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What first-time questions do I ask the doc?
#1
Hello.

Very new here.  Just turned 65.  I did an at-home sleep-study over the time change weekend, and just today received a call from a CPAP provider that my doctor has ordered a machine for me.
I have not seen the test report, nor have I spoken to my doc.  Appointment is Thursday.
Scared, depressed, anxious, still trying to accept it - I suppose going through the range of emotions all of you have experienced.
Doing some web research on what it is all about.
I've read through the wiki here, and I like the pro self-management ability I see.

What are the important questions I need to ask my doctor? 


Thanks for your responses.  I'll try to contribute to the board as I venture farther on this new journey.
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#2
First thing first. Call your cpap provider and ask what machine the doctor has ordered you. You want to be sure to get a machine that works with Sleepyhead, so look at the links at the top for the list. Basically, an auto-machine with efficacy data.

Many DMEs don't understand that efficacy means the additional wave form data over and above the compliance information. Don't settle for less or you will be stuck with a machine you won't be able to adjust!

If the machine is not what you want, you want to contact the doctor's office and ask him to change the prescription to such and such machine (I personally recommend the Resmed for Her, but there are others).

While you are on the phone with the DME, ask them about their return policy on masks. In other words, if you find one doesn't work for you, how long do you have to exchange it for another?
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#3
Questions for your doc:

Ask for an explanation of the results. On a scale of mild to extreme, how is your sleep apnea? Is it obstructive, central, mixed? Why did he prescribe the pressure settings he did? Why did he select the particular CPAP he did? What kind of adjustments will he be willing to allow you to make for your own convenience, comfort, and experimentation?

At the DME: try on a few masks, if possible. Ask which one they've had the best success with. Mention of you sleep on your back, side, or stomach and ask which mask generally works best for that position. Ask about exchanges (it took me 3 times before I found a mask that worked for me).

Will you own the machine or rent it?
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#4
I already don't like your Doctor. He has no business ordering a machine for you without first meeting with you to discuss options.

One of those options is which machine you select and who you select it from. Don't accept any machine until you've had a chance to look around and see who you want to deal with.

Also demand your Doctor write the prescription for a full Data Auto Cpap.

Also get a full copy of your sleep report and prescription. They have to do that according to law.

Welcome to the Board.
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#5
Hi Acheron2010,
WELCOME! to the forum.!
Ask what machine you are getting, you want to get an AutoPAP machine, such as The Resmed Airsense10 AutoSet, or the Respironics DreamStation Auto, (I never can remember the complete model number of that one.)
Good luck as you start your CPAP journey, hang in there for more suggestions.
trish6hundred
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#6
All of the above and just about anything you can think of.
Write the questions down and ask them, there is no question silly when it comes to Sleep Apnea.
After 20 odd years I am still learning something new every day, so someone new to it could not be expected to know it all, so do ask any question you can think of.
I tested three machines just lately (my own preference) an S9 Auto, a Dreamstation Auto, and an ResMed Airsense10 Auto.
I chose the Airsense10 auto over the Dreamstation, not that there was a lot between them performance wise, but the Airsense10 just had the edge and I think slightly quicker to respond and was a lot more compact than the S9 which had a big bulky clip on humidifier (which I found awkward) the Dreamstation worked ok, but the Airsense was so quiet I sometimes woke up and wondered if it was still working!
The only drawback for me with the Airsense10 was it ran on 24Vdc and the convertor power supply cost fat to much for what it is to convert from 24Vdc to 12Vdc.  My old machine ran on 12Vdc which was very handy and didn't need a fancy plug for the 12Vdc.
If you go camping, boating, or use a motorhome you might want to keep this in mind as well, though it can be worked around.
Some, but not all motorhomes and boats use 24Vdc but not all.  Just some things you may need to think about.

I would find out if you tend to breath through your mouth, this will have an impact on what masks to use.
The biggest problem people usually have is the mask, if you can, look at as many as they stock.
If you breath through your nose, the Nasal Pillows are easier to get on with than the Nasal Mask.
You may need a chin strap to keep your mouth shut even though you normally breath through your nose, when you sleep everything relaxes and the mouth drops open, you may still breathe through your mouth, but with air at a set pressure keeping your throat from closing, it will leak out of your mouth.

When I was in at the hospital not long ago I tried quite a few Nasal Pillows and Nasal masks.
I found the Swift FX (Soft) Nasal Pillows very easy to use (except the hose goes down from the Nasal Pillows, I like the hose to go over the head.  I kept pulling on the hose by accident and pulling the Pillows away from my nose.  So I taped the hose to the side I never sleep on, but kept the hose on a wide loop, this worked like a charm) have a look at these and as many masks as you can.
Do not be shy in asking questions here, I find they do their best to help and are a good bunch.  After you get sorted out, you can learn how to get Sleepyhead software to read your data of your sleep and post your charts so they can give you some more help.
But this will come in due time, first get sorted out with some good kit.

As for as equipment goes, go with what you are most comfortable with, though I do believe there is often problems with insurance over there if you are in America and some other countries.

Ask the doctor what he would go for if he were you?  If he points you towards a Resmed Airsense10 Auto or a Dreamstation Auto, he/she may be worth listening to, otherwise he/she might be just looking at their profit margins.

Welcome to the forum!

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#7
Do US docs write a scrip for a particular machine? Mine didn't but that was many years ago. He wrote the scrip for a pressure setting, no particular CPAP - that was between me and the DME.
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#8
(11-14-2017, 09:05 PM)KSMatthew Wrote: Do US docs write a scrip for a particular machine?  Mine didn't but that was many years ago.  He wrote the scrip  for a pressure setting, no particular CPAP - that was between me and the DME.

Yes they'll write a script for a particular machine. Just ask. Mine originally wrote a description that was so specific only one unit would fit the bill, but at my request, she threw in the exact name (see my info in sidebar).

Medicare? Medicare pays the same for the machine whether it's low end or high end. Get high end!

Look in the Wiki (in the menu) and get a mini list of machines to make sure you ask for. There are two APAPs that make the top of the list: a Resmed Airsense 10 Autoset and a Phillips Respironics Dreamstation (whose exact name I'm unfamiliar with since I use Resmed). If you take a note to yourself (advised) to your doctor visit make sure you write every single word in the name (many units have similar-sounding names).

Read instrux on this site before you pick up your unit at the DME, so they don't even try to rip you off.

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Get at least the sleep test summary from the sleep doc. It's yours under the law. If your clinic has online access, while you're working on health matters, get an online account. Then you can look up doctor's notes and test results whenever. This is all part of taking charge of your health.

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Ask the doctor to explain clearly what any of the terms mean, especially obstructive sleep apnea, central sleep apnea, hypopnea, oxygen desaturation. What might be helpful is if s/he can give you concrete information (with gestures, body parts, graphics, etc.) what happens during each event. This forum has a lot of definitions and sleep graphics, but sometimes IME it's difficult to visualize exactly what that means on a body.
Ask what you need to pay attention to the most.
Get a clear printout of what the compliance requirements are for Medicare.
Find out how to communicate with your sleep doc for follow-up questions or what would be a cause for concern.

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Before you go (or soon) look at your face in the mirror, so you have a good idea what kinds of mask headgear might or might not work with your facial structure. This will go a long way to helping you disqualify a LOT of masks.

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Camping/travel: I camp ALOT (up to 100 nights a year). I didn't let camping dictate the choice of machine, since there's plenty of advice here on how to make it happen. You may need an adapter, or you might not, depending on which machine you get and what your electric source is.

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And, yes, absolutely, your feelings are likely to be all over the place. You will find plenty of fellow-glad-sad-scared-wowed-anxious-depressed-thrilled-posters here.
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#9
Read the links in my signature.  The "New to Apnea" link contains a lot of info on what to expect. 
The "Mask Primer", well the mask is the interface that delivers the therapy.  If your facial structure was 100% identical to mine I would have no issue recommending a mask, but I have this strange suspicion that your face is different from mine.  Masks MUST be tried on and tried on under pressure, preferably while lying down in sleeping position.  My suggestion is to try masks on from least intrusive (nasal pillows) to most intrusive (Full Face Mask).  Nasal masks are in between.  The correct mask is the one that works for you, NOT ME.

Try different masks at EVERY chance you get.


on machines

(best choice) indicates a full data capable machine that has Sleepyhead software capability and an Auto Mode.  These are in general the best available machines

Always specify the exact machine you wish, This removes all ambiguities and prevents substitutions.
DAW (Dispense as Written) prevents substitutions.
General Information on DreamStation Models from Philips Respironics
Current acceptable in Production Machines (ResMed and Philips Respironics, the 2 most popular manufactures)
  • ResMed AirSense 10 AutoSet (best choice) (E0601) (Fixed CPAP, Auto CPAP)
  • ResMed AirSense 10 AutoSet for Her (best choice) (E0601) (Fixed CPAP, Auto CPAP)
  • ResMed AirSense™ 10 Elite CPAP Machine with HumidAir™ Heated Humidifier (37205) (E0601) (Fixed CPAP)
  • Philips Respironics DreamStation Auto CPAP Machine (DSX500x11) (Not all DreamStation Models, Check SN on bottom, bricks look the same) (Fixed CPAP, Auto CPAP(best choice)
  • Philips Respironics DreamStation CPAP Pro (DSX400x11) (Not all DreamStation Models, Check SN on bottom) (Fixed CPAP)

Current Machines to Avoid

  • Any ResMed AirStart (Lack of full data capability)

  • ResMed AirStart™ 10 CPAP Machine with HumidAir™ Heated Humidifier (all models, 37201) (Lack of full data capability)

  • ResMed AirSense™ 10 CPAP Machine with HumidAir™ (37015, 37203) (Lack of full data capability)

  • Philips Respironics DreamStation CPAP (DSX200x11) (Not all DreamStation Models, Check SN on bottom) (Lack of full data capability)
Note: These are current machines, there are older models that have full data capability that are available via secondary markets if budget is an issue. Please inquire on the forum and your questions will be answered.

that said,  most here recommend the ResMed over the Philips Respironics machine for 2 reasons, The ResMed responds faster to events and the Pressure relief (EPR) seems to give better results, but any of the highlighted machines will work.

NOW is when you can influence which machine you get.

Fred
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#10
(11-14-2017, 04:02 PM)Acheron2010 Wrote: ... and just today received a call from a CPAP provider that my doctor has ordered a machine for me.

Notice that the call came from the cpap provider (DME), not the doctor's office.

You have a right to choose whatever DME you wish, according to your insurance coverage. Normally the doctor's orders only specify the type of machine unless you've specifically asked him to do otherwise. Some DME's take advantage of this to give you an inferior machine which gives them a higher profit margin (the insurance pays them the same amount, so they make more if they give you a cheap machine).

The links you've been given will explain all of this. I just wanted to point out that you have options. It is not (necessarily) the provider that calls the shots unless you allow them to.
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