SmartCards - Are all Fully Data Capable?

I hate to interject this but ----- are you going to keep track of the data?

Most doc's don't give a flying leap about it. They only want that you are using the machine x hours a night so they can get insurance to pay for it.

In other words, before you work yourself up more about having data, ask how you will use it? The LED data off the Respironics machines isn't that great - lots of errors we hear. To get reasonable data you need to get the software and the card reader and insurance rarely pays for that.

The plus and the pro offer the same therapy modes. Both m series machines offer cflex (there is a lower model called the basic which doesn't). The Pro will automatically adjust for high / low altitudes; you have to go in and set the altitude on the Plus (3 options I think it is).

I absolutely will track data - it seems the only reasonable way to keep up with my therapy and make adjustments as needed to make it work as well as possible (and I am an engineer and nerd at heart so it would be hard for me not to). It doesn't seem realistic (or cost effective, or even possible) to run to the doctor every time it seems therapy is not going well, I'm not feeling like it is working well, etc. Many things I can work on myself if I know what the problem is (like leakage) and if I know whether or not AHI is increasing or not I will know if things have changed enough to go to doctor to get new pressure (or DIY).

It seems to me, auto would be nice, essential for long term unless I buy new machines or have new CPAP titration sleep lab studies as needed (which cost far, far more than any auto machine). While auto is nice, I think data capabilities are a must or I will not be able to be very involved in my therapy (which I believe is what often causes people to give up or as they say become "non-compliant". Since more than half who make it this far are "non-compliant", there is a real issue I want to avoid, having data may help me avoid some of the pitfalls.

The problem is that the way the system is set up, the equipment you get initially is what you are stuck with. Otherwise, I would be more inclined to take whatever they want to give me, if it doesn't work, try something else, etc, etc, etc. Of course if that were an option, I may well do just fine with a straight CPAP (at least for now) but it seems I would need data to know if it really is working well for me.

My other concern is that during my CPAP titration test, they came up with 9cm but:
1) It was so hard for me to breathe against that pressure that when I would wake up, I had trouble catching my breath and breathing against that high a pressure so the tech would turn it way down until I could get to sleep again and then increase the pressure to deal with events;
2) Even with CPAP at 9cm, I still had >9AHI. That does not seem like highly successful therapy. I was still sleepy (granted there is a sleep debt) but if I go to all the expense and discomfort and hassels of therapy, I would hope I would not still be waking up 9 or 10 times and HOUR (waking up 80 times every night doesn't seem like the ideal "cure").

It seems to me (a newbie who is just learning about all this stuff so my understanding is far from complete), that an auto CPAP machine might make it possible for me to comfortably breathe against lower pressures when I am trying to get back to sleep or when I don't need the full 9cm AND it could automatically adjust so maybe I could get the AHI lower than 9+, even into the normal range, as if the xPAP therapy was working to resolve the OSA.

okay - will reread your post again to digest it - just first comments

I self titrated with the Pro 2 - took a while but doable - my background is PhD in math and taught math modeling to math majors, minors and MS grad students.

Machines have ramp which is the machine starting at a lower pressure and over the next x minutes raising the the upper pressure for the night. The lower pressure and the x number of minutes can be reset in the menus (not the patient one always but again doable).

I have never been titrated in a sleep lab - only did the original diagnosis study 4 years before cpap actually. I hope never to be titrated in a lab.

What I don't understand is why is there resistance to "letting" the end user make adjustments to their own CPAP equipment? You are certainly far more educated, and must likely more capable, than any of the techs I have come across!

You do have a point that it is possible to do your own titration on a straight CPAP (making yourself the "auto" part of the machine). The only downside is that you could not use different pressures in a single night (so I may not be able to get under 9AHI).

I still think it is necessary to have data capabilities to do your own titration. I realize software/readers will be out of pocket but you still have to start with a machine that has data capabilities...(and all the more reason to not spend more out of pocket than necessary since there is that software and reader to purchase).

One more question: Is a reader necessary with the new Encore software?

yes the reader is necessary - no other way to get the data from the machine to your computer - you get graphs such as - this first one is apap - second is cpap - if you get encore pro (not for sale anymore) you can get graphs comparing nights of data easier with EPA - I rarely do that so you can see trends





when I titrated myself it did take a month - I followed the directions of my sleep doc - an APAP will give you the same information faster of course

just you have to decide how much it is worth the hassles right now - I dumped my DME after trying to get bills straightened out and decided it wasn't worth the headaches when I was spending 2 hours a month being insulted by them on the phone and the bills weren't being straightened out -

getting a data machine such as a Pro might be doable with the script you have - and dealing with that DME on mask - getting an APAP to match the humidifier etc. OOP in a few months when you no longer have to demonstrate compliance to insurance might be the way to go

what you need to do now it get this treatment started - having a local DME for mask fitting, exchanges might save in the short run too - most of us go through many masks before we find one we can call a "keeper"

SleepyinWhineCountry wrote:What did you not like about the Pro 2?

Like Jules, my Pro 2 was my first machine and I still LOVE it......even though I have three other Autos.....and I have them all set for single-pressure (CPAP mode). I was even looking to buy another one in the fall of 2007, but the supply had dried up and I had to "settle" for an Auto.

SleepyinWhineCountry wrote:I am considering paying out of pocket and buying online - it may even end up cheaper than to copay for the markup DME's charge.

We just pay so dearly for all this insurance that it seems wrong to not use it just because the DMEs are the way they are. Bottom line is that I need a machine that will work well for me for a long time or all is lost.

Someone said that his insurance reimbursed him (at a lower rate for out of network) for an online purchase - I will check that out and see if it is doable and/or if it makes good sense to do.

There is definately a value to be placed on avoiding the hassels of dealing with the DMEs.....

My insurance provider reimbursed me at the "in-network" rate because they consider their group members to be "in-network". I purchased all of my equipment from CPAP.COM and charged it to my credit card......then using their invoice, created an invoice of my own (they had all of the insurance codes on it) with me as the billing party and my insurance provider as the party being billed. I submitted the invoice to my insurance provider and they reimbursed me for 80% (standard DME percentage) of my equipment. The only thing they wouldn't reimburse me for (even though I did try) was the software and card reader......which I purchased with my initial order.

It CAN be done if you know how to work with them. Most of them WANT to save money and if you can demonstrate how they can, they should be cooperative.


Den

but Den, if Medicare is primary, buying OOP and submitting is probably NOT going to fly

jules wrote:but Den, if Medicare is primary, buying OOP and submitting is probably NOT going to fly

OK......I re-read that post.....I guess my eyes focused on the "BC" part and I missed the "Medicare".....it's a longer word.

If Medicare and BC insurance works on a 13 month rental (or rent to own) process

Actually, way back then, I was prepared to purchase all of my stuff (totally) OOP if my insurance provider hadn't been willing to go along with me......just to get what I wanted. (I'd been reading horror stories here long before I joined)

Den

you are forgiven, well, this time only, but I started exchanging messages with "whine" here -

viewtopic.php?f=1&t=37381&p=325753#p325753

I also was ready to go OOP if the DME hadn't done the leg work to get my original PSG and get the machine approved - no release I had ever signed to get the PSG sent to any docs out here in WA ever had been honored

the RT at the DME did get it (I gave her release off the labs hospital page, gave her phone numbers etc.) - she called the lab directly and actually talked to someone who remembered me from 4 years before (when she was a student still) as I was the only patient they were not allowed to put a mask on since I am chemically sensitive - the RT actually faxed the report to my sleep doc

I was still on my learning curve when I dealt with the local DME, but also knew that I had a max out of pocket which was close to being met and it would be a lot cheaper to go with the Pro 2 if the insurance would front their part but the RT also knew that I could buy an APAP OOP from cpap.com with the script I had (and it wasn't from my sleep doc but from someone I saw once and wasn't going back to)

Interesting, Jules! I'm currently trying out the OptiLife cradle cushion and I find the pressure is much stronger w/it than w/my Simplicity nasal cushion despite I noticed little if any difference between the Swift LT and the Simplicity.

Hey! So if we need more pressure and don't know how to change the pressure on our CPAPs we can just get a nasal pillows mask!!! You think?

well slinky, once you figure it all out, let me know

my AHI sucks on both FFM's I have tried - doesn't matter what pressure or what range - that was my best liberty night posted above - that first graph

I can get an AHI of 8 - 15 and a heck of a snore index too with the Liberty (beautiful leak graph however) most nights but if I go back to the Somnoplus (nasal), my AHI can be under 2 every night, snores almost non-existant with an not as pretty of a leak graph, but acceptable, and with the Soyala FFM I can get leaks nice, and get these whoppers of AHI

I have tried fixed pressure, narrow ranges, wider open ranges and still -- the FFM suck AHI wise - that is part of why I was using the Pro 2 this fall thinking it was the APAP screwing up

Wow! Take one nap and look what I miss... (yeah, still napping since I haven't actually started CPAP yet). I have been working on this for over 2 months now - all the dr. appts, sleep tests, wait for results, wait for doc to read, wait for prescription, nothing like waiting for DMEs.

I am absolutely considering buying online. It just seems that since I have double insurance coverage each of which cover CPAP (since it is diagnosed with PSG), it should not have to be all out of my pocket, especially since we pay dearly for this insurance. It doesn't even seem to be an insurance issue but a DME issue. I am getting to the point of putting a dollar value on NOT having to hassel with a DME...

Yes, Medicare is primary (I think) but my understanding is that if they do not cover something the other insurance does cover if it is within their policy limit.

At this point, I am just trying to find out what would work best for me (still worried that I will end up one of the 50% who fail or give up on CPAP therapy). It seems that once you take a machine - that's it, there's no going back so I am a little stressed about getting something that will work for me (from the DME who will not take it back or from my own online order since I could not possibly afford to buy more than one xPAP right now).

Who knows, maybe the first DME I actually get a chance to deal with will be concerned primarily with my well being, will be highly educated and ethical and will figure out and supply the best xPAP for me. If not, and I am actually up on this stuff enough to recognize there is an issue, perhaps the doctor will listen to my concern and write a prescription that some DME somewhere will help me out with... Then again, I could just give up now and order something online.

Thanks for all your input. I may not know much but thanks to you guys, I know a lot more now than I did a couple of weeks ago.

the mask is more important than the machine right now

Did anyone mention cpapforseniors.com? I've forgotten.

yes - whine actually asked about it. Read that link I posted above with whine's first post on the forum for what whine asked

first thing I remember seeing about all of this was here -

viewtopic.php?f=1&t=29806