Lousy DME + Mask Issue

[hookedonstitch]

Yesterday I went to my DME's office for what I thought was a mask swap.  It's just outside of the 30 day guarantee swap window but I had to wait over 2 weeks to talk to my Sleep Dr about pressures so she said she would waive it.  I get to my DME and what does she do but switches my frame from Medium to Small puts it on and says I am good to go now.

Long story, short...it's completely wrong, it didn't matter how tight or loose I had it, it kept leaking or popping off my head  I had questions for her since she is supposed to be my contact and her attitude was just switch to the small frame and leave.

I'm wondering if I have to stay with this DME?  I was referred to this company by my Sleep Dr.  It's out of the way from my home and I am about to completely give up on CPAP but I don't want this one tech's attitude to ruin my experience.

I live in Ontario, Canada and used the Assisted Devices Program to subsidize half of the machine cost.  The other part was covered mostly by my private insurance.  Not sure if that makes a difference.  I also paid a wifi connection fee so this company could monitor my compliance.  Can I turn this off?  If I do will there be any negative repercussions?

I would like to try another mask but refuse to deal with this lady again.

[Sleeprider]

What mask model are you using? There are some options in Ontario that some of our members local to your area will suggest. There are much less expensive ways to source equipment, meanwhile, this thread may be worth reading http://www.apneaboard.com/forums/Thread-...e-strategy

Thanks for posting your chart. It looks like your total therapy time was only 32 minutes and most of that was ramp. That doesn't tell us much since events are not counted in ramp, and I doubt you actually slept for this. Clearly there are some leak issues there, and it appears that your settings are for 5.0 to 9.4 with EPR at 3. The graph you posted shows your exhale pressure never got above 4.0 cm. I'd like to suggest that you turn off ramp and change EPR to a setting of 2.

[SarcasticDave94]

There's several Canadians on the forum. I'm sure they can help with insurance and supplier DME questions. I myself would not put up with supplier jokers like that. I'd research your insurance, maybe a customer service call and ask where you may go to get supplies. One that's nearby and doesn't have jokers as reps. As you know the mask is a make or break for therapy. I wish I had specific do this and that to get a better supplier.

[Cpapian]

Hi Hooked on Stitch,

I am from Ontario.   Toronto.  Let's see if I  can help you.  But first, what DME?   Also if you could tell me what city it would help because it would give me a better idea of what to suggest in terms of new DMEs.

For more specific advice, I wait till I  hear back from you.  However in general terms here are how some of these things work.

Here in Ontario,  the ADP program does not require users be monitored.   However your sleep doctor will probably ask the DME to provide a report for him when you have an appointment.  So this might be a question you should bring to  the doctor's office. 

You can also choose your own DME for masks and other equipment.   If you want you can use a new one every time.  You're not tied into them, except for the machine.  Any warranty issues with the machine will have to be brought back to them.

For me, once I  know what mask I like, I  order it from Supplier #32.  They are a Canadian business located in Richmond Hill.   They have been great for me.  Sometimes my order arrives the next day.  Which is amazing.  Their prices are substantially lower than DME prices.

When I want to try out a new mask, I go to a DME and have them fit me.  It also allows me the opportunity to figure out if I will like it.  So the extra cost is like paying for a fitting.

Extended health insurance will probably pay for a new mask every six months.   I have found them pretty cagey about giving out this info, but finally dragged it out of them.  Your coverage may be different.   They will also pay for new cushions in between.   Mine won't pay shipping costs or the cost of filters.  Supplier  #32 gives free shipping on orders greater than $x .... maybe a hundred.

In terms of your current mask.  If you aren't satisfied with the service provided,  you can talk to the manager of the location.   Explain your difficulty and ask for further assistance.     If you can't get satisfaction from the manager of the operation,  try talking to your sleep doctor.   Particularly since the sleep doctor recommended the DME.  Take your mask and machine in and ask them to help you.  If they determine the fit is incorrect they will have "authority" when they speak to the DME.  DMEs probably want to keep on the docs good side, so they may be more amenable to correcting things.

Don't let any of this put you off CPAP.  In the end you are the winner for using your CPAP.  Your body is depending on you to help it function properly.

[Grandpapa-G]

In Ontario, if you are covered by OHIP the ADP (Assisted devices Program) will pay for 80% of the approved cost of a CPAP device (including a basic mask, humidifier and tubing) which, last I checked, was around $800.00 C. and you would have to use private insurance, or pay out of pocket for the remainder. All additional supplies would be paid by your private insurance. Here it is much better to avoid the DME and buy online as the price will be much less expensive than through a storefront DME. The Resmed "Autoset for Her" with basic mask and plain tubing should be covered by the ADP. Most masks and a heating tubing will probably be considered extra and should be sourced online.

[hookedonstitch]

Mask is the Phillips Dreamwear Pillow Cushion, which overall is OK when I use the Medium frame which is what I have switched back to for tonight.

I'm not sure about my pressure, the last prescription from the Dr. was for pressure 7.0 constant.  I use the ramp to acclimatize to the pressure.  My ears pop when I first put the machine on and if the pressure starts too high I get anxiety about it.  I have the ramp set to 15 minutes now up from the 45 minutes I was using before.

I will try an adjustment for tonight as you have suggested.  It's obvious from my appointment yesterday that I'm on my own figuring this out

---

Thanks for the feedback.  I'm very disappointed with my DME but not sure how to proceed.

[hookedonstitch]

Hi Hooked on Stitch,

I am from Ontario.   Toronto.  Let's see if I  can help you.  But first,  what DME?   Also if you could tell me what city it would help because it would give me a better idea of what to suggest in terms of new DMEs.

For more specific advice, I wait till I  hear back from you.  However in general terms here are how some of these things work.

Here in Ontario,  the ADP program does not require users be monitored.   However your sleep doctor will probably ask the DME to provide a report for him when you have an appointment.  So this might be a question you should bring to  the doctor's office. 

You can also choose your own DME for masks and other equipment.   If you want you can use a new one every time.  You're not tied into them, except for the machine.  Any warranty issues with the machine will have to be brought back to them.

For me, once I  know what mask I like, I  order it from Supplier #32 .  They are a Canadian business located in Richmond Hill.   They have been great for me.  Sometimes my order arrives the next day.  Which is amazing.  Their prices are substantially lower than DME prices.

When I want to try out a new mask, I go to a DME and have them fit me.  It also allows me the opportunity to figure out if I will like it.  So the extra cost is like paying for a fitting.

Extended health insurance will probably pay for a new mask every six months.   I have found them pretty cagey about giving out this info, but finally dragged it out of them.  Your coverage may be different.   They will also pay for new cushions in between.   Mine won't pay shipping costs or the cost of filters.  Supplier  #32 gives free shipping on orders greater than $x .... maybe a hundred.

In terms of your current mask.   If you aren't satisfied with the service provided,  you can talk to the manager of the location.   Explain your difficulty and ask for further assistance.     If you can't get satisfaction from the manager of the operation,  try talking to your sleep doctor.   Particularly since the sleep doctor recommended the DME.  Take your mask and machine in and ask them to help you.  If they determine the fit is incorrect they will have "authority" when they speak to the DME.  DMEs probably want to keep on the docs good side, so they may be more amenable to correcting things.

Don't let any of this put you off CPAP.  In the end you are the winner for using your CPAP.  Your body is depending on you to help it function properly.

Thanks for the feedback CPapian.  My appointment at the DME yesterday was to ask for assistance with my mask as recommended by the Sleep Dr.   The Dr. wanted me to try a different mask but the technician's only concern was changing the frame on my current mask.  I did some research on masks I was interested in seeing and each one she didn't have at the office.  I got the vibe that she just wanted to be done with me as quick as possible and get on to the next patient despite my 30 min appt.  I should contact her and let her know what an epic fail last night was but to be honest I think it will be useless and I would just rather deal with someone else who has the ability to actually be of assistance.

My insurance company wouldn't tell me how often they would cover new supplies, they just kept telling me normal wear and tear and an estimate has to be sent over first before purchasing.  Filters are not covered.

I'm trying desperately not to let this put me off.  I do understand just how important it is for me to treat this.  My heart/lung issue that is under investigation probably has a lot to do with being undiagnosed for so long.

I will look at the online suppliers tonight.  I also sent you a PM with the name of the DME as even though it's warranted I don't feel comfortable naming & shaming.

[Cpapian]

About insurance companies... they told us the same thing .... but my husband can be pretty persuasive and/or dogged but he finally got them to say roughly six months. 

After a while I got fed up with obtaining a predetermination, so I  just submitted my bill and they have paid them without any problem.   The supplier I mentioned will do a predetermination for you.  

I don't use your mask, so I can't offer any advice,  but other members here will likely be able to help, if you still need help.

Don't get discouraged.   It takes a while to adjust to all the newness and strange contraption,  but before long it will be second nature and you will barely notice.

You mentioned your ears popping.   Again,  that's not something I have encountered,  but other members have.

Just a thought, but tongue placement, believe it or not, can make a difference.   Apparently,  when you are not talking,  your tongue should rest at the top of your mouth, a little bit back.  It took me a bit to learn this, but it helps with CPAP.  in the correct position it stops one's breath from getting into the mouth.  If one's tongue is in the right position,  one should be able to open their mouth and air won't escape. I don't know if would help with the popping,  but it is worth a try.  

Also you might lessen the problem by sleeping in a different position.  Again, something to try, but no promises. 

You have a good machine, BTW.

Someone else suggested practicing with mask and machine while reading or watching TV.  That is an excellent idea.  I did that my first night.  And of course my husband made fun of me.  (In a fun way, of course)

CPAP is worth it.  You just need to get over the humps initially.   Before you know it,  it will be as normal as brushing your teeth before you go to bed.  There are tons of members here who felt dismal when they started, but now are successfully using their equipment and proud of it.  So, you are not alone, and people here will help you.

I won't try to give advice on pressure because there are others here who know these matters best.

[hookedonstitch]

Thanks for the feedback Cpapian

I am determined to make this work and not give up.  Last night was more comfortable.  I'm still exhausted during the day but will give it more time.  I reduced my EPR to 2 and that seemed to help.

I actually read with the mask on before laying down to sleep.  I find that this has helped with the anxiety of getting used to the feeling of the air from the machine.  Definitely a good trick to adjust for anyone struggling!

I emailed my lousy DME tech and explained what happened with the smaller frame.  The response was to let them know if I adjusted by going back to the Medium frame.  I will be contacting my insurance company to see if it might be possible to get a different mask covered from the online supplier you've recommended.

My ears only pop for a moment when the machine first starts, it's like being in an airplane.  

I will try the trick with the tongue placement to see if that helps.   I would've never thought of this.

At least I am glad that I did get a really good machine, that's a bonus for the DME.  I wasn't given a choice either, it was just given to me.

I'm not going to give up, I have too many health issues that are under investigation that are probably directly linked to (probably years) of untreated sleep apnea.

I appreciate your feedback, it has greatly helped!

[Gideon]

I'll suggest that you add your province to your profile, In Canada, it makes a big difference.