Some nights I just can't use the cpap

I guess it is was it is then.

Ben, try not to feel too badly about this. You are not alone. People come to DME's for equipment and help while they are still in shock about the reality of their new Sleep Apnea diagnosis, and the DME's just take total advantage of their ignorance. It's shameful.

Most people who have insurance don't really understand how it works, especially with DME because a sleep apnea diagnosis may be the first time in your life that you need any sort of DME. The general public has no knowledge of diagnosis and HCPC's codes for billing, how reimbursement for DME works, etc. Unless a need arises, it's not something most people ever think of.

The worst part is most people are clueless that they've been taken advantage of by their DME. They have trouble with the CPAP and give up quickly, so the machine ends up in a closet, basement or garage, after a very brief and unsuccessful attempt. If DME's made the effort to engage patients in their care by giving them access to data, showing them how to use it to monitor the efficacy of their treatment, I think the compliance rates would be a lot higher than they are. Not everyone is capable of monitoring themselves or wishes to be that involved in their therapy, but those that do should be given access to every tool available to ensure effective use of the machine.

Thanks so much. I am thinking of calling the firm that sent the machine tomorrow and telling them what I found out. But not sure what my real compelling argument is to them.

Do I tell them that I feel that I was not given any options on the machine and I realize that I need a different machine? What do I use as a reason?

I can be pretty persuasive with these people and will tell them that I will be calling the BBB and local legislator but I need more details and why I need a better machine. Can you help? In the end I will probably not get anywhere but nothing ventured nothing gained right?

I doubt they will care very much if you file complaints--it's standard business practice with them to be sure. And most people never realize how they've been suckered.

You might catch more flies with honey rather than vinegar. Call them and ask for help with your current problem--that there are some nights you just can't use the CPAP and you need help figuring out why and what to do about it. They are supposed to help with things like this, that's one of the reasons they charge so much more than online suppliers for the equipment--because they are supposed to provide you with a SERVICE as well.

Perhaps they would be willing to loan you a data capable CPAP so you can take a look at what might be going on those nights you are having trouble. You can enlist your doctor in this process as well. He may even order a trial of a data capable CPAP (short-term rental) to assist you in this matter. If you approach them nicely, rather than confrontationally, they may be willing to work things out with you.

Yes, I agree it stinks that you have to play these games with them. They should have given you a better machine in the first place. We all understand that the rule is that the buyer must be ware, but we don't expect to have to have to follow this rule to get decent medical care.

Good idea... So the next question is how would a data capable capable help me in going to bed with it on?

On a side note.... It's no wonder why our health care in the US is so messed up?

benalexe wrote:Good idea... So the next question is how would a data capable capable help me in going to bed with it on?

On a side note.... It's no wonder why our health care in the US is so messed up?

It is the same every where currently.

The data the good machines record is every breath you take and how the machine tries to respond to it or the lack of it.

So maybe your pressure needs change during the night but your machine is not responding adequately but a machine with data capability would be able to tell you that.

benalexe, it looks like you're on Medicare like I am. I also got an old type CPAP with no multi pressures adjusments. I doubt it if my doctor (an internist and geriatric) would agree to prescribe a new Rx to replace the CPAP.

By any chance, do you know if Medicare has rules about when allowing auto and bilevel CPAPs?

Good news!

Thank you everyone for your help. So after getting an education from all of you I called my DME today and spoke to them about the issues I was having. They were very pleasant and eager to help. They explained to me that my Dr. Just ordered a regular CPAP machine set to 7. They would only send an AUTO CPAP if the Dr. requests it. It is under the same script. I told her the problem that I sometimes can't put it on at night because it makes me feel out of breath. She told me that an auto cpap would help especially because the auto cpaps also have a bi-pap mode one where my inhalation pressure is different than my exhale pressure so I will not get out of breath when I put it on. This sounded exactly what I need.

She then told me that the machine is on rent from my insurance carrier and I am 7 months into a 13 month rental which means that as long as the Dr. provides a new script I they can pick up the basic machine and swap if out of the auto pap machine.

Without all of your advice I would not have gotten here so thank you. I will report back as soon as I hear.

In the meantime- What boggles my mind is that I think all machines should be auto setting. Peoples weight and breathing changes so I am surprised that every machine does not just auto adjust.

Truthfully, you really don't need a new script for an auto, because an auto can be run in CPAP mode. But I wouldn't look a gift horse in the mouth right now. IF your doctor is willing to give you the new script, go for it. Otherwise we can tell you how to overcome that obstacle, too.

She told me that an auto cpap would help especially because the auto cpaps also have a bi-pap mode one where my inhalation pressure is different than my exhale pressure so I will not get out of breath when I put it on. This sounded exactly what I need.

That's not really "bipap". It's called "exhalation pressure relief" ("flex" on Philips Respironics machines) and is standard on almost ALL machines except the piece of junk they gave you. It helps a lot with comfort.

Auto machines work by sensing your breathing and adjusting the pressure to prevent events. They really should be prescribed for everyone (some people do best at straight CPAP, but auto machines can be used as straight CPAP's too) because you can also use the auto feature to capture data to see what problems might be occurring and determine what pressure needs are. It will be a huge step up from the very low end machine you have now to an auto--that's wonderful news!

Good for you for speaking up for yourself, and it sounds like you did it diplomatically so you got your DME to be cooperative rather than adversarial!

benalexe wrote:Good news!

Thank you everyone for your help. So after getting an education from all of you I called my DME today and spoke to them about the issues I was having. They were very pleasant and eager to help. They explained to me that my Dr. Just ordered a regular CPAP machine set to 7. They would only send an AUTO CPAP if the Dr. requests it. It is under the same script. I told her the problem that I sometimes can't put it on at night because it makes me feel out of breath. She told me that an auto cpap would help especially because the auto cpaps also have a bi-pap mode one where my inhalation pressure is different than my exhale pressure so I will not get out of breath when I put it on. This sounded exactly what I need.

She then told me that the machine is on rent from my insurance carrier and I am 7 months into a 13 month rental which means that as long as the Dr. provides a new script I they can pick up the basic machine and swap if out of the auto pap machine.

Without all of your advice I would not have gotten here so thank you. I will report back as soon as I hear.

In the meantime- What boggles my mind is that I think all machines should be auto setting. Peoples weight and breathing changes so I am surprised that every machine does not just auto adjust.

Now that you have your foot in the door, I would try to get a specific model of your choice. You don't have to be pushy, but just direct in telling the you want to be compliant but are struggling with it and would like to be able to have some choice in your treatment. I chose the S9 Autoset because of its capabilities and high ratings. Do some research and find a data capable machine that has EPR (different inhalation pressure) and the APAP mode of your choosing. You can tell the DME you did your homework and would like "X model, if possible". While you are at it, ask for a climateline hose so you can control the humidity. Check with your insurance company directly and ask them if you can get what you need in terms of the hose and the humidifier or if they have specifics they require. Mine said they didn't care what I got so I went for it. When the DME tried to tell me what my insurance would allow based on it being BCBS, I told them I had called and gave them the specifics. They confirmed and I got exactly what I wanted from my DME based on my doctors script of "CPAP machine set at 7 cm". It really never hurts to try. You are the one trying to sleep with the equipment nightly. It is all just in a days work for them.

Do some research and find a data capable machine that has EPR (different inhalation pressure) and the APAP mode of your choosing. You can tell the DME you did your homework and would like "X model, if possible".

On the other hand, the PR System One Auto is a very good machine and you already have the humidifier that will work with that machine. The humidifier is a PURCHASE and your insurance company will not pay for another one, so you need to factor in the out of pocket cost of buying an entirely different humidifier for the S9 if you decide to change brands of machines.

The S9 would have been a great choice from the beginning, but since you already have a PR humidifier it will cost you money to change brands at this point.

And the PR S1 Auto has exhalation relief (if needed) in the form of C-Flex or C-Flex+ (if running in CPAP mode) and A-Flex or A-Flex+ (if running in APAP mode). Unless the OP has a problem with how his PR S1 Plus has been delivering the airflow each night there really is no good reason to jump to the Resmed S9 at this point since the OP has the System One humidfier and the Encore Viewer software.

Janknitz wrote:

Do some research and find a data capable machine that has EPR (different inhalation pressure) and the APAP mode of your choosing. You can tell the DME you did your homework and would like "X model, if possible".

On the other hand, the PR System One Auto is a very good machine and you already have the humidifier that will work with that machine. The humidifier is a PURCHASE and your insurance company will not pay for another one, so you need to factor in the out of pocket cost of buying an entirely different humidifier for the S9 if you decide to change brands of machines.

The S9 would have been a great choice from the beginning, but since you already have a PR humidifier it will cost you money to change brands at this point.

I was basing my post on benalexe's December 28th post about getting a new machine. I see though that benalexe lists an autopap in the equipment area, so now I am just confused. Here is the post I a referring to:

"Thank you everyone for your help. So after getting an education from all of you I called my DME today and spoke to them about the issues I was having. They were very pleasant and eager to help. They explained to me that my Dr. Just ordered a regular CPAP machine set to 7. They would only send an AUTO CPAP if the Dr. requests it. It is under the same script. I told her the problem that I sometimes can't put it on at night because it makes me feel out of breath. She told me that an auto cpap would help especially because the auto cpaps also have a bi-pap mode one where my inhalation pressure is different than my exhale pressure so I will not get out of breath when I put it on. This sounded exactly what I need.

She then told me that the machine is on rent from my insurance carrier and I am 7 months into a 13 month rental which means that as long as the Dr. provides a new script I they can pick up the basic machine and swap if out of the auto pap machine."

I was basing my post on benalexe's December 28th post about getting a new machine. I see though that benalexe lists an autopap in the equipment area, so now I am just confused. Here is the post I a referring to:

No, he doesn't have an auto yet. He MIGHT get one if he can get a new script from his doc. The DME gave him the bottom of the line brick from PR. Doesn't even have flex (EPR)! And no data, of course.

When I spoke to the DME they told me my machine has data and that I can send them the card and they would read it for me. I never knew this stuff was so involved!