Newly Diagnosed, looking to confirm equipment selection

Midnight Son · Post by **Midnight Son** » Mon Mar 13, 2006 5:51 pm

After many months of MRIs, CT-Scans, trips to specialists the neurologist prescribed a sleep study for me which was completed Feb 13, The results indicated I had moderate OSA, 32 events per hour.

I went back March 7 for the CPAP study and was fitted with a Mirage Swift Nasal Pillows for the test. I also tried a nasal mask but the pillows were more comfortable. I normally sleep on my side if that makes a difference. Per the tech I tolerated them well, and after a few hours of pressure adjustment got about 4 hours of good sleep. I also wore a strap to keep my mouth closed. I felt much better than usual.

I have been reading the forums for advice for new users, and so far I am tempted to order the following: (My HMO insurance should cover equipment, but not sure what type/model). I probably will pay the difference after reading the posts as it seems important to get equipment that provides statistics on usage to maximize it's effectiveness.

Remstar Auto C-Flex CPAP w/ heated humidifier

Mirage Swift Nasal Pillows (Should I get more than one to try?)

Encore Pro Software with smartcard reader.

To be honest I am less concerned about the cost than getting whatever will help me get a good nights sleep. After headaches, historically unusually high blood pressure, brain ischemia on MRIs, etc,

Are these good choices?

What else do I need?

I saw references to DMEs? WHat is/are DMEs?

Any help/suggestions are most appreciated.

Thanks,
Jack Baker

Linda3032 · Post by **Linda3032** » Mon Mar 13, 2006 6:09 pm

Hi Jack, and welcome to "hose-head land".

Yes, excellent equipment. You are certainly off to a great start.

DME = durable medical equipment. A DME supplies you with the equipment you need (or the stuff he has in stock and wants you to take off his hands - depending on a good DME vs a bad DME). He helps you get fitted with various masks and (see above). A good DME is invaluable, especially to a newbie who hasn't read the forum or educated himself.

You've done that.

Many of us (including myself) have taken our therapy into our own hands and bypassed a DME. My excuse is that I live in rural Arkansas and don't want to drive 70 miles to one.

Your insurance will probably allow you to buy from cpap.com (lowest prices), and act as your own provider. Then you just submit a claim to them. They should reimburse you just like they would a network provider - and maybe even 100% since you would be saving them a ton of money.

The Swift is a very good nasal pillow interface. So are the Aura Headrest, and the Breeze pillows. All of them need for you to insulate your hose very well. You will probably need one or more hose covers. Also, you could purchase (out of pocket) an Aussie Heated Hose. They work great too, but I still have to have mine covered with 3 covers to avoid "rainout". Be sure to read all about rainout on this forum.

Well, others will have more to add, good luck.

Oh, and don't make a decision until you know what your "pressure" is going to be. If it's really high, you might need a Bi-Pap. Your prescription will have your pressure on it.

NightHawkeye · Post by **NightHawkeye** » Mon Mar 13, 2006 7:08 pm

Excellent choices, Jack. Couldn't have picked 'em any better myself. Come to think of it, I didn't! It took me a while to come up with the same combination of equipment that you've selected. I've got the Aussie heated hose, too. It works well.

Regards,
Bill

johnnygoodman · Post by **johnnygoodman** » Mon Mar 13, 2006 10:02 pm

Greetings,

If you have insurance but want to choose your own equipment, you should also consider contacting billmyinsurance.com. If they are in network for your insurance carrier, you can get what you want and have your insurance cover the bulk of the cost.

Johnny

Linda3032 · Post by **Linda3032** » Mon Mar 13, 2006 10:44 pm

Midnight Son,

Here is the site for the Aussie Heated Hose if you want it. And if you can afford the $89.00 (includes shipping), it's well worth the price.

Takes about 10 days to get to the USA.

If you get a Respironics Remstar, you want SZ4

http://www.sleepzone.com.au/

Midnight Son · Post by **Midnight Son** » Tue Mar 14, 2006 5:45 pm

Update: I spoke this afternoon with the University of Michigan Sleep Lab coordinator, they are faxing prescription to U of M MedEquip (DME?). She told me the prescription would be for a Remstar PRO 2 Cflex CPAP, and the Mirage Swift Nasal Pillows System. I inquired about the Remstar Auto CPAP CFLEX model. She said the recommended Pro 2 model was the cadillac, and the auto unit was not needed. She indicated my pressure setting was 9.

Comments? Should I pay the difference for the auto unit? She indicated the MedEquip people (DME?) would work with me to setup the unit and teach me how to operate.

THanks for the previous replies, they were helpful.

Linda3032 · Post by **Linda3032** » Tue Mar 14, 2006 7:02 pm

You still should check with billmyinsurance.com

cpap.com will sell you any machine you want as long as you have a prescription for cpap.

You would be fine with the Pro, but finer with the Auto. ...

chdurie2 · Post by **chdurie2** » Tue Mar 14, 2006 7:31 pm

i'm a relative newbie, but i would think that valid arguments could be made for getting you the auto, and i think i would be willing to pay the difference out of my own pocket. but i wouldn't offer that up unless you're at the defeat point. basically, the argument you want to make is that an auto would protect against greater future time and expense, mostly theirs. there's tons of peer-reviewed literature that says one sleep study does not necessarily make a great match on pressure. an auto would keep you out of their hair, nice for them if they're heavily booked. i think the best threat to hold over a clinic or insurance company's head is the more costly one of another sleep study, but since yours was just done, that probably won't work for you. you might try to say something along the lines that they ought to do it for you because you've been through nine zillion expensive, time-consuming tests, and maybe from that, they could infer that you will need more. or given the amount of medical attention you've gotten so far, you really can't afford for this not to work. i've tried that line on the insurance company relative to other things, and it has worked. you want to show them that in your case the auto IS the cheaper alternative, even if it costs a few hundred more now. but in the end, i think i would offer to kick in the money.

you also can ask if you can shop around for an auto at their regular cpap budget, would they go for it. then check cpap.com and a few other places and see.

The Youngs · Post by **The Youngs** » Tue Mar 14, 2006 7:58 pm

After reading this forum for a few weeks, my dh was prescribed CPAP at 9cm. I wanted dh to have an auto, so I checked our insurance company's policy, which was APAP only if CPAP doesn't work. Local DME's were incredulous that we'd want an auto and no help at all. I called billmyinsurance.com and told them I wanted an auto because my husband loses and gains weight, sleeps in all sorts of positions, and I wanted to make sure he got the best treatment possible. *They* called my insurance company, then called my doctor, faxed him the letter he needed to sign to justify the APAP, got approval from BCBS and shipped us the Remstar Auto with C-Flex - all in one business day!! We paid only our co-pay, and an extra $10 or so for overnight shipping, and had it by 10am the next morning.

Now, as to whether you really need it: my dh had an AHI of 58.9 at the sleep study, he was titrated at 9cm with no events. After a month on APAP, his 90% pressure is actually 10-11. The other night he had a series of 13 apneas in a row, that took 13cm to resolve. Near as I can figure, at 9cm straight CPAP, about 15% of his apneas/hyponeas would not have been resolved *and* he would have spent all night at 9cm, instead he spends the majority of the night at a lower pressure. Your mileage may vary, but the cool thing about APAP, is you can get the pressure you need on a night to night basis.

My advice is stay tough and advocate for yourself! I hope you have as good a result as we did!

Midnight Son · Post by **Midnight Son** » Tue Mar 14, 2006 8:01 pm

Thanks for the comments. I do plan to question the recommendation, and to investigate the option of procurement through CPAP.com, and billmyinsurance.com.

A question for those of you using the Remstar AUTO CPAP, CFLEX: How does your prescribed CPAP pressure compare to the settings and actual pressures when using the auto setting?. From the pdfs I read it seems the primary benefits of the auto machine is notable improvements in percieved comfort (easier to exhale), and somewhat lower actual pressures than established in the lab. Does experience prove this to be true?

After the extensive sets of diagnostic tests, finally leading to the sleep study, I just want something that works and that I can learn to adapt to. Actual user experiences mean more to me than lab technicians, or "experts". I really value the input.

Also, if there are other users of the Pro2 that have good experiences to report I am equally interested in that feedback as well.

Thanks much for the help.
Jack

Midnight Son · Post by **Midnight Son** » Tue Mar 14, 2006 8:09 pm

The previous post from the Youngs (8:58pm) is exactly what I was looking for. I also vary in weight (I hope to lose weight once feeling better/more energy to keep up exercise regimen) so I also wonder how much experiences vary over time. The concept for an auto (adaptable) appeals to me. I also tend to be a side sleeper, the tech kept asking me to sleep on my back in the test. I wonder how much position effects the needed pressure?

Jack

Cockney · Post by **Cockney** » Tue Mar 14, 2006 9:45 pm

Rather than start another thread I thought I would tack on to this one since I have the same questions. The doc said I stopped breathing 80 times a hour and sometimes for up to 40 seconds.....He said dont bother with surgury, it isnt for you......

I dont feel like waiting six weeks for my Insurance Company to sod around trying to rent me the cheapest machine they can find...So I decided to buy my own.....

I ordered

REMstar Auto C-Flex CPAP, REMstar Heated Humidifier with bag, hose and manuals $725.99 1 $725.99

ComfortCurve Nasal Interface - All Size Cushions (S, M, L) Included $118.99 1 $118.99

any opinions, Is there anything else I need?

Thanks In advance, I appreciate it.........

chrisp · Post by **chrisp** » Tue Mar 14, 2006 9:51 pm

"She said the recommended Pro 2 model was the cadillac, and the auto unit was not needed. "

Liar, Liar. If a pro is a caddy its a really OLD caddy. Now you know why I say

BEWARE of the EVIL DME

Get the Rx in YOUR hand . Its yours. And try bill my insurance site or cpap.com

Call your DME and say NO DEAL.

:twis ted:

Linda3032 · Post by **Linda3032** » Tue Mar 14, 2006 11:02 pm

Jack, to help you with your argument for Auto, here's my theory.

I was titrated at 7, and for 3 years using a Nasalaire, my 90% pressure was a 7. I had my machine set for 5-9.

But, when I switched to the Aura the end of January, I consistently had a 90% of 8. So I set my machine for 6-10.

If I had a straight cpap set for 7, I never would have known that 8 was my ideal pressure with the new interface.

Autos help take the guesswork out of the equation.

Midnight Son · Post by **Midnight Son** » Thu Mar 16, 2006 4:31 pm

Final Update:

This is a bit complicated, but may be relevant for other newcomers. My PCP referred me to U of M Neorology after being unable to determine the cause of the myriad of symptoms I was experiencing. The UM Neurology doctor suspected OSA, and requested the polysonogram and CPAP evaluation. (Two docs so far). The results of the polysonogram and CPAP were provided to UM Neurology doc (he is not a sleep doctor). He has since referred me to a UM Neurology sleep doctor (earliest appt scheduled April 14).

The UM Sleep Center recommended me for the Pro 2 (what I was tested on), and would not concur with the Auto unit. I spoke to the UM Neurology doc (not sleep specialist) who was understanding but said to get the auto unit would need support from sleep doc. He then consulted with the sleep doc, and reported back that the sleep doc has reservations about the auto unit (reportedly have had some patients have difficulties with the unit) and I can go ahead with the Pro 2, or wait to start treatment until after I can get in to see the sleep doc 4/14.

Bottom line is I am anxious to start treatment, and feel it is better to proceed with the Pro 2 than wait further. THe other caution is apparently the University of Michigan Neurology sleep doc(s) have some reservation about the auto unit. I can't elaborate at this point, but will post further info after my appointment 4/14.

Thanks to all for your help. I still suspect the auto is the better choice, but rather than "fight city hall" I am going to proceed so I can get started. Worst case I will bite the bullet and pay for it myself if the sleep doc doesn't convince me otherwise.

Mask

Additional Comments: Large mask collection

Newly Diagnosed, looking to confirm equipment selection

Newly Diagnosed, looking to confirm equipment selection

New too........