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Just titrated - few questions
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bwexler Offline

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Posts: 563
Joined: Mar 2012

Machine: PRS 1 BiPAP autoSV Advanced, with Heated Tube humidifier
Mask Type: Nasal mask
Mask Make & Model: Sleepweaver √Član
Humidifier: Resperonics Heated Tube humidifier
CPAP Pressure: Max pressure 25.0 cm H20, Max
CPAP Software: SleepyHead EncorePro

Other Comments: CMS 50i with Software for SpO2

Sex: Male
Location: San Marcos, CA, USA

Post: #11
RE: Just titrated - few questions
You can also check Craigslist an eBay.
A quick check in my area found four s9s starting at $350 including humidifier, mask, hose and case.
You don't even have to wait for your prescription for a used machine.
Do your shopping first so you can compare pricing on the first contact with DME.
That way if you are unhappy on the first phone contact you can go to number 2 or 3 before you even get into your car.
06-16-2013 12:33 PM
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SuperSleeper Offline

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Posts: 9,972
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #12
RE: Just titrated - few questions
(06-16-2013 12:37 AM)Paptillian Wrote:  Been doing a lot of reading and thinking about advantages of auto CPAP. Does such a machine relieve you of needing followup sleep studies to track progress since theoretically the pressure is always correct?

I don't think that APAP pressures are "always correct", but I do believe that they offer better overall therapy results, hands-down (for most patients with simple OSA).

For the average OSA patient, many of us feel that the modern APAPs are actually better at finding the correct pressure than having regular lab titrations. Why? Because the machine is constantly adjusting to your changing pressure needs - and seldom does one need the exact same pressure every night, or even during one night - the needs change as the sleep cycles change and as other changes occur within your body - there's a plethora of things that can affect your AHI levels - how much sleep you've gotten recently, whether you have a cold or other illness, what kind of food you eat, whether you're dehydrated or not, the temperature and humidity, how much exercise you've gotten recently, etc., etc.

I personally will never pay for another sleep study - ever (I don't have health insurance). But I'm pretty sure that baring any changes in my physical issues, I wouldn't even go for another titration even if insurance paid for 100% of it. It's kind of a pain to schedule it, plus it's uncomfortable to do it - why would I go through all that again when they're just going to give me a "titrated single pressure" which only prescribes an average "best" pressure or a range of pressures that "seem" right for me on that particular night?

My Auto-CPAP can adjust to my needs a lot quicker and with more effectiveness as my needs change - so sticking to a "lab-titrated pressure" or "lab-titrated range of pressures" will not give me the lowest possible AHI over time when compared to using my S9 AutoSet along with my "tweaking" using software like ResScan or SleepyHead for ongoing analysis.

Coffee

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

06-16-2013 03:12 PM
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Paptillian Offline

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Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #13
RE: Just titrated - few questions
@iSnooze - I think I'm only stalling myself with all this information available to me Big Grin That's a good thing, though.

@bwexler - In this case does 'used' mean machines that are sold privately between patients? I know masks and hoses can be disinfected pretty easily, but what about the internals of the CPAP itself? Any concern about contracting something?

@SuperSleeper - I feel that the way I slept in the lab during the titration is very different than how I normally sleep. For one thing, I was aware of the equipment, wires, and foreign environment I was in the whole night. It wasn't comfortable. Second, I'm normally a belly sleeper but that wasn't really possible so I tried to sleep on my sides. For what the titration is going to cost, I sure hope it's at least accurate. Do you think I should talk to my doctor about prescribing an APAP, or is that a conversation best had between myself and the DME?
06-16-2013 05:02 PM
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iSnooze Offline
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Advisory Members

Posts: 239
Joined: Feb 2012

Machine: Respironics PR System One C-Flex+
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage Micro
Humidifier: System One Heated Humidifier
CPAP Pressure: 11
CPAP Software: SleepyHead

Other Comments: also use a Comfort Gel Full Mask by Respironics

Sex: Female
Location: Indiana

Post: #14
RE: Just titrated - few questions
(06-16-2013 05:02 PM)Paptillian Wrote:  Do you think I should talk to my doctor about prescribing an APAP, or is that a conversation best had between myself and the DME?

I'm not SuperSleeper but I would definitely talk to your doctor. If he prescribes an APAP then your DME has to give you one to fill the prescription. She or he can even specify what type.

If I understand correctly how DMEs work, they will be reimbursed the same amount of money from Medicare and most insurance companies whether they give the lowest costing machine or the highest costing machine. They are a business and of course want a higher profit margin. If you have a prescription, they have to give you what is on the script.

If your doctor won't give write a script for a specific machine, then use the prices from the online suppliers as leverage with your DME as others have suggested.

Good luck getting the right machine for you.
06-16-2013 08:58 PM
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SuperSleeper Offline

Administrators

Posts: 9,972
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #15
RE: Just titrated - few questions
(06-16-2013 05:02 PM)Paptillian Wrote:  @SuperSleeper - I feel that the way I slept in the lab during the titration is very different than how I normally sleep. For one thing, I was aware of the equipment, wires, and foreign environment I was in the whole night. It wasn't comfortable. Second, I'm normally a belly sleeper but that wasn't really possible so I tried to sleep on my sides. For what the titration is going to cost, I sure hope it's at least accurate. Do you think I should talk to my doctor about prescribing an APAP, or is that a conversation best had between myself and the DME?

Hi again Paptillian - the issues you stated are yet another reason that titration pressures should not be used "blindly". There's too many in-lab distractions and conditions that are not like sleeping at home at all.

That said, I never recommend that a newly-diagnosed patient who is able to have a complete sleep study (diagnostic and titration) forgo that option. Sleep studies are important for proper diagnosis, as OSA may not be the only problem. In addition, while titrating a patient, it may become evident that standard CPAP will not suffice to control apnea events, or that central events might be a factor. Such discoveries during the sleep study/titration may necessitate giving the patient a bi-level CPAP or an ASV machine for centrals or mixed sleep apnea. If someone simply does not go in for a titration in a sleep lab, and goes straight to APAP, they may be doing themselves a great disservice by purchasing an APAP, when they should have purchased a bi-level APAP or ASV for instance.

My main point was that after going through an in-lab titration, it's important to realize that the prescribed pressures and settings may not be the best for the patient over time or in all circumstances. It's one set of data to consider, but if you're placed on a data-capable APAP or auto-bi-level, and you monitor and adjust your settings to get a lower and lower AHI over time, you're going to have more effective treatment that if you were to blindly accept the unchanging "settings" that were given to you during a "one-night-stand" (overnight titration in a sleep lab).

Coffee

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

06-17-2013 10:06 AM
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archangle Offline
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Posts: 3,159
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

Sex: Undisclosed
Location: USA

Post: #16
RE: Just titrated - few questions
Even an Auto machine works better if you set the correct pressure range for you.

If you start with too low a pressure, you may have trouble breathing whenever you turn the machine on because it starts low and works up very slowly. If you need 12 most of the time and start at 4, you may find you have apnea for 8 minutes as the machine raises pressure slowly.

Also, as your apnea comes and goes with sleep stage, etc., you pressure will drop back down, and you may have problems as you change sleep stages.

I find I feel better if I start at a higher minimum pressure, even though I don't have any apneas if I set it lower.

Pressure changes disturb some people. Also, if you fit your mask at a low pressure, and the pressure increases a lot due to auto, you may have a lot of problems with leaks. It's easier to make everything work if the pressure doesn't change that much.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
06-17-2013 02:27 PM
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Paptillian Offline

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Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #17
RE: Just titrated - few questions
I called and left a note for my doc to consider adding "auto cpap with efficacy data" to the prescription, as well as requesting a copy of it (and the sleep study results) for myself. Let's see what happens. The receptionist didn't know what that meant but she wrote it down.

To my dismay I found out my coverage for DME is much less than I thought. It could be cheaper to get my own machine online after all, but insurance wouldn't tell me the DME allowable rates. Are these different for each DME they contract with?
(This post was last modified: 06-17-2013 05:25 PM by Paptillian.)
06-17-2013 05:24 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #18
RE: Just titrated - few questions
(06-17-2013 02:27 PM)archangle Wrote:  I find I feel better if I start at a higher minimum pressure, even though I don't have any apneas if I set it lower.
Whatever works best for you, I might take different approach but all roads lead to Rome
06-17-2013 05:34 PM
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Paptillian Offline

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Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #19
RE: Just titrated - few questions
(06-14-2013 10:54 AM)PaulaO2 Wrote:  Before you sign, find out what your co-pay is. Then go to Supplier #2 in the Supplier's List (link at the top of ever page) and check out their machines. More than likely, it will be cheaper for you to get one on your own vs through a local DME. You will probably have to pay for your own machine supplies (filters and probably hose) but the DME should still do the masks. You want to do this locally until you find one that works.
Insurance told me their replacement schedule is 1 hose/cushion/filter per 6 months. When I asked them about masks/headgear, I was told "only if it breaks."

Filters are cheap enough to buy in bulk, and 6 months seems reasonable for a hose. I don't know about that "only if it breaks" mask policy though? It's plastic so I guess they should last a long time, but then I've seen replacement guidelines suggesting otherwise.
06-17-2013 05:47 PM
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Paptillian Offline

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Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #20
RE: Just titrated - few questions
Some good progress; I got my prescription this morning along with the sleep study results from the titration. I'm starting the process to get information from the local DMEs and comparing with my online options. I do have some concerns...

First the good news: My AHI dropped from 12.3 (baseline established on 12/2012) to 0.6 during the overnight titration! The optimal pressure was just 5 cm H2O, but the doctor prescribed auto-CPAP with a range of 4 to 10 cm H20 and Pressure Relief = 2.

The bad news: My second sleep study conflicts with the first about my type of sleep apnea and I'm not sure which one to trust. The baseline study found only obstructive apnea which was really prevalent during REM. The second study (CPAP night) showed no obstructive events, but central events instead! I had 3 centrals and a couple hypopneas. The diagnoses however is still "obstructive sleep apnea." I'm not sure how to read this.

Is it that I had no obstructive events, or that they didn't occur because of the CPAP and my pressure being so close to the minimum? Why did central events suddenly start showing up on the CPAP study and not before? Should I be concerned about them, and is the doctor still right about prescribing Auto CPAP or am I better served by some kind of Bi-Level / VPAP or other machine?

Finally, can someone please decipher what the underlined language means on the prescription:

"Mask: Resmed SwiftFX Size: Medium q 3 months x 1 year PRN"
"Head gear q 6 months x 1 year PRN"
"Tubing q 1 month x 1 year PRN"

Many, many thanks!
06-19-2013 12:07 PM
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