Just got my prescription, can you guys look it over and let me know what's up?

[vroomvroom]

I just got my prescription electronically from the doctor. Since I have a bunch of questions, I'll underline them. 



This is what the RX says: 

No Substitutions
 
Diagnosis:          Obstructive Sleep Apnea (G47.33)                                                              
Length of Need:  99 months
 

• ResMed S10 AirSense auto CPAP (E0601)     Pressure range: 6.0-10 cm H2O
  

 

• Mask Type: ResMed Airfit P10, medium nasal pillows or patient preference.
  

 

• Heated Humidifier    (E0562)                                
  
  
• Heated tubing (A4604)
  
  
• CFLEX/EPR
  
  
• Airview  (lifetime) and SD card
  
  
• Chinstrap (A7036)
  
  
• Airview  (lifetime) SD card
  
  • Account Name:  [redacted]
    

 
Replacement Supplies (only per insurance guidelines)

• A7034 Nasal Interface Mask (1× 3 months)    
  
  
• A7033 Nasal Pillows Replacement    (2 × 1 months)              
  
  
• A7035 Headgear (1 ×  6 months)
  
  
• A4604 Tubing heat element  (1 ×  3 months)                          
  
  
• A7038 Disposable Filters (2 × 1 month)
  
  
• A7046 Water Chamber Humidifier (1 x 6 months)
  
  
• A7036 Chinstrap      (1 x 6 months)
  

       

Does everything look good here? I read on another post that until I pick up the products from the DME, I have the most "power" so to say, so I'd like to get all this figured out before I make my trek to a DME. I've also learned that I am supposed to be getting a "trial kit" that should come with different size masks and some people have been shortchanged what they end up with during the trial process. 

I note that the prescription does not say "for her" model for the Airsense S10, but likely that is because I did not ask. Since it also says "no substitutions," would I run into any issues with the DME requesting the "for her" model? Should I ask the doctor to redo the prescription with the "for her" language on there? 

And just to confirm, since this is the CPAP I will be using for however many years, is this the absolute best machine to get? I think it is based on the prices I have seen while googling ($883) and I believe it matches what I read on the wiki here. Knowing my luck, they will make an S11 model in a few months LOL. 

I've also noticed that there is a "for her" version of the nasal pillows. Will using regular nasal pillows (whatever the resmed brand is and per above) impact diagnostic readings when using a "for her" machine? I assume the "for her" version of the pillows is just merely sizing changes and would otherwise have no real substantive variance in diagnostics. Not sure if I am allowed to link to the actual resmed folks since they're not a "vendor," so here goes.

Does this model CPAP have the cellular modem built in? Do I really need or want that?

For those that have insurance, how does the replacement supplies restock work? Does the patient usually have to call in every x months to get new supplies or do they get sent to me on a schedule? I hope that once I meet my deductible (I will once I pay for the resmed), that the replacement parts are going to be 100% covered by insurance!
 
Thanks for your help! 

[Fats Drywaller]

It sounds like you're lucky to have an understanding & accommodating doctor.  My experience was much more average: I was given a generic prescription with no specifics, which is basically OK and usable; then I was referred to an incompetent DME, which I had to fire eventually.

I think I can answer all of the underlined questions except this one, so I'll put this at the top:

• For those that have insurance, how does the replacement supplies restock work? Does the patient usually have to call in every x months to get new supplies or do they get sent to me on a schedule?
  

The others:

1. Does everything look good here?
   Almost but not quite. The correct model name is "Resmed Airsense 10 Autoset".  Other than that, I'm impressed that every little detail is specified.  The only other reservation I have (and those who know that I hate the P10 will have known this was coming) is that personally I would use that clause "...or patient preference" to get an F&P Brevida rather than a P10.  Presumably you've seen the active thread "Evidence of Airfit P10 vent obstruction causing hypercapnia".  IMAO that's not the only reason to shun the P10, but it's one reason.  For a sales pitch recommending the Brevida, see this post of mine from yesterday.
   
2. Since it also says "no substitutions," would I run into any issues with the DME requesting the "for her" model? Should I ask the doctor to redo the prescription with the "for her" language on there?
   I think yes and yes, but that depends on how important you decide that model is.  The non-Her model of Autoset works just fine also.  Here are two items that might be helpful, the first from a Resmed product catalog: "... Airsense 10 Autoset for Her is the first device that provides therapy tailored to respond to female-specific characteristics of sleep-disordered breathing.  It works by increasing sensitivity to flow limitation and optimizing the response to these events.  By responding to each flow-limited breath, the algorithm helps provide comfortable therapy."  And the second is in a post by Sleeprider here: "The Airsense 10 Autoset has both a standard and soft Autoset modes, as well as CPAP mode.  The For Her adds an additional third Autoset mode.  Both report the same data including RERA.  Relatively few people seem to benefit from the For Her mode.  Consider the information attached and decide if it might be useful or not.  Both are the same price, but availability varies.  You should request a copy of the Airsense 10 Clinical manual where the features are detailed." ... which is followed by more details from Resmed.
   
3. is this the absolute best machine to get?
   Yes, in the basic tier of machines that do CPAP and auto-adjusting CPAP (APAP). If you need bi-level or ASV, there are two higher and more expensive tiers for those needs, and the Resmed machines in those tiers are all called "Aircurve <something>" rather than "Airsense <something>".
   
4. Will using regular nasal pillows (whatever the resmed brand is and per above) impact diagnostic readings when using a "for her" machine?
   No.
   
5. Does this model CPAP have the cellular modem built in? Do I really need or want that?
   Yes and yes.  But that second "yes" depends on, first, whether you are required by your insurance to meet any compliance requirements, and second, whether you want to use Resmed's myAir, either from your phone or on the web site.  If either compliance or myAir is needed, then you should let the modem do its thing (transmitting the basic compliance data to Resmed, to be retrieved by the DME).  ISTR that it happens once per day, an hour after the sleep session has ended.  Those are just the basic numbers; the only way to get the full data is via the SD card.  If you don't want those transmissions of compliance data to happen, you can put the machine in "Airplane Mode", but that's only a temporary workaround, not a real Off switch.  Once the insurance/DME deal is over (typically 13 months, I think) and you own the machine, you can, if you want, open the thing up and disconnect the modem hardwarily, assuming that you have no further use for myAir at that point. During a compliance period if there is one, you're legally obligated by the contract to let the DME have access to the compliance data, either automatically via the modem or by you delivering the SD card every month, or whatever you work out with the DME ahead of time. Simply letting the modem transmissions happen is the line of least resistance.
   

BTW, as I understand it, posting links to manufacturers' web sites to point to information is OK according to the AB guidelines; only retail links to sites of suppliers are verboten.

[Fats Drywaller]

One detail I missed the first time through: I would suggest to the doctor one more change, this time in the line mentioning the mask. The pillow or cushion size should not be specified; instead, "complete mask package with all pillow or cushion sizes and all documentation" should be the thing. Some DMEs like to be picky & choosy about what parts of the mask package they give to patients, sometimes even withholding the instruction booklet and sizing guide. None of that control-freak stuff makes any sense. The mask should always be the full retail package, unopened, and the patient should try all sizes of pillow or cushion at home to find out which one works best according to the machine's reported numbers (AHI and leak rate) and the patient's comfort.

[JimMcD]

Your prescription looks a lot like mine. 

My story is like this: a little over a year ago, I went to my GP about persistent insomnia. I had had a few experiences of waking in a panic and being unable to breathe, but I wasn't aware of apnea as an ongoing problem. Also, I'm a heart patient, and I thought insomnia might be contributing to my problems. 

The GP referred me to a sleep clinic--no MD in attendance, but staffed with well-trained and experienced technicians. They gave me what they called an 'Aegis' device, which I wore for one night and returned to them. It detected AHI of over 80, so CPAP was indicated. After a year on the machine, my AHI is now closer to 3.

What I'm getting to is that, while my GP has no expertise in sleep therapy, I've had a continuing relationship with the techs at the sleep clinic, and they've been very helpful and supportive. I trust them. As far as I can tell, they deal exclusively in Phillips devices; I don't know what their relationship with Phillips is, but, as I say, I trust them. They collect all the massive amounts of data that the device generates, and they can tell whether it's doing what it should be doing, and they can tweak it to make sure it responds to your needs. 

And here's the big point--the sciences of respirology and sleep are crazy complex. You can, with a little effort, acquire a layman's grasp of them but you need more than that. You need to find a professional you can trust.

I have insurance (thank God!) managed by Sun Life. It's a Canadian public employees' supplemental health plan, and it covers eighty percent of my costs--that's the CPAP device, itself, and the filters. I pay, and they reimburse.

[OpalRose]

A few P10 facts:

The ResMed P10 ”For Her” comes with 3 nasal pillows, size X-Small, Small, Medium.  
The headgear is pink/gray.

The ResMed P10 ”regular” comes with 3 nasal pillows, size Small, Medium, Large.  
The headgear is blue/gray.

Be sure the Script calls for Mask Fit Packs, this will include all size pillows or cushions.
Some DME’s remove the pillows that they feel you won’t need, don’t let them do this!  

Also, most of us P10 users find that they start out with a size nasal pillow too small and need to move up to a larger size.

Consider that the headgear for the P10 For Her is approximately 1 inch shorter than the blue headgear.  I have ordered both, and prefer the blue headgear as I have thick hair and it fits better on my head without feeling tight.  

The script should say “patient choice”  for mask and machine.  

One more thing:  Don’t listen to the P10 Naysayers....”resistance is futile.”  

[Fats Drywaller]

The script should say “patient choice”  for mask and machine.  

For the mask, that's definitely the way to go. However, for the machine, is that compatible with "No substitutions" or "Dispense as written"?

[Fats Drywaller]

One more thing:  Don’t listen to the P10 Naysayers....”resistance is futile.”  

I say that anyone who hasn't tried both of them doesn't know.

I know of one person here, Wally, who has tried both and who hated the Brevida, partly (but not entirely) because of having a mustache. That's fine; it's a valid data point. Then there's anyone with a damaged nose; I've already mentioned that as a special case, excluded. Anyone else, fine, step right up and say that you've tried both of them and you prefer the P10 for whatever specific reasons; those are valid data points too.

The thing about the Brevida, for those of you who have not looked at it, is that the design basically leapfrogs the P10 by improving the pillows and the headgear (both major points) along with the frame/tube connection and the tube/hose connection (both minor points). And, as we're now seeing, having a replaceable diffuser could be very important too.

It's not at all like recommending, for instance, the Eson 2 over the P10, or the Dreamwear over the P10. I don't care which company sells the thing; I care about comfort and usability and good sleep and good numbers from the machine. The point is that the Brevida is just like the P10 in some ways (nasal pillows with only a backstrap as headgear) but is so much better that it's phenomenal.

[Gideon]

Ask the DME, say the prescription says DAW and Autoset, can I get the "Autoset for Her" instead of the straight Autoset? The cost to both the DME and to you should be the same. With your pressure range being low (6-10) The additional algorithm works best with lower pressures, without question, the For Her variant is likely to be better for you. We will not know until both algorithms are trialed at home.

[OpalRose]

Ask your doc to rewrite the script to say ResMed AirSense 10 AutoSet or AutoSet for Her, patient choice.  That should cover whatever you decide you want.

Some DME’s are real stinkers, and follow the doctors script to the letter, others may give you what you ask for.

Folk either like the P10 or hate it, but it’s worth giving a chance.  The Brevida is fine too, but I didn’t like the headgear.  You may prefer one over the other.  I’ve tried a few different masks the first year, but prefer the simplistic design of the P10 pillows and headgear, and that’s the very thing that others may dislike.  

Don’t forget to read the mask reviews.  http://www.apneaboard.com/forums/Forum-C...sk-Reviews

I’m not pushing any particular mask, because we all have preferences, different face and head shapes, and certainly different nose shapes.  You just have to try out a couple different masks...if your lucky, you’ll hit it right the first try.

Good luck!

[Fats Drywaller]

It is true that masks are subjective and personal. That's one reason there are so many of those products on the market, with such big differences among them. (And, speaking as a consumerdroid, I think that's a good thing: we need many options there. And we need competition among the manufacturers for market share, based on features and comfort.)

Something I often inadvertently overlook is that a patient who is new to this stuff might not realize that although the machine choice is super-important because it's a very expensive item that you'll have for five years (that part is obvious), the initial choice of mask is not such a big deal. You can always get a different mask ... and you should, because otherwise you won't know much about what those options are or what you might be missing out on. And even if you buy a mask yourself once in a while rather than being able to have insurance pay for everything, it's an expense that shouldn't break the bank. I'm thinking mainly of the simple masks like the most basic nasal-pillows types ($75, let's say), so there could be exceptions to that also.