Confused re: CPAP Prescription in Canada

The DME will probably use an auto machine set to a wide range of pressure and let you used it, then download the data and adjust the pressure based on that until they com up with a good 90% number. They will help you if you are having leaks by adjusting your mask or suggesting a new one if necessary. However one DME in Calgary, sent my father home with his machine and brushed him off when he had issues unless he wanted to pay for a new mask.

It all comes down to the Resp Technoligist. When you find a good one it make the whole process easier. My GP did not decided the pressure settings for my machine. When I originally got the machine a sleep doc set a pressure of 10. When I got an Auto I chose to set it from 8 to 12. My Resp Tech liked the settings for my numbers (90% - 9.2) and used them for the new machine.

Where in the city are you? Did you get my PM?

Chris

The oddness continued. We went to the appointment at the DME (Dream Sleep). Even though I'd called in advance and was told my husband didn't need a prescription for the trial, when we showed up he was told that yes, he needed a prescription for the trial and was sent next door to the walk-in clinic to get one (which took an extra hour!). If we'd known that was needed, we'd have gotten it from his GP in advance...*smh*

All that aside, the tech at least seemed to know what he was talking about. After reviewing the studies and asking a number of questions, he suggested doing the trial with the Respironics System One 60 series (with humidifier, etc...), and the Wisp mask. Having done the research ahead of time, we were completely fine with both of these suggestions.

He's only tried it one night so far, but the results were shockingly awesome for the very first try! He didn't have much problem getting to sleep, only woke up a couple of times, and felt noticeably more lucid than usual upon getting up in the morning. AHI was 1.59 (down from 50+ in his sleep studies!), and SH shows the leaks maxing out at 16, although from the info I got on the Wisp's intentional leak rate I think it actually maxed closer to 20-22. Median was probably around 8. So not terrible, but not great from my understanding. We're going to try the fabric frame instead of the silicon (he found the silicon uncomfortable on his cheekbones). We don't want to make other changes yet based on one night, but things we're keeping an eye on if the leak rate stays up are mask liners, and the CPAP cutout pillows. Changing masks will obviously be an option, but other than the cheekbone issue he finds the Wisp quite comfortable, so if we can reduce the leak rate and the AHI numbers stay low, I think he's likely to stay with the Wisp for now.

The real dilemma is going to be - is it worth paying the higher price at the local DME (insurance covers some, so the out of pocket difference should be about $400 or so when all is said and done) to have a local supplier, and for the support (he can supposedly call or drop in at any time with questions, etc...)? I kind of don't want to on priniciple, because I've found this whole process irritating and shady, but...*sigh*

I know there were recommendations to go to a proper sleep clinic and start the process over, which is tempting, but...the one or two in town that seem to fall into this category apparently have very long waits, plus then we have to pay all the fees again. If he keeps responding this well to the machine, I think that just sticking with this equipment and letting the Auto do the work (plus monitoring in SH, etc...) might be the way to go rather than putting the whole process off again for months.

Who is monitoring his data? Has he had a titration study? Does his Rx have a pressure? I would certainly not be comfortable without a sleep doc at least periodically looking over my progress, do you have one or did you go directly from your gp to the cpap store? The wait for a proper sleep clinic might be long, but it is a PROPER sleep clinic and the initial stages of cpap will set him up for a life of compliance or not. Plus, my understanding is that sometimes there are side effects to cpap (like centrals in some at higher pressure), a proper sleep doc will have the knowledge and experience with problems that you, sleepyhead and a gp may miss. Just IMO though.

Anyone more experienced than me want to offer some sage advice?

His GP doesn't seem to know much of anything about all of this, other than saying his snoring is a potential bad sign and should be looked at. Merrell did the initial sleep atudy, and said he should get a CPAP and sent us to the DME. The DME tech set him up with the machine as a trial, which basically seems to be serving as the titration study. The tech wants follow ups every week during the trial period to review the data.

Mind you, the "tech" may actually be a sleep doc - he seemed quite knowledgeable. I'll have to check his card when I get home.

As for the initial stages setting him up for compliance, that's exactly my worry. He's already pretty fed up with all of the stupid hoops we've jumped through...if I say we need to scrap that and go on a big waiting list to start over, I could easily see him just throwing up his hands and saying forget it.

teleute wrote:As for the initial stages setting him up for compliance, that's exactly my worry. He's already pretty fed up with all of the stupid hoops we've jumped through...if I say we need to scrap that and go on a big waiting list to start over, I could easily see him just throwing up his hands and saying forget it.

I only had to wait a month or two to get in to see a doc at the Calgary Sleep Clinic in Sundance. My GP referred me, then they called and I was in. That was back in August.

Hmmm...the only one I knew of for sure that was a "proper" one was the Foothills one, and I've heard a 12-18 month wait (I can't even get them to phone me back). I'll gently broach the subject and see how it goes. He's really been quite sensitive to and resistant on this whole subject, so I'm treading carefully. *sigh* I wish this hadn't gone so far off track to begin with... All the DMEs here (I've called quite a few) keep telling me that this procedure we've been through is perfectly normal, but no one on here seems to think so...

Called them and they're closed til the New Year, so I'll write them an email and talk to them after the holidays. Thanks!

Hoping that they can just review the data from the trial and make recommendations, as opposed to having to start over from the beginning, but we shall see what they say...

It sounds to me as if he is doing quite well. He has a very good machine and is dealing with the whole thing quite well for a newbie. You say he woke feeling quite good and didn't wake a lot in the night. This is a very good sign. His leak line does not sound too bad.

In my opinion, I don't think he needs a formal sleep study at this stage. I think he is fine to continue as he is. He needs to find the "right" mask as all of us do but, other than that, his numbers are pretty good. You feel that the DME is doing a kind of titration and I think that is fine.

Just keep asking questions on this forum and note who replies - some are more experienced and knowledgeable than others. These are the people you want to listen too. If you could post a few nights data from Sleepyhead here, you will get some helpful feedback.

My opinion at any rate.

I received a copy of a letter which was basically the report my sleep specialist send to my family doctor telling her that my sleep study showed that I had sleep apnea and would need a cpap machine set at a pressure of 10.

That is what I forwarded to cpap.com as my "prescription" and it was accepted.

Unfortunately he doesn't really have a "sleep specialist" - that's kind of the root of the issue.

Before i knew my sleep report qualified as a prescription i asked my gp for one and told her my pressure and she wrote a prescription. Hopefully you can get this resolved soon. Good luck.

What she is talking about is not technically a prescription, it is more like a requisition. It could easily be mistaken for a prescription, though, and cpap.com should be careful as if push came to shove it would not be regarding as a prescription my the physician that provided it.

In my case, having a Sleep Specialist turned out to be useless.

I went through a sleep study (2002) and my GP wrote the prescription because it was going to be several months before I saw the Sleep Specialist after the sleep study. My GP got the setting by calling the Sleep Specialist and then the GP wrote the prescription.

That was 12 plus years ago. I've been using that old prescription online ever since.

I did have another sleep study in 2008. The same Specialist would not give me a prescription for a new machine ( you need a newer prescription to get a machine where I live). After waiting almost a year to get the sleep study and see the Specialist, he said -you can have a new prescription if and when you machine is broken beyond repair!!! There had been many new features added since I got my original machine. It gave no data except compliance. I wanted an auto and I wanted exhalation relief but he was not going to let me have a prescription for that. I went online and got a machine with the features I wanted and I have been happy with it. I paid out of pocket.

I have bought several machines online since then. I will not go back to the Sleep Specialist. As I said, he has been useless to me. I use this forum as my Sleep Specialist and have done very well.

Hawthorne wrote:In my case, having a Sleep Specialist turned out to be useless.

I went through a sleep study (2002) and my GP wrote the prescription because it was going to be several months before I saw the Sleep Specialist after the sleep study. My GP got the setting by calling the Sleep Specialist and then the GP wrote the prescription.

That was 12 plus years ago. I've been using that old prescription online ever since.

I did have another sleep study in 2008. The same Specialist would not give me a prescription for a new machine ( you need a newer prescription to get a machine where I live). After waiting almost a year to get the sleep study and see the Specialist, he said -you can have a new prescription if and when you machine is broken beyond repair!!! There had been many new features added since I got my original machine. It gave no data except compliance. I wanted an auto and I wanted exhalation relief but he was not going to let me have a prescription for that. I went online and got a machine with the features I wanted and I have been happy with it. I paid out of pocket.

I have bought several machines online since then. I will not go back to the Sleep Specialist. As I said, he has been useless to me. I use this forum as my Sleep Specialist and have done very well.

That really sucks that your sleep doc was so tough to work with. Not all of them are equal! As the OP lives in my city I can refer them to my specific sleep doc whom has been wonderful to, hopefully, avoid another horrific story like this. I am super glad you found cpaptalk.