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manich (Therapy Thread)
#1
manich (Therapy Thread)
Newbie here. 

I started my journey toward a cpap in Feb. After first consult got scheduled for sleep study in March with followup in April. Got scheduled for a sleep study using cpap in June, last week, and followup and Rx sent to local DME this Monday. DME says all they can acquire now are Luna and ResVent. But they say they can't call me back for scheduling until end of next week. Then, I think, I might be looking at my DME appt in July, and maybe getting a "2nd tier" cpap in August. Should I try online suppliers to see if things move along a little faster, or is this just the way it is? If I pay cash now, with online dealer, is it too much hassle to get Medicare reimbursement? Do I need more patience with this process?  I worry by August, supplies could be worse.

With ResMed out of stock, and Phillips "shut down", what would the boards' recommendation be between Luna and ResVent, or other?
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#2
manich (Therapy Thread)
Hi manich!  -  Welcome

First question that comes to mind is, there aren't any Resmed AS11s available?  

As far as I'm aware, any online procurement is not insurance or Medicare reimbursable.  If you go this route, expect to pay out-of-pocket.  As an alternative, look for used Resmed AirSense 10 Autoset (or the "For Her") models with low hours.  Low hours can be assumed to be reported machine time divided by about 7.5 hours (average per night sleep session).  The devices can reach 1an average of 18,500 hours in their lifespan (18500/7.5/365.25= 6.75 years).  They can be found at Supplier #2, OfferUp, CraigsList, Market Place, and a DME clearing website named, "dotmed".  An easy way to search most of the previous suggestions is to use, searchtempest.com.  It will search all the mainstream "For-Sale" sites in one search.

Good luck!
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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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#3
manich (Therapy Thread)
Hi manich, my former boss was very selective regarding brands she would stock, and amongst the usuals (being ResMed and Philips) there were F&P and DeVilbiss machines. However having said that, the first step is to ensure the machine you’re looking to buy can deliver the prescriptive requirements you need - different machines exist to serve different therapeutic needs based on the type of sleep breathing disorder that is present. This is why sleep studies are done: to determine the type of breathing issues, then (if a titration study is undertaken as well) to determine the pressure and settings requirements.
Trialling of rental equipment is often times a good idea, because it gives the opportunity to see if it’s comfortable and practical to use, as well as ensuring the prescription settings are working for you (if either of these are not working for you, then having trial/rental equipment to start with allows a change of settings or brand/type of machine to ensure you’re getting the correct treatment).
I was wondering if you have a copy of your study results/titration or your prescription that you might like to share with us please..?
This might help in answering your question with some level of accuracy within the scope of what can be provided here.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE EVEN WHEN COMING FROM A MEDICAL PROFESSIONAL. ALWAYS SEEK THE ADVICE OF YOUR OWN 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
manich (Therapy Thread)
Call Hart Medical.  They will ship to you and accept Medicare.

IMHO because of data access you want a ResMed
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#5
manich (Therapy Thread)
(06-23-2022, 10:17 AM)Peach25 Wrote: I was wondering if you have a copy of your study results/titration or your prescription that you might like to share with us please..?
This might help in answering your question with some level of accuracy within the scope of what can be provided here.
Initial sleep study. Moderate sleep apnea, CSA and OSA

MD impressions using ResMed CPAP: G47.33 OSA, Overall AHI of 7.5/hr.(high due to being awake 3.5 of 7 hr test)
MD recommendations: CPAP at 11cm H2O. Expiratory pressure reduction, ResMed N30i mask
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#6
manich (Therapy Thread)
Do you know the amount of CSR in the initial study..? With that ICD-10 code for OSA from the specialist, I’m presuming there wasn’t a significant quantity of CSA…however (and I do apologise for banging on about this) I do think it would be a good idea to trial/rent a machine from a provider for a month or so on the prescription before purchasing your own, just to make sure it’s treating what it needs to (considering all machines aren’t equal in what they can do in terms of range of conditions). I’m not sure about the trial situation where you are, however there might also be opportunities to trial masks before buying too.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE EVEN WHEN COMING FROM A MEDICAL PROFESSIONAL. ALWAYS SEEK THE ADVICE OF YOUR OWN 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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#7
manich (Therapy Thread)
(06-23-2022, 06:04 PM)Peach25 Wrote: Do you know the amount of CSR in the initial study..? With that ICD-10 code for OSA from the specialist, I’m presuming there wasn’t a significant quantity of CSA…

I don't see CSR or CSA on my initial sleep study report. The PA highlighted these:

CA      5.7
Apnea 6.0
A+H  13.2
RERA   8.1
Total  21.3
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#8
manich (Therapy Thread)
My apologies: a typo - CSR should’ve been CSA, and CSA refers to central sleep apnoea (I’m sorry again - I didn’t review my autocorrect’s). 
Thanks for sharing the data; the amount of centrals is worth following regarding initiating therapy for obstructive apnoeas using set pressure: maybe they’ll resolve once you’re on therapy, however in some instances they don’t. The best indicator is if you still feel tired despite being on treatment for a while. Then, it might be worth checking the data, which will be able to show the types of apnoeas occurring (keeping in mind that being able to report the different apnoeas/other events, some machines can’t treat the more complex types). 
My apologies again for not checking the spelling before posting, and for any resultant confusion it may have caused.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE EVEN WHEN COMING FROM A MEDICAL PROFESSIONAL. ALWAYS SEEK THE ADVICE OF YOUR OWN 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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#9
manich (Therapy Thread)
CA = CSA = 5.7 = Central Apnea
OA = 0.3 =. Apnea - CA = 6 - 5.7
H = 7.2 which could be either Obstructive or Central. Most sleep tests do  not distinguish between them.
RERAs = 8.1, a series of flow limitations ending in arousal.  These are typically under reported.

IMHO you should have a diagnosis of CSA. This opens the door for possible treatment with an ASV or a BiLevel with Backup rate.

Making a bad assumption that all of the hypopnoea is obstructive your doc can make a good case for a diagnosis of OSA.  In that case ask him to make a secondary diagnosis of CSA to eliminate the need to take another diagnostic sleep study just to prove you have some central apnea
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#10
RE: manich (Therapy Thread)
Hi manich,
I moved the discussion in the "Machine Choices Thread" and started this new thread for you here. See your PM.
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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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