Newbie - Prescription Written

Hi All,

I was diagnosed with mild to moderate sleep apnea a couple of weeks ago. I had an AHI of 14.9 and my oxygen levels dropped to 76%. I did my titration study this past Sunday. I just received a message that the doctor has my prescrption written for me. Over the last couple of days, I have spent a lot of time reading about the different types of machines and features. I think that the APAP sounds the most comfortable with the ramp feature. I also know that I want a data capable machine so that I can track my progress. I have not called the doctor back yet. I was curious if I should request these things or if there is a reason that not all CPAP users would need these features. Is there anything that I should be requesting or hoping for in the prescription?

Thank you!

Many people do better on straight pressure than they do on an auto range but it is an individual thing. The nice thing about the Apap is that you can change to a straight pressure and see which suits you better. If you go Cpap you do not have the option of switching to auto mode. I run straight pressure most of the time but I do switch to auto two or three tims a year to check and see if my pressure is still correct rather than having to go back to the sleep lab and get another sleep study. Apap is the best of both worlds. The only problem is getting the doctors to approve it and the DME's to give up the extra $$$$$$$$$$$ to let you have it.

Jerry

There is no reason not to have APap available, whether you use it or not. It takes nothing away from cPap therapy. I was very fortunate. I was not nearly as well educated as you are going into it, but my DME gave me an aPap without me asking or my script stating that's what I needed. Further, my RT (after he knew I knew how to get into the clinical setup part) actually suggested I try aPap for a few nights. So, I would definitely fight for an aPap. Some DMEs will tell you that you must be prescribed aPap in order for them to give you one. This is not true, but it may be easier for you to have your doctor write the prescription that way rather than argue with them. Again, my prescription didn't say I needed it, but they gave me one anyway.

Also, you should DEFINITELY get a data-capable machine. Clearly you are taking an active role in your treatment (which is excellent, by the way) and you will want to be able to track your therapy and progress. I can't believe they even make machines any more that AREN'T data capable.

I have been very happy with my machine. It does everything I need, but it doesn't have all of the features of the ResMed S9, which is currently the Cadillac model xPap. I wouldn't suggest anyone go with any less than what I have (see below). The S9 has better rainout features and a few bells and whistles, but fortunately I don't have rainout problems...

That covers machines... masks are an entirely different beast. The only way to truly know if a mask will work for you is to use it for several nights. Make sure your DME has a good return policy or trial period for masks. What feels great the first night might end up causing problems after long term use. My first mask was fine for one night, but within a week caused the bridge of my nose to abcess. Fortunately, I went back to my DME and they refit me with a new mask and sent me home. Said I could keep the old one (which I'll never use unless it's a dire emergency) since they can't sell used medical equipment. They just told the manufacturer (Respironics in this case) and the DME doesn't have to pay for it. I'm only telling you this so that you might get an idea of what you can expect from a GOOD DME, and also so that you can identify a bad one... Your mask choice is a highly personal one, so I wouldn't begin to make suggestions. I depends on your habits, the shape of your face, and your general comfort. A good DME will work with you to find what's best.

Okay, so I called the doctor and found that he wants to order me a Remstar Plus M Series CPAP machine. This one does not appear to be be data capable for me. Also it looks like it is a lot louder than the S9. He said that I can go to the DME and take a look at the machines and request the prescription to be changed if I want. Any suggestions?

Your doctor wanted you to get that? Or your DME?

The M Series has been discontinued, so if your DME is trying to give it to you they're just trying to pass off what they have in stock... It's not data capable (an absolute MUST) and it's not auto-titrating. Even if it was data capable, it uses old technology meaning you'd have to find a SmartCard reader (not impossible, but not easy to find) and you'd need to use a computer with a 32 bit operating system to read the data (There are ways around the 32 bit part, but it's a bigger pain because of the smartcard).

If it is your doctor (not your DME) who suggested the M, he probably doesn't know about the data issues... Tell him it's been replaced with the System One, and tell him you want AT LEAST a System One Pro (the Plus isn't data capable). That is, if you can't talk him into aPap, in which case you want the System One Auto.

I'd at least ask him to write the prescription for an auto... I can't imagine he'd have an objection... Like I said, mine was written for a CPap device, 15 cm/H2O, with C-Flex or EPR. That was enough that they gave me something decent that I didn't know I should be asking for...

It's a money game between you, your DME, and your insurance company. Someone's going to win, and someone's going to lose. Make sure you don't lose.

Thanks Wil. My doctor wrote the prescription for the Remstar Plus M. It feel like my doctor is trying to make me lose. I will see what I can do.

is this PCP or sleep doc?

It is a sleep doctor specialist.

are you in a HMO?

hmm sounds like kickback time

go to your PCP and get them to write the script you want - also check around with other DME's - you should be able to choose which one unless you want to use insurance and insurance only contracts with one of them

Hmm... It's a lot easier to fire your DME than it is to fire your MD... I'm also wondering if it's a sleep doctor or your PCP... Sleep doctor should know that the M has been discontinued, and should also have NOTHING but your best interests in mind. If he doesn't have your best interest in mind, you may want to find another MD anyway.

Since you've already had your sleep study done, it really shouldn't be too big of a deal to find another sleep clinic to interpret your results. It's not terribly difficult to interpret, but if you don't have MD after your name you're not allowed to interpret them and decide what you want...

A good sleep doctor will not be concerned about anything except your comfort. If they don't give you a machine that you are comfortable with the odds are you will not use it. Only about half of the people prescribed xPap actually are still using it at the six month mark... he should be more concerned with your success. If he won't do what you want, find another who will...

I don't want to come off heavy handed, but this is a decision that you will have to live with for at least the next five years with most insurance. If you don't get something you can use and you give up, it will be something you have to live with for the rest of your life. I just want to make sure you know that you have rights and you can exercise them. It's so easy to go with the flow and end up worse off than you start.

Best of luck... I hope I wasn't harsh! Let me know if I can do anything to help!

Welcome to the forum! It looks like you've gotten off to a great start by learning all you can about how to make the most of your therapy.

You already know you need a data-capable machine, and no GOOD doctor will try to foist off a lesser machine on you because there's no medical reason for you not to have the data. If your doctor is suggesting anything less than the data-capable APAP machine you want, get a prescription from another doctor. I don't know your financial circumstances, but if you can manage the cash outlay up front, you can send your prescription for "CPAP and supplies" to our host website and get ANY MACHINE YOU WANT. Again, depending on your situation, this might be cheaper in the long run. Run the numbers and see how much that outdated machine is really gonna cost you.

Masks are insanely personal, and there's no way to know beforehand which is gonna be the best for you. Return policies are key to successful mask choice, because it might take several tries to find the right one.

Keep us updated on your progress!

Jennwild......

Sounds like your doctor is "in bed with" the DME. Be very careful....your success is at stake.

Also.....you must have a perfectly clear understanding of exactly and precisely what "data capable" means. I'm betting that the doctor and the DME will try to "spin you in circles"....using unclear definitions of the words they use.

"Data Capable" means that your machine can be used with patient owned software....that allows the patient to monitor his progress every night....and print out a report the next morning showing apneas, hypopneas, non-responsives (centrals), shallow breathing, and the number of hours used every night (compliance).

The software allows the patient to perform a "poor man's" titration on himself every night....if desired. Over a period of two weeks or so, I can do a far better job of determining what pressures are best for me. The software allows me to tweak the system so that I get the best therapy....with maximum comfort. You can do this too! It's easy...and interesting!

"Data Capable" does NOT mean simply "compliance" information. "Compliance" means that you are using the machine at least 4-hours per night....the minimum usage that will allow the DME to get paid by your insurance company. "Compliance" is generally all the doctor and DME care about....because their pay is tied to that data only.

Be very firm in your demand for a prescription that says "auto adjusting". The Philips Respironics PR1 automatic with integral humidifier is a good choice....they have just recently made the software available that you can use with it. Research the machine on CPAP.com....and ask your insurance company if they'll allow you to purchase from CPAP.com. CPAP.com will help you with the information you need to write your own prescription...to be given to your doctor....so that he knows exactly what is acceptable to you. I did exactly what I'm suggesting....and I couldn't be happier. My therapy....managed by myself.....is a terrific success!

Be careful.....you're messing with snakes.

jennwild wrote:He said that I can go to the DME and take a look at the machines and request the prescription to be changed if I want. Any suggestions?

Hi, jennwild. My suggestion would be to tell the doctor that you don't need to check out machines at the DME first. Inform him that you have already researched machines thoroughly and you know which specific machine you want to purchase. The doctor told you that you could request that the prescription be changed, so just tell him exactly which specific model you DO want.

I hope all works out well for you. Please let us know how you're doing.