What to expect when I pick up my machine :?:

Thanks to all of you who have answered my questions on other threads.

I'd just like any advice about what to expect when I go get my machine (in about 14 hours!!). I've got a gigantic stack of papers about different machines with lots of notes. I have an estimate from billmyinsurance.com, as a comparison. I have a list of prepared questions, like about how often I could get new masks, if I can try different machines, etc.
I know I want an AutoPap, probably a Remstar M-Series with A- or C-Flex.
They have got me scheduled for an hour and a half appointment, what all will I be doing during my appointment?

Any advice to help me get the most out of it would be appreciated!
Thanks!

When you and the DME supplier finally agree on a machine, you will be shown how to set it up. For instance how to attach the integrated humidifer if you are getting one. Where the filter is and how to change it. There's not all that much to these xPAPS, they are simple to operate.

Then will come the mask selection and fitting. If you know what mask you used during your titration and it was comfortable you might do well to select that one. However, it doesn't hurt to check out some others. So unless that mask is written on your order, just keep it in mind and check over the selection they have to offer. Often they will have a selection of masks on display on head stands. Don't be bashful about asking if they have any others for you to look over.

Ideally, they will have a cot or something for you to lay on and a CPAP machine to turn on at your pressure. They should help you don the mask whilst you are sitting up and adjust it loosely, then have you lay down on your back on the cot. Lift the mask up to let it fill w/air (the machine should be turned on) and lay it back down on your face, then proceed to tighten the straps of the headgear so that it fits COMFORTABLY w/no or only minor leaks. Then you should roll over to one side and make any minor adjustments you might need, including pulling the mask from your face a very slight way for it to refill w/air if needed, then roll to your other side and do the same. The mask should now fit COMFORTABLY, the straps should NOT be too tight or uncomfortably tight as the longer you wear (like while trying to sleep) the more uncomfortable it is going to get.

Minor leaks can often be eliminated by running your fingertip along the seam between the outer mask cushion cover and your facial skin. And sometimes just twitching your nose or wiggling your jaw or scrunching your mouth around a bit will eliminate a minor leak.

Try on as many masks as interest you that will let you. Hopefully you can try at least one of each style, full face, nasal cushion and nasal pillows. Be sure to thoroughly discuss their mask exchange policy before making your final selection!! It will usually take at least a week to have a good idea if the mask you selected is going to work comfortably for you or not. Usually once that first 30 days has gone by you are fresh outta luck for any further FREE exchanges.

Carefully read the contract you sign. Be sure to ask and make them clarify anything you don't understand. Question anything you are uncomfortable with, if they agree to a minor change make sure it is handwritten on the contract and initialed by them.

Good luck!!

Amanda,
What happens can vary greatly on the DME.
If you've got a good one, it'll go well, they'll show you how to setup the machine, and get you setup with a mask and make sure that it fits right. Plus go through cleaning and maintenance routines (filters, etc.)
If you haven't... it could be anything less than that, or more ridiculous.

Good luck on your first night!

My DME is a mixed bag. They did a good job with mask choice, since I tried on 4 or 5, including some (but not all) that I'd requested. The RT was good about showing me how to set up the machine, very clear instructions on cleaning, etc. They have been good with follow-up and it is very easy to get replacements from them. They are very prompt. On the minus side, although they had a bed in the room, the RT acted surprised when I asked to try the mask I liked best lying down and was not really helpful there.

She also gave me some misinformation, particularly that mouth leaks don't matter (I had chosen a pillow style mask). She certainly was not that well informed about things that people on this board seem to know. Had I not had this forum, I'd be in the dark about a lot of things.

My biggest gripe was in getting the machine my doctor ordered. They tried everything (including trying to get the doctor to change the script) to give me a lesser machine than the one I ordered. But in the end, they did get me the machine my doctor requested. However, had my doctor not been so totally on my side, this would not have worked.

My DME is certainly the best in this town and have been very prompt with refill supplies and responsive to phone calls. They have given me a few extras, like an extra chin strap and headgear with my 3-month replacement mask at no charge. They are improving over time. They are a regional DME, not a big chain and have by far the best reputation. But you have to know what you want from them and not be willing to settle for less. I know someone who got an older model bottom of the line machine from them.

My main advice is to be ready to walk out if you don't get the equipment you need. Once you have the machine it is very difficult, if not impossible to get another one. Be ready to be very, very assertive in a pleasant teeth-gritting kind of way.

Be pleasantly suprised if they are cooperative, knowledgeable, and have your best interests at heart.

Good luck with your appointment!

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CPAPopedia Keywords Contained In This Post (Click For Definition): DME

Well, I finally got my machine! Now I'll get to have nifty pictures at the end of my posts, like the rest of the "cool" people do!

Here's how it went:
They did the mask fitting first. I need a full-face mask because I get really bad seasonal allergies and end up breathing through my mouth when my nose is too stuffed up. I tried the one I wore during both my studies, and then a different, smaller one that I ended up liking better. So the winner is: the Mirage Quattro full face mask in size small.
I got to try it out for about 10 minutes laying down in one of the rooms where they do the sleep studies and it seemed to work pretty well-- no leaks, no air blowing into my eyes, etc.

I went in ready to demand an AutoPAP machine, but since my insurance has a long "rental" period before they will buy the machine, the guy convinced me to at least try the straight CPAP machine they'd picked out for me. So I said I'd give it a month or two, which seemed to satisfy him; then he said if I really didn't like the straight CPAP and really wanted an Auto I could talk to my doctor about it and he'd switch me over.

All in all, it was not as perfect as I was hoping, but better than I was expecting.
The machine I got is a Respirionics REMstar Pro M Series with C-Flex. He showed me how to set it up, use the humidifier, do the ramping and C-Flex settings, change the filter, etc. It seems pretty simple and user friendly, but we'll see how I feel about that when I take it home and set it up myself.

I asked about the smart card and mentioned getting my own card reader and software to monitor my progress. He said that wasn't really necessary, if I wanted to have access to the card I could always bring it in and he could print out the info for me.
Yeah, right. I'm going to drive half an hour so someone else can do something that would take me a few minutes? I think not. I'll be getting a card reader and software ASAP. Obviously, he didn't realize who he was dealing with. Not only am I completely obsessive, I also happened to get my degree in Biology and I work in a medical lab. If I can get a decent grade in organic chemistry, I think I can figure out how to use some software.
Maybe he just wanted to spare me the expense of the computer stuff, but it's worth it to be able to self-monitor. Or maybe I just look like I'm stupid. Whatever.

It ended up taking a little over an hour +1/2 and I'm looking forward to hopefully get a decent night's sleep!

The DME won. You walked away with a non APAP when you really wanted an APAP. I truly hope that if you still want an apap you won't have any trouble changing it but I suspect it will be a challenge.

I agree, once you start putting on compliance hours on the machine ... they are going to be less likely to take it back. You should forget trying to convince the DME for the APAP ... start working on your doc to write you the Rx with the specific machine make and model and pressure range.

Yep, SnoreGirl is most likely right. BUT - at least you managed to walk away w/a fully data capable CPAP! That in itself can be a real accomplishment w/some of the local DME suppliers.

Welcome to the ranks of CPAPping!!

I agree that it will be hard to get a new machine once you start putting hours on it. Are you 100% sure you got the Pro with c-flex, not the Plus? If you have the Plus, I wouldn't use it, but would take it back without putting any hours on it. It is not data capable.

If you did get the Pro, you still have a good machine since it's data capable. At least you can track your progress every night. If you can get your doctor to write you a script for a new machine, you may want to go for the Remstar Auto with A-Flex. That's the top of the line one.

Aren't they insulting, assuming we can't interpret our own data? Grrr

They must all go to the same training in how to downgrade the equipment the patient needs.

Wishes for the best sleep

(we need a sleeping emoticon).
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CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX, auto

Well... it's not at all surprising that they used psychology and soft promises to keep the cost down a trifle. Good salesman the DME was, helping your insurance company.

At the least you're finally under treatment, even if you do have to get a different machine later. I am pleased to know that another sufferer is on the way to finding some relief.

Masks are a whole different sport from the machines, as for getting what works best for you. I have been through a slew of masks - most of which seemed great when trying them. But all but two proved less than substantially beneficial for me once I had one on and was trying to sleep.

Amanda, were I you, with the option of going A-FLEX from the start (and knowing what I know now about the DS510 REMstar), I would demand A-FLEX. The A-FLEX DS510 can run multiple modes, not just as A-FLEX. It can be a straight CPAP, C-FLEX or A-FLEX -- simple and fast provider/clinician setup changes accomplish that. It is a versatile machine.

With the A-FLEX unit you have the option of using it as your needs dictate. That is, if you can get them to change its function without another sleep study. Or, if you know how to get into the main setup mode, you can change the provider/clinician setup functions, and then tell your doctor, DME and clinician that you have made the changes.

As for the DME suggesting that you don't need the software. It's like electricity, water... etc. For many decades plumbers and electricians (as examples) wanted everyone to think there was something mystical about their profession and their work, and that only certified persons could change faucet washers, or replace a faucet, or a wall receptacle, light switch or light fixture. Too, many folks are dangerous just turning on a faucet and should leave tools to the hands of others. ::::ducking::::

The DME is protecting the DME, doctor and clinician from having intensely valid questions tossed at them, from having you possibly know the exact condition of your OSA in graphical details.... and from you possibly finding that you have more, or more varied kinds of episodes than your one-night sleep study recorded. Many sufferers have more kinds of episodes than the a sleep study reveals, because some kinds of episodes may not occur every night in an individual. Many life and lifestyle factors can vary the frequency, intensity and duration of each kind of episode or event.

Too, as mentioned elsewhere in a reply to your post... the DME is protecting income into the DME's accounts by billing for your visits and needs.

I DO NOT suggest or recommend that anyone buck their doctor, clinician or DME. However, it is well documented that those trained folks are not always right, and that they do make mistakes. <sigh>

I do exactly that... because it's my health and they have sorely misdiagnosed the severity of my OSA, the types of episodes that I have, and twice misprescribed the type of CPAP machine to treat my OSA. In exasperation I purchased my own, and do not regret the decision to buck them in the effort to salvage and better protect my health.

And I am still trying to acquire the Encore Pro 1.8i software so that I can do a better job of knowing what I am dealing with.

Best wishes for your success in achieving frequent and beneficial REM sleep.

Since it is still in rental phase ... take the DME up on his promise. Tell him you want to try out each of the 3 name brand APAPs ... sure would be fun to see the look on his face

Just do not agree to "BUY" until you are certain you will be getting an APAP. Make sure you have a copy of your Rx from your doctor and just be prepared to walk away and buy out of pocket if neccessary. If on the other hand you don't want to mess with their silly games and instead hurry up and get on with your treatment ... buy online and start pap'in.

Thanks for the advice.
I have decided I am going to give this machine 2 weeks, and if I don't like it, I'll start pestering my doctor to write a prescription for an APAP (specifically the A-Flex). You can bet I'll be using data from the software to back up my argument... Heaven forbid that patients actually participate in their own treatment.

I know that the same billing code is used by insurance companies for both CPAP and APAP machines, but does the prescription really have to be written specifically for an APAP, or is that just a line of BS that the guy at the DME was feeding me?
If not, I may just call up the DME and say I want to return this CPAP and that I'm going to go online to get the A-Flex from cpap.com.

I can't decide yet how well the machine is working. The mask seems to be fine, it leaked a little early this morning, but I think it had shifted around while I was sleeping.
Even with the C-Flex set at 3 and using the ramping, my pressure seemed really high. It's set at 13, which is kind of uncomfortable. My lungs and my airway hurt right now, like they're irritated and swollen or something--I'm wondering if this could be because of the high pressure? At one point during the night, it seemed so high that it felt like it was going to blow the mask off my face.
At 7 am when I woke up with it leaking, I was really fed up and just took it off and went back to sleep for 2 more hours.

So far, I feel pretty much the same as usual. Tired, didn't make it into work until after 10 am (thank God for intermittant medical leave); and on top of my usual OSA symptoms, my lungs hurt and I'm having trouble breathing.
Granted, part of the tiredness is my fault: I stayed up too late (2 am. Yes, not a good choice I know) watching random crap on TV because I didn't feel very sleepy.

Maybe tonight I'll turn the humidifier up to 4 (it was at 3) and see if that helps. Any other suggestions are always welcome.

amandalee wrote:Thanks for the advice.
I have decided I am going to give this machine 2 weeks, and if I don't like it, I'll start pestering my doctor to write a prescription for an APAP (specifically the A-Flex). You can bet I'll be using data from the software to back up my argument... Heaven forbid that patients actually participate in their own treatment.

I know that the same billing code is used by insurance companies for both CPAP and APAP machines, but does the prescription really have to be written specifically for an APAP, or is that just a line of BS that the guy at the DME was feeding me?

It may depend on their company policy. That's what I was told and I got my doc to write a script not just for the apap, but for the specific machine with the specific pressure. In the case of an apap, the specific range of pressure (like 9-14). If you ask for the specific machine it will be harder for them to pawn off a different auto on you (one they have in stock and want to get rid of, for instance).

Sorry to hear your airway feels bad. It does take most people time to get used to it, so hang in there.

The Dr is not required to write APAP....however many DMEs will use that as company policy knowing that 1. most docs are just as asinine when it comes to giving good treatment and 2. The average patient isnt going to go bug their dr and get them to write the script. So basically by doing this the chances that they are going to have to give you an APAP are pretty small. Your insurance co is going to pay the same amount regardless...they do not care if your script says APAP, CPAP, or vacume cleaner. (well....might question the last one).