon Jan 03, 2022 2:04 pm

Makes a lot of sense, Pugsy. What do you think of the N30 versus the P10?

I ordered the P10.

Don't know yet. Just got it today and I will give it a try tonight. Initial thoughts...quite comfy but I wonder about stability with a lot of tossing and turning. I will do a review on it tomorrow or the next day.
The N30 headgear is better because it has a buckle to adjust with.
The P10 weakness is the headgear will eventually stretch out and while it can be shrunk back down for a while...eventually it won't shrink enough to maintain tension. P10 has those little clip thingies to take up slack but they are a bit annoying.

Side note...the N30 headgear will fit on the P10 frame...that's good news for any P10 users out there.

I gotta go find some fleece side strap covers for the N30 or else I will have dents on my cheeks tomorrow....I hate dents...that's why I prefer the Bleep...no side straps needing to be covered.

I used to experiment with all the new masks but kinda got out of the habit last couple of years.
The P10 is essentially silent diffused venting and was always a critical preference of mine.
The N30 is supposed to be silent with same diffused venting. I just had never got a chance to try it.
When the Bleep came along I could make it silent with diffused venting easily and no headgear....met all my preferences.
The N30...is just an experiment. I will eventually offer it for sale at a discount.
The one I am using is the Small... I have another one on order in the Medium size I will be selling and won't be opening.

I had to spend some FSA dollars or lose them New Years Eve.....got some P10s (both the regular size and the for her size) coming as well as an AirSense 10 AutoSet that I will be selling as well. I forget all that I bought.

I will make a post with a list as soon as everything gets here.

Hi Janknitz,
I have the Kaiser Advantage Medi/Medi plan, which means Medicare is primary and MediCal is secondary. Together, they fund my Kaiser Advantage plan. So Medicare pays the lion's share of everything, and then MediCal comes along and picks up whatever is left over. I do not pay co-pays, not ever. Well, I do pay $1.25 or whatever for prescriptions. But no co-pays at all for visits, ER, surgery, ortho, etc. In fact, I never even saw a bill for my five surgeries, numerous hospitalizations, etc. I've had the plan for a little over 11 years. I get to keep it until after I've graduated and worked full time for at least nine months.

Pugsy,
Good deal! And yes, I note that the N30 headgear fits the P10. Will pick it up. Have seen images on some websites that seem to indicate the newer P10s are shipping with the N30 headgear.

BuckarooBanzai wrote: ↑

Mon Jan 03, 2022 3:32 pm

Hi Janknitz,
I have the Kaiser Advantage Medi/Medi plan, which means Medicare is primary and MediCal is secondary. Together, they fund my Kaiser Advantage plan. So Medicare pays the lion's share of everything, and then MediCal comes along and picks up whatever is left over. I do not pay co-pays, not ever. Well, I do pay $1.25 or whatever for prescriptions. But no co-pays at all for visits, ER, surgery, ortho, etc. In fact, I never even saw a bill for my five surgeries, numerous hospitalizations, etc. I've had the plan for a little over 11 years. I get to keep it until after I've graduated and worked full time for at least nine months.

Pugsy,
Good deal! And yes, I note that the N30 headgear fits the P10. Will pick it up. Have seen images on some websites that seem to indicate the newer P10s are shipping with the N30 headgear.

Ah, yes, I forgot that exception. It is said that Medicare/Medi-Cal is the best coverage there is because what one doesn't cover, the other will (if you can get a Treatment Authorization Request approved by Medi-Cal). Good to hear.

Yes, the Kaiser Advantage Medi/Medi program, which I think they technically call Kaiser Advantage Special Needs, is the very best. Treatment Authorization Requests are not required; when I need something, I get it - and immediately.

When I signed up in 2010, I asked the representative if there was any substantive difference between this plan and any other Kaiser plan. Answer: "No, there is no difference. That would be unethical."

I feel quite fortunate: My AHI has ranged from 0.2 to 1.9 since I started CPAP last Thursday. I have all of you to thank.

Pugsy and others have commented about Kaiser. I am convinced that Kaiser has substantial geographical variations. We are in Almaeda County east of San Francisco Bay Area. My experience is different than others have reported. Here is mine:
1. I told Primary Care doc about my symptoms of gasping in the night, and she sent me to the sleep center.
2. I took the Watch Pat home sleep study.
3. After evaluating Watch pat results, Kaiser loaned me a machine for trial to see whether CPAP will help.
4. follow-up appointment in 1 week to see what the loaner machine results were, and the I got a ResMed AirSense 10 Autoset (a purchase in my case, no rental plan offered to me), set wide-open at factory defaults, and one-on-one instruction by a RT showing how to use the machine. There was NO class. RT encouraged me to call her if problems or questions.
5. Follow up in 3 weeks to tell me what they thought the pressures should be, based on 3 weeks results.
6. Then six monthly follow-up calls from RT to see how things are going, with recommendations as appropriate.

Seems that Kaiser has different process in different places. In my case, NO class and machine was a one-payment PURCHASE, not a rental.

Hi Clownbell,

It sounds like you went through the process pre-pandemic, though? I just went through my process last month. Things change.

Your process does sound familiar to my own. I also took a home test, not a lab titration test. I was not offered a rental but just a here-you-go, plus "This is how much it will cost you." Your experience from post machine p/u sounds the same.

Found out today that the new AirFit P10 masks are being issues with the N30 headgear!

Well, it seems that I always wake up about 2.5 hours after I go to bed. Apparently, at this point, I have an episode 'bad' enough for the machine to push hard and that wakes me up.

If your machine is increasing the pressure a lot at the 2 1/2 hour mark there is a reason.
The machine doesn't do anything without what it thinks is a good reason.
The most common reasons for pressure increase and the worsening of OSA symptoms....supine sleeping or REM stage sleep or maybe a combination of both.

So how high is the pressure going that causes you to wake up? Ever think that maybe it isn't so much the pressure change that is causing the wake up but instead maybe it is whatever is causing the pressure change that might be responsible for the wake up?

Also remember...it's normal to wake up after a REM stage...entirely normal...and maybe that is what is happening.

Side note...quick note about the N30 experiment....more details later but in general it is a nice comfy little mask.
It is silent like the P10 which is a critical requirement to get my vote.
I need to download last night's details and see what happened but I got Mr Frowny on my machine this morning for leak management. Yesterday I had really good leak management numbers.
I have a sneaky suspicion that there are going to be some overall stability issues with the under the nose cushion compared to the P10 but I don't think they are deal breakers though. The softness of the silicone...pretty sweet and very likely worth a compromise as long as leaks don't disturb sleep.

Oh, I have no doubt there is a reason for the 2.5 hour episode. I'm a side sleeper, so I think I must be having a relatively serious apnea episode when dropping into a new sleep phase (probably REM) at that point. The machine ups my pressure to help me blow off the episode, and I then wake up with the sense that I am fighting the machine. But my guess is, these particular apnea episodes are bad enough that I would wake up in shock even without the CPAP machine. In other words, things would be worse without CPAP.

I think this explains why I am sleeping 'in stages' (sleep 2.5 hours, get up for 30-60 minutes, then go back to bed) every night.

The N30 sounds alluring. Those soft cushions look really comfy. I was sorely tempted and seriously considered the N30, but (temporarily) knocked it off the list for two reasons: (1) the leak issues you mentioned, and (2) many users report difficulty lining up the mask holes to their nostrils. I am a side sleeper with a mustache/beard, and am concerned these known issues would be problematic for me in particular.

How long do you plan to try the N30?

BuckarooBanzai wrote: ↑

Wed Jan 05, 2022 10:07 am

The machine ups my pressure to help me blow off the episode, and I then wake up with the sense that I am fighting the machine.

Please understand that while/during any apnea event the machine doesn't do a damn thing. It won't/can't increase the pressure to blow open the collapsed airway. It simply doesn't work that way. People think that is what is happening but it isn't. These machines simply can't or won't increase the pressure fast enough or simply high enough to actually move the collapsed airway tissues.

What happens during the apnea event is the machine sits by and twiddles its little thumbs during the actual collapse.
Once the airway is open again the machine uses its auto adjusting algorithm and evaluates all the data it has collected and decides to how best to prevent that from happening again and makes adjustments accordingly. All data gathered is factored in...and the flow limitations and snores are part of that criteria. It's not just an OA or hyponea.

These machines do their best work PREVENTING another collapse from happening....that's the whole idea and that's why the minimum pressure used is so critical. The machine has to be able to get high enough and quickly enough to better stent the airway open and prevent further collapse. These machines don't/can't increase the pressure in the blink of an eye in an effort to better prevent further collapse. It's not nearly as rapid as people think....the increases are gradual and over a matter of minutes...not seconds. Zoom in on your pressure line where it increases and you can see the gradual increase.

All the while the machine is evaluating and thinking and deciding to increase the pressure....the airway can still collapse or get restricted and THAT can cause a wake up. The actual airway collapse (fully or partially) is the real cause of the wake up...not the machines response.

I suspect that you would do better with a slightly higher minimum pressure to start with.

BuckarooBanzai wrote: ↑

Wed Jan 05, 2022 10:07 am

The N30 sounds alluring. Those soft cushions look really comfy. I was sorely tempted and seriously considered the N30, but (temporarily) knocked it off the list for two reasons: (1) the leak issues you mentioned, and (2) many users report difficulty lining up the mask holes to their nostrils. I am a side sleeper with a mustache/beard, and am concerned these known issues would be problematic for me in particular.

How long do you plan to try the N30?

Lining up the holes isn't really needed IMHO. The silicone cushion is so flexible and soft that I think if you get it close it is good enough. I just slap the cushion on and don't even think about lining up the holes with my nostrils. I put the N30 on in the dark. I can barely see the little colored dot that tells me the L and R sides are in correct placement which tells me the cushion is right side up. I have had zero issues moving enough air to be comfortable.

The under the nose cushion isn't (at least for me) quite as stable in terms of overall mask movement causing leaks.
Not unexpected....I had a similar issue with the DreamWear under the nose cushion compared to the DreamWear nasal pillow version.
But then again I have always worn my masks extremely loose....I learn a long time ago that they seal just fine barely hanging on to my head. Unless I am doing a lot of tossing and turning they will stay put.
Unfortunately I tend to do a lot of tossing and turning due to low back/pelvic issues and trying to get in a comfortable position to relieve pain. 95% of the time any mask movement leaks don't disturb my sleep though...so I really don't care if it leaks a bit with mask movement. It's rarely large or prolonged anyway. Now last night.....ugly leak night and while prolonged at times...not really all that prolonged deep in large leak territory. I spent a lot of time around 30 L/min excess leak and that's not enough to negatively impact the therapy itself and since I slept through the bulk of it...I don't really care but the leak report is for sure ugly just looking at it.

I got the Small cushion....to be honest I wish there was an X Small version to try. This was my same thought when I tried the DreamWear under the nose cushion. I don't have a peanut sized nose either but I do think that the Small cushion is perhaps a bit large for me. Not so big I can't make it work but big enough that stability overall could be impacted.
It would be nice to at least try something smaller but that can't happen because they don't make it.

I will probably try the N30 for at least a week. I haven't had any deal breaker issues with it so far to make me hate it enough to abort the experiment.....so that says a lot. I don't screw around with masks that give me issues right off the bat and try to make them work. I have no patience for that sort of thing. Like when I tried the P30i...it was so noisy that I didn't even bother trying to sleep with it.

I do really like the N30 headgear though. When you are a small woman with a small head...having further adjustability in headgear tension is a definite plus.

The N30 cushion is extremely soft and flexible....both a pro and a con depending on someone's needs and preferences.
Much more soft and flexible than the P10 pillows. I don't see using the N30 requiring any Lansinoh use for a sore nose.
If someone gets a sore nose with the N30....they got that sucker WAAAAYYYY too tight for sure.

Thank you, Pugsy, for the very helpful information about how the CPAP machine algorithm works. Regarding setting a higher minimum pressure, right now my ramp is 6-20; it seems my average pressure every night is 11.2. What would you suggest for minimum pressure? I am considering just setting it up to 7 for now, to see how that goes; am thinking slow but sure incremental changes.

Your report makes the N30 sound promising. Will definitely keep it on my list of masks to try - in fact, probably the next mask if I end up only marginally happy with the P10.

By the way:
1. the new P10 ships with the N30 headgear; and
2. I ordered a climate line hose for the AirSense 11 on Monday 1/3 and received it TODAY 1/5. So Apria, at the very least, has them in stock.

BuckarooBanzai wrote: ↑

Wed Jan 05, 2022 1:05 pm

it seems my average pressure every night is 11.2.

Where are you seeing the 11.2 number? Off the machine LCD display or OSCAR median number?
If off the LCD display that's a 95% number and NOT an AVERAGE number.
95% number just mean you were at OR BELOW that number for 95% of the night.
Now OSCAR will show both the Median Average as well as the 95% and max numbers.
You need to understand what you are seeing.
A lot of people mistake that 95% number off the LCD screen as the overall average and it simply isn't.

BuckarooBanzai wrote: ↑

Wed Jan 05, 2022 1:05 pm

I am considering just setting it up to 7 for now, to see how that goes; am thinking slow but sure incremental changes.

I think 7 minimum would be a great choice to make and be sure and give it some time before you want to change it again.
I also like to make small changes and take my time unless there is a huge need for a more drastic change and that's just not the case with you.

BuckarooBanzai wrote: ↑

Wed Jan 05, 2022 1:05 pm

I ordered a climate line hose for the AirSense 11 on Monday 1/3 and received it TODAY 1/5. So Apria, at the very least, has them in stock.

Good job. They either had some inventory available or they pirated a heated hose out of another boxed up AirSense 11.
Doesn't matter....as long as you got one. DMEs pirated stuff all the time.

I do think the N30 is a promising alternative for people who just don't care for nasal pillows for whatever reasons.
It checks off a lot of my own personal boxes. Won't replace the Bleep because of the headgear thing but it's a very decent option ...IMHO. Sure worth considering when people don't care for the nasal pillow thing and there's a lot of people like that.

Now will it work for everyone? Of course not. All masks come with a big YMMV sticker but it definitely is a nice little mask.
Comfy...silent...diffused venting so you don't get cold air bouncing back onto you or your spouse.
It essentially disappears on my nose after about 5 seconds of wearing it.

I will do an official review in a couple of days when I have time but overall I like it for what it is.
It was just an experiment to try for grins. I knew it wouldn't replace the Bleep but it has more pros than it does cons...for me anyway. Masks really are the one man's trash vs one man's treasure thing and people just have to try masks to see what category it ends up being for them.
Even failed mask experiments are always a good thing because we always learn something from our experiments.
Sometimes all we learn is how bad of an idea that was but we always learn. With every failed experiment we learn more about our own person preferences, wants and needs and that knowledge will help us in the future when new masks get released and we can draw on our knowledge to get an idea if we even want to bother trying a new model mask.