Insurance Frustrations + CPAP purchase

kaiasgram wrote:(jdm, OP can't use secondwind right now because he doesn't have a prescription yet)

Fizzled, no wonder you're fizzled -- you have Kaiser. Last year I went through what you're now going through with them -- their sleep medicine program is high volume and IMO woefully inadequate.

It's a bit of a risk to buy a machine without knowing your diagnosis and which machine you might end up needing. There are different types of machine and they function differently. On the other hand, you wouldn't be the first person to take matters into your own hands. Look up forum member "dos coyotes" -- he came onto the forum early this year with no insurance but knowing he snored and sure he had sleep apnea. He bought an Auto CPAP machine and mask from forum members and did his own titration to figure out what pressures he needed. He downloaded free software to help him determine his optimal pressure settings and to monitor his therapy and last I heard he was doing really well.

If you decide to go this route, let the forum help you with the process, and definitely with how to buy a decent machine and one that you can actually do an at-home titration with. It's possible that someone on the forum might have an auto pap machine to sell (look for an established forum member, not someone who's just posting for the first time to sell a machine).

Your argument for a higher end machine makes sense. I'm on my work lunch break now, but I'll look up dos coyotes when I'm home. Thanks!

Thanks for machine point into the right direction. I skimmed the post on the differences and would probably lean towards something like papman's, for the effective service life of these machines the annualized difference is negligible.

I'll poke around some more and be sure to post back before pulling the trigger.

49er wrote:Hi Fizzled,

Two forum members are selling machines:

viewtopic/t88566/For-Sale--PR-S1-Series ... e-485.html

As an example of Shawn's character, when a former member was selling a very similar type machine who was an absolute jerk, without asking, Shawn showed him how to better present the data to increase the chances of a sale.

viewtopic/t90549/RESPIRONICS-760HS-bIPA ... -Mask.html

I am mentioning this thread for two reasons even normally, a new member would not start with a bipap machine. Even though Shawn is offering a fantastic price, the deal papman is offering is a steal since it is an auto bipap machine which is usually alot more expensive than a regular apap machine. And he is including a mask which you need.

As an FYI, Papman has several satisfied customers. But even though I don't think Shawn has done any previous sales on this forum, I would have no reservations about purchasing something from him.

With either purchase, it will be possible to obtain the manual that will show you how to change the pressures. You will also be able to use free Sleepyhead software that will enable you to access data that will guide you in what pressure to use. Forum members can help you with this process.

49er

PS - This thread gives you an idea as to the differences between a bipap and an apap machine.

viewtopic/t81886/Dumb-Question--APAP-vs-BiPap.html

zoocrewphoto wrote:You will definitely want a machine with full data, and preferably an auto machine.

I would also recommend going to cpap.com and going through the pages of masks. Think about what you might consider the most comfortable. Do you need to breathe through your mouth or not? Look at the photos. It will still be trial and error, but you will have a better shot at picking a good one for you.

Girlfriend says I seem to flip flop between nose and mouth breathing. Is it possible that a normal nose breather becomes a mouth breather in response to apneas? I'm curious if treated with a nose mask if it'd potentially stop mouth breathing.

mgaggie wrote:Is there any way you can speed up the sleep study?

I would be really loathe to just buy a machine and start using it. Far to many variables.

Don't think so. The presenter said she had several other classes the same day of the same size. She indicated the reason they're quoting 3-4 weeks before they'll schedule the at home study is because they're that far out.

Several of the people in my class had issues breathing being awake and sitting there; not sure I should be high on the priority list.

123.Shawn T.W. wrote:One more thing Fizzled ... If you go to cpap.com (our generous hosts) and look at the masks ... Alot of the masks have a sizing guide ... You can print out and then cut out and apply to your face to check for size ... The real test is hooking it up to a machine and putting it on your face, and laying down in your sleep position.

I had collected 5-6 masks before I got a machine for my wife and myself (2 machines off Craig's list!) my wife picked the one she wanted and is still using that same mask, it works and she has no desire to try anything else ... Me on the other hand have gone through 12-15 masks in the last year! My wife has never had a sleep study, but I used my oximeter on her, and she was down in the low 80's, now no more snoring and she feels more rested, thanks to the help we got here on the forum!

Cpap.com can not sell you a whole complete mask ... Since a prescription is required for a complete mask (same as ebay) But they can sell you the parts to make up a whole one! Or once you decide what style you want to try, and the size ... Post here a "looking for ...thread." Quite a few of us have rejects that did not work for us just sitting around ... I never worried about a "used mask" that was cleaned by me ... No real difference than washing silverware that a guest used ... Sometimes you will see a mask for sale here, sometimes just postage to mail it to you!

Stick around as there is lots to learn, and lots of good folks here that have been down the same road that you are starting on!

Sweet, thanks for the encouragement.

I'll try the cut out fitment guide tonight.

I'm not germophobic or xenophobic, used equipment is no problem with me!

sleeplessinaz wrote:Dear FIZZLED:

Can you call sleep study places to see how much a a split sleep study would cost if you paid out of pocket for it? A split study is they monitor you and determine if you have sleep apnea then come in and place a mask on you after a few hours and they will "titrate" you at that point with the mask on. Then you can buy a machine and know what your numbers are?

It might be worth paying out of pocket for it to save your sanity!
Hope this helps,
Carrie

As far as I know Kaiser only does take home studies in this area.

That split study sounds great, but that would make too much sense for Kaiser to practice.

Janknitz wrote:Welcome to Kaiser, that's how they work.

That's some good insight into Kaiser, the consummables and the process in general.

I used to have a sharp HMO that was leagues better. I could see my doctor in a few days, if he referred me to somewhere else his word was nearly law. In this situtation I'm sure he could have prescribed the sleep study directly, no orientation, no waiting to hear back, etc.

Kaiser seems to tie the doctors hands when making medical decisions. I dont feel as if the doc actually felt I may be anemic, but blood test, the sleep orientation, etc. is just Kaiser's policy for this kind of treatment so that's what he did.

kaiasgram wrote:On the other hand, you wouldn't be the first person to take matters into your own hands. Look up forum member "dos coyotes" -- he came onto the forum early this year with no insurance but knowing he snored and sure he had sleep apnea. He bought an Auto CPAP machine and mask from forum members and did his own titration to figure out what pressures he needed. He downloaded free software to help him determine his optimal pressure settings and to monitor his therapy and last I heard he was doing really well.

If you decide to go this route, let the forum help you with the process, and definitely with how to buy a decent machine and one that you can actually do an at-home titration with. It's possible that someone on the forum might have an auto pap machine to sell (look for an established forum member, not someone who's just posting for the first time to sell a machine).

I am another who just recently did this. I couldn't afford to pay for a sleep study, so I did my own. I bought a Respironics M Series BiPAP Auto off Craigslist for $100 with a full face mask included. The first night I cleared all the memory and set it for a minimum of 8 and a maximum of 12 and when I checked the display in the morning I was shocked to see it had spent the night maxed at 12 and still had an AHI of 82! I slowly let the max climb each night until the machine stabilized with an AHI around 4 and 90% pressures of 17 / 19! Incredibly, for the first time in memory I went the whole day without being tired!

After that I got serious about treating this an bought a practically new (it still had the protective plastic films attached) Philips Respironics Series One BiPAP Auto for $400, which also came with a few masks. I think I just got incredibly lucky that my first purchased happened to be a BiPAP instead of a CPAP which I can tell is really a plus at this high of a pressure. I am keeping the older machine as a backup and travel unit.

123.Shawn T.W. wrote:One more thing Fizzled ... If you go to cpap.com (our generous hosts) and look at the masks ... Alot of the masks have a sizing guide ... You can print out and then cut out and apply to your face to check for size ... The
real test is hooking it up to a machine and putting it on your face, and laying down in your sleep position.

I had collected 5-6 masks before I got a machine for my wife and myself (2 machines off Craig's list!) my wife picked the one she wanted and is still using that same mask, it works and she has no desire to try anything else ... Me on the other hand have gone through 12-15 masks in the last year! My wife has never had a sleep study, but I used my oximeter on her, and she was down in the low 80's, now no more snoring and she feels more rested, thanks to the help we got here on the forum!

Cpap.com can not sell you a whole complete mask ... Since a prescription is required for a complete mask (same as ebay) But they can sell you the parts to make up a whole one! Or once you decide what style you want to try, and the size ... Post here a "looking for ...thread." Quite a few of us have rejects that did not work for us just sitting around ... I never worried about a "used mask" that was cleaned by me ... No real difference than washing silverware that a guest used ... Sometimes you will see a mask for sale here, sometimes just postage to mail it to you!

Stick around as there is lots to learn, and lots of good folks here that have been down the same road that you are starting on!

Oh, god yes... I again lucked out and found two suppliers of brand new sealed masks in the $40 - $70 range. I have a large and medium Mirage Quattro, a large and medium FlexiFit 431, a large and medium Forma, a medium Comfort Gel 2 Full, a medium Amara (my previous favorite), and a large Liberty Hybrid with medium nasal pillows (my current favorite). I think masks will be my equivalent to a woman's shoe closet! Embarassingly enough, I still really want to try the Hans Rudolph V2, the Innomed/ResCare Hybrid, and the Quattro FX! Oh, and maybe a pure nasal mask with a PapCap!

Most definitely if you decide to go it on your own, but probably even if you work with the sleep lab, you most likely need to become something of an expert on this kind of therapy and what does and does not work for your body and your face. Minor pressure changes, mask changes, changes in flex settings, etc. all seem to affect each person differently, and I don't think most sleep labs are going to take the kind of time necessary to really know exactly how your body responds to every possible adjustment. It is a long process, but I can already see how rewarding it is in the long term.

My daughter is a school teacher and everyone in her district has Kaiser. If you are not on Medicare, Kaiser is a whole "nother" story, and actually pretty good.

For those on Medicare/Kaiser, it's handled differently. I don't know the exact differences b/c I don't have Kaiser, but it is vastly different. I've heard some excellent things about Kaiser and I've heard some pretty awful stories... like most insurance companies I suppose.

djhall wrote: I couldn't afford to pay for a sleep study, so I did my own. I bought a Respironics M Series BiPAP Auto off Craigslist for $100 with a full face mask included. The first night I cleared all the memory and set it for a minimum of 8 and a maximum of 12 and when I checked the display in the morning I was shocked to see it had spent the night maxed at 12 and still had an AHI of 82! I slowly let the max climb each night until the machine stabilized with an AHI around 4 and 90% pressures of 17 / 19! Incredibly, for the first time in memory I went the whole day without being tired!

Kaiser seems to tie the doctors hands when making medical decisions. I dont feel as if the doc actually felt I may be anemic, but blood test, the sleep orientation, etc. is just Kaiser's policy for this kind of treatment so that's what he did

Absolutely correct. Kaiser has protocols for everything and the doctors are required to follow the protocols. Thinking outside the box is highly discouraged, and you're right, the doctors are not in charge. Once your doctor makes a referral to the sleep clinic, your sleep issues are out of his hands, and you'll notice that you never see the sleep doctor, either, unless you have really unusual symptoms.

You can tweak this to some degree by choosing a doctor who will think outside the box and help you work around the system when necessary and possible. Using another DME or going elsewhere for sleep care isn't possible, however.

The other thing to be aware of is that you can go to any Kaiser facility in your region, so if you are unhappy with the specialists locally you can ask to see a specialist at another Kaiser facility in the same region. I travel 2 -3 hours to consult better specialists in some circumstances--mostly for my daughter who has a genetic disorder.

forthguy wrote:
Been lurking on this board for a while, and I was dreading what I was going to experience from Kaiser Northern CA after reading some of Janknitz's posts, and in no way does it help the OP, who seems to be experiencing things similarly...

Good to know Kaiser doesn't suck for everyone everywhere; for employers they do offer some of the most competitive rates for the coverage. If they can deliver at a low cost basis it's a winner of a solution.

I suspect like most places the larger they get the less individualized the experience can be. They have several campuses (not buildings, entire blocks) just in San Diego and they're almost always packed.

There were ~30 people in my sleep apnea/snoring class, the presenter commented that ~50 were scheduled to be there that day and she had done several classes that day.

They're throwing out sleep apnea referrals like crazy and I suspect that that's everyone who complains of sleep/daytime fatigue problems.

I sent papman a PM inquiring about mask options. I'll pick up his Phillips machine assuming it's still around.

I looked up the masks and am thinking about the comfortgel nasal mask. I did the paper cut out fitment guide and found that I'm a medium. The small covers my nostrils but not the bridge of my nose.

I'll put on a chinstrap and have my girlfriend let me know if I turn into a mouth breather with it on.

Any thoughts on this?

Maybe do a third thing. Take a shot at sleeping sitting up, but not on your back. That way you might get productive sleep, and then waiting for the your own machine. This only works if your problem is simple Obstructive Sleep Apnea.

No one has mentioned that often the test and titration are miserable because the pressure is less than one needs to breathe and the patient feels like they are suffocating.

If you want to know the other problems which your trying to use a machine to self titrate, look up on Wiki, Periodic Breathing, Cheyne Stokes. Conditions which are challenging for some doctors to detect from the results of a competent overnight sleep lab.

Best of Luck.

No one has mentioned that often the test and titration are miserable because the pressure is less than one needs to breathe and the patient feels like they are suffocating.

That's actually one advantage of Kaiser's home testing and titration system. You get to test in your own bed and normal sleeping positions, and auto titrate so that the pressure will adjust for your needs. Much more comfortable than a sleep lab. I would have run screaming from a sleep lab and still be undiagnosed.