Question regarding Cost of Equipment in Canada

Hello, I am hoping a Canadian, particularly here in Ontario might be able to answer this question for me.
I am new to Sleep Apnea but without going into a long story, feel i have been taken a bit of advantage of by the company I am using. There is one question in particular I wish to get the answer to as it will determine if I am being lied to at all, or not?


Regarding machines.
I was automatically given a ResMed S9 Escape when I had been advised by others far wiser than I, that it should be the S9 Auto-Set that I should get.
I was given a story that i could try that later on but this S9 Escape was what they happened to have that day.

When I tried to change it 2 weeks later, told I had 30 days to exchange it, I was then told i needed a new prescription by the Respirologist that i went to.
I was told you had to have a certain level in order to be given this machine.

The problem was in my case that they screwed up the first sleep study and needed me to go again and do another one. I was told I had severe sleep apnea but that without the second study it was impossible to tell if i could get the S9 AutoSet or not.

Originally on the first sleep test, both my husband and I went, thinking he had Sleep Apnea. As it turned out he hardly did and I had it severely which surprised us both.
We each slept on our backs all night. The Doctor said that they should have come into the rooms, awakened us both up and has us turn on our sides and without us being tested on our sides, they had no way of really knowing what level we were at.
Because he didn't have it badly, they did not prescribe him a machine but wanted me to get mine before i did the second one although i am not sure why but thats what i did.
Since we haven't had the second one yet and am about to book it, if i decide to continue with this doctor and the Sleep Clinic, and my 30 days is almost up, I will be stuck with a machine I don't want and unable to get the one that i do.


Thereofre, does anyone know if there is any truth to this, that one needs a special prescription to this AutoSet machine?

I have been told by some Americans, that this isn't true,at least for them and that I am being given a shoddier machine since they make the same for the Escape as it does the AutoSet, that its in their interest to give me the Escape so they can make more money.
I need to know if there is any truth to this.


Here is a copy of what was said to me by email:

For S9 Auto-Set it should be special prescription from doctor (not CPAP ,it should be for APAP ).
S9 Escape has a Data Memory Card (SD card recording all data and you can upload any time).
http://www.resmed.com/us/service_and_su ... nc=dealers

The escape has a data memory card but it only records hours used and a small bit of data about AHI. At worst you want an Elite.

Thanks, no I understand all that and know what each one does but need specifically to know what I asked......must I have a special prescription for the AUTOSET? The Auto Set is the one I want but was told you had could not get it without special prescription.

Any Canadians here that can tell me if that is the case or not?

Let me make this clearer...


I don't need to know what the machines do as I already am aware of all of that.

I NEED to know IF as a Canadian with Sleep Apnea, can I specifically ask and get a AUTO=SET machine or, as I was told, apparently not because you need a special prescription for it and must have a bad enough case of Sleep Apnea to qualify for it.

CAN anyone let me low if this is true or not?

I am on disability and it is paid for 100% by my plan. But MUST ANY OF US QUALIFY specifically for an AUTO SET or must one be bad enough to warrant a special prescription for it?


When going to be fitted for the mask and to get the machine with the prescription I had, I was told, For S9 Auto-Set it should be special prescription from doctor (not CPAP ,it should be for APAP ).


i need to know if that is true or not?
If so, or even if not, if you have a link to any thing written somewhere that states why I can get it or why I can't, please let me know the link.

I am fighting for the AUTO SET and need to know if I can get it......

In Saskatchewan we get a S9 Elite for free. You have to buy humidifier and mask etc. yourself unless you are on provincial subsidy(welfare). I had to get another Rx. from sleep lab to get an autoset, which my plan at work paid for 100% including humidifier and mask.

ShelaghDB wrote:Thanks, no I understand all that and know what each one does but need specifically to know what I asked......must I have a special prescription for the AUTOSET? The Auto Set is the one I want but was told you had could not get it without special prescription.

Any Canadians here that can tell me if that is the case or not?

I believe her point was that clearly they are lying to you about the data, therefore, I wouldn't trust them about anything else.

You don't need a 'special' prescription - what a crock! You do need one written by your MD that spells out which machine and model you do want... and then they have to fill it.

In Ontario, not all CPAP prescriptions and titrations allow you to get an APAP (such as an S9 Autoset) through the ADP. IIRC, for that you need a minimum pressure of 10 and an increase of at least 4 in a different stage or position. I don't meet those requirements, and so my ADP-partially-covered machine is a PRS1 450. Independently of that, my DME still allowed me to buy myself an APAP (my PRS1 560); the province simply didn't cover any of the costs.

tetragon wrote:In Ontario, not all CPAP prescriptions and titrations allow you to get an APAP (such as an S9 Autoset) through the ADP. IIRC, for that you need a minimum pressure of 10 and an increase of at least 4 in a different stage or position. I don't meet those requirements, and so my ADP-partially-covered machine is a PRS1 450. Independently of that, my DME still allowed me to buy myself an APAP (my PRS1 560); the province simply didn't cover any of the costs.

This is very similar to what my doctor explained to me.

My process consisted first of a sleep study, where I was diagnosed with an AHI of over 40. I received a prescription for an APAP study, which I used to obtain a Phillips Respironics APAP machine as a loaner. I used it for six weeks, then went for a titration study. The doctor used the data from the APAP and titration study to prescribe me a pressure setting of 9 cmH2O, which I could use to obtain a CPAP.

I asked her about the APAP machine, and she explained for the Province to cover their part of the cost (75% to a maximum of $780), there had to be a significant difference AHI difference between sleeping on your back and on your side. In my case there was a difference, but not severe enough to warrant an APAP. She said almost no-one meets the guidelines for an APAP prescription. As tetragon said, my prescription would allow me to purchase an APAP machine if I really wanted, but the province would cover $0.

I was disappointed at first, as I really liked the APAP (it would run at 4 to 5 cmH2O for much of the night and ramp up to 9 or 10 when needed) but I've had my CPAP at a fixed pressure of 9 (with a C-Flex+ setting of 3 which really helps) and haven't had any issues.

I wanted an auto PAP as well but was unable to get one as a prescription for APAP is required in Ontario and my prescription was for CPAP. As your prescription is for CPAP, not APAP, that's all you can get. That said, the Escape has no data capability and that's a problem if you want to track your therapy. Exchange the machine for the the Elite model.

By the way, if you really don't need the APAP, there's really no reason to have it. I borrowed one from my supplier on instructions from my doctor (I badgered him until he agreed) after I'd been on CPAP for a couple of months and I couldn't sleep with the thing. The changing pressures kept waking me up. I took it back after only a couple of nights.

I apologize for never having answered this post, originally but it was the first time with Sleep Apnea forums and i found another one and never could figure out which one this one was. I have since discovered this one again and then just noticed it has quite a few Canadians in it, whilst the other one didn't.

I've long since passed this post as this was done last December, although I had a lot of problem getting going with my machines for my Sleep Doctor seriously messed up on my initial 2 sleep tests.
Secondly, up until recently I had a lot of problems with condensation causing a blocked nose 90 minutes into my sleep. I was getting advice from somewhere else but wasn't overly impressed with what I was being told, such as "whats the problem, breathe through your mouth.........??!!"

Anyhow I finally figured it out about 4 nights ago. I had purchased a brand new S9 AutoSet from Kijij for $650 on May 28th but I never though to change the climate control settings as they were fine for our weather at the end of May but I suppose it changed within a matter of days and i never made the connection to it being the settings.......being new to CPAP so I was looking everywhere else for the answer, until i finally turned it right off and now I can sleep right through the night without any problems, as long as I get to bed early enough and don't leave it too late.

I was advised by a group of Americans that the AutoSet was the only way to go. Now that hat I own one, I can see that the ELITE is perfectly fine I believe for most people.
So far, as one other poster mentioned, I too did not like the feel of the changing pressure and am at present for now using it as a CPAP machine, not Auto until i master for at least 2 weeks, the ability to sleep all the way through the night without the feeling of suffocation. I experienced that when my nose became clogged.
Once I get there, I will then start adjusting my pressure settings, one point at a time, slowly to get where I should be.

By this i mean, at 13.
For some reason my doctor who said my prescription was 13, well when I was given the Escape and used it for a few months, it was only when I got the Auto Set I discovered that the DME had set it at 10 and not 13.
So I just want to get used to what i was at with the Escape and then I will slowly make the transition to 13 and Auto from CPAP

n Ontario, not all CPAP prescriptions and titrations allow you to get an APAP (such as an S9 Autoset) through the ADP. IIRC, for that you need a minimum pressure of 10 and an increase of at least 4 in a different stage or position. I don't meet those requirements, and so my ADP-partially-covered machine is a PRS1 450. Independently of that, my DME still allowed me to buy myself an APAP (my PRS1 560); the province simply didn't cover any of the costs.

Hi I don't clearly understand the above though? I was told I had Severe Sleep Apnea with a prescription of 13.
On my first sleep study, the hospital never came in once to wake my up and I slept all night on my back, as i normally do so that test was considered inconclusive so he sent me to another sleep diagnosis centre but due to problems, I had only just picked up my machine and had not yet used it so I wasn't told to bring it to the send sleep study. I thought we came alone. I was never told anything at all in hindsight.

Being a mouth breather, the sleep study place had only FF masks. I no longer use them because I open my mouth and wake up with a cotton barton feeling.
So I switched to a nasal mask and it was perfect. No leaking, etc but i had the condensation problem although that as not related to the style of mask.
I mention that for knowing the above, I had someone tell me that I should be using a FF mask and learn to live with the cotton batten feeling.
Its beyond me why I would do that when the nasal mask is perfect, but its one reason why I looked around for a different forum to get information from.
So they tried about 15 different FF masks on me but each one lakes terribly. She must have come into the room and wakened me about 12 x on that second sleep study because of the leakage. She kept trying to tighten it down with mask until i was getting bad headaches from it but there just wasn't any other make to work with.

Finally she came in and told me they had to have at least an hour for me on my side, which i never sleep on but I did and then the leakage was so bad and was shooting into my eye that i am not really sure I did sleep keep but thought i just lay there quietly for she was getting rather frustrated and was pleading with me to get more sleep, that she needed at least one more hour or it would be inconclusive.......but I couldn't help it with masks that didn't fit, or were taped so tight i had a headache or they were shooting air into my eye.
Suffice it to say, it was not a good sleep that night and i had to go home to sleep another 3.5 hours that day to make up for the 8 I didn't get the night before.

Somehow from this he decided I was a 12.
The irony was that my husband was also being tested at the same time. He slept like a baby that night and never woke up.
I don't know what happened but they considered his test inconclusive and although he had border line SA with a pressure of 8 he told my husband 2 x that he just needed to lose some weight and didn't really need a machine.
He didn't even want him to get one but the hubby insisted that he should have it if he has Sleep Apnea.

When we went to the DME a week later to pick it up for the second time it turned out he had not signed it. The first sleep test he never wrote a number for him and on this one he didn't sign it.
For whatever reason, he didn't seem to want my husband to want one although he is terribly overweight right now and snores....but the DME just figured he had overlooked signing it and gave him one.
Up until now he has fought using it because he keeps telling me that the doctor told him he doesn't have it /sighs

( I have arranged one night this week to set my auto set at his number and try him on it for just the one night and from that we will see if he really does have it or not )

So Why AM I explaining all this to you?
Besides giving you an understanding of what a joke the whole sleep study process was for he and I here in Toronto, I quoted someone above that says what one must have to get an AutoSet.
SO IF i was given a 13 if i read this properly, in order to get 4 levels above 10, Id have to at least have a 14 or rather a 10 so that 4 levels above 10 would be 14 in different sleeping positions if i read that correctly?
So if they did not do my tests properly, he can't possibly really know what the correct pressure was and therefore, even 13 might be a guess?


You know what, it might almost be to difficult to know WHAT this doctor was thinking.

So better, does anyone know, in Ontario how often OHIP will pay for sleep studies?
Id like to know the soonest we could repeat them but with a better doctor?

For those unable to get OHIP to pay for your AutoSet, I guess you do know that if you want one badly enough that you can buy them on Kijiji usually new for $650?
I just got one that comes with the better hose, and came with a Swift Wisp Nasal Mask, I believe it was called all new?

They usually have the Elite for $450
But just last week I saw a lightly used one, an AutoSet for only $350

I'm not sure they are AS great as some people believe. By this, what I mean is that yes, I do agree and wish that people were not given the S9 Escape for I think everyone should be able to check their Data but do I think $650 is worth it JUST to read your data?
That I am not sure of............

I guess what I am trying to say is that i believed people that essentially stressed to me that without an S9 i was wasting my time. I don't believe that today. I might not have been using my time to its fullest on it but i don't believe it was a complete waste of time either.
If people are happy with their S9 AutoSets I think we end up stressing them more making them feel that their S0 Escape is useless when if set to the right settings, it is certainly miles ahead of not using anything at all and I think many people in their 50s and up are either retired, not wealthy, perhaps poor or on disability, welfare, etc and just can't easily spend that $650.
To those people, I just want to say that my life has not changed dramatically at all with the S9 and if all you can afford is the ESCAPE, then enjoy and just get a sleep test every so often so they can tell how you are doing pressure wise, etc.... at least in my humble opinion, that is what I would say.......

When you get adjust to sleeping with it, change your settings to 8- 20 for a few nights and look at your data see where your 95% pressure is.

Putting yours on your husband will only show that with pressure he doesn't have sleep apnea. Since he has to lose weight tell him that it is much easier to lose weight when you don't even have "mild" sleep apnea. Many people are overweight BECAUSE of sleep apnea - sleep deprivation cause hormones to be produced which makes you want to eat.

Plus it's likely your 'condensation' is caused by a too-high (or any) humidifier setting - try turning it down or even off, as it's only for your convenience, and not therapy.

ShelaghDB wrote:Any Canadians here that can tell me if that is the case or not?

It's not a Canadian thing but specifically for Ontario. There are no Canada-wide rules. If you want to have the machine funded 75% by OHIP ADP then there is a well defined set of criteria for each class of machine (i.e., you need an APAP prescription for an APAP machine). Your doctor has almost zero discretion.

See a full discussion here: viewtopic.php?f=1&t=95962&st=0&sk=t&sd=a

There is no problem to go outside the ADP program and buy on-line in the US. You will pay 100% of the cost and receive no ADP assistance. Your sleep doctor will have to write a prescription for the machine, and for any fully assembled masks because you must satisfy US FDA rules to complete the purchase. No sales taxes when importing medical equipment into Canada. There are taxes for supplies.

If you are currently undergoing a trial then return the loaner machine at the end of the trial and buy from the vendor of your choice whatever class of machine you have been prescribed. Your doctor has to sign a set of ADP forms which are used instead of a prescription. Alternatively you can ask your doctor for a prescription and buy outside the ADP. In this case you are able to get CPAP, APAP, VPAP or whatever you like.

It's not that there isn't 'sales tax' if you buy from e.g. Cpap.com in the US, but that you don't pay any duty because it's a 'medical device'.