Introduction and a questions

Doesn't hurt to do some "window shopping". Just don't sign anything until you've checked out everything and are satisfied with what you're going to get.....and from whom. I'd say do some visiting at several DMEs (if available) and get a feel for how they treat their customers.
Make sure you have your prescription (physical piece of paper) from the doctor.....don't let them fax it to the DME of THEIR choice. If your insurance provider requires copies of your sleep study (some of them do), be sure to make sure they have copies and are satisfied. (My sleep doctor's office neglected to send a copy of mine to my insurance provider until I found out from my insurance provider.....this could have been problematic if I would contracted with a local DME.....I may have been "on the hook" for a LOT more money than what I ended up spending for my gear.

Last (but not least) piece of advice......DO THE MATH. Check the online prices, local prices and ask your insurance provider as many questions as you need to......before you sign on the dotted line.


Den

You know, 3 years ago, I went thru my sleep study, got "titrated", took my RX to the DME, went home with my remstar c-flex autopap, with a card, humidifier and all the stuff, went to bed, and have slept great ever since. I have made ONE mask change to the mirage LT....that's IT!!!
I REALLY feel for all of you who have had issues with treatments/equipment.
I've been reading here for a few weeks, and can't BELIEVE what you have to go thru to get help from your various providers.

I hope you all continue to sleep well!, and if you don't....can find the path to restfull sleep!

Steviemain wrote:I've learned so much from this forum in the past two days that I'm thinking I may cancel my DME visit this Tuesday. What the heck, I've been sleeping poorly for years so another week or two delay won't make too much of a difference. Of course, some of you may find delaying the DME visit as a bad idea...please feel free to hammer me if this is poor judgement.

Don't delay (you knew someone would say that). Unless of course they balk at giving you the right machine. You've gotten a lot of suggestions but as I see it there are only three real deal breakers.

1. They won't give you a data capable machine. At least a "Pro" if it's a respironics machine as Rested Gal said (it doesn't adjust automatically but it does keep track of what's happening and you can adjust it yourself for future nights).

2. The mask leaks air or is otherwise uncomfortable (the mask - not the air pressure). You can't sleep if the mask is pinching, squirting air into your eyes etc.

3. It will cost you MUCH more going thru your insurer than paying out of pocket. If you have a huge deductible that you otherwise won't meet or very high copays AND your insurers contracted price with Lincare is very high* you might be better off paying out of pocket. But don't forget to allow for replacement masks when calculating out of pocket costs. *What Lincare bills the insurer is probably the vastly inflated price they charge walk in customers. What Lincare GETS from the insurer is usually much much less. And your copays will be based on that contract amount.

I'm tempted to say that Den's advice of checking out the DME's reputation and attitude (if your insurance allows you a choice) before committing *might* also be worth a short delay but I wonder if what you can tell in advance is worth the delay.

I think everything else that's been raised can be dealt with later - after you've started therapy. And it's absolutely IMPOSSIBLE to research everything (I overanalyze too. ) - and you'll be sleep deprived while trying to do it.

Other miscellaneous thoughts.

Steviemain wrote:1. What exactly is/are the benefit/differences between the C-Flex and the A-Flex? I've read about them, but am still unclear between the two.

I stopped using CFLEX after a few months because it didn't seem to sync with my breathing exactly and that annoyed me. I never missed it (pressure of 14). AFLEX might be bettter - I don't know or care. Note AFLEX and CFLEX are jjust respironics names. Other companies have equivalents (eg EPR).

Proving compliance to insurers.

Wulfman wrote:#3. All depends on your insurance provider and the DME. Minimum requirements for "compliance" are at least four hours per night for 70% of the nights.

My DME told me my insurer would check. They never did and after three months paid for the machine in full and I stopped worrying about it.

My Remstar "Plus" counts only counts "sessions" which are at least four hours long. If you sleep for 3 1/2 hours, get up for a minute and turn of the machine, then sleep for another 3 1/2 hours that = no session. So leave it on when you get up in the middle of the night until insurance has paid in full. While you aren't going to accept the lowly "Plus" I think the others count sessions the same way.

Wulfman wrote:Make sure you have your prescription (physical piece of paper) from the doctor.....don't let them fax it to the DME of THEIR choice.

Get this NOW even if you are going to use Lincare. Later it make take another doctors visit. And Lincare may treat you better if they know you can go elsewhere. One problem with DME's is they tend to see the doctor as their customer, not you. Your doctor probably faxed it to Lincare. If so they can refax it to you.

Steviemain wrote:the Mirage Micro was the mask I used at my sleep study.....it seemed to work fine, but then again I'm ignorant at this time to what is "fine" and what is "good".

Fine is good! The ideal is a mask that you can just forget about. (Yes you can actually get to that point). I started with a F&P 407 nasal mask and still use it most nights. I later added a full face mask but it's not as comfortable and I only use it when I need to.

If you wear glasses and like to fall asleep watching TV many masks including mine won't work. That's the only mask factor I can think of besides comfort anf full face versus non full face. On positive side I've saved a fortune in replacement costs in glasses wrecked by sleeping on them since starting cpap.

Finally remember the pressure should feel easier very quickly, the machine will sound quieter once you put the mask on, and that nasty plastic smell coming from the hose will dissipate quickly if you hang it up to air out or run the cpap for awhile before putting it on that first night.

Whew. Sorry about the length of that..

midnightowl

Hello again...today was quite enjoyable as I was able to make some calls and speak like I knew what I was talking about (which I sort of do thanks to all of you).

I first created a document with all the questions to ask and actions to take during my DME visit (compiled from all the pros and experienced members in this forum) and a list of all the insurance codes and details....at this point my confidence was pretty high and I started the phone calls....armed and dangerous, ha! If someone hasn't done it already I'll gather more info, formalize it and then give this document to the CPAPtalk forum for all the other new folks who might have similar questions. Anyway....

The DME was actually closed for Presidents Day so I'll speak with them tomorrow...

I called my insurance and gave them all the codes that I thought would apply and they informed me that all items were covered and I wouldn't need prior authorization as long as the items were prescribed by my Doctor....this rated somewhere on the "Yahoo or WooHoo!" charts. They were quite impressed that I had all the codes.

Sharkbait - I had to try and this is what transpired. I think you were right, no one had ever called the Doctor to tell them what machine they wanted, ha!!

I then called my Doctor and spoke to the nurse.....I'm pretty sure I overwhelmed her because when it was all said and done she was going to go to the Doctor and have her change my prescription (then fax it to me) all based on the information Iearned here at CPAPtalk. The original script stated, "CPAP with C-Flex and heated humidifier and nasal mask". It will now read something to the tune of "Remstar M-Series CPAP Auto with C-Flex or A-Flex, heated humidifier and nasal mask. Patient will not accept anything less than an M-Series Pro with C-Flex." When I threw all this information at the Nurse she said it would take the Doctor some time to research this information because the Doctor didn't know more than the basics for CPAP machines. I told her I did so much research this past weekend that the Doctor didn't need to do any more research and she could just change the script because the machines I mentioned are all top of the line and the most widely used in the CPAP community (true as best I can tell anyway). She agreed and would have the Doctor change my script.....of course, I'll know for sure tomorrow, but it all seems promising.

I'll call the DME tomorrow and ask them to bring at least two masks for me to try, the Micro Mirage (used at my study) and the Comfort Gel version....I'll also be able to ask more questions about the machines to see if they give me educated answers.

So.....if the DME will bring me the right machine I'll keep the Tuesday night appointment and thanks for everyone's help and input up to this point. I'll fill you in with more details tomorrow.

Steve

Well...it didn't go well as we never progressed past the following phone conversation.

Me-Hi, we spoke last Friday and you told me I was getting an M-Series machine. I'm calling again to ask what type of M-Series
DME-you're getting an M-Series from Respironics
Me-Yes, Respironics makes the M-Series machines. What model M-Series will I be getting
DME-(perturbed) A Remstar M-Series
Me-Yes, they're all called Remstar M-Series
DME-(more perturbed) It's a Respironics M-Series
Me-(perturbed) Listen, there are several different models of the Remstar M-Series CPAP machines. There's a basic, plus, pro, and auto, and there are mulitple versions of the pro and auto. Which one am I getting?
DME-(highly perturbed) You're getting a basic!
Me-No I'm not! I'll not accept it!
DME-(slightly less perturbed) Which machine do you want?
Me- A pro or auto. My Doctor is changing the prescription to state so.
DME-Well, I'm not sure we have any pro's in stock.
Me-Well, then please cancel my appointment for tonight and I'll be in touch.
End of conversation
Later on the home technician called me and asked if we were rescheduling because they didn't have any Pro's in stock. I told her yes...I'll be in touch...but probably not.

I then called the Sleep Study Center to explain what happened and that I didn't want to use Lincare. After several questions and me providing answers (basically explaining why I wanted a Pro or better model) I asked her to send me a list of the local DME's at my disposal. She did and I've eliminated 11 of 16 of them for various reasons based off internet searches.

So I'll continue to sleep poorly for a few more days as I'm out of town starting Thursday and will not return until Sunday.

Thanks for all the information about DME's as my first experience and impression was not good. It seems as if they assumed I didn't know what I was talking about and they didn't want to divulge the information I was asking.

Oh well, back to the drawing board as my Doctor was out today and I didn't receive my new script yet. Perhaps tomorrow...one thing is for sure though, I'm anxious to get started, but I would like to get started on the right foot.

These are the names of the DME's I'm considering. If anyone has any information about them, pro or con, I'd appreciate the feedback.

1. Advacare Home Services Inc
2. American Home Patient
3. Qualicare Home Medical
4. Dubois Medical Supply Co
5. Apria Healthcare

Or perhaps I would be better served using CPAP.com......

Thanks again,
Steve

I wonder what her response would have been if after she told you they didn't have the Pro in stock,you had asked for the Auto w/Aflex? Just a thought.

The Sleep Study Tech told me I wasn't going to get an Auto Machine....I didn't pursue as I just want to get something that is data compatible and I wasn't up for the conversation until after I see how my Doctor writes my script.

Success with the Doctor!! She rewrote my script for the Remstar M-Series Auto with C-Flex...she was impressed that I had done so much research and knew so much about the process....wonder where I learned that?

The nurse I spoke with today also said she had heard similar complaints about the DME that I was dealing with and would make a note of it....plus I felt better because then I no longer felt as if it was just me.....She also gave me the name of another DME so I called them to set up an appointment to interview them for next week after my return from a mini-vacation.

And.....I visited the "Our Collective Wisdom" link and it makes much more sense to me now that I've been given so much information from all of you. Based on Slinky's page about DME's and getting the right CPAP equipment I am now in possession of my script and the 7 page results of my sleep study. Not sure what all the numbers mean, but the summary basically says I'm a no sleeping machine...I can hardly wait to see what I'm supposed to feel like and I'll be all over this page reading info and asking questions to make this a successful journey.

Perhaps someone can better tell me what these results mean, i.e. laymen's terms

146 minutes of total sleep with an overall sleep efficiency of 80%.
Overall arousal index was 59.
11% stage 1, 79% stage 2 and 9% stage REM sleep.
14 apneas and 119 hypopneas.....overall AHI was 54.7
Nadir saturation was 85% with 16% of the study with saturation in the 80% range

The Sleep Doctor's impression comments were....(the short version)
Significant desaturation to a nadir of 85%
Patient should be advised regarding weight control and avoidance of sedative hypnotic agents (I'm not overweight, but does this mean sleeping pills)
This patient should be followed closely to assure acceptance and adherence to positive pressure therapy.

Anyway, that's enough for now as I need to pack for a 4 day trip to Florida to see an old friend and contemplate the mysteries of the world.....

Thanks again......chat atcha later,
Steve

Steviemain wrote:These are the names of the DME's I'm considering. If anyone has any information about them, pro or con, I'd appreciate the feedback.

1. Advacare Home Services Inc
2. American Home Patient
3. Qualicare Home Medical
4. Dubois Medical Supply Co
5. Apria Healthcare

Or perhaps I would be better served using CPAP.com......

Thanks again,
Steve

Yo - Stevie - you said you researched? If you did, why is Apria still on your list?

You are down to four.

Good job, Steve! When the time comes to actually ask the DME you choose to order (or give the machine to you, if they happen to have it right there) I'd ask for the Auto with A-Flex. The machine with A-Flex also has C-Flex in it, so that will still fill the Rx.

The wait you're going through will be worth it, to get the machine you want.

"overall AHI was 54.7" Apnea/Hypopnea Index -- you had an apnea or a hypopnea an average of almost 55 times an hour while you slept. Severe Obstructive Sleep Apnea. Not good. Normal would be AHI under 5.0.

"Nadir saturation was 85% with 16% of the study with saturation in the 80% range" Nadir means the lowest point. The lowest your O2 dropped was down to 85%. Not good.

Sixteen percent of the time you were asleep, your O2 was between 85 - 89%. Not good.
Normal (while sleeping) would be 90, or at least 89, and above. The more "above", the better.
Sixteen percent of the time is a lot of time to spend "below normal."

"Patient should be advised regarding weight control and avoidance of sedative hypnotic agents (I'm not overweight, but does this mean sleeping pills)"
Yes, "sedative hypnotic agents" are sleeping pills.
This patient should be followed closely to assure acceptance and adherence to positive pressure therapy.

I'd bet those last two statements are always included, just as a matter of course, on all the summary reports from that doctor. Just a standard part of the report template, probably.

The good thing is you're getting your ducks in a row to start treatment in a very informed way, and will be getting a good machine soon.

Thanks Gumby....has anyone ever heard of Blackburns?

I'm actually going to interview these companies before I hire them as it seems as if once you pick one it becomes a marriage of sorts....and marriage is an institution...and wasn't the film "One Flew Over the Cuckoo's Nest" at an institution........sorry, my feeble mind wandered again...

Please don't forget to look at my sleep study results and let me know what they mean in rookie terms.....other than they look bad...

Til next time,
Steve

Rested Gal - thanks for the feedback. I guess it's no wonder why I feel as I do.....

As best as I can tell, I've had some form of OSA for about 7 years and didn't know anything about it until recently. Ironically enough I've also had GERD for about the same amount of time.....from what I'm reading on this site that may go away with the use of a CPAP....another plus!!!

The more I learn the more I really believe I'm going to start life anew......how cool is that!?!?

Ciao for now

Hello again all!!! I've not posted anything to save you all the sleepy details to getting my first machine and mask.

Well I'm finally set-up and ready for my first night's sleep. I ended up with the M-Series Pro with C-Flex, Heated Humidifier, card reader and a Swift LT Nasal Pillow. The LT felt perfect so I hope it works well...My setting is 7 so the pressure isn't too overpowering. I actually used Slinky's link in "Our Collective Wisdom" to get the Doctor to write the exact prescription I wanted. They weren't willing to give me the Auto machine at this time, but everything else was perfect, even down to the "mask of patient's choice". THANK YOU SLINKY!!

I ended up using Blackburn's (Tarentum, Pa) as my DME and they've been wonderful! Friendly, helpful, responsive.....all the things that Lincare wasn't.....nuff said. I did have to find the link to the 2 page set-up guide because the DME took it with him. I can now see my leak and AHI data...love this site, ha!

I've been all over the site looking for info regarding issues with Swift LT nasal pillows and there isn't much that I can find other than some basic information regarding using lanolin in the nostrils and perhaps some Afrin if I clog up.

Does anyone have any other hints or tricks they can provide or a link to the same regarding the Swift LT Nasal pillows?

Thanks and wish me luck on my first night ever with a CPAP system!!

Steve

Steviemain wrote:Thanks and wish me luck on my first night ever with a CPAP system!!

Steve

Woooooo, Steve. You did it!

You got good stuff! Best of luck tonight!

Steviemain wrote: Does anyone have any other hints or tricks they can provide or a link to the same regarding the Swift LT Nasal pillows?
Steve

Hi Steve. Not sure what information you would like about the Swift LT, but you will find tons of references to this mask if you type it into the search box above. Lots of fans here, and I'm one of them. My own experience is that the top strap can be fairly "loose"--pulling the straps to just contacting but not snugging it down any tighter to your head. I just slightly have some tension on the back strap--still surprisingly not tight at all. You should not be tightening the straps so that the nasal pillow is shoving your nose upward! In fact, the thing works best if you can have the nasal cones just making good contact with each nostril, with no air escaping, but not collapsing the little neck of each of them. You should just make tiny adjustments once you are lying down, by rocking the pillow slightly on its hinges, and/or pulling the pillow away and re-seating if necessary after you have turned on your machine. Although I do not have oily skin, I am one who finds that the seal is best when I wash the pillow daily with baby shampoo and dry thoroughly. Some folks use Ayr nasal gel, but I find that it is too slippery and causes the pillow to become un-seated. I do absolutely have to tape my mouth, or all the air escapes when my lips flutter......but that's a whole 'nuther subject. I love this mask!! Good luck!