Trying to proceed with the least frustration

[Maggie Dru]

After years of wearing a mandibular advancement device,  I am now needing to proceed with a C-Pap.  This happened after my dentist decided I needed several new crowns, plus a new MAD.  Six months later my bite is screwed.  I can barely chew food properly.  The dentist says he cannot correct my new bite dysfunction. He says it was caused by my use of the MAD.  Funny that I never had any problem before the new crowns and new MAD.  But that's water under the bridge now.  I will need a C-Pap. I've studied Medicare reimbursement for these devices, and it appears that they won't pay for an A-Pap or Bi-Pap until you've given a standard C-pap at least a 3 month trial, then they will pay for a 13 month rental, after which you own the device.  I don't have the patience for a trial, nor probably the stamina, given my chronic insomnia and moderate to severe apnea.  Moreover, I would like to be able to chew food again.  I want to start with an A-pap or Bi-pap, given the known better success rates with these.  The cost of these devices is not beyond my reach.  I thought that the A-pap would be the most advanced choice, until I read this forum's wiki on device choice.  Unless I'm understanding it wrong, the Bi-pap is the more advanced/sophisticated between the two, according to the wiki.  Can I get a recommendation?  I have sinuses that are usually partially plugged, due to allergies, I generally, but not always, sleep on my back.  I use sleep aides (Belsomra, and a combo of herbs. Does anyone know if I start with an advanced device, which I pay for out of pocket, will Medicare pay for accessories, such as masks, filters, etc.?  I haven't been to the sleep doctor yet re this next step, but have had 3 sleep studies in the past, all of which diagnosed apnea.

[sauerkraut]

Maggie Dru;
The Bi-Pap is the more advanced machine ..  But the Apap works for most ..
You will need a perscription from Your GP Dr. or Dentist ..  You don't need a
Sleep specialist ..  Then use the Supplier List at the top of the page to check
prices and purchase a machine ..  I can't advise about Medicare I use the VA ..
After You receive Your new machine down load OCSAR from the top of the page ..

You can down load the Clinician Manual for the machine at the top of the page
(Cpap Setup Manuals) ..  That will tell You how to access the setup menu on 
Your machine and get You started ..

Starting settings for the Apap would be 7cm h2o min. 15cm h2o max. EPR 2 try 
Your first night without ramp, when using ramp the machine doesn't start therapy
until the ramp time is over ..

If You buy the Bi-Pap, I have no experience with one ..  Other folks on the site 
can help You with it ..

The machine brand of choice on the site is Resmed ..  OSCAR supports it and
most of us use there machines ..

Best of Luck !!

[Maggie Dru]

Thank you, sauerkraut.  I do plan to download the clinician's manual when I get whatever device I decide to purchase, if for no other reason than to compare with the calibration provided by whatever doctor I eventually end up with.  Right now, in our area, to get an appointment with an ENT or anyone qualified to prescribe a device, the first available is around third week of August.  I want to buy a device that transmits data to the doctor, at least until I learn to interpret the data myself.  I think that choosing a doctor with experience in apnea would be to my advantage

[SarcasticDave94]

Which of your current doctors will be open to discuss and prescribe CPAP for you? Make the appointment with that one.

If you buy your own CPAP or Auto CPAP, you'll need that doctor to script the supplies. Then yes Medicare should pay.

If you've gotten test results that say you're needing CPAP, then it's just a script. It does not need to come from a sleep specialist.

[sauerkraut]

Maggie Dru;
You seem concerned about waiting time to see a specialist ??  Experience around here is that You don't need
one .. Your General Practitioner/Internist can prescribe a device even a dentist can .. You will need an at home sleep study !!
That I believe Your GP/Internist can also prescribe ..  If You want a specialist a pulmonologist is probable the correct one 
again Your GP/Internist would be the one to ask ..  Maybe a referral could speed up the process ??
Even sleep specialist seem to use base line settings of  5-7 cmh2o minimum 15 cmh2o maximum ..
Some use ramp to start some add EPR some don't ..  This is for a Apap a Bi-Pap has more indepth settings ..
I hope this has helped You ..

[ejbpesca]

I think you will find that an APAP machine will be covered by Medicare.  My first covered machine was an APAP 19 years ago.  It was recalled and discontinued.  I currently am on my fifth machine which is my second ResMed Autoset 10, APAP.  I tried the newer 11, found the 11, I was issued defective, and returned it for an AS 10.  ResMed machines are very popular.  Most machines today are APAP with a feature called EPR that when turned on reduces the air pressure on exhale.  I was prescribed a machine after a sleep study by a pulmonologist.  I take it you have done the sleep study and now are looking for a PAP therapy machine.

I am issued a new machine every 5 years that is covered by Medicare and yes, I own the expired ones as backups.

To get a BPAP machine I would have to be prescribed one by my doctor which I have not done so far.  The BPAP has more functions and a much better handling of exhaling than an APAP.  My current prescription is APAP/CPAP only so to try out BPAP I will either have to get my doctor to write a prescription or find a way to buy one out of pocket without a prescription.

Dealing with DME suppliers has been frustrating but successful in getting PAP gear to me with no cost for the products or shipping. If you have a prescription for CPAP I think you will have no problem getting an APAP machine.  If your sleep study has the pressure settings, it will be set up by the DME for Minimum and Maximum pressures.  If you do not have the pressure settings you can establish them yourself with help forum. this forum.  After you begin therapy you can post OSCAR reports here to get help with fine tuning the therapy.

I was prescribed a MAD by my dentist.  The thing was so uncomfortable I did not use it but a week and then returned to APAP therapy.

[Jay51]

Here is some reading from our ApneaBoard Wiki on Dealing with a DME, insurance, etc.  Scroll up and down to read all of the different headings and get all of the information:  

• 1Advice for brand-new patients