Newbie - Should I consider changing doctors? Help?!?

[Hollyboop]

Here I am unable to fall asleep. I noticed that the machine "snorted" 3 times and stopped working. Completely. I had to turn the machine on again to get it going. This happened two different times before and I reported this to the DME and they sent someone to look at the machine and he reported that it is fine. Has anyone had their machine quit? Does this mean the machine is defective?
I am someone who slept great before the machine and diagnosis of sleep apnea. I slept 7+ hours every night and woke up feeling well-rested. Only recently did I notice I didn't have the stamina I used to in my dance classes (I take 4-5 each week.). I feel like I'd rather have reduced energy but have a great night sleep.
I only had an at-home sleep test because the over night study would have cost me $900. And the doctor said it wouldn't have given us much more information than the at home study. After reading on this forum, I'm not sure that I agree with him. How do I know if I must use a full face mask versus using just a nasal one? The DME was going to give me the nasal one and I mentioned that sometimes I wake us with a dry mouth and he immediately said that I need the full face mask. Maybe I don't ?!?
I am questioning whether I should research local doctors and possibly change. Also, perhaps spending the $900. for the full sleep study would have been worth it. I appreciate your opinions and wisdom.

[49er]

Here I am unable to fall asleep. I noticed that the machine "snorted" 3 times and stopped working. Completely. I had to turn the machine on again to get it going. This happened two different times before and I reported this to the DME and they sent someone to look at the machine and he reported that it is fine. Has anyone had their machine quit? Does this mean the machine is defective?
I am someone who slept great before the machine and diagnosis of sleep apnea. I slept 7+ hours every night and woke up feeling well-rested. Only recently did I notice I didn't have the stamina I used to in my dance classes (I take 4-5 each week.). I feel like I'd rather have reduced energy but have a great night sleep.
I only had an at-home sleep test because the over night study would have cost me $900. And the doctor said it wouldn't have given us much more information than the at home study. After reading on this forum, I'm not sure that I agree with him. How do I know if I must use a full face mask versus using just a nasal one? The DME was going to give me the nasal one and I mentioned that sometimes I wake us with a dry mouth and he immediately said that I need the full face mask. Maybe I don't ?!?
I am questioning whether I should research local doctors and possibly change. Also, perhaps spending the $900. for the full sleep study would have been worth it. I appreciate your opinions and wisdom.

Hi Hollyboop,

Welcome to the forum.

Unfortunately, the Escape machine that you have is known as a brick, meaning it doesn't provide any useful information so you can determine if your therapy is optimized or not. If you have had it under a month, your chances of exchanging it are better so I hope that is the situation. Here is a link to more information on the machines you want and don't want:

http://www.apneaboard.com/wiki/index.php...ne_Choices

Getting one of the autopaps that is data capable would be preferable because you could either set a pressure range or one pressure depending on your needs. But if you end up being stuck with a data capable cpap machine, it is still better than having the escape.

And thanks to having a brick, you don't know whether you need a full face mask or you don't as that is a common myth that having a dry mouth means you need one as you need to look at the data to see if you have consistently high leak levels or just a few times during the night. Looking at the leak level on your screen (one of the few bits of information the escape does provide) may help but without being able to look at the computer data, you're really shooting in the dark.

As to whether you need a full scale study, the answer is no if you have a data capable machine as you can download sleepyhead, which is a free program, to see if your therapy is optimized. Can't do that with the escape unfortunately.

If god forbid, you can't exchange your machine, I would take the money you were going to spend on a full scale sleep study and use it to buy a data capable machine. If you chose to go that route, we can advise you as to how to get the right one for you at the best price.

Regarding changing doctors, see how cooperative he is in helping you exchange your machine for one that has data capabilities as if the DME allows you to exchange it, they will probably require that he write a new prescription. If he refuses, then you know he doesn't have your best interests at heart.

But still, if you can get a data capable machine and optimize your therapy with the board's help, you might not even need a doctor as many people have gone for years without seeing or only see them minimally to satisfy insurance requirements.

Best of luck.

49er

PS - Holly, I noticed in your other thread, you have had this machine for nearly a month. So if you are going to have any chance of getting the DME to exchange it, you need to act as quickly as possible.

[big_dave]

That's awful. I hate to hear you're having so much trouble.

Here I am unable to fall asleep. I noticed that the machine "snorted" 3 times and stopped working. Completely. I had to turn the machine on again to get it going. This happened two different times before and I reported this to the DME and they sent someone to look at the machine and he reported that it is fine. Has anyone had their machine quit? Does this mean the machine is defective?

The machine is defective. You will need to insist on a warranty exchange.

How do I know if I must use a full face mask versus using just a nasal one? The DME was going to give me the nasal one and I mentioned that sometimes I wake us with a dry mouth and he immediately said that I need the full face mask. Maybe I don't ?!?

Another option that's easier for most people is a chinstrap to hold your mouth closed. Full face masks are harder to get used to than nasal masks, and it's harder to get a good seal. I would recommend trying a nasal mask with a chinstrap before trying a full face mask. I could not get the Mirage Quattro to work for me (a full face mask) but a chinstrap works well.

I am questioning whether I should research local doctors and possibly change. Also, perhaps spending the $900. for the full sleep study would have been worth it. I appreciate your opinions and wisdom.

You don't need another diagnostic study if you've already been diagnosed. It might be helpful to go for the second study (titration) but it's also possible to use the data from a good auto CPAP to set either a fixed pressure or a narrow pressure range. Unfortunately, the S9 Escape Auto is about the worst machine you can buy, especially with the wide-open pressure range of 4-20. It doesn't give you the data you need to find a more appropriate pressure range. Better machines include the S9 Autoset, the Airsense 10 Autoset, the System One Remstar Auto, or the Dreamstation Auto.

The problem with the 4-20 pressure range is that the machine spends too much time at an ineffective level of pressure. The pressure should be kept within 2 or 3 cmH2O of your 95% pressure to work effectively--but with the Escape Auto, your 95% pressure is unknown.

Your DME is useless. It would be better to switch DME's than to switch doctors. Let your doctor know how useless your DME is; in particular, that they won't fix a broken machine for you.

[Sleeprider]

I don't see how changing doctors would help you when your problems are entirely with the durable medical equipment provider you're using. They issued a bottom of the line, discontinued CPAP that does not provide data, and won't back that up with good service. Your doctor might be able to help if he will modify your prescription to specify auto-titrating CPAP. This would allow you and your doctor to get continuing feedback through data produced by the machine. Nothing is inherently wrong with a home titration, but you might as well have an auto machine on a permanent basis.

[Hollyboop]

I spoke with the DME and they are claiming that I simply need to "get used to the equipment" and don't believe that the machine is malfunctioning. I am going to the DOE's office before going to my doctor tomorrow morning to get a report printed from the SD card. They said that they will also evaluate the machine. My insurance only covers a CPAP machine (not an auto) and the DME told me as a favor to my doctor they gave me the auto machine with no extra charge. I checked with my insurance (Oxford United Healthcare) and they only list CPAP as covered. So if I want to change the DME I am working with, I might be stuck with a CPAP, not auto machine. GR-r-r-r. Hopefully, they will change out the machine and at least I won't have one that malfunctions. Any suggestions on what I should ask and discuss with my doctor tomorrow? Thanks so much!

[big_dave]

It sounds like your doctor wanted the auto machine for an at-home titration, but the Escape Auto can't be used for this purpose. The DME has done no favor for your doctor. They have only wasted his time.

[PaytonA]

Don't let them fool you. The Autoset IS a CPAP machine. The DME's problem is that they get paid the same amount whether they give you an Escape, Elite, or Autoset. The term CPAP is actually the general term identifying all Positive Airway Pressure machines including bilevel and ASV machines as well as the three models mentioned. The term has been used also to identify plain vanilla PAP machines like the Escape.

Best Regards,

PaytonA

[DWaldman]

I checked with my insurance (Oxford United Healthcare) and they only list CPAP as covered.

Yes, that is correct. ALL CPAP machines, whether the most basic bottom of the line brick or the top of the line, fully reporting auto cpap, are billed under one code, it doesn't matter what the DR prescribes. Get your DR to write an RX for the exact machine you want, say a Resmed Autosense 10 for her, with humidifier and heated hose. The DME HAS to fill the RX as written, and your insurance will pay for it. Believe me, they pay enough for the DME's to make a profit on the best, most complete machine out there. Your DME is just trying to stick you with a brick to make more money.

[big_dave]

Check the blower hours on your machine. The Escape Auto was discontinued over a year ago, so I'm sure the DME was looking for a way to clear their inventory of a machine that someone else returned. ResMed's current product line doesn't even include a comparable machine. If you can prove that the machine is used, you will have more ammunition in case you need to confront the DME again.

I don't have the instructions for checking the blower hours. Hopefully, someone else on the board will post them. Just be aware that the machine reports both therapy hours (which can be reset to zero) and blower hours (which cannot be reset to zero).

[rarebear]

You may have had a bad sleep study, I know I did..
I slept well at a 10 and was restudied and was told 15 was my new number..
I had chest pains for months and was told get use to it..
I just bought a Autosense 10 and my 95% pressure is 9.8 and I sleep much more rested now I set my pressure..