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New CPAP user by proxy
(11-12-2014, 07:02 PM)suedanem Wrote: . . .
I did call Lincare again. They insisted that the CPAP machine would be an autoCPAP. Anything I read about the "ResMed Elite" says it's a straight CPAP only machine. (They said it was the S10 model. I can't find anything on the S10 Elite, but they also told me it has a modem in it. Oh great!)
. . .

Hi Sue,
Welcome to the forum!!!

Here is a link to an article about choosing a machine:

If I were starting over again today, I would have 2 main criteria
for choosing a machine:

(1) The machine has to deliver Full Efficacy data, not just compliance data.
Archangle's article discusses this issue

(2) I would choose an Autoset (Auto-PAP, APAP, whatever term applies) over a straight CPAP for several reasons. First, any APAP can be configured to run as a fixed CPAP, so it is 2 machines in one. Second, APAP mode is useful even for those who do better on a fixed pressure (some folks don't seem to adapt well to the varying pressure of an APAP). APAPs are often used for an at-home titration study, to determine what pressure or pressure range should be used. If you have an APAP, you can repeat this procedure as often as you wish. Thirdly, needs change, our bodies change, one night is not the same as the next night, so pressure needs can change too. An APAP is monitoring what is going on breath by breath, and can adjust to the situation it sees.

Remember, the DMEs are known for lying, they often play on your ignorance. I have read here that all basic PAP machines are reimbursed under a single insurance code, meaning that the DME gets a fixed amount regardless of which machine they dispense. This means that they have a financial motive to dump the cheapest machine possible on you, to maximize their profit.

About what they have already told you:

1) There is no S10. The latest machines from ResMed are the AirSense series, or A10 series. The A10 series have an integrated modem, so that is apparently the family of machines from which they are planning to deliver.

2) The A10 series is not a single machine: there are several models, with different capabilities: A10 Autoset and A10 Autoset for her and A10 Elite are all full-data machines. The A10 Elite is a basic CPAP, not an Autoset or APAP. Review Archangle's machine choices article carefully on the A10 series.

The 1st hurdle is to get the right machine. When I went thru this a few months ago, the key factor was that the PAP Rx had to be written with a pressure range, not a single number. So check the Rx first, and see what it says. I was able to get my PCP to re-write the Rx for a pressure range, and that was all that I needed to get the machine I wanted.

So inform yourself, and be stubborn if needed - polite but firm usually works. As someone has already mentioned, you have the most leverage BEFORE you accept delivery of a machine.

Good luck on your Mom's care and journey.
PAPing in NE Ohio, with a pack of Cairn terriers
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Thank you all for your tips and information. The woman at Lincare INSISTS that 1: the prescription is written for AUTO and that the Elite is auto. (I even got the "I've been doing this for 10 years and I know what I'm talking about line.") Looks like I better get into "battle mode."
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The correct name for the series is ResMed AirSense 10. The previous series was ResMed S9.

Apparently, a lot of people are calling it "S10" instead of "A10." "S9" was the official name, but "S10" or even "A10" is just a "slang" term for "AirSense 10" or "AirCurve 10."

"Elite" is absolutely not Auto. Not in the A10, S10, or S9 series or any previous ResMed models.


Be sure your prescription says "Auto" CPAP and specifies a pressure range. It would be illegal for the DME to dispense an Elite if the prescription specifies a pressure range.

BTW, the Elite is an excellent manual CPAP in the S9 or A10 form.
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.
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(11-12-2014, 08:49 PM)suedanem Wrote: Thank you all for your tips and information. The woman at Lincare INSISTS that 1: the prescription is written for AUTO and that the Elite is auto. (I even got the "I've been doing this for 10 years and I know what I'm talking about line.") Looks like I better get into "battle mode."

Keep us posted.
Evpraxia in the Pacific Northwest USA
Diagnosed: 44 AHI when supine, O2 down to 82%
Treated since 20 Sept 2014:: 0.7 AHI, Settings 7-15, EPR on Full Time at Level 3
Better living through CPAP/APAP machines!
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Thanks everyone.
The Lincare representative is still sticking with her "the S10 Elite is an APAP device". I am sending her the following fax:

Attached to this fax are several pages from various CPAP vendors on the Internet, including one from the ResMed website itself, describing the AirSense S10 Elite as a “premium fixed pressure” device. I’m sure it is an excellent device, however, it is NOT an auto-adjusting CPAP device as prescribed for my mother, Jane Doe by Dr. John Smith. Therefore, it is not the correct machine for my mother and it would not be in her best interests to take possession of it. If you think I am mistaken, please email or fax proof (to both Dr. Smith and me) that the ResMed Elite S10 is auto-adjusting,

We have two requirements in the APAP machine we will accept. One is that it must fit her prescription and be auto-adjusting. The other requirement is that it is capable of recording complete efficacy data for mom’s doctor. The ResMed device that fits our requirements is the ResMed AirSense AUTOSET (S9 or S10), which has the same fine features as the ResMed AirsSense Elite, but is truly an Auto-CPAP machine.

You may carry other Auto-CPAP machines that would fit the bill; however, we will not take possession of any machine that we have not had the chance to completely investigate ourselves, especially since you are in error on the Elite S10. We won’t accept a “brick” i.e. a machine that records Medicare compliance data only.. We are aware that there is one Medicare billing code for CPAP and APAP machines. The CME gets paid a set amount no matter how “fancy” the machine is.

Please note that while we are definitely NOT refusing treatment, we are prepared to go with a different DME supplier to get the Auto-CPAP mom needs if necessary. I regret being difficult, but I will go to whatever length is required to get my mother the appropriate treatment.

OK guys, I'm going to fax several web pages that list the Elite as a "fixed pressure" device to the Lincare rep. Otherwise, it's just her saying it IS an APAP and me saying no it's not. Mom is making an appointment with her doctor to discuss this and hopefully, write us another prescription that we can take to another CME.

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You are completely correct Sue. The only change I would make if you haven't already sent this is the model names are "S9 Autoset" and "AirSense 10 Auto." But your attachments will point that out just fine.
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Thanks, Retired Guy. My problem is that the Lincare rep is mislabeling the AirSense 10 as a S10. I will label it appropriately in my faxed letter as it shows I'm informed as to the correct names.
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Greetings Sue;

Great fax and info for the DME! Your mom is one lucky and fortunate woman to have you as her daughter and advocate.
Evpraxia in the Pacific Northwest USA
Diagnosed: 44 AHI when supine, O2 down to 82%
Treated since 20 Sept 2014:: 0.7 AHI, Settings 7-15, EPR on Full Time at Level 3
Better living through CPAP/APAP machines!
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Thanks Evpraxia, I need all the encouragement I can get. My normal nature out in public is somewhat meek and reserved. For this situation, I need to be the mouse that roared! I do have my mom's SpO2 report to give me encouragement too. In an eight hour period, her 02 went down into the 70s about 7 times and one time it went into the 60s. I really hope that was an error. It went back to the 70s/80s right away. I also read that atrial fibrillation can be hard to control if the sleep apnea isn't under control.

So I did fax that letter to the gal at Lincare and I dropped a copy of the fax and the downloads from the Internet that showed that the item in question is a fixed air pressure device off at mom's doctor's office. I handed it directly to the nurse. I just told her there was a problem and I wanted to keep the doctor in the loop!

I also appreciate the info that sleep apnea is hereditary, Evpraxia. As soon as I get mom's problems settled, I will have a sleep study done. And, I'm working on my sister to have a sleep study also. (She lives in the North West also.) She has a terrible time sleeping. She says, "I could never keep a CPAP mask ON. When I wake up in the morning, I toss and turn so much my sheets are in knots." Well, maybe if she could BREATH properly, she wouldn't toss and turn!

I sleep ok, and without much movement. I have Rheumatoid Arthritis (mostly controlled now) which, for a period, made movement so painful and difficult, I learned to sleep in one position most the night. However, I do have a problem with fatigue. It is always blamed on the RA. Hmmm Maybe not!!
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Well, it's not exactly hereditary since it is not a genetic disorder. It is more like the body type and throat shape that makes it "hereditary". For example, my biological paternal parent has a small mouth and throat which I "inherited". This, plus the body type (obese pear shape) I inherited from my mother, made me ideal for sleep apnea. The paternal parent has been diagnosed with sleep apnea, had major surgery for it (unsuccessful of course), but I don't know if he uses an xPAP.

So if your mother has it but you are physically structured more like your father, you may be in the clear. But it would be a perfect thing to get the sleep study done! If nothing else, you can, ahem, sleep better knowing one way or the other.
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Breathe deeply and count to zen.


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