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New and overwhelmed
#1
Exclaimation 
Hello, all -

I'm brand-spanking new at this...recv'd dx last week. My "Certificate of Medical Necessity" states that I need an auto-titrating machine at 5-15 pressure. My insurance coverage for DME is not great - have to meet my $2400 deductible, then I pay 50% of the cost of the machine for 10 months (at which time they say it should be paid in full). On the other hand, my health system sells used units for $350 (they quoted a Resperonics), then another $200-250 for mask, tube, etc... Now I'm doing some checking on some of the cpap resale sites, which look like even better pricing. My problem is that I don't know exactly what I'm looking at. For instance:
1.) is "auto set" the same thing as auto titrate?
2.) C-flex and A-flex...my order didn't say anything about either one. Do all machines have one or the other, or do some have neither?
3.) do all machines work with software? Am I supposed to be interpreting the data myself??

Thanks for the help. I'm sure I'll have *many* more questions along the way!

Cheers
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#2
Brewgirll68: Welcome

Quote:1.) is "auto set" the same thing as auto titrate?

Yes, there are several names for the same thing, trademarks and all.

Quote:2.) C-flex and A-flex...my order didn't say anything about either one. Do all machines have one or the other, or do some have neither


I am not sure if all machines have this. This is a form of pressure reduction on exhalation as a comfort feature.. Respironics calls it A-Flex and C-flex (different wave forms). Resmed calls it EPR. I used it when I started, I don't anymore.


Quote:3.) do all machines work with software? Am I supposed to be interpreting the data myself??
No you need a "data capable" machine, which costs a bit more:
http://www.apneaboard.com/wiki/index.php...e_Machines

You don't need to interpret the data yourself, but no one else will. Who else will care more about your health?
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#3
Hi brewgirl68,
Welcome to Apnea Board!

You can definetly purchase a machine cheaper through Online suppliers than with your insurance.
Check out the suppliers list to compare prices.
http://www.apneaboard.com/forums/Thread-...plier-List

EPR/Flex are comfort settings. EPR is ResMed's exhale relief pressure and AFlex is the term that Phillips Respironics uses.

Be sure you purchase a fully data capable Auto Machine, and my advice would be to stick with one of the two major brands.....either ResMed or Phillips Respironics, which then you should not have problems using the free SleepyHead software offered here. With the help here on this forum, you will quickly learn to interpret the data yourself.

Here is a link that lists machines available and which one to avoid.
http://www.apneaboard.com/wiki/index.php...ne_Choices
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
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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.




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#4
G'day Brewgirl, welcome to Apnea Board. Yes, it can be overwhelming when you start out, but it does get easier with practice. Sometimes it takes a while before all the stars align and everything works properly, but keep at it and ask as many questions as you like.

Just to expand on the answers given above, all current cpap machines have some kind of software, but some are so limited as to be nearly useless. To be sure of good software support stick with the big two - Resmed and Philips Respironics. They have their own software (ResScan and Encore), and are also supported by an excellent third party software called SleepyHead. You can download Sleepyhead from the link at the top of this page. Note that the base models have extremely limited data capacity - that's why we call them "bricks". Use the links given by Chill and Opal Rose to select good data capable machines.

Note that there are some excellent machines made by other manufacturers but because Resmed and Respironics are the most popular, it's easiest to get support for them.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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.
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#5
Thank you all so much! I stayed up until the wee hours of the morning going down the rabbit-hole of research. If sleep deprivation doesn't make me foggy, all of this new information sure will :-)

One lingering question...how do I know if a machine is capable of supporting a heated hose? Is any machine able to, or is it something that is specifically called out in the description?

Cheers!
sheila
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#6
Hi , brewgirl688,
WELCOME! to the forum.!
I know all of this can be overwhelming but, you seem eager to learn, so you'll get there.
Hang in there for more answers to your questions and much success to you and good luck on your machine decision.
trish6hundred
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#7
Some things are simple, if not buried in the details.
1. read up and then ask here before buying.
2. for "most" people a regular APAP (auto machine) is fine, for some of us we need a BiLevel machine. I you go through insurance and it turns out you need the BiLevel you can just bring back your regular unit and pick up the BiLevel-it's a rental. If you buy outright then you are left with trying to sell it in the gray or aftermarket and buying another unit. This can be a risk/reward kind of thing and you "may" end up spending more.
3.Machines will say if they have a humidifier and heated hose, ask here to be sure once you figure out what you think you want

What you think you want:
1. data capable-for sure
2. ResMed or Resperionics- they "do" the same thing for treatment. How they do it is different and some people like each and others don't really care. They will both treat your apnea, you will only know one is better than the other for you if you try them. I have heard people talking about liking on verses the other, but can't remember anyone saying they changed because they could not deal with the first machine brand they got.
3. Tolerating the machine is the big thing, once treated will you use it? for some this is a big issue, others take to it like a duck to water.
4. there are many settings on both machines to help you tolerate therapy
5. Auto titrate is just basically giving the machine a range of pressure settings (5-15) and it will monitor you and adjust within that range to the pressure you need right then. Fixed CPAP sets one pressure and ALWAYS stays there. The auto machines can be set to fixed, but the fixed cannot be set to auto.
6. your doctor will monitor your machine and should have you bring it in to look at the detailed data, do not expect them to do everything, they just don't have the time and much of this will be what makes you comfortable and they just cannot know that.

1. read all you want and then just pick a brand. Your Doctor/DME will have one they work with mainly because they are used to the software from that vendor and this has nothing to do with your case personally. Find out which brand they suggest and make life easier for them and you.
2. verify that it is data capable and has a humidifier and heated hose (don't "need" but makes it nicer bay far"
3. decide if you use insurance/rental or direct buy. Flip a coin if you have to, your call based on risk of needing another one (most are indeed fine with the first one)
4. you could also buy the machine with insurance and mask on line (most offer 30 day trials)
5. stick with this thread so we can follow how you are doing and remember what you are doing Smile
6. many here are happy to help, we will get it working
7. you will need an SD card reader, you may already have one on your PC, if not they are under $10
8. sleephead software is free, you will need to install it. At first just so you can show us graphs of how you are doing so we can make suggestions. Pick it up as you go, you will "get it" after a while.
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#8
Thank you all so much!

I think I've decided to go with a pre-owned machine from an online supplier. However - and this may sound silly - how do I know what to do when I get it? My local DME would have scheduled 1.5 hours to go over everything - use, cleaning, etc... But if I get a pre-owned unit, I'm on my own to figure it out. I really have no clue what is involved - maybe it's easy, maybe it's not.

Should I rethink going online for my first one? I can get a pre-owned unit from my local DME for $350, then the humidifier is $75. Then tubing, face mask, etc...is on top of that.

Good grief, I feel dumb!
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#9
I recommend going to the DME for the mask - once. They'll fit you for one, and it's easy to swap out until you find one that works best for you. They should explain all the adjustments and cleaning procedures for you, too. After that, mail order replacements. The hose generally comes with the machine.

The setup for the CPAP: when you order yours, you'll make a copy of your prescription for the supplier, they'll configure it for your settings. When you get it, you'll be ready to go. BUT, there will be "comfort" settings that can be adjusted by you (like the "flex" settings), and for those you can get all your support on this board.
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#10
Hi, brewgirl68. Can you find out exactly what model of machine your DME is selling for $350? You'll also want to know how many hours of use it has on it. If it's a Respironics machine, it probably should be a System One 560 model. The DreamStation machines are the newer models, but it seems unlikely that one of those would be going for $350.

I can see how it could be beneficial to go through the DME to buy your first machine. If you decide to do that, though, I would ask them for a complete cost estimate for all the items that you will need before you make a decision. They tend to mark up the price on things hugely - Respironics machines have two air filters - tiny things, about 2"x1". My DME charged $12 for one filter and $6 for the one that has to be changed every month. I later bought 12 of the monthly-use filters online for $6.

I was feeling very brain-fogged when I first got my machine, but it's not hard to set up. The user manuals (there are two - one for the consumer and one for the clinician - a DME typically will not give you the clinician manual, but you can get it via this site - see link at top of page) explain really well how to set up the machine and use it. There are also a lot of videos floating around on YouTube that help with things.

I had more problems getting my mask on and adjusted correctly when I got home than I had with the CPAP machine itself.

This forum is a great resource. It's really good that you found it before you bought your machine.

There are lots of details to take in when you start CPAP therapy. It just takes time, and there will probably be some errors and re-dos along the way. The fact that so many of us are having memory problems and fatigue from the untreated sleep apnea during the period when we are shopping for the machine and first mask makes it lots more difficult.

You sound like you're doing very well so far. Smile

(07-20-2016, 02:54 PM)brewgirl68 Wrote: Thank you all so much!

I think I've decided to go with a pre-owned machine from an online supplier. However - and this may sound silly - how do I know what to do when I get it? My local DME would have scheduled 1.5 hours to go over everything - use, cleaning, etc... But if I get a pre-owned unit, I'm on my own to figure it out. I really have no clue what is involved - maybe it's easy, maybe it's not.

Should I rethink going online for my first one? I can get a pre-owned unit from my local DME for $350, then the humidifier is $75. Then tubing, face mask, etc...is on top of that.

Good grief, I feel dumb!

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