New to apnea, need help.

[Chalk]

This is a great forum. I have read quite a bit, but still have some specific questions as it relates to my situation.

I completed two sleep studies and was given a prescription for a CPAP machine with a pressure of 12, flex of 3. My PCP is the one who ordered the test(s) and basically said this isn't her specialty so she copied and pasted the recommendation from the sleep center/doctor for the prescription when I asked about getting an APAP machine. She sent it to a DME and I asked them if I could get an APAP machine and they said all the new machines they sell have auto capabilities. I am a little suspicious of that based on everything I've read on here. When I asked for the exact model that would be available she said ResMed AirSense 10. When I questioned if this was the AutoSet model, she said yes it has auto capabilities but you would have to have your doctor change the prescription so they could change the settings down the road. Does that sound right? I called another DME and they told me the prescription would need to be changed to a range (I.E. 5-20) in order to get an APAP machine. I'd rather not have to hassle my PCP for a new prescription since it doesn't sound like she is very knowledgeable about it. Can I get an APAP machine with the current prescription I have or do I need get it changed?

I also asked the DME about the data monitoring capabilities and she said they would get the data and monitor it. When I asked if the data would be available to me, she said they have some software they would give me to use.

Also, the DME said I would need to do a rent to own because my insurance requires it, although they will ask if the insurance will buy it outright instead of rent to own. I have met my rather large mediacl insurance deductible for this year and would love to just get the machine included under that and not carry into the new year month by month. Any help on this?

Sorry this is so long, but thank you for any help!

[Crimson Nape]

Hi Chalk!

Because of the high dropout rate of new CPAP users, insurance companies usually require a rent-to-own initial acquisition. Asking for another script from your PCP is no biggie. If asked why, just tell her that you'd like the CPAP to be able to auto titrate based on your body's current needs. (I don't know if this will actually work. . . but it sounds plausible.)

As far as the different models, Look at some of the supplier's sites (link at the top of the webpage) and you'll get a grasp of the different AS10 model names. . . with the Autoset being the auto adjusting unit. The AS10 has a cell phone modem builtin that medical professionals and DME's can monitor and adjust the patient's settings. This is a subscription service that they have to pay for. The DME will probably use it to see compliance data so they can get paid by your insurance while it's being rented.

About you being able to monitor your data; A free software named, "SleepyHead" (link at top), will work with the AS10 models. . . at least the ones you will be using. My experience with vendor supplied software leaves a lot to be desired. It doesn't provide the level of detail most people (on this forum) want.

Good Luck and welcome to the forum (again)!

[kaiasgram]

When I asked for the exact model that would be available she said ResMed AirSense 10. When I questioned if this was the AutoSet model, she said yes it has auto capabilities but you would have to have your doctor change the prescription so they could change the settings down the road. Does that sound right?

It does sound right. Since this DME only sells APAPs (let's trust them on that for the moment), then the rep is just saying that pressure changes are always by prescription. That's standard practice. So down the road (not now) if you need your pressure changed, you'd need a new prescription. You don't need a new prescription right now.

If the rep stated that it is an AirSense 10 Autoset then you just need to confirm it when you pick up the machine (or the machine is delivered). The name (Autoset) will be right on the front of the machine:



If it says "CPAP" or "Elite" then it is not the Autoset and don't accept it (once you accept a machine it is very hard to exchange it). Don't worry about the other comments about the doc changing the prescription, etc. Once the Autoset is in your hands you can learn how to change the pressure(s) should you need to. You really won't need a new prescription, but don't suggest this to the DME rep.

And you can use SleepyHead software to look at your data. You don't have to rely on the DME for this.

[trish6hundred]

Hi Chalk,
WELCOME! to the forum.!
Hang in there for more responses to your post and Much success to you as you start your CPAP therapy.

[justMongo]

If you can get the AirSense 10 Autoset, it can run in straight CPAP mode. So, the Rx of 10 can be set by the supplier.
ergo, the Rx you have should be good enough; unless it does not satisfy your insurance company. For the DME supplier to set it into auto mode would require them to have an Rx with an upper and lower range of pressures. This gives your doctor the freedom to call for auto with a range of pressure at some future point in time; or, you can, if you choose, exercise that option.

I'd try to get the autoset, but run it as a CPAP at prescribed pressure for a while to see how you adapt to the therapy. You might do just fine at fixed pressure.

[Ghost1958]

Your PCP can write for an autoset, once you have been diagnosed with a study and insurance will pay for it. Insurance pas the same amount on cpap or apap.
Your dentist or a nursr prac can write the script as well.
No need to settle for a cpap instead of auto.

[DariaVader]

What the DME told you both sounds correct, and is a plausible scenario. My DME (Providence Home Health) only issues APAP no matter the Rx. They can only set it to the prescribed pressure. so that part is also correct. The second DME who told you they will not issue APAP without a prescribed range is doing that to keep their costs down. Insurance companies do not pay more for APAP than they do for CPAP. Same billing code; but APAP costs more than CPAP so the DME has to eat that difference. Lower budget DMEs will try not to give an APAP when CPAP will do, for that reason. As the consumer, though - what you want is the APAP. Your Prescription is good for CPAP and also for APAP, but if it was written for a range the DME is forced to issue APAP, where it is their choice when it is written for a single pressure. Make sense?