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[CPAP] Should I stay or should I go?
#1
Should I stay or should I go?
About ten years ago, I realized that my excessive weight, constant snoring and fatigue or sleepiness during the day likely meant I had sleep apnea.  Lacking medical insurance to cover the expense, I paid out of pocket for my first CPAP machine and began visiting The Apnea Board in, well founded, hopes of teaching myself how to use it.  I installed the Oscar software. In short order, I learned that I did indeed have sleep apnea with a daily AHI ranging between 10 and 15.  I learned through experimentation that no matter how hard I tried, I was a mouth breather, which called for a full face mask in order to keep the Large Leaks manageable.  Also learned how to important it was to keep the equipment clean.  On average, I have the mask on nearly 8 hours a night.

In 2017 I bought my first Resmed Airsense 10 and added a Flashair SD card so I could send the daily events record from CPAP to PC wirelessly.  Within a few weeks of playing the Airsense 10 settings, I was able to bring my average daily AHI reading down to between five and ten.  A few months back, I set the EPR level to 3 and the impact on daily AHI average was significant.  I'm now seeing daily AHI readings under five with many coming in lately, under two.   I rotate face masks between the Resmed F30 and F30i. I prefer the F30i but switch to the F30 if my beard hairs get too long and the leak rate gets excessive.

So, here's the deal - after nearly ten years of self taught CPAP use and paying for everything out of pocket and now that I have Medicare, it may be time to formalize the process and get Medicare to start picking up some or all of the tab.  In line with that, I've scheduled a sleep study and expect the results (along with nearly eight years of SD card data) to show that I do indeed have mild (at this point) sleep apnea.  What may follow will be equipment I don't have to pay for (and may not be able to choose) and medical supervision of my use.

My question for those of you who may have, or known others who may have made this move?

Is it worth it to formalize this process and save a ton of money on equipment costs?  Or would I be better off continuing to manage my own apnea care because medical supervision might take me out of the driver's seat and ultimately be a pain in the neck?
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#2
RE: Should I stay or should I go?
I'm not going to comment on which road to take--Medicare or do-it-yourself. I have an excellent sleep doctor (he has sleep apnea) and have had good luck with local DME offices. I do use Medicare and my secondary (Tricare4 Life) and all expenses are paid 100%, so I am very satisfied with both my medical personnel and Medicare. More often the case is people not being satisfied with one or both. I will speak out about continuing with Resmed machines--the new Airsense 11 or the past Airsense 10. Many DME's are issuing cheaper off brand machines due to the Resmed shortage caused by the Phillips recall. Others will answer some of the other questions. Good luck and welcome!
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#3
RE: Should I stay or should I go?
I'm sure other, more knowledgeable, types will chime in soon. My initial thoughts are that there is no harm in exploring your options. Have your sleep study. You know that you should stop using your machine for several days beforehand? Not sure how many days, the knowledgeable ones will know. Stopping will give a more accurate result. Once you have that, you can find out about coverage, whether you will be in perpetual rental mode or able to buy a machine. You can always go through the process and decide to buy a machine out of pocket. But I would think, once you have a diagnosis and prescription, even if you choose to do that, you should be able to get your supplies covered. I don't see a downside to at least looking into things. Yes, of course there is the (possibly high) possibility that you will run into some of the many "professionals" out there who look at an AHI, say "Hey that number looks great" and that's the extent of their care, but if so, you are well able to continue on your own.

If I am mistaken in anything I have said, I will very shortly be corrected. I do look forward to hearing about your experience, however, as both hubby and I (both PAPers) go on Medicare next year!
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#4
RE: Should I stay or should I go?
I think the other posters are correct...
I've also been told you need a few nights off cpap before your sleep study for accurate study results (don't know the reasoning behind that).

You should always have a say in what machine you get from the DME. Get a copy of your prescription and shop around if one says they can't get you a Resmed. 

You also get to keep control of your settings. You've proven you know how and you have expert backup here. (DME will set to the script from the doc but you can change it)

I really don't see any downside to letting Medicare pick up the tab. You've earned it.
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#5
RE: Should I stay or should I go?
I am on Medicare. I manage my own therapy. I choose my own machine. My Rx is for a BiLevel. I demonstrated my need for a BiLevel with a stack of about 30 charts. Went over 1 in detail and said this is similar. I did show a couple of normal and good nights to my sleep doctor. Bottom line was that Medicare required a diagnostic test to qualify for the device. My doctor justified it based on a demonstrated poor performance on CPAP. My previously prescribed machine was CPAP at 19, and no data. Turns out that device could only produce a " good enough" 18.

Anyway my original AHI was mid 90's.
My second was a failed split study without the numbrs needed sleep ( only 1 hr 59 minutes) and my absolute worst night sleep since I started CPAP. BTW my AHI showed a drop of 20 to 77. I don't EVER not use my VAuto.

The goal of this Medicare required sleep study is to prove you have Apnea and little else. The need to take time off becomes more important for milder cases and especially if the purpose is to prove you are apnea free and no longer in need of a CPAP.
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#6
RE: Should I stay or should I go?
Thanks to all who responded to my thread. I feel like I'm better armed now with good information. Particularly the bit about ceasing current CPAP use for a few days before the test but also the notion that giving up a bit of autonomy in exchange for Medicare covering some of the constant expenses is a wise move.

In line with your advice/suggestions, I've scheduled a sleep test and stopped using my CPAP in the interim.

I sincerely appreciate the support offered by this community and the enormous bounty of useful information that can be found here. It's proven very helpful over the years and has made all the difference in teaching me how best to treat my sleep apnea as time has gone by. From recommending amazing tracking software like Oscar to instructions on how to set up a flashair drive to transmit daily results the benefits of following this board just keep on coming.

Many thanks to all who make this place the high quality resource that it plainly is. I could not have come this far without your help.
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#7
RE: Should I stay or should I go?
Medicare will pay for a high priced sleep study, CPAP, and gear.  Your choice of gear will be continuously resupplied. Your doctor visits for apnea (once a year unless more appointments made) will have a copay. ($18 here) Your machine will be replaced periodically.  I have a supplemental insurance policy with Medicare.  I am not sure if it why I have no copays except for doctor visits.  All insurance is handled by clinics and cpap gear vendor.

With the above in mind, why since you pay for Medicare, would you not want to benefit from it?  Start anew with full blown, in clinic, big deal, sleep study (not fun). You will still have control over how you use your gear.  I have been with Medicare for years.  It is just now clinic is wanting proof of compliance via a data report, but did not demand one, just asked for for the first time in 15 years.
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