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Hi all, I need help! I was just diagnosed with sleep apnea. Yesterday the DME (Lincare) gave me a Resmed Escape which I then found out from these boards won't give me the full data that I'd like to get. The rep told me that no one had ever asked her about a machine with data and that I didn't need it because I only have a pressure level (or titration level?) of 7. (Sorry I don't know all the terms yet). So I took the machine, and then read some more on these boards and got nervous and annoyed about not getting the right kind of machine. The rep called me to find out how it went and I told her that I wanted a full data machine. She said that I wouldn't be able to read it because you need the software- I said I would go ahead and buy the software. She asked what machines I wanted, I told her a Redmed Elite II or Autoset II (I don't know anything about the machines, I just picked those because the first one she brought was a Resmed and those machines were listed on this website as giving data), she checked with her manager and said that they "don't order these expensive type of machines for people" (although online it was only $90 more than the one she brought) and that they won't order it for me. That in itself seems odd to me that if I got a prescription for it they won't order it. She said that I can try to get it from another company if I want. But she said that for someone with a low pressure level of 7 that I don't need this and it's only for people with servere apnea or who need really high pressure. But that if I go to another company, I have to do so within a week because by then I'll have been billed for this machine (including a $300 deductible) and I won't be able to get the money back. So I have this huge time pressure now. I don't even know if I can get in touch with the doctor within a week.

I'm worried about compliance because I know 2 people with sleep apnea who hardly ever use their machines, so I'm hoping that with a machine that gives me data I will be more compliant. I can already tell this is going to be a big pain, but I want my life back where I'm not tired all the time and I get enough sleep to think straight.

The insurance company said that if I get a prescription for a specific type of machine that they'll cover it although I might have to provide evidence that it's medically necessary. I'm going to call the doctor and ask for a prescription for a specific machine. After my most recent visit with her, I asked a little about the machines and she said that she didn't know anything about them but that the Lincare person could tell me about them. So I think that I'll have to tell her about the machines and hope that she listens. So, these are my questions for you:

1) Should I ask for an APAP machine? Or with a pressure level of 7 do I not need one? I think that I only have mild sleep apnea, but enought to need a CPAP. It's seems like I should get the best machine possible now so that if anything changes in the future I won't have to get a new one but I don't know if I can convince the doctor with that logic. But I don't know enough about the machines to convince the doctor to write a prescription for an APAP, if I only need a CPAP machine now should I just ask for CPAP with data info?

2) Do I need a machine that will give me data even though I only have a pressure level of 7? It seems to me that it will help with compliance, but again I'll have to convince the doctor of that, which is hard since I've only had it for one night.)

3) Who is a good DME provider? Or how do I find one? The doctor told me to go to Lincare and that she knew of one other one but said they weren't good. I called the insurance company and they told me to look at the list of in-network medical equipment providers - there are 101 of them in my county. I'm not sure how to pick one that's good. Since I"m just starting out I think that I will need to rely on a DME some for mask changes, to answer questions, etc. If I buy online that's out of network and I have a $1200 deductible.

I know that I need to advocate for myself, I just don't want to end up going to a bad DME when Lincare was the recommended one.

Thanks for any suggestions!

Do you HAVE your prescription? (physical document) If not, you should be able to either get it from the doctor's office (if they faxed it to the DME) or get it from the DME.

Your DME sounds like one that needs to be run away from as fast as possible. They're going to collect the exact same amount from your insurance provider regardless of which CPAP machine they give you. What your DME told you says that they put their profits above your therapy.

It's YOUR therapy, not theirs. Since YOU and YOUR insurance are paying for YOUR equipment, YOU have a right to select whichever machine YOU want.

Getting a fully data-capable machine is the primary objective. Getting an APAP is somewhere down the list......the adjusting pressures work for some people, but for others, the adjusting pressures all night long can disturb sleep.
BUT......they can all be set to straight pressure CPAP mode.......so, they're flexible.

Ask your insurance provider if YOU are considered to be "in-network" and whether they would reimburse YOU for out-of-pocket purchases. (many of us have purchased our equipment from places like CPAP.COM and then billed our insurance provider and they reimbursed us at the in-network rate)


Den

A fully data capable machine is ALWAYS best and it has nothing to do with your pressure. It is a way to keep track of how your therapy is going and - as you said- a great motivator to keep using the machine.

The Elite11 will give you full data but the Autoset 11 is better again because you have 2 machines in one. You can use it in straight cpap or use it in auto mode with a narrow range.

Even if you find (after have tried both modes) that you like straight cpap better, it is great to have a machine that runs in auto mode too so that you can do a "mini home titration" if you feel that the pressure you are using is not doing so well for you anymore.

I don't know a lot about Resmeds but I think there is quite a bit of detailed data that can be seen on the LCD display, even without software, if you don't get that right away. Someone who knows Resmeds better can tell you about that.

In my opinion, you should push for an auto but don't settle for anything less that an Elite11.

By the way, your pressure setting is not that high but it has nothing to do with the severity of your sleep apnea.

Respironics is the other major names in cpap machines but you have a Resmed and upgrading with that may be eaiser than switching to Repsironics. In Respironics, don't settle for a "PLUS". You want a "PRO"or an "AUTO"in this brand.

pam933 wrote:She said that I can try to get it from another company if I want. But she said that for someone with a low pressure level of 7 that I don't need this and it's only for people with servere apnea or who need really high pressure. But that if I go to another company,

That really is annoying when they come up with things like this. I guess it depends on how many apnoeas you had a night. I currently sit around a pressure of 8 and go up to 10 some times, I stop breathing / have events of 141.2 an hour without a CPAP machine, in a 7.5 hour night that equates to 1059 events. It's true the lower the pressure you need probably the less apnoea's you have but that doesn't always ring true.

pam933 wrote:I'm worried about compliance because I know 2 people with sleep apnea who hardly ever use their machines, so I'm hoping that with a machine that gives me data I will be more compliant.

You are correct, it will give you more of a will to stick with the machine. Most people get on fine with CPAP machines, there are some people that can't adapt to them and just feel it's unnatural so if you feel it's going to help then you should get the machine that does everything you want.

pam933 wrote:1) Should I ask for an APAP machine? Or with a pressure level of 7 do I not need one? I think that I only have mild sleep apnea, but enought to need a CPAP. It's seems like I should get the best machine possible now so that if anything changes in the future I won't have to get a new one but I don't know if I can convince the doctor with that logic. But I don't know enough about the machines to convince the doctor to write a prescription for an APAP, if I only need a CPAP machine now should I just ask for CPAP with data info?

I would personally go with an APAP as it gives you the best of both worlds. If you have problems adapting to CPAP (hopefully you won't) you can set the min pressure lower and at least get off to sleep more easily. Setting it too low means it won't react as well to apnoeas but it might help if you experience difficulties. I personally always leave my machine in APAP mode.

pam933 wrote:2) Do I need a machine that will give me data even though I only have a pressure level of 7? It seems to me that it will help with compliance, but again I'll have to convince the doctor of that, which is hard since I've only had it for one night.)

That is difficult to answer. If you want to be in control of your health and be able to verify if you feel you have a bad night to see if it was truly a bad night due to oxygen levels or whether you're just tired for some other reason, then it would be good to have data. Most machines do provide the AHI, AI, HI figures on the LCD display so you can write these down when you wake up, enter them into a spreadsheet and manually record them without needing additional software.

pam933 wrote:3) Who is a good DME provider?

I can't answer that as I'm not in the US, so I'll leave this up to others to try and answer.

As you're already thinking about and looking at ResMed you might want to look at the new S9. The data is written to an SD card that can be readable in most laptops or desktop PC's with a cheap card reader and the software to read the data on the PC can be accessed for free.

I would find another DME.

Just to deal with one subject, the business of "only a 7" is purest nonsense. The Elite II and Auto II are not better because they provide more pressure. They are better because both provide more information and the Auto II can provide varying pressure. Someone can correct me on this, but I don't think they differ mechanically, only electronically.

What's worse, though, is that saying you're "only a 7" is begging the question. Sleep studies usually do a good job of determining the pressure needed to keep someone's airway open, but sometimes they get it wrong. The unfamiliar environment makes it hard to sleep, and sometimes the study misses a person's worst combinations of position and sleep stage. Maybe you're not "only a 7." One of the best reasons for getting a smart machine is to make sure. Sure, we can try to evaluate subjectively if treatment is helping, but seeing results in black and white (and green and red and blue) is a important too.

Since you say you want to optimize your therapy, yes, I think a data capable machine is essential. I would not settle for less. It may be a hassle now, but you will be glad you did.

I have a ResMed, so am only familiar with them.

The S8 Elite II (cpap--fixed pressure) and S8 Autoset II (auto) were the data capable choices up until recently.

Now there is the S9 Elite and S9 AutoSet. There have been some reviews written here, and the most appealing feature for me is the climate contol--to prevent rainout (condensation in your hose or mask).

Both machines give good information on the lcd screen, and the software is available, if you know where to look. If you decide to get any of the Resmed's, just ask and someone here can give you more info on that. The S8's require a Resmed card reader (about $70), and the S9's use a SD card which can probably into your computer, or a generic card reader.

Also, read this thread:

viewtopic/t50132/Does-all-the-data-really-help-you.html

Another thought I just had...you mentioned in your post that you had a $ 300 co-pay and a $1200 deductible. If that's the case, you might even consider buying on-line. The DME cost for a cpap/apap will certainly be much higher, and depending on what your co-pay and deductible is, your out of pocket cost be may more than buying on-line. Do the math both ways, and see.

I have a friend recently who bought a S8 Elite II from a DME. Their price was $3000, his co-pay was 20% = $600. The on-line price was under $450.

Good luck to you!

I think you might want to check out this opportunity.

viewtopic/t50136/For-Sale-Two-Respironi ... d-acc.html


Den

pam933 wrote: The rep told me that no one had ever asked her about a machine with data and that I didn't need it because I only have a pressure level (or titration level?) of 7. (Sorry I don't know all the terms yet).

Pressure has nothing to do with severity!!! I have very severe OSA (O2 drops below 56%) and I did really well on 7 Now on 9 after some tinkering. You want to know what you scores are every day for the first few months to see if the titration was right and that has noting to do with presure or severity, but with effectiveness. And Yes you can see from the LED display what your AI, HI, AHI are and if they don't know that it is like a car sales man who doesn't know how to drive.

I was just going to say that the pressure setting has NOTHING to do with the severity of your sleep apnea. It is the pressure needed to keep YOUR Airway open enough to prevent as many events as possible.

BlackSpinner beat me to it but I thought it was worth saying again!!!!

Like you, I'm new to CPAP. And my sleep study recommended a pressure of 7.

When I saw my sleep study doc, I told him there were three things I wanted in my machine: full data (he agreed), a heated hose (I sleep in a very cool room), and if possible, I would prefer to get an APAP since the cost difference is minimal in the event that my apnea should progress giving us the ability to use the automatic function down the road without having to buy a new machine. He was happy to write the prescription specifying the S9 autoset.

Now--once I started checking with Aetna and the DME's, it was clear that my least expensive option was to buy online. The Aetna rules to rent for 11 months combined with my deductible and the DME charges for the rental would have been far more expensive, plus the in network DME in the Bay Area has a horrible reputation. My doctor was only recommending out-of-network DME's and compare to that cost, buying from cpap.com was a no-brainer.

I sent you pm earlier and everyone else pretty much says it. One other item you might want to consider down the road is an oximeter. There are a couple of long threads which I'll try to locate and edit to this post later tonight, or someone else might have them on-hand to post.

Thanks everyone for all your replys! I found out from my insurance company today that they'll cover any CPAP the DME charges them for with me paying 20% - so I'm definitely going to return the Resmed Escape to Lincare on Monday. I don't know if they'll let me return the hose and mask because I think that I've bought those even though I'm just renting the machine right now. I called a friend who has sleep Apnea and go the name of the DME that she used- I don't know if they'll be better, but I'll try them out and now I know to tell them what functions I was a machine to have. And I'll find out what they charge the insurance companies for each machine. I have to check with my insurance company about the $600 deductible (it's for all my health care for the year not just the sleep study but doesn't include copays or anything with a copay, noncovered expenses or out-of-network expenses, so I don't know what it does cover -so far the only thing that they've applied to the deductible this year was $300 for my sleep study) and once I figure that out I can see whether it would be cheaper to buy it from them or online (my insurance company won't consider me as an in network provider so it would be all out of pocket online). I've also left a message for my doctor and asked her to call me to see if I can get a prescription for an APAP -seems like if I can it will be better to get that, but if not I'll at least make sure that I can get a machine with the data functions. I've only even seen her twice so I don't know her well enough to know what she'll do, and at $60 copay to see her as a specialist for about 20 minutes of her time I don't really want to see her that often. I'd rather monitor it myself.

The first DME makes me so mad saying that they don't order "those expensive machines" and making me think that I was crazy for wanting the data or wanting to try a mask with nasal prongs (she insisted that they were the same things as nasal pillows). And for making me think that having a CPAP at 7 cm meant that I didn't need the data etc. It's very confusing because you think that they are health care people but they are really just salespeople.

I will let you all know how this works out (and will try not to obsess about it this weekend). I really don't know what I would have done without all the help from this website. Thanks!

pam933 wrote:Thanks everyone for all your replys! I found out from my insurance company today that they'll cover any CPAP the DME charges them for with me paying 20% - so I'm definitely going to return the Resmed Escape to Lincare on Monday.

That's great news!

pam933 wrote:The first DME makes me so mad saying that they don't order "those expensive machines" and making me think that I was crazy for wanting the data or wanting to try a mask with nasal prongs (she insisted that they were the same things as nasal pillows). And for making me think that having a CPAP at 7 cm meant that I didn't need the data etc. It's very confusing because you think that they are health care people but they are really just salespeople.

It is confusing, we put our trust in most of the health care profession because they should know more than we do. They are (in theory) highly trained in the profession and it's their job to know more. Unfortunately we live in a world of profit and greed and everyone wants their slice of it. It sounds harsh even as I type it, but it's the reality of it.

The other thing is a lot of doctors don't like patients knowing more than the doctors do because it puts fear into them and makes them doubt what the patient says and whether a patient will follow their advice but I always believe an informed patient who is willing to understand their condition, work with their condition is a much better patient long term.

I want to put in that you can have your PCP write the script. I have never seen my sleep study doctor. I had my family Doctor write prescription for AutoSet II. I had a talk with her about how important it is for me to see leak rates and my AHI. I have made her my ally in my therapy.
I am considering having her rewrite my prescription to a machine that has S9 in the name.

m