Medicare CPAP for Forgetful Senior

[webmanoffesto]

I'm have a family member, a senior citizen, whose doctor prescribed a CPAP. But the supplier says that due to supply chain problems no CPAP machines are available.

Do you know what CPAP machines I'm likely to be offered for a senior on Medicare who has some supplemental insurance (MediGap?).
I don't know how accurate / up-to-date this is, but on the supplier's website I see,

• "Breas Z2 Auto Portable Auto-CPAP Machine, $800 - BACKORDER"
  
• "AirMini AutoSet Travel Auto-CPAP Machine, $999", and this one is not listed as on backorder.
  
• "DreamStation Go"
  

Also, this senior is showing early signs of dementia. They are cooperative and they maintain a generally cheerful disposition but they are forgetful and unreliable. I think that for them to actually use the CPAP, that will require my direct involvement (in person or on phone) to make sure they put the mask on at bed time.

So, I'm wondering what to expect
- will the Medicare Durable Medical Equipment supplier offer me a crap machine, and the senior will probably not use it anyway?
- or maybe I could get a good quality machine, and with my direct involvement help this senior to actually become a bit more healthy.

I'm new to this, but I think that a "good quality machine" would at least be one that allows me to export data and examine it.

What do you think?

[SarcasticDave94]

Pay attention to the exact full model name. Any change can make a big difference in therapy.

None of the machines you mention will make the cut.

If this is simple Obstructive Apnea, a CPAP like the ResMed AirSense 10 or 11 AutoSet is your best bet. If it was a BPAP you're interested in, ResMed AirCurve 10 VAuto is your choice. 10 has been out for a bit, so the 11 is newer. Both ResMed 10 and 11 will be fine, 11 is just a newer form factor.

If it's anything more complicated, we'd need to know what that complication is. Respiratory Disease, then another ResMed like the AirCurve 10 ST-A. Central or complex Apnea, ResMed AirCurve 10 ASV.

2 things are consistent. The brand is ResMed. All these specific models work with a free program, OSCAR, so you see very detailed info about the PAP and therapy. This is more than most doctors care to bother themselves with.

Not that I hate Chinese people, but stay away from their PAP machines please. Also avoid Philips Respironics, they are in a foamgate tainted foam battle recall. Do not get a travel device.

Am I biased? Yes. I suggest what works.
Welcome to Apnea Board.

[staceyburke]

I would search for a used ResMed s10 autoset. It could be found on craig’s list or dotmed.com. You should look on YouTube to see how to find the run hours. Of course divide 8 into the hours for days, ect. look for one with less than a year old.

You can buy one for around 500 or less.

[SarcasticDave94]

I forgot to mention, you can look for used PAP via Search Tempest or DOTmed. Look for the ResMed models I mentioned according to therapy level need.

[GuyScharf]

If you are looking for a machine and being able to read data with OSCAR, my first choice would be the ResMed Autoset. Fisher & Paykel Sleepstyle and DeVilbiss BLUE machines are compatible with OSCAR and seem to work well. You won't encounter as many users with those machines but they appear to be good from what I have heard.

[Ratchick]

Hi and - the others have given you great advice on types of machines. Resmed is always going to come top of the list - to the point that I was ready to fork out £3,500 or more for a Resmed ASV machine out of pocket if the NHS didn't provide me with one. Thankfully, they did.

RE: the person being able to use it. I happened to be in the hospital in November with an older lady next to me who was being taught how to do this. Honestly, she struggled to get the mask on - using a mirror confused her more because the reflection was backwards and she found it a challenge to learn how to fasten the mask. She also seemed to forget every time that she could move the mask or alter the fit to counter leaks, or to mention that it was uncomfortable on her nose.

Now, obviously, I don't know your relative and how severe their dementia is... if it's mostly okay, you can always stick a note onto the machine or wall perhaps, that reminds them how to do everything or at least stickers next to the buttons on the machine. With the Resmed machines, it's very simple for the end-user. There's one button on the top that turns the machine on and off. That's it.

There's also an autostart/stop option that you can set so that as soon as someone breathes into it, or takes the mask off, it will figure out to stop and start it running. That said, I avoid that because some people find that it can be a little unreliable.

I think the hardest time is going to be the first few days and weeks while you figure out the most comfortable mask, making sure the fit is okay and there's no redness or soreness starting, and that they aren't pushing it off in their sleep or because it's annoying them, as well as getting them used to sleeping with it running. If you can teach them how to put it on in person, and then as you suggest, call them to make sure they're putting it on every night, then it should be doable.

[webmanoffesto]

Thank you for all the helpful advice. Do you think I should get for the senior the
Nasal CPAP Masks
Nasal Pillow CPAP Masks or the
Full Face Masks

Sorry, I wasn't able to find the doctor's exact diagnosis online. I'm guessing that this is "simple Obstructive Apnea". The senior did an at-hospital sleep test and an at-home sleep test, both times was "off the scale". The doctor explained that during sleep there is a relaxation in the mouth/neck muscles, and this leads to a blockage which stops breathing. I don't remember the doctor talking about any more complex issues.

The doctor said that some people have more success with the nasal mask, I guess just because it's less obtrusive and less intimidating. But his concern seemed to be that Medicare (or their contractor) checks the transmitted data during the 1st month and if the machine is not being used then they take it back.

I found one that says "Main (replacement) unit only. Manual, masks, tubing, filters & any other accessories are not included." How much will it cost me to add all those parts?

[webmanoffesto]

And if the doctor "recommended" a nasal mask did he mean Nasal CPAP Mask or Nasal Pillow CPAP Mask? I don't know.

[Ratchick]

It's going to depend on the machine, cost-wise.

Nasal pillows are the smallest and most "discreet" option, they can come with lighter headgear that is less bothersome, and there is some evidence that pillows give slightly better therapy over nasal masks which are a little better than full face masks. That said, the difference usually isn't enough to be the determining factor over comfort and fit. Whatever mask gets the job done is the most important. If the person breathes through their mouth while asleep, then they may find it easier with an FFM to control for the leaks that would cause. So it's going to depend.

Are there any DMEs near you that are willing to trial fit a few masks for comfort, or at least provide you with a couple to try? Honestly, masks are often the most expensive part, if you have to try and find the right one. you're looking at maybe $90 to $130 per mask, but if you can get them through Medicare/Insurance, they will provide you with refills as far as they cover that.

Assuming it's a Resmed 10, then for a heated hose, you're looking at maybe $40, filters are a couple of bucks or so, make sure it comes with a humidifier tank, too. If not, you need to get one of those as well. That's about $20.  Find out if the machine comes with an SD card for data or not. If you need that, you should be able to get a 32Gb full-size card (or microSD card with a full-size adaptor) that will be plenty big enough for less than $10. Again, things like hoses, tanks, filters etc might be covered by Medicare/Insurance, too.

It's worth noting that we have a Supplier List. If you go to Supplier #1, it looks like they have a reasonable discount for your first purchase too, and I'm sure some of the others do as well, if you need to buy out of pocket.

[OpalRose]

"Sorry, I wasn't able to find the doctor's exact diagnosis online. I'm guessing that this is "simple Obstructive Apnea"


If the "senior" you refer to has insurance coverage, Medicare or Medicaid,
try to get coverage instead of paying outright.  Of course, what way to go depends on deductibles.

It you are unable to access sleep study reports, how do you know what her AHI was and the breakdown of the AHI, like Obstructives, Hypopneas, Centrals?  Many doctors refer to all results as Obstructive sleep apnea, when in fact they may have Central sleep apnea and that may require a different machine.

If you pay out if pocket for a machine, it could be the wrong type of cpap based on her/his results.