newbie looking for tips/advice

Just did round two of sleep study yesterday. I have not meet with doctor to discuss results of either test formally yet but I was told I have sever apnea, irregular and slow heart beat based on 1st test which is why I went for cpap testing 2nd time. Had a good nights sleep even with all the wires, straps, cameras, I assume because of cpap. I was told I was waking up 55 times per hour on first test by tech last night.


So my question is are there are suggestions on machine/mask I should ask for. Looking for quiet, size is not to important, line in Northeast so I guess humidifier would help as well. Had a nose mask at second test, which they let me keep but I was not crazy with fit.

Any other tips/suggestions is more than welcome and I am excited about getting some good sleep in near future.

For the machine, the MOST IMPORTANT thing is to get one that is FULLY data capable. There are only 3 mfgs that make these and not all of the machines they make are FULLY data capable. Here's the distinction from someone who used to frequent this forum, SleepySandy.

Compliance-Only Compliance-only machines only gather machine usage data - the dates / times the machine was actually used. Compliance-only machines offer very little information and do not allow you or your doctor to see what types of events (apneas / hypopneas) may be happening when you use the machine. They exist mainly because the insurance company wants to make sure you are using the machine if they are going to pay for it.

Fully Data Capable Fully data-capable machine collect a lot of data regarding therapy. In addition to compliance information, AHI data, leak information, pressure information is included. A Fully data-capable machine will give a lot of information about how the therapy is progressing.

The machine that offers the most features is the Respironics REMSTAR Auto with A-Flex. If you are at a higher pressure the features it offers can't be beat. If I were new and getting a machine, this is the one I'd get first. The software for this machine is readily available.

However, in order to get this machine through your insurance, you will most likely need your physician to write a prescription for that exact machine. Then watch closely or the medical equipment supplier may try to circumvent the script.

The second thing is the mask. For most of us, we have to try a number of masks until we find one that works best for us. Here the best thing to do is to see if there's a hospital sleep lab that offers mask fittings for free or for a small amount. Then go and try on a number of masks. I had to call a number of hospitals before I found a place that would do this. It wasn't the big name hospitals with the research-oriented sleep labs, either, but a small community hospital. You just have to call around.

You will also want to start DME shopping. This is tough. If you have a good hospital sleep lab where you can try masks and you have BC/BS insurance, I'd go through billmyinsurance.com. You could also buy the machine and get reimbursed. Insurances differ vastly, so you need to know about yours.

This is not the easiest thing to do while sleep deprived, but well worth it. Good luck

CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, DME, AHI, Prescription, auto

Also, take advantage of all of the knowledge available under the yellow lightbulb, "Our Collective Wisdom" and the red dot, "CPAP FAQ." It is incredible how much you can learn about the different types of machines that are available to you.

As Rosemary said, getting a fully data capable machine is probably one of the most important criteria.

But knowledge is going to be the most important asset you can bring to the negotiations with your doctor and your DME.

Good luck,
Susan

[quote="differentdave"]Just did round two of sleep study yesterday. I have not meet with doctor to discuss results of either test formally yet but I was told I have sever apnea, irregular and slow heart beat based on 1st test which is why I went for cpap testing 2nd time. Had a good nights sleep even with all the wires, straps, cameras, I assume because of cpap. I was told I was waking up 55 times per hour on first test by tech last night.


So my question is are there are suggestions on machine/mask I should ask for. Looking for quiet, size is not to important, line in Northeast so I guess humidifier would help as well. Had a nose mask at second test, which they let me keep but I was not crazy with fit.

Any other tips/suggestions is more than welcome and I am excited about getting some good sleep in near future.

Almost as important as what machine is where to buy it and how to pay.

Decide if using insurance is worth it (online cash vs. local DME) and get that prescription from you doc and copies of the sleep studies no matter where you decide to buy. You may want those later.

Many times once you take a machine from somewhere it makes it much more difficult to get a change or go to a different supplier.

_________________

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

differentdave wrote: ... are there are suggestions on machine/mask I should ask for. Looking for quiet, size is not to important, line in Northeast so I guess humidifier would help as well. Had a nose mask at second test, which they let me keep but I was not crazy with fit.

Any other tips/suggestions is more than welcome and I am excited about getting some good sleep in near future.

Hi Dave, Welcome to the forum. Short memory here so I may reiterate what others have suggested.

NOW is the time to call your insurance company and ask 1] what CPAP DME supply companies they are contracted with in your local area. Hopefully you will have the option of several to choose from. Also ask 2] what your deductable and copay are for CPAP DME equipment. Ask 3] whether they purchase the CPAP machine outright or whether they rent, 4] if rental for how long and is it a capped rental wherein the CPAP is paid in full at the end of the rental period. Ask 5] if you self-pay for equipment and then provide the paid in full invoice will they reimburse you directly and at what percent or in full. (This would give you the option of purchasing online rather than thru a local DME supplier). You might also ask 6] just to be sure whether the other equipment such as humidifier & mask are outright purchases. Ask 7] how often they will pay for a new mask and headgear.

Also, call your sleep lab or better yet, FAX them. 1] Tell them you do not want your equipment order sent to a DME supplier but 2] to give you a copy of your order to take to the DME supplier yourself. 3] Tell them that you will definitely want a fully data capable xPAP so that if you have difficulties w/your xPAP therapy your doctor will have the data available to help ascertain what the problem is and what therapy adjustments might be necessary. 4] Ask them for a copy not only of the doctor's dictated results of both your sleep evaluation AND your titration study (about 1-2 pages each) but also the full data summary report w/graphs (about 5-6 pages for each). 5] Ask them to indicate on your equipment order "full face, nasal cushion or nasal pillow interface of patient's choice". 6] Ask that the equipment order include patient access to the advanced patient menu for AHI & leak data.

Yes, you would be wise to ask for a heated humidifier. Since size is not an issue for you, I would strongly recommend the Fisher & Paykel HC 150 stand alone heated humidifier rather than an integrated heated humidifier specific to the brand of xPAP you receive. If you opt for the F&P 150 I would suggest that you include that in your FAX to the sleep lab.

Check out the various CPAP machines available at cpap.com so you have an idea of what CPAPs interest you. Specific xPAPs to check out are the following:

Resmed S8 Elite w/EPR
Respironics M Series Pro w/C-Flex
Resmed S8 AutoSet Vantage
Respironics M Series Auto w/C-Flex
Respironics M Series Auto w/A-Flex
Puritan Bennett GoodKnight 420E

The first two listed are fully data capable straight CPAPs. The next 4 are fully data capable autoPAPs. All straight CPAPs and autoPAPs are billed w/the same insurance (HCPCS) code and reimbursed at the exact same amount despite the autoPAPs are more expensive than the bare-bones, compliance data only straight CPAPs. Thus the DME suppliers PREFER to get away w/providing you w/the bare-bones, compliance data only CPAPs. Thus the need for your equipment order to be quite specific.

Bear in mind that Resmed, Respironics and Puritan Bennet also make the bare-bones, compliance data only type of xPAPs so it is necessary to be sure of the model name. Not all Resmed S8s or Respironics M Series or Puritan Bennetts are fully data capable and the various models w/in the brands look alike.

When shopping DME suppliers determining 1] what their mask exchange policy is is of primary importance! Also important is 2] how they conduct their mask fittings. (Check the Red Ball w/Question Mark in it at the top of this page and scroll down to Mask Fittings to get an idea of how a PROPER mask fitting should be conducted and some hints to help you get a comfortable fit). 4] Do NOT accept ANY equipment if it is not what you want. 5] Do NOT sign ANYTHING until you are provided w/what you want. Once you accept an xPAP you will play heck getting it changed to the one you want. If you can get them to exchange it at all. 6] Keep in mind, tho most DME's would prefer you didn't know it, Respironics, Resmed and Puritan Bennett will replace FREE to the local DME supplier ANY of their masks that a patient has tried and was unsuccessful with simply by the DME filling out a form and returning them to the manufacturer w/in 30 days. 7] Take what your DME supplier tells you w/a grain of salt. Double check what they tell you when possible. Some have a tendency to be somewhat less than truthful if it affects their profit margin. Others have really great RTs who will do their best to get and keep you comfortable w/xPAP therapy.

Happy PAPping.

differentdave wrote:Any other tips/suggestions is more than welcome and I am excited about getting some good sleep in near future.

Welcome, Dave!

Others have given you great advice about machines, DME's etc. so I just want to add that it sounds like you have a great attitude which is so important in successful therapy. I've just passed the 3-month mark on my Respironics M-series APAP with AFLEX and integrated humidifier (and live in Northeast) and am feeling *much* better.

The 3 P's (patience, perseverence, and pro-active) are the keys to success. There may be times when it gets frustrating and it does usually take time to feel better. Just hang in there and you'll find this forum is immensely helpful to getting settled in with CPAP therapy!

Mindy

The machine that offers the most features is the Respironics REMSTAR Auto with A-Flex. If you are at a higher pressure the features it offers can't be beat. If I were new and getting a machine, this is the one I'd get first. The software for this machine is readily available.




Can not sem to find remstar auto with a-flex, I am thinking it is the remstar auto with c-flex. Can someone confirm this?

differentdave wrote: Can not sem to find remstar auto with a-flex, I am thinking it is the remstar auto with c-flex. Can someone confirm this?

Dave,

If you mean you can't find it in the drop-down list for your profile on the forum, I couldn't find it either so selected the M-Series auto with c-flex and then added a note at the bottom that it *really* was a-flex!

Mindy

I am going to doctor tomorrow (ENT) to discuss results of sleep studies, get prescription for machine, etc. I think I want the respironics m series auto cpap with a-flex and the Fisher-Paykel HC150 Heated Humidifier. Did a done or reading/research on different models and although most seemed very capable of getting the job done, I figired the a-flex is the new technology and since I will be locked in for 5 years on this machine, getting proven new technology is probably not a bad idea.

I was planning on asking doc for copies of both sleep studies (complete copies), my insurance company has a bunch of dme's did not contact any yet, waiting to talk with doc first. Did find out though that my insurance covers 90% in network and 80% out of network (after 300 annual deductible) which is not that bad from what I understand.

Will insurance pay for more than one mask? (After reading a lot here and elsewhere) I got impression that at least two masks are mandatory if not more. I was give one mask from sleep study clinic after second test. Since I already has a nose mask which actually fit pretty well, I as thinking about getting a nasal pillow from DME. As a rule of thumb should I stick to masks of same style (both nose masks for instance) instead of getting different styled masks?

I can not begin to thank the posters of this forum and those that run cpaptalk enough. The wealth of information I got from this website over the past week is insane. I have spent 2-4 hours a day reading/researching on apnea, treatment, etc. The wisdom and faq areas had tons of great info throughout. I feel bad for my doctor tomorrow as I am going in with so much info and knowledge, I do not think him nor the dme’s will have a chance against me. I am brining my wife with me to take notes, etc.
Any last minute suggestions and/or tips would be welcomed.

You're probably also going to want (at least sometime in the future), a full face mask to deal with colds and other forms of congestion.

Hi Dave,

Good for you for doing all your research! You will be an educated cpap user and you already know how to get more info.

You're doc will hopefully respond very positively to this (there are definitely a number who do).

As far as masks, I got one from the DME and was told I could get one new one every 3 months. My first was a Swift II (which I had used in the sleep lab). I just got a FFM at my 3-month mark per doctor's orders after I asked about the need to have one in case of a cold, etc. For me, being able to switch between masks can be helpful. None work perfectly for me so far, so I switch annoyances

I did end up purchasing one mask in addition to the two from the DME and received one from a friend who had one she couldn't use.

There's also cpapauction.com and the "mask roulette" thread.

Good luck with your visit!

Mindy

Not sure if anyone cares but I will update anyhow
Have a prescription in hand for the m series w/a flex and the hc15o heated humidifier. Doctor could not believe I knew zero about sleep apnea few weeks ago. He was very impressed that I did so much research/work, came in with notes, had list of questions. My optimal CPAP pressure is 9 cm/water. Doctor said I have sever sleep apnea and I was on the high end of the scale for severe (felt like asking what’s worse than severe?)
Here are some numbers from test, 1st test/2nd (cpap) test in that order
Rdi 55.7/0.0
O2 Saturation 92%/93%
O2 low 86%/90%
Sleep efficiency 68.1%/79.3%
Rem onset 202.0 min/ 71.5 min
HYP number 139/3
Sum ap 108/5
OA 106/1
Leg movement index 4.4/0.7


So how bad/good is it really? Anyone have experiences with DME’s especially on Long Island/Nationwide? Have a list of over 50 within 20 miles of house.
Once again thanks…

Dave,
I don't have experience with DME's in your area... but from experience where I am, try the mom and pop's first... save the national chain's til last (aka Apria and Lincare).

If you can afford the extra 10% for out of network providers, you might want to use cpap.com: https://www.cpap.com/cpap-machine/remst ... -flex.html

What you should keep in mind with in-network providers is that they may want you to rent the machine with a monthly 10% copay. Buying it outright could be a better deal.

But, having a brick and mortar DME, who is competent and cooperative, is an asset for mask fittings.

Susan