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[split] Request for Machine Recommendation
#21
(04-26-2015, 12:17 AM)Shvitzer Wrote: My doc wants to see technical info on the A10 Auto, since he says that only someone with inhalation issues (is that Central SA??) can benefit from an Autoset. Since I have Obstructive only, he feels it's not needed. What's the best place to get this info for him?

I'm concerned that, if all I get is a scrip for fixed pressure, Medicare will not pay for the Autoset. Thanx.
I have not got the foggiest idea what the doc is talking about ... AirSense 10 AutoSet might detect both obstructive and central apnea but only designed to treat obstructive apnea, also respond to snoring and flow limitation which are precursors to obstructive apnea (not central apnea). People who diagnosed with central apnea would not be using an AutoSet but rather a different machine amd that different conversation altogether

The AutoSet can deliver two mode of therapy .... fixed pressure or variable pressure
Scroll down to "Functional features" for comparison and specifications of different models
http://www.resmed.com/us/en/commercial-p...toset.html

From: http://www.resmed.com/au/en/consumer/sup...toset.html
Q. What are the benefits of using ResMed’s S9 AutoSet device?
A. AutoSet adjusts pressure on a breath-by-breath basis to suit your personal breathing needs throughout the night. As a result, you receive the minimum pressure required for therapy, and these lower average pressures help to improve comfort.

Q. How does the device know to adjust pressure in AutoSet mode?
A. After you fall asleep and your pressure needs begin to vary, your AutoSet device responds to three separate parameters, based on the degree of airway blockage caused by your sleep apnea: inspiratory flow limitation, snore, and apnea. AutoSet devices automatically increase pressure as airway blockage starts to occur in order to minimise the chances of it developing into apneas.

Don't sell yourself short, ask the doc for AutoSet script and and write "dispense as written" to avoid any confusion
Keep a copy for yourself too ... you never know when you might need it Coffee




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#22
(04-26-2015, 12:17 AM)Shvitzer Wrote: My doc wants to see technical info on the A10 Auto, since he says that only someone with inhalation issues (is that Central SA??) can benefit from an Autoset.

I have no idea what the doc means by "inhalation issues". His claim is so vague as to be meaningless. Like saying only someone with sleep apnea can benefit from CPAP therapy. Well, duhh!

Tell him to call you once he gets that technical info and brings his knowledge far enough up to date that he's in the same decade as the rest of us. When auto-adjusting CPAP machines first came out they of course had to be marketed as a solution to some problem. Naturally they targeted categories of patients for whom CPAP therapy was less than optimal for any reason they could think of that might be remedied by the new technology. Avoiding the cost of a new titration was one of them that I still hear from some health providers.

The fact is that there are a lot of people who have trouble tolerating CPAP therapy for a variety of reasons. This is perhaps the most well-known feature of CPAP therapy and doctors are aware of it because it's by far the biggest obstacle to the effective treatment of sleep apnea. Auto-adjusting CPAP machines allow the user to spend more time at lower pressure thus reducing the problems known to interfere with compliance. It's a real no-brainer. Manufacturers could easily convert their assembly lines to manufacture only auto-adjusting bi-level CPAP machines. It would in fact lower their costs because all they'd have to do is load the same firmware on every machine, but it would prevent them from realizing the profits they get from the marketing scheme of providing a variety of machines with a dizzying array of features. They would have to be forced to make this change. That would have to be done by our elected politicians. They control the medical industry through the laws they create to regulate the practices of insurance companies.

My advice to you is to find a new doctor.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#23
I think that the doc saw "inspiratory flow limitation" as something that the machine responded to and decided that it was a separate issue rather than a precursor to apneas. Now, since you are not suffering from "inspiratory flow limitation" you do not need an autoset.

If you replace the word inspiratory with inhalation you have a new issue that surely must require an autoset. Huhsign I can not believe that some docs can be so unenlightened. Oh-jeez

Best Regards,

PaytonA
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#24
(04-26-2015, 12:17 AM)Shvitzer Wrote: My doc wants to see technical info on the A10 Auto, since he says that only someone with inhalation issues (is that Central SA??) can benefit from an Autoset. Since I have Obstructive only, he feels it's not needed. What's the best place to get this info for him?

Your doc's an idiot. Unfortunately, that's not uncommon. You may need to do a little extra amount of managing your own therapy.

Some people do better on a manual CPAP. Luckily, all auto CPAP machines also work as manual CPAP, or can be adjusted for a narrower pressure range.

Many docs seem to think the only way to use an APAP is to set it for the maximum range of 4-20 cmH2O. That's wrong for most people, and the minimum pressure should be set to something that fixes most of your apnea.

With a properly set auto, your pressure drops when you don't need as much pressure, and raises when you need it. This helps with aerophagia (gas), leaks, discomfort, and some other problems. It can also raise to a higher pressure if your needs change during the night, for instance, when you roll over on your back, or during REM sleep.

(04-26-2015, 12:17 AM)Shvitzer Wrote: I'm concerned that, if all I get is a scrip for fixed pressure, Medicare will not pay for the Autoset. Thanx.

Medicare will probably want you to buy from a local DME (CPAP salesman.) Medicare will pay the DME a fixed amount of money for any CPAP machine, so they tend to want to give you the cheapest machine they can get away with.

Assuming you're going through an in-network DME for your insurance, he can't bill you extra for the APAP, and medicare will pay if you meet the "compliance" requirements.

It's easier to get an APAP if your doctor specifies a pressure range on your prescription. The DME CAN give you an APAP even if the doctor specifies manual pressure, but he doesn't have to. Read through the Useful Links in my signature line at the bottom of this post for some ideas on how to work your way through the insurance minefield.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#25
(04-26-2015, 10:49 PM)archangle Wrote:
(04-26-2015, 12:17 AM)Shvitzer Wrote: My doc wants to see technical info on the A10 Auto, since he says that only someone with inhalation issues (is that Central SA??) can benefit from an Autoset. Since I have Obstructive only, he feels it's not needed. What's the best place to get this info for him?

Your doc's an idiot.

Ha! Best answer nominee!
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#26
Thanks for all the info in the recent posts by zonk, me50, archangle, sleepster, and others. I have given the info, as well as the blurb on the A10 Autoset contained in the ResMed website, to my doc, and we'll see what kind of response I get.
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#27
(04-28-2015, 09:07 PM)Shvitzer Wrote: Thanks for all the info in the recent posts by zonk, me50, archangle, sleepster, and others. I have given the info, as well as the blurb on the A10 Autoset contained in the ResMed website, to my doc, and we'll see what kind of response I get.

Hi, all...back again. Finally got my doc to agree to give me an Autoset prescription, but he sent me for a new sleep study, in order to determine the settings. Sleep study determined that I now need a bi-level machine. Report is on its way to me by snail mail.

I have the info from Arch's recommendations---
"I consider any of the PRS1,ResMed S9 bilevel, or ResMed AirCurve 10 machines to be acceptable, because all of them record full data, including airflow data."

My question at this point is - is there anything new I should know re bi-level recommendations, or do I just go with what's quoted above? I'd like to stick with a ResMed product, and would appreciate guidance on which one to choose.

Many thanks.

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#28
I chose to stick with Resmed because when I first was diagnosed, I was given a PR and I quit using it (of course, I was not educated as to how much that could have hurt me....like waking up dead). Then I got a Resmed Elite then a Resmed S9 Auto and then a Resmed S9 VPAP. I chose to stay with Resmed because I didn't have any trouble with it like I did the PR and since I was accoustomed to it, I thought and was correct that there would be less adjustment.

PR has a good machine and some people prefer it over Resmed. It is just what works best for each individual person. Both are good machines but there are some differences and I just couldn't get used to the PR but I have never slept without my Resmed and the only problems I had was with my mask and I needed a bi-level instead of the CPAP Auto and never the machine itself. YMMV
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#29
(06-18-2015, 01:08 AM)Shvitzer Wrote:
(04-28-2015, 09:07 PM)Shvitzer Wrote: Thanks for all the info in the recent posts by zonk, me50, archangle, sleepster, and others. I have given the info, as well as the blurb on the A10 Autoset contained in the ResMed website, to my doc, and we'll see what kind of response I get.

Sleep study determined that I now need a bi-level machine. Report is on its way to me by snail mail.

... is there anything new I should know re bi-level recommendations, or do I just go with what's quoted above? I'd like to stick with a ResMed product, and would appreciate guidance on which one to choose.

Hi Shvitzer,

Just like there are plain CPAP versus Auto-adjusting CPAP machines, there are plain bi-level versus auto-titrating bi-level machines.

Since you express a preference for a ResMed machine, I suggest asking your doctor to prescribe the AirCurve 10 VAuto. Can be adjusted to behave like a plain bi-level machine, but can also operate in auto-titrating bi-level mode.

Learning how much pressure an auto-adjusting machine applies according to its treatment algorithms provides us with additional information - information on how our pressure needs are varying throughout the night/week/month/year.

Our pressure needs vary according to sleep position, diet, changes in medications, allergies, and other reasons. In my opinion it is helpful to have an auto-adjusting bi-level machine.

Usually, insurance will pay the Durable Medical Equipment (DME) provider the same (high) amount whether a standard bi-level or a slightly more expensive auto-adjusting bi-level machine is ordered for you. So the DME provider will usually not provide an auto-adjusting model unless specifically prescribed or unless the patient insists on it. Best to ask your doctor to prescribe the machine you want.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#30
(06-18-2015, 03:15 AM)vsheline Wrote:
(06-18-2015, 01:08 AM)Shvitzer Wrote:
(04-28-2015, 09:07 PM)Shvitzer Wrote: Thanks for all the info in the recent posts by zonk, me50, archangle, sleepster, and others. I have given the info, as well as the blurb on the A10 Autoset contained in the ResMed website, to my doc, and we'll see what kind of response I get.

Sleep study determined that I now need a bi-level machine. Report is on its way to me by snail mail.

... is there anything new I should know re bi-level recommendations, or do I just go with what's quoted above? I'd like to stick with a ResMed product, and would appreciate guidance on which one to choose.

Hi Shvitzer,

Just like there are plain CPAP versus Auto-adjusting CPAP machines, there are plain bi-level versus auto-titrating bi-level machines.

Since you express a preference for a ResMed machine, I suggest asking your doctor to prescribe the AirCurve 10 VAuto. Can be adjusted to behave like a plain bi-level machine, but can also operate in auto-titrating bi-level mode.


Learning how much pressure an auto-adjusting machine applies according to its treatment algorithms provides us with additional information - information on how our pressure needs are varying throughout the night/week/month/year.

Our pressure needs vary according to sleep position, diet, changes in medications, allergies, and other reasons. In my opinion it is helpful to have an auto-adjusting bi-level machine.

Usually, insurance will pay the Durable Medical Equipment (DME) provider the same (high) amount whether a standard bi-level or a slightly more expensive auto-adjusting bi-level machine is ordered for you. So the DME provider will usually not provide an auto-adjusting model unless specifically prescribed or unless the patient insists on it. Best to ask your doctor to prescribe the machine you want.



Take care,
--- Vaughn

Talked to my DME lady re getting a ResMed Bi-PAP. She claims that there are a number of docs she deals with who normally insist on ResMed equipment for all of their patients, but make an exception for Bi-PAP, and prescribe Respironics. I'm wondering if anyone has any info on this issue. She says she can easily order a ResMed Bi-PAP for me, but would need a prescription specifying ResMed. I can easily get one, but I'm puzzled by the objection these docs have to the ResMed Bi-level machines. Will check further with DME on specifics.

If the group thinks I'm better off with a Respironics, that's OK with me.Thanks.

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