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Veteran PAP User, New DME
#1
I have been using positive air pressure therapy since 2008. Today, nearly 8-years later, I picked up my first insurance replacement, a Resmed Aircurve 10 Vauto. I thought I'd tell the story in case it helps anyone else.

My original M-Series Auto was just retired in December 2014 when I bought a used PRS1 Auto (560) on another forum. That was followed by a PRS1 BiPAP Auto (760) purchased via local Craigslist, and upgraded with the heated hose retrofit kit. This machine has worked great since January 2015. With the auto bilevel, my AHI and RERA are much lower than with CPAP (more for RERA). I have some residual CA events but obstructive stuff is pretty limited, and I feel pretty good these days. I don't obsess over PAP therapy, but have paid more attention to data and results over the last year than I used to. It wasn't easy to check the Smartcard data anyway.

So the hard part was getting approval for the auto bilevel, when my original prescription was for auto CPAP. I have not had any sleep tests since 2008, but used the Respironics Encore data to document efficacy, and improved therapy with bilevel. I knew it worked better, but proof is needed for insurance. I recruited my primary physician as my sleep doctor, and provided him with written summaries of the bilevel benefits along with summary data from Encore. In order to qualify for bilevel his notes had to state I did not tolerate CPAP, which is a bit of a stretch, but therapy is improved with bilevel. I also wrote my proposed prescription information including machine type, humidifier, heated hose, mask, filters and supplies with insurance codes. I had his office submit the prescription to the new DME, Remworks.

Of course insurance denied the upgrade, but approved auto CPAP, which I declined. It took a couple more submittals by Remworks to finally get the approval for the auto bilevel, which came in today.

So, I set an appointment for noon, and after running some important errands (like changing oil, transmission fluid and picking up some beer), arrived for an appointment with the RT. I had a choice of the PRS1 760 or Resmed Aircurve 10 Vauto. I selected the Resmed (brand agnostic), and we reviewed settings and equipment. The machine was not originally set to auto mode and no climateline hose was included. We discussed it, and the RT found the DME form from the doctor had those items included and made appropriate changes. So, bottom line is, tonight will be a new machine.

I really appreciate my doctor for working with me and respecting my knowledge of my needs and incorporating those into my health record and prescriptions. Remworks is a new DME in the area and is owned by the BCBS affiliate Highmark. Great staff and an inviting comfortable store and service center, and they kept after it when Aetna originally denied the bilevel. The RT was very knowledgeable and had good empathy for patients. So, this is what a DME should look like today.

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#2
Hi Sleeprider,
That's great to hear, you are certainly proof that perseverance pays off, for sure.
Good luck to you with the new machine and CONGRATULATIONS.!
It will be interesting to hear how things go for you, hopefully, you will post your comparisons between the different machine.
Sleep well.!
trish6hundred
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#3
The inside looks like they are a dept. store that makes money from an illness. Imagine there was a dept. store for other illnesses like cancer.
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#4
I think it is a lot more approachable for most people that need sleep disordered breathing therapy. Nothing wrong with normalizing this health issue to improve its acceptance and support the people using it with easy access and assistance. Consider that lots of forum members struggle with leaking masks. Well when you shop at REMworks, someone can answer your questions, show you different mask liners, let you touch and try the products. Also when you are prescribed a machine, you can look at the options and make a choice. Choice is empowerment and gives patients ownership in the process. Similarly, if something needs adjusted or there is a problem, you can call or walk-in and not feel like you're imposing or need an appointment. This is a retail establishment with the RT services behind the showroom.
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#5
First night impressions, results and comparison between the PRS1 760 and Aircurve 10 Vauto: Both machines were setup similarly in auto mode with EPAPmin 9, IPAPmax 18, and PS 4 (PRS1 used a PS range of 4-6). AHI was low 1.07 compared to an average of 1.38 over the past week with the PRS1. That is within normal variation, so I don't expect AHI to increase or decrease with the machine change. Time will tell. The PRS1 scores more CA, and the Resmed more OA, with hypopnea about the same. The Resmed does not score RERA which is a bit of a disappointment.

Most treatment parameters are the same, with both machines recording the same average and 95% IPAP, but Resmed kept EPAP about 1.0 cm higher. Overall comfort is similar, however I am more aware of the PRS1 occasionally not syncing with inspiration and expiration. If I have a prolonged exhale with low flow at the end, the PRS1 will often boost pressure and I'll respond with an inhale. I don't get that with Resmed which is imperceptible and seems to work more closely with me.

QUIET! Resmed is far quieter, in fact the machine itself is inaudible compared to the PRS1 which can be heard changing pitch on each breath.

Resmed pressure changes are much faster, and of course IPAP and EPAP move together, and PS is constant, compared to PRS1 which seems to hold a much more even pressure through the night except for the 2-cm IPAP pressure fluctuations built into the algorithm. When the PRS1 changes pressure, it does so much more slowly.

I'll refine this as I get more experience. The take-away is both machines are equally capable of treatment, and differences are subtle, with a slight advantage to Resmed for being quieter and working more in sych with my breathing pattern.
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#6
(02-25-2016, 10:34 AM)Sleeprider Wrote: I'll refine this as I get more experience. The take-away is both machines are equally capable of treatment, and differences are subtle, with a slight advantage to Resmed for being quieter and working more in sych with my breathing pattern.

Both your settings and your experiences with the two machines are much like mine. I had a 760 for one week on trial, but chose the AC 10 for purchase. I too found the Resmed breath sync to be more comfortable, but both machines were very nice. I really didn't want to give the 760 back when my one-week trial was over.
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#7
Nice to hear the confirmation. I'm kind of fine-tuning things as last night was 2.07 AHI (mostly CA). Last night the leak rate was better, humidity improved, and it felt great, but AHI was higher. The Resmed is really finicky over leaks.

Oh, my Resmed MyAir score = 100 FWIW. What a worthless program.
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#8
(02-25-2016, 03:53 AM)player Wrote: The inside looks like they are a dept. store that makes money from an illness. Imagine there was a dept. store for other illnesses like cancer.

Actually, we have at least one of those locally that focuses on breast cancer patients. Much more comfortable shopping experience for a woman who has lost a breast and her hair to select a wig, hat, mastectomy products or specialty apparel. They are already emotionally devastated so making it a 'normal' environment helps.

Unfortunately, with cpaps and Medicare, you are stuck with limited options and often, getting choices of masks is like pulling teeth. I would LOVE to go to one of my local DMEs instead of across town, but since I'm in a Medicare Bid area, I'd have to pay out-of-pocket at premium prices to go local. So, I go via online for my try-outs.
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#9
Sounds like you have a good DME Sleeprider. That's half the battle. Glad you are happy with your purchase!
APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

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EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
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#10
The good ones are few and far between unfortunately. I talk to a lot of forum members not so fortunate. Imagine being new to this and your DME sticks you with a Made in China CPAP instead of a widely accepted brand like Resmed or Philips Respironics. REMworks seems to be about good patient education and they talked with me on my level which is pretty advanced. I'm sure they can dumb it down, but it was refreshing to be treated that way.
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