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New User, question about Friday's DME appointment
#1
Question 
Hi everyone. After a long and at times frustrating processing I'm finally off to the DME to get my first CPAP machine. It seems like this has taken forever to get to this point, even after the sleep study was done. I went last week back to the sleep lab for what was supposed to be a check up visit to see how I was doing on the CPAP... except they had never sent the prescription to my DME or to myself has had been requested. I spent a very nice half hour with the tech?... nurse?... finally reviewing my titration study, getting and getting copies of all my paperwork and finally the script for the machine. It states a CPAP with a pressure of 6, advanced data capable, heated humidifier & hose, and mask of my choice.

When I asked why a CPAP and not an APAP the tech? told me that I didn't need the APAP because the level of pressure I needed was so low and the titration study showed that it stopped all the events & snoring.

My question, is should I still request from the DME to get an APAP & set it to work as a CPAP? I know from the reading I've been doing over the past few weeks here & on other sites that the majority feel the APAP is a better machine, but with my low pressure needs, is it really needed? I feel sure the DME is going to want to give me an S9 Elite or the RemStar Pro. I dislike confrontations, but at the same time want what is going to be best for me. If this is a battle I need to fight I will... but I really just want to get a machine to get started on so that I can start feeling better. I'm so ready to get started.

Thanks in advance for your thoughts.

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#2
The question becomes what is the difference between being able to specify a range of pressures, or just having one size fits all. In my case a pressure of 6 would leave me feeling like I was suffocating all night. But could I be happy as a clam with a fixed 12? Maybe. But I do like the security of being able to let the machine decide if 7 or 8 is ample, or if it should slip slide me up to 12 or 13.

So it becomes why not have the more capable machine? Whether it's set on cpap or apap, the general idea is to make you as comfortable as possible while delivering the proper treatment.

Setting a machine on 6 and sending you home doesn't sound like a very good idea to me. Yes, it does leave all the control in the hands of the technicians, but frankly I'd just as soon the technicians hands stayed out of my bedroom.

Tell them that on good advice you want a Resmed s9 Autoset, and you'd like it set minimum 6 (to make the doc happy) and max of 10 (to insure you too stay happy).
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#3
(05-05-2014, 11:45 PM)SleepyDreamCatcher Wrote: My question, is should I still request from the DME to get an APAP & set it to work as a CPAP?
Yes! You should be provided an autoset device.

My initial titration study, during which I was awake most of the time, resulted in the same prescription you have been given. "Get a straight CPAP, set it at 4 and come back in 90 days."

I made the obvious argument that if I had an autoset device, the machine would determine my pressure needs over many nights as opposed to the single night of the titration study. If the titration study was correct, the autoset would confirm it.

As it turned out, the titration study was wrong. My average pressure over the past 30 days has been 9.75 and my autoset is configured with a pressure range of 8-14.

Other members of the forum will tell you that the DME makes more money if they sell you a brick so don't depend on them for advice on machine type. Get an autoset, download Sleepyhead and watch your numbers to confirm what you will learn from the forum.

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#4
Hi SleepyDreamCatcher,
WELCOME! to the forum.!
I would get an APAP because it will adjust to what you need.
Hang in there for more suggestions and best of luck to you at your next appointment and with your CPAP therapy.
trish6hundred
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#5
While I suggest trying to get an Auto-Titrating machine (APAP), don't get hung up on one brand and don't burn any bridges trying to win the battle and wind up losing the war. The S9 Elite and the DS460TS are both fine data capable machines and if that's what you wind up with it's not a bad thing.

Having said that, I'd call the place that the script came from and see if they would change it to a APAP with a range of pressures. They may be persuaded to change it and send it to the DME before Friday.

If they won't change it you can still talk to the DME and see if they'll supply an APAP set to operate as a CPAP.
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#6
I'm a bit different I guess. I started CPAP way back in the days before 'autoset' machines, and data-capable machines. Yes, a single-pressure CPAP with data *could* be all you ever need, but it may take some time and data mining to determine the 'best' pressure for you, as a sleep study is not like sleeping at home.

That said, the nice thing about the 'auto' machines is that they can be set up either way. Straight single pressure CPAP, or put into auto-set mode - along with other possible comfort features. The advantage is that if you suspect that your pressure may not be correct, you could yourself put it into auto mode for a week or three, and check the data to see what it thinks you need. Thereby taking the doctor (and cost) out of the picture.

So, while not the end of the world, it would be a clear benefit to you to get an upgraded machine, and I believe worth some effort to make it happen now, rather than later.
*I* am not a DOCTOR or any type of Health Care Professional.  My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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#7
My sleep study was like many -- very artificial conditions, wired up like I-Robot, and forced to sleep on my back, something I never do (except when I pass out in a recliner) -- I probably "slept" a grand total of 2 hours over the night and that was broken up by the tech coming in to try a cpap on me (I was so bad that they could not even let me finish the study), etc. I got sent home with an M-type (that would to APAP, once I learned to get into the clinical settings) and a setting of 14. I was still choking and dying in my sleep, so I asked and the sleep doc set my pressure up to 16 with many warnings, chewing me out for "trying to manage my own sleep," etc. I then divorced the fool and started to learn my own needs and apnea in general. I've come a long way over the next 7-8 years with virtually 100% use, AHI in the 1.6 range over 10,000 hours+, and a straight CPAP setting of 18.

I now have a brand new S9 autoset that I got via a site that will have a doctor issue an Rx for those who do not have one based on a survey of sleep habits and prior CPAP use. It ran me around $1000 total including Rx fees. Worth it, and I paid out of my pocket. I will now attempt to apply that toward my medical deductable (I would have had to pay anyway) so that some of that is covered for the year. The machine is WONDERFUL and I am sleeping best ever! I'm auto adjusting between 14-18 and using a #2 setting on the exhaust breathing cycle with humidity at 4. My AHI is now below 1.6 (had a .5 Sunday night!) and the SILENT machine is a blessing.

GO AUTO if you can!
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#8
SleepyDreamCatcher,

The very first thing you need to do is read JanKnitz's What you need to know before you meet your DME. DMEs are notorious for trying to tell new OSA patients a variety of misleading statements to out right bald-faced lies about the equipment that the DME has "selected" for the patient with little or no input from the patient him/herself.

Yes, it would be nice to get a Resmed S9 AutoSet or PR System One Auto CPAP. But the more critical thing is to get a machine that records full efficacy data instead of just usage (or compliance) data. So the bright line in the sand is really the difference between getting a Resmed S9 ELITE instead of a Resmed Escape. Or a PR System One PRO CPAP instead of a PR System One PLUS CPAP (or the even more primitive PR System One SE CPAP).

You write:
(05-05-2014, 11:45 PM)SleepyDreamCatcher Wrote: I spent a very nice half hour with the tech?... nurse?... finally reviewing my titration study, getting and getting copies of all my paperwork and finally the script for the machine. It states a CPAP with a pressure of 6, advanced data capable, heated humidifier & hose, and mask of my choice.
The fact that the scrip specifies "advanced data" is encouraging. That ought to tell the DME that you need a machine with full efficacy data. But there's still a chance that someone will try to tell you that an S9 Escape has "advanced" data because, after all, there's an SD card in its back ....

But the bigger potential problem is that someone at the DME may decide to try to appease your desire for an APAP by selling you a Resmed S9 Escape Auto. And they'll claim (correctly) that it records AHI data. But they won't mention that the AHI data is just summary data---it's not broken down into the number of OAs, Hs, and CAs you had. And there's no flow limitation data. And there's no snoring data. And most important: There's no leak data recorded on the S9 Escape Auto.

So if the choice comes down to an S9 Elite (fixed pressure, but all the efficacy data) or an S9 Escape Auto, you would be way better off getting the S9 Elite.


Quote:My question, is should I still request from the DME to get an APAP & set it to work as a CPAP?
Yes. You can ask the DME to sell you an APAP and set it to CPAP mode. Some very nice DMEs routinely set up all their new patients/customers with a full efficacy data APAP set up in CPAP mode.

But as I said earlier, you need to be very cautious that the DME doesn't try to sell you the S9 Escape Auto if you insist that they must give you an APAP.


Quote:I know from the reading I've been doing over the past few weeks here & on other sites that the majority feel the APAP is a better machine, but with my low pressure needs, is it really needed?
Maybe, maybe not. Some people do better on APAP; some do better on straight CPAP. For a lot of people it really doesn't matter that much.

Quote:I feel sure the DME is going to want to give me an S9 Elite or the RemStar Pro.
Do NOT expect anything from the DME until you verify the exact model number of the machine they are selling you. While many DMEs are excellent, there are enough really bad DMEs out there to give the whole industry a big black eye. There are many people on these boards who will tell you about DMEs that make slimy used car dealers seem to be honest, forthright salesmen by comparison.

Quote:I dislike confrontations, but at the same time want what is going to be best for me. If this is a battle I need to fight I will... but I really just want to get a machine to get started on so that I can start feeling better. I'm so ready to get started.
No one wants a confrontation when they've just been diagnosed with a serious, chronic condition. But a certain percentage of DMEs seem to take advantage of their new CPAP customers simply because so few of them ever make a stink about being provided the cheapest equipment the DME can sell them.

And since the process of switching out a machine you later decide you don't want (because it does not record full efficacy data) is very difficult at most DMEs, it's critically important that you have the knowledge and the will power to walk away without a machine if the only machine(s) the DME is willing to sell you are machines that you already know are NOT acceptable. In other words, if the DME pulls a fast one and tries to convince you to accept a Resmed S9 Escape, an S9 Escape Auto, a PR System One Plus, or a PR System One SE, you're better off saying you refuse to take delivery and that you plan on purchasing your equipment from another DME.


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#9
I have been using ResMed Elite set at 6 since I started in February and have had no problems.
I don't understand what you mean retired_guy about a straight 6 not being good.
I have not found that a heavy force.

(PS retired_guy how did you go with your Airfit P10, did I miss your follow up comment?)
Sleep Tight...
Gabby
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#10
(05-05-2014, 11:45 PM)SleepyDreamCatcher Wrote: When I asked why a CPAP and not an APAP the tech? told me that I didn't need the APAP because the level of pressure I needed was so low and the titration study showed that it stopped all the events & snoring.

My question, is should I still request from the DME to get an APAP & set it to work as a CPAP?
The tech is right, at such low pressure APAP is not needed and you,re also on the right tracks in requesting APAP

The most important is to ensure the machine collect efficacy data such as AHI and leak data, this is something worth fighting for

The other important thing is mask choice, mask that feel comfortable and seal well is essential for successful treatment


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