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Newbie questions
#11
The DME acronym required a Google search yesterday. Other than crutches, I've never dealt with medical equipment suppliers before.

I did two nights at the sleep center. The first without a CPAP and the second with. They're the ones who dialed in 17 cm H2O. They faxed my information to the DME down the road. I had no input into selection of machine and it appears that since I have fairly gold-plated corporate health insurance, they picked a best-of-breed machine. After I pay the first $500/year deductible, my insurance picks up everything except co-pays so this whole thing is zero cost to me at the moment. The problem is that my employer is pretty shaky and it's not at all clear I'll have this insurance for 13 months. I really needed to know how the machine rent-to-own thing works so I can make an informed decision about the machine rental if I change jobs. The good news is the worst case looks to be $800 out of pocket to buy a new machine on the internet plus replacing filters, mask seals, hoses, etc as needed.

The first night at home, it took hours to fall asleep. I got around 4 hours of sleep and was pretty groggy yesterday. At least I didn't have an AHI of more than 3/hour. Last night, I got 6+ hours of sleep and only had one event all night. Now that I don't have 60 apnea events per hour, I need to re-baseline how much sleep I need. I have always been 8 hours but I likely didn't get much REM sleep. I have some leaking with an hour of sustained 30+ l/m but the average is under 24 l/m threshold. I dialed the ramp back to 10 minutes and will likely put it at 5 for good.

The ResScan software to analyze the data on the SD card is huge. I simply can't believe it isn't made available to users as a matter of course. I'm completely unwilling to go the "use the machine for a month and we'll tell you how you're doing in your office visit to a nurse practitioner" route. For the moment, I think my strategy is going to be to use the sleep center/nurse practitioner to experiment with masks. The Respironics Wisp nasal mask seems to be performing OK but I'd like to try other alternatives to see if I can maximize comfort and minimize leaking.

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#12
Geoff, the rent-to-own thing is mandated by Medicare, and most insurances follow Medicare rules. I wondered about that when I picked up my machine and asked why I have to rent for 13 months and that's what they told me. The only rental item is the machine, the humidifier, mask, hose, etc. are all outright purchases. The amount you pay out-of-pocket is based on your personal insurance and deductibles.
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#13
So that means that if you lose your current insurance, I would think that you could continue the rent yourself until you own it or maybe a new employers insurance might pick up the remaining rental.

Best Regards,

PaytonA♦
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#14
(09-11-2014, 08:16 AM)GeoffD Wrote: The first night at home, it took hours to fall asleep. I got around 4 hours of sleep and was pretty groggy yesterday. At least I didn't have an AHI of more than 3/hour. Last night, I got 6+ hours of sleep and only had one event all night. Now that I don't have 60 apnea events per hour, I need to re-baseline how much sleep I need. I have always been 8 hours but I likely didn't get much REM sleep. I have some leaking with an hour of sustained 30+ l/m but the average is under 24 l/m threshold. I dialed the ramp back to 10 minutes and will likely put it at 5 for good.

The ResScan software to analyze the data on the SD card is huge. I simply can't believe it isn't made available to users as a matter of course. I'm completely unwilling to go the "use the machine for a month and we'll tell you how you're doing in your office visit to a nurse practitioner" route. For the moment, I think my strategy is going to be to use the sleep center/nurse practitioner to experiment with masks. The Respironics Wisp nasal mask seems to be performing OK but I'd like to try other alternatives to see if I can maximize comfort and minimize leaking.

I think after awhile you'll find the ramp is just not needed at all. But, 5 minutes isn't too bad in any case.

Your DME/Docs might groan a little about you using the ResScan software, and tell you how inferior you are to think you can properly use it, but so what?

Using the DME for mask advice is a good idea.

Good start Geoff! Keep up the good work. When you can, post some results for us to stare at with you: Pressure min/max/avg, Ahi, Event makeup (CA vs OA vs Hypop's) Leak numbers....
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#15
(09-11-2014, 11:24 AM)retired_guy Wrote: I think after awhile you'll find the ramp is just not needed at all. But, 5 minutes isn't too bad in any case.

Your DME/Docs might groan a little about you using the ResScan software, and tell you how inferior you are to think you can properly use it, but so what?

Using the DME for mask advice is a good idea.

Good start Geoff! Keep up the good work. When you can, post some results for us to stare at with you: Pressure min/max/avg, Ahi, Event makeup (CA vs OA vs Hypop's) Leak numbers....

I have degrees in Electrical Engineering and Computer Science and a 30+ year professional career. I think that at this point, I think I can handle a fairly trivial piece of lab equipment and the GUI software that sits on top of it. The goal is to tweak the settings and masks to minimize AHI while also having some comfort with a minimal amount of leaks.

Last night, I only had one event in 6+ hours. On the ResScan GUI, it's a little blue hypopnea dot. So my AHI was point.squat. I'm still letting it blast away at 17 cm and haven't enabled AutoSet. Leak median last night was 8.4 with 95th percentile and max leak in the high 30's. The night before, the numbers were a bit invalid because it took me 4 hours to get to sleep with an unfamiliar gadget strapped to my face so the leak data is understated. All the respiratory indices were below 1.

There's no point in posting things up in more detail with screen shots until I get a couple of weeks of baseline with this configuration. It's quite likely that a static 17 setting is too aggressive and I can get away with something more like AutoSet 12/17 or lower but I think it's more important to hold everything constant for a while to collect the data. I think I will just leave it alone until I get with the nurse practitioner in 6 weeks. That way, I'll know for sure whether or not this "phasers set on kill" configuration has occasional nights where I log a much bigger AHI.
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#16
Great attitude and approach Geoff.... I can't think of a thing you could do better than what you have planned.

But keep us informed as to how you're doing.

Afterall, my motto is "if it's broken, fix it. If it's not broken, break it."
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#17
(09-11-2014, 11:15 AM)PaytonA Wrote: So that means that if you lose your current insurance, I would think that you could continue the rent yourself until you own it or maybe a new employers insurance might pick up the remaining rental.

It's hard to say. I just wanted to know the worst case if I had to pay cash for a CPAP machine. That number is $724.00 at Supplier #1.

If I do change jobs and end up with crap insurance, I likely have a lot of leverage with the DME. They don't want to eat a used CPAP machine so I'd think they would be motivated to strike a cash deal with me.
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#18
Good luck in your quest! Be aware that the standard disclaimer is that a leakage rate >24 L/min may cause the data to score inaccurately. I've found that statement to be a bit on the optimistic side. I don't trust the event scoring when leaks get >12 L/min. I also don't trust the event scoring when the pressure is set unnecessarily high, since I tend to get lots of "wide awake" or "half asleep" CA events under those conditions. Maybe that's just me but there it is, in case it comes up during your journey.

Again, good luck and post back to let us know how you're doing. Sharing your experience on a forum like this can help many others with the same issues. These little black boxes can be hard to crack on your own but the resources available on this forum can save you a lot of grief. Feel free to use it fully!



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#19
(09-10-2014, 04:01 PM)GeoffD Wrote: Are most people just sheep who allow this nonsense?

It depends on what kind of a deal you can get. My co-pay is outrageously small so I get all the supplies I can every time I can. I have a stockpile.

My insurance company paid for all but about $390 for my first machine and mask. After that I started buying them on craigslist and now have a collection of four.

One I use, one is a back up, one is broken but still works, and I probably should sell the other one but I keep it in case a friend or family member might need it.

Sleepster
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#20
Thanks for the info on the forum. It certainly helps in trying to set up my machine.

I had a sleep test. Yes, you have apneas. Heres a machine, good luck. Huhsign

So I purchased my new machine and will fend for myself. It will be interesting to see what data is generated since I have chosen my own settings.

Happy days ( or should I say nights)
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