is my experience normal?

I’m pretty much a newbie, I’ve been using CPAP for three weeks. After my sleep study, I was told I would be contacted about a CPAP machine. In about a week I received a call to pick up my machine at a home care company . I was given a quick “how to” lesson on a M Series Remstar Plus C flex with a humidifier. I’m a mouth breather, so I use a full face Comfort Gel Mask, which was the only mask used or tried during the sleep study.
I was asked how the mask felt, but wasn’t given anything to compare it to. I was also set up with an oxygen concentrator at 2lpm. It was nice to finally sleep. I sleep in a recliner due to a back problem, and at times, I would need to sit straight up in order to breathe, most likely from a recently detected minor heart problem. Now I can recline in comfort, with no gasping for air. My machine is set at 7, so I guess my apnea isn’t too bad. I feel some air leaks around the mask edges, but I have no idea how much is too much. My machine has a smart card, which I have to send back to the home care company at the end of 30 days, they will then send it to the Dr who ordered the CPAP (I’ve never even met him). I’ve just learned on this forum that my machine doesn’t show any info other than compliance on the card. The place where I got the CPAP doesn’t offer a lot of suggestions about the mask, (tighten the straps), which was my first thought! My questions are: Is it normal not to have a choice in any of this, is it because I have MEDICARE ? This is my first time using any type of medical equipment, so I don’t know if this is a “normal” experience. Since the card doesn’t show much info, will my DR change my machine. I have no complaint about the machine.

Thanks for providing so much accumulated wisdom.

You do have a choice. Contact the DME company and ask to be refit.

There are more comprehensive answers than that one, so hang on for ones from people like Wulfman, Snoredog and Rested Gal. I can address some of your issues, but not half as well or knowledgably as they can, however hopefully this note will push yours back up to the top to be seen again.

Coloradogal, now's the time to ask to swap machines...before another month has gone by. Ask your DME (the home health care store that gave you the Plus) to swap it for an M series Pro cpap. You can keep the humidifier you've already got for the Plus. The M series humidifier works with any "M" series machine.

It makes no difference whatsoever to Medicare whether you are given a Plus, a Pro, or even an Auto with A-flex. Medicare considers all three of those Respironics machines to be a "cpap" (the autopap is simply an "autotitrating" CPAP machine in Medicare's eyes.) All three of those machines fall under the same Medicare "cpap" billing code: E0601. Medicare pays the DME one set amount for "cpap" whether the cpap is a Plus, a Pro, or Auto with A-flex. Any of those three machines are appropriate for filling a doctor's prescription for "cpap" -- even the autopap, since all autopaps can be set for "cpap" mode at one single pressure.

Naturally the DME wants to give people the least expensive machine to fill the Rx, since they are going to receive one contract fee from Medicare regardless of how much the machine cost the DME to buy and put into their stockroom. The Plus is cheaper than the Pro...so...the Plus is what they gave you.

coloradogal wrote:My machine is set at 7, so I guess my apnea isn’t too bad.

Seven is a nice low pressure...you're lucky there. But the amount of pressure really doesn't correlate to "how bad" a person's OSA is. You could have severe OSA and need a pressure of 6 or 7. You could have mild OSA and need a high pressure.

The pressure is simply what it takes to keep a person's airway open...to push the soft tissues out of the way when our muscles relax in sleep. The amount of pressure it takes to do that depends mainly on a person's anatomy -- not on how severe or mild their sleep apnea was diagnosed as being.

coloradogal wrote:Since the card doesn’t show much info, will my DR change my machine.

The doctor probably couldn't care less about getting any info from the machine other than "hours of use" in order to comply with Medicare's requirement that you're actually using the machine for at least a required minimum number of hours. The doctor most likely figures that the sleep study titration "got it right", that he has prescribed the pressure the sleep study came up with... and that's the end of the story, as far as he's concerned. Most doctors, once they've prescribed the type of machine and the pressure, leave all the equipment matters up to the DME.

It woudn't hurt to ask the doctor to change the prescription to a specific machine at the same pressure... the M series Pro, for example. Some doctors would willingly do that. A few might get their back up if a "patient" suggests anything.

For that matter, the DME might be pefectly willing to swap the Plus for a Pro. Doesn't hurt to give that a try right away. The earlier in your relationship with the DME you ask to do that, the more likely they might do it, since your machine will not have been "used" much yet, and you're still a new enough customer that any DME would be willing to accept you. It's after the first DME has already received several months worth of reimbursement from Medicare for your machine that it could get difficult to switch to another DME.

Right now, while you are a desirable (in just the first month of rental) customer for ANY DME who accepts Medicare patients, is when you have your best bargaining chip -- "Well, if you can't swap, I'll have to give you this Plus back and go to a DME that can give me a Pro. Are you sure you don't have one in a back room? Would you mind checking, please? You all are so nice, and I'd really like to stick with you." Then stand there with a pleasant, hopeful smile on your face.

Give them an opportunity to go tell their manager, "Hey, we're about to lose one...she doesn't want the Plus...she insists on a Pro...what do you want me to do?"

While you're there, it wouldn't hurt to ask to try another full face mask, like the Ultra Mirage FF.

coloradogal wrote:I was also set up with an oxygen concentrator at 2lpm.

Ask the doctor to order an overnight recording pulse oximeter test for you at home while sleeping with CPAP. If the only reason O2 was ordered for you was because of the way your oxygen levels were dropping during the DIAGNOSTIC (while no cpap was being used) part of the sleep study...and especially if the supplemental O2 continued on through the titration part of the study.... it may be that it was only the OSA that was causing the O2 drops. It may be that with CPAP holding your throat open so you can actually breathe during sleep, you may not need supplemental O2 at all.

An overnight pulse oximeter test with you using just CPAP and no O2 , would show if you reallllllly need supplemental O2 while using CPAP. An RRT who worked for a DME and used to post here quite a bit wrote that most DME's will provide that oximetry test free for one night if the doctor orders it.

A lady here in town had her O2 dropping down to 43% (! !) during her sleep study. They started her on O2 very soon into the study. When she was prescribed cpap later, the doctor also prescribed O2, at 2L just like you. A couple of weeks after she had been using both, I suggested to her to ask her doctor for an overnight recording pulse oxi test, while using CPAP but not using O2. That overnight test showed her O2 stayed almost exactly on 95% all night...CPAP and no supplemental O2. She was able to get rid of that O2 concentrator taking up room in her bedroom. Just keeping her airway open with CPAP was all she needed.