Debkarm - Therapy Thread

[Debkarm]

Hey everyone, I’m hoping for some advice.

I’ve already gone through a sleep clinic, completed a sleep test, and got a prescription. They’ve given me a one-month trial with the ResMed AirSense 10 Autoset, and it seems to be working well.

Now I have a choice:
I can continue with the clinic and pay $2700 for the machine. My benefits cover $2000 every 5 years, so I’d be paying $700 out of pocket pluss coat of makes 
OR
I could buy the same machine online at a much lower price and try to figure things out myself.

I’m wondering:

• Is it worth paying the extra to stay with the clinic for their support and setup?
  
• Has anyone here bought their CPAP online and managed the settings on their own?
  
• How hard is it to learn how to monitor results and adjust things like pressure settings?
  
• What would I need to know or do to make sure I’m treating myself properly if I go the DIY route?
  

Would love to hear your thoughts and experiences. Thanks 

[Deborah K.]

No, you don't want to depend on the sleep clinic.  They are not at all helpful with any follow-up once you are using your machine.

If you have good health insurance, it usually covers Pap machines and the accessories needed.  At least that's how it is in the US.  I don't know about Canada.

Even if you have to use your own money, yes, if you can get it cheaper by buying it elsewhere,  go ahead.  You won't miss the non-help that the sleep specialists offer.

Best wishes for achieving great therapy and comfort!  

[sptrout]

I noticed that you are from Canada, so things may be different there, but in the US I think that I would never waste money on buying a machine from a clinic. As you mentioned, you can buy machines online for about what they are quoting you (not a bad price actually), but in my experience provide little or nothing later except find ways to get more of your money. Curious, about how much money can you save buying online? $700 CDN (I assume) is a good price and would usually be hard to beat, but can be with a little searching.

Do you have a computer and do you use it? If yes, then there is a free program called OSCAR that is easily downloaded and installed. The the program uses the data that will be recorded all night by you ResMed machine and provide a large amount of very useful information. If you need help, there are many experts and longtime CPAP users at this site that can provide guidance. If you do not have a computer, or are not comfortable with handling data, then there is a 100% web based program call SleepHQ. Both are excellent and have very similar capabilities, or you can do as I do, and use both. No reason actually, but I am a computer nerd.....

Will the Sleep Clinic help with mask selection? Masks can be more of a pain than buying a machine. If they are really helpful, then buying a mask from them may be okay. After you buy whatever kind of equipment you need, you can always throw the clinic under the bus and look at the bottom dollar and go online for everything.

[Debkarm]

Hi everyone,
I’m considering purchasing my own ResMed AirSense 10 AutoSet from an online outlet  after using it during a free trial through a clinic. I also use the AirFit N30i mask, which worked well for me. During the trial, the clinic handled all the settings remotely from their computer, so I didn’t have to touch anything myself.

Now that I’ll be setting it up on my own, I’m feeling a bit lost. Could anyone walk me through:

• What software (if any) I need to download to access and adjust the clinician settings?
  
• How to access those settings on the machine itself, if that’s possible?
  
• Any other tips or resources you’d recommend for someone brand new to this?
  

I really want to feel confident using and managing my machine, but right now I’m not sure where to start. Thanks so much for any guidance. 

[TonyJ]

If you want to send me a pm I can direct you to a couple of good on line retailers that will save you a lot of money.

[Deborah K.]

Right now, you can download and start using Oscar, our free apnea reporting program that creates wonderful charts revealing lots of information about every night's sleep.  You can download it at the top of every page, in the black ribbon.  

You will need an SD card that contains no more than 32 GB.  Your machine may come with one.  You will put that in the slot on the left of your machine, and when it's in, it will record everything.  Then many of us will be able to advise you as to settings to change as well as other topics.

[SaldusMiegas]

Hi Debkarm,

when you say you could buy online at a much lower price, I'm guessing you mean much lower than $2700, but that's not your out of pocket.  I don't expect you will find a new A10 for under $700.  So it might be better to stay with the insurance and cost you less out of pocket. 

Also, consider your insurance benefits for ongoing supplies.  If you go outside the insurance, you will be picking up the total cost of not only your machine but also replacement masks, hoses, water reservoirs, and filters.  I'm guessing the insurance cap is for a new machine every five years, and there would be some benefits to cover expected use of supplies and parts that wear out.  The annual cost of these supplies could run several hundred dollars per year. If insurance covers all or most of that, you might come out way ahead using insurance versus out of pocket.  That said, if you did choose to pay out of pocket without insurance, the parts can last longer than the normal scheduled replacement intervals.  But all things being equal, it's better to have the option for new stuff (and have a backup already on hand when something wears out) covered by insurance if the coverage is good. Again check the out of pocket either way. Insurance suppliers might be a bit more expensive than online but then out of pocket might be less after insurance covers part of the cost. 

As for benefit of the clinic, in my experience in the U.S., I have had really good doctors who appreciate my taking charge of my own therapy, offered encouragement and occasional advice, and they didn't change my settings remotely when I wasn't looking. They answered questions I had about symptoms and provided reassurance when I had concerns. I also had one doctor who thought self management was nonsense and his one time sleep study report said all he needed to know. We didn't work together very long.  Another thing the docs offer is periodic prescriptions which my private insurance now requires every six months to pay for recurring cost of supplies, and some sort of annual statement that (1) I do continue to use the machine, and (2) the therapy remains effective. 

Some things in the U.S. require prescriptions, so if you aren't using insurance you might still incur medical visits to renew your scripts. YMMV in Canada. Actually, it might just be the machine that requires a script, and the supplies might only need a script if my insurance is paying for them.  But do your due diligence on this so you won't get surprised later. 

Bottom line is have a look over your total costs out of pocket when you think about whether or not to use insurance to pay for your therapy.  It's not just the machine itself, there are recurring costs and potentially recurring requirements for prescriptions to purchase supplies even if paying out of pocket.

You can count on solid technical advice in this forum for optimizing your settings and dealing with nuances and nuisances of life on CPAP therapy. 

So make the financial decision that works best for you.  Clinic might be a nice safety net if costs are about the same. You will probably get your best technical advice here in any case. 

to your questions: 

• Is it worth paying the extra to stay with the clinic for their support and setup?
  

make sure you are comparing out of pocket costs as described above.  May not cost extra to stay with the clinic. 

• Has anyone here bought their CPAP online and managed the settings on their own?
  

I have not bought my machine outside of insurance.  I have bought masks to try out using liberal return policies of some online stores to allow me to try and return if it didn't work out. The clinic might allow such flexibility at replacement intervals, but some online suppliers make it part of the deal on any purchase. 

Manage settings on my own -- all day every day for ten years since April of 2015.  With the help and advice of this forum I have gone far beyond whatever my sleep doctors could have done.  The effectiveness, comfort, confidence, quality of life improvement from actively managing my own therapy with advice of experts available 24/7 here; the feedback and tweaks suggested based on capturing and sharing my data using OSCAR -- priceless! 

• How hard is it to learn how to monitor results and adjust things like pressure settings?
  

easy peasy -- and you have a whole community to help you learn.  And as for interpretation, you don't have to learn it all, you have expert clinicians and technicians who volunteer on this forum to help people like you and me.  They will tell you what the data means, give you sound advice, and if you are interested they will help you learn how to interpret it yourself.  Of course you and I don't have the education and clinical experience, so I'm personally happy to get a civilian's grasp of my data and ask the tough questions of the experts.  Goal is effective therapy and settings.   

You have in the A10 machine a full featured data collection system that automatically captures all your data on an SD card. You must have a computer to read the data and run OSCAR for analysis and reporting.  So that's a potential issue if you do not have a computer with a media slot to insert the SD card. 

There's a hidden clinician menu to set and adjust things like pressure and comfort settings.  This community will teach how to access and use it effectively.  It's not illegal to mess with your own machine settings, but they keep it out of the way so people who don't know what they are doing won't mess them up.  

• What would I need to know or do to make sure I’m treating myself properly if I go the DIY route?
  

Regardless of whether you go with the insurance or on your own, in either case, you are already doing the most effective thing that will make a difference in your therapy, which is:  you are taking an interest and an active role in learning about how to manage your own therapy; you are seeking out wisdom from a community of experts who are here to help you with practical advice, interpretation of data, suggestions for tweaks and settings, feedback and reviews of various types of masks, and more. That makes all the difference. Be encouraged Debkarm. 

If you want, I invite you to peruse the forum a bit. See what sort of questions people ask and the kinds of answers they get. You will be impressed at the competence and gentleness of the tone of discussion. 

Best wishes on this new journey you have started. If you have been suffering from sleep apnea like most of us who came here initially tired, foggy, red-eyed, hoping for something better -- your life is about to get better. You are already experiencing enough to tell you this type of therapy will be effective for you and make a positive difference in your quality of life. That's a big hurdle for a lot of people. From now on, you are building upon good to make it better and more better.  

Saldus Miegas

[Debkarm]

Thanks for the detailed reply. I wanted to clarify that I can get insurance coverage whether I buy the CPAP online or through a clinic. The main difference is that the clinic includes clinician support—they’ll handle pressure adjustments, follow-ups, and help interpret the machine’s data. If I go the online route, I’ll be saving around $700, but I won’t have access to that clinician support.

So my big question is: is it worth saving the money and managing things on my own, with help from this group and the resources available? Or is the support from the clinic worth the extra cost?

Also, I really appreciated your thoughts on doing the settings myself—do you know if there’s a step-by-step procedure I can follow once I receive the machine in the mail?

Thanks again for your help and I'm excited for this new journey to improve my sleep
and health. 

[Expat31]

Hello, a video to access to clinical menu settings will help you to start things off.

Also when you post graphs, initally all we need are:-

1.Events
2.Flow rate
3.Pressure
4.Leak rate
5.Flow limitations

Important - exclude calendar & pie chart so statistics and settings on the left side are fully visible. 

This link, Attaching images, files and posting charts should help also. 

[SaldusMiegas]

Hi Debkarm,

Oops I guess I misread the cost tradeoff. So it sounds like you have to trade off $700 plus clinical support versus no clinical support.

So, I’m wondering what is meant by clinical support.

In the US we get our machines from what we call DME suppliers they are vendors with technical staff who provide Durable Medical Equipment (DME). They are technicians not medical staff, and they provide the initial setup, help you pick out masks, show you how to use them, care for your machine etc.

And they program the initial settings based on the prescription the doctor wrote.  There is not an ongoing clinical relationship, ie they don’t evaluate you medically nor prescribe changes. You see your own doctor for that, but if the doc changes the prescription the DME provider is capable of changing settings remotely.

Your situation being called a clinic may be more medical and prescriptive than a DME vendor or maybe not.

I guess I am not qualified to speak to what you gain or lose with or without the clinic.

Here if we don’t use a DME vendor we miss out on initial fitting, training, first couple of weeks hand holding while we get used to the machine. No ongoing medical evaluation or advice. For that we see our doctor. But a US DME is not called a clinic.  

If you don’t buy from the clinic do you still get to see a doctor or does the medical care come as part of the package?

If your clinic is like our DME then I don’t think you lose much. But if your medical care is tied to the clinic supplying the equipment then that is different in ways someone else from Canada would better address than me.

If your experience is similar to mine, you will have this cool auto adjusting machine set by prescription to a fixed pressure indicated in the sleep study.

You will use it like that until you learn a little and start to wonder what can be done about the things you are not happy about. And if auto adjust might do better for you.

Then you will decide to reset it to auto adjust and see what happens.  The machine might settle on pressures as originally prescribed or it might do something better, let’s find out. Worst case we reset it back to how it was.

Or more likely it will find a sweet spot and dynamically adjust throughout the night, and on different nights based on what your body is doing.  You roll over, you get a stuffy nose, you’re tired or or had a drink or just restless — all things the auto adjust can handle in different ways to keep you breathing best.

All this with data captured to provide breadcrumbs to help any decisions to make gradual changes to settings that will eventually be optimal.  You share some data and get some feedback and begin to understand your own peculiarities.

My optimal settings took many months across mask changes and breathing techniques I learned here to keep my mouth closed and migrate to nasal pillows from full face masks.  

I was a mouth breather with full mask, high pressure, leaks when I moved that woke me up.  To my delight over time I got a chin strap to work, tried nasal pillows, lowered pressure, got rid of the chin strap, sleep even better.  

What I ended up with is far more comfortable, less noisy, lower pressure, lower AHI, than what my original prescription called for.

Most all of that came from this forum. My first doc was a set fixed and forget kind of fellow. My last doc was fascinated by my proactive interest and liked how the numbers improved over time.

Don’t get me wrong— if all I ever got was my initial settings and mask I would be happy for the life changing difference it made.

But it got even better as I engaged this forum and learned all I could, experimented a little, and got stepwise improvements over my first couple of years that have remained stable for many years since.  

Okay I need to quit gushing about this place and say no more out of school about the Canadian clinic situation.

End with this … I don’t know but I believe I would not enjoy the success I have had if I didn’t take charge of my own therapy based on what I learned here. 

Figure out your best option regarding the clinic but keep a toe in the water here and learn all you can.  

Hope someone else with a Canadian perspective will chime in with wisdom about to clinic or not to clinic. 

Saldus Miegas