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Demmom
  Unread post  Post subject: Want to Restart sleep apnia treatment the right way  |  Posted: Thu Oct 29, 2015 11:51 am

Joined: Fri Oct 23, 2015 12:09 pm
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Location: AZ
PAP Mask: Resmed F20 Air Touch FFM with travel pillow
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Over 10 years ago I was diagnosed with Sleep Apnia. I started CPAP treatments with little support. I have a chin drop when I am in Rem sleep and did not find a way to correct. I became very frustrated and stopped using the CPAP. Now I am excited about finding your forum with the information that has been needed to help me be successful with cpap treatment. I am on Medicare and I have my consult with the doctor in 1 week. I attempted to get an at home sleep study but my insurance told me that the provider had to be approved for full coverage. I could go to an unapproved provider for the study but there would be no guarantee that the service would be approved. TheLankyLefty can you provide any help here? If medicare approves the service my secondary insurance will pay the bill in full.

I called medicare, my insurance, the sleep study group my primary physician recommended, and the DME equipment provider and I was told:

1. The doctor consult recommends the equipment for my treatment. If I don't like his recommendation I could go consult another doctor. What is the best way to communicate that an APAP is to be the equipment of choice. I am leaning toward the:
A. Resmed Airsense 10 Autoset CPAP (APAP)
B. Swift FX Nano mask
C. Chin strap (I will order the Ruby chin strap for $15 if not provided)
D. A mouth piece which I will purchase from Sears for about $4 for a double mouth piece. (I heard of the NRU 5 adult pacifier as an option to the mouthpiece)

2. I am embarrassed to tell the doctor that I stopped using my CPAP. I still have the affects of sleep apnia with the addition of (a-fib) atrial fibulation. Be aware that not using the CPAP has consequenses.

I am so grateful for a forum like this where I can learn from your experience and can share my experience. I am seeking your comments and recommendations.


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TheLankyLefty
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Thu Oct 29, 2015 10:02 pm
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Demmom wrote:
I could go to an unapproved provider for the study but there would be no guarantee that the service would be approved. TheLankyLefty can you provide any help here? If medicare approves the service my secondary insurance will pay the bill in full.
I wish I could offer help here. Here is what I have learned about health insurance. I know enough to know that I don't know ANYTHING at all about it.

I am considering applying to Medicare, but there are some serious hurdles to overcome. These hurdles translate into money for me. Money that I simply don't have.

With Medicare, if they aren't approved, then Medicare is going to deny it. It could be God floating down from the clouds to perform a sleep test on you and it will be denied by Medicare if the provider (God in this case) isn't approved.

Demmom wrote:
What is the best way to communicate that an APAP is to be the equipment of choice.
By simply asking for it. The BEST way to do this is to say that you want to be COMPLIANT with your therapy this time. From what you read/heard/experienced, you know that an APAP machine is what it's going to take to make you COMPLIANT. :)

Demmom wrote:
A. Resmed Airsense 10 Autoset CPAP (APAP)
B. Swift FX Nano mask
C. Chin strap (I will order the Ruby chin strap for $15 if not provided)
D. A mouth piece which I will purchase from Sears for about $4 for a double mouth piece. (I heard of the NRU 5 adult pacifier as an option to the mouthpiece)


Excellent choices! (Did I speak with you on the phone the other day? Second time I've heard about the NRU in 24 hours)

Demmom wrote:
2. I am embarrassed to tell the doctor that I stopped using my CPAP.
Why? The truth is important with your physician. How else can you be properly treated unless you are honest? It's nothing to be embarrassed about. I'm embarrassed constantly. Trust me.....it's not so bad and you get used to it! ;)

Demmom wrote:
I am so grateful for a forum like this where I can learn from your experience and can share my experience.

I'm just glad that people use it! :)

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Demmom
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Fri Oct 30, 2015 4:50 am

Joined: Fri Oct 23, 2015 12:09 pm
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Location: AZ
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I thank you TheLankyLefty for your response. Yes I did talk to you on the phone. I will attempt to do that again soon because I want to have a strategy that will bring success in treating my sleep apnia. I noticed the symptoms of sleep apnia when my wife complained of my shaking the bed when I was trying to get a breath of fresh air after a long delay. When I had problems using the cpap I turned the cpap off and started sleeping on my side successfully!!!! It really helped I think, but it does not cure the sleep apnia. I was feeling tired and I thought I would try to use the old cpap last night and I found poor success with mask being loose, waking up with dry mouth, holding onto the mask to maintain seal HAHA!!

I think that a ffm will work better with a cold or sinus problem and a chin drop problem. I can get the nose mask later. Any comments or recommendations.

In Phoenix we have many sleep study companies and DME's. I plan to get a commitment from my consulting Dr. to provide my desired APAP machine before I schedule the sleep study. Any guidelines on how to select a sleep study company and a DME. I notice the sleep technicians are usually with the DME company. How does all of this flow together to provide excellent support for me. What are the symptoms of a good sleep technician support.

I am blessed by my secondary insurance company being a PPO and part of the FEB - Federal employees benefit program. I can use preferred providers at no cost, or use non preferred providers at minnimum cost as long as medicaire approves (this is where I can go stuck and may have to go out of pocket). My plan is to work with Medicaire and to deviate only when absolutely necessary. I would love to figure out a way to do the home sleep study, the easy way is to just do it and pay for it. I hear a bird singing, cheap cheap cheap. But if medicaire does not accept the home study it looses value.

I feel like I have a little bit of the everready battery in me, I just keep going and going and going. I am delighted to report that I have found a place to provide me the support that I need to succeed in treating my sleep apnia. It is right here on this forum.


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Demmom
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Tue Nov 03, 2015 4:10 pm

Joined: Fri Oct 23, 2015 12:09 pm
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Location: AZ
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Well I did my doctor consult today with a technician who was challenged when I said I had a source that did a better home sleep study. I had requested a home study but then I learned that they only use the home study to see if you have sleep apnia, I found out 10 years ago that I had sleep apnia. So I am scheduled for the 2 way study in about 10 days. After my comment she couldn't wait to get me out the door to the overnight study scheduling. Fortunately I found a very nice technician in the office that made me feel very welcome and supported. We shall see how the test goes.

I also learned that this company only uses Resmed cpap products, which I can live with. They recommend the Resmed Airsense 10 Autoset and the Air Fit F10 mask. Amazing that I can get what I want.

I also received in the mail today from Sears my $4 Everlast boxing double mouth guard. More on that later.


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trish6hundred
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Tue Nov 03, 2015 10:16 pm

Joined: Tue Apr 14, 2015 12:10 pm
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PAP Mask: Fisher & Paykel Simplus
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Hi Demmom,
Good luck to you at your sleep study and it’s good you get to pick the machine you want.


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Demmom
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Thu Nov 05, 2015 10:23 am

Joined: Fri Oct 23, 2015 12:09 pm
Posts: 187
Location: AZ
PAP Mask: Resmed F20 Air Touch FFM with travel pillow
PAP Machine: Resmed AirSense 10 Autoset
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Pressure Setting: 10 20

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I almost used the power of the purse. I was very upset with the tech that did my 30 minute interview because she was so rude and I wanted to change to another company to do the sleep study. But I ran into another tech in the office that was very helpful. I told my primary physicians staff about it to report my experience and get another company to do the sleep study. As I talked I realized that I found a good and helpful support person which is a real treasure. Too bad I had to go through the manure pile to find her.


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Demmom
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Thu Nov 12, 2015 11:12 am

Joined: Fri Oct 23, 2015 12:09 pm
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Location: AZ
PAP Mask: Resmed F20 Air Touch FFM with travel pillow
PAP Machine: Resmed AirSense 10 Autoset
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Pressure Setting: 10 20

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Did sleep study 11/11 diagnosed extreme sleep apnia. Woke up with dry mouth, high air pressure, puffy cheeks, mask felt tight. My idea that a full face mask was a good choice was questioned by the tech. He said that the Nose mask would require less pressure than FFM and that an apap could be used to determine the pressure. My thoughts exactly but the sleep study employees keep saying that they have to determine my pressure level(must relate to job security). I keep hearing the conversation that you cannot have an apap unless you have a medical validation/reason. Maybe this will qualify.

I had a nose ridge pressure with the Small size Airfit F10. Tech said that was common and set me up with a different mask. He did not even try a larger size, he said it had to have the ridge close to the front of the nose, and setting it closer to the eyes was not recommended it causes air leaks????

They also had a document for me to sign to give them permission to order my product through the DME. Any one have any idea what happens if you do or don't sign this document??


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TheLankyLefty
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Thu Nov 12, 2015 1:38 pm
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Demmom wrote:
I keep hearing the conversation that you cannot have an apap unless you have a medical validation/reason. Maybe this will qualify.
The magic word is "Compliant."

To your doctor/DME, "I don't think I can be compliant with PAP therapy unless it's an APAP." No compliance on your part means no pay for them. Guess who's gonna get a APAP?!? ;)

Signing the document gives them permission to order whatever the hell they want from the DME on your behalf. It's like Power of Attorney for CPAP crap.

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Demmom
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Mon Nov 16, 2015 6:06 pm

Joined: Fri Oct 23, 2015 12:09 pm
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PAP Mask: Resmed F20 Air Touch FFM with travel pillow
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I received the results of my sleep study and I have the prescription for the Autoset: 5-15cm with efficacy and Event Tracking. Res Med AirSense 10 or Airsense 10 for her, to include water chamber. I have heard that there is an advantage with the 10 for her. Would like some help here.

Thank you TheLankyLefty. I went and picked up my prescription from my sleep study company, and they provided all I asked. They were a little surprised when I requested the data files on my sleep study. They are making a CD for me.

I found something out about compliant at a DME. because I have had a cpap over 5 years ago, I do not have to do any compliant quals. The DME also says when I select a mask it is mine and that only the company will allow a replacement within the first 30 days. Any thoughts on how to handle this. I know that I have 3 DME locally that accept medicare.

My mask size is on the cusp between Small and Medium. The Air Fit F10 hurt my nose bridge when placed in position. I switched to the new Amara view full face mask for the test. My cheeks caught air and I had dry mouth at the end of the test. I did not like the air leak in the front of the mask at the end, pressure seemed too high.

I have oral surgery tomorrow and will be getting my equipment after recovery. I have time to see if I can work these DME's for the best results.


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seanconnery
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Mon Nov 16, 2015 6:26 pm

Joined: Sun Nov 15, 2015 9:04 pm
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Location: Vancouver BC, Canada
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If this is any encouragement, I have purchased the Resmed S10 Autosense also and on the very first night (a week ago) and ever since, I was able to sleep without opening my mouth (using nasal mask). I used to tape my mouth every night for years and now - NOTHING! I hope you find this machine as wonderful as it has been for me. Good luck.
sean


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trish6hundred
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Mon Nov 16, 2015 8:03 pm

Joined: Tue Apr 14, 2015 12:10 pm
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PAP Mask: Fisher & Paykel Simplus
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Hi Demmom,
The Resmed AirSense10 AutoSet For Her has an extra treatment mode, I think that is to treat RERAs, Respiratory Effort Related Arowsals.)
Hang in there for more answers to your questions.


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TheLankyLefty
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Mon Nov 16, 2015 9:39 pm
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Demmom wrote:
I have heard that there is an advantage with the 10 for her. Would like some help here.
From what I understand, the algorithm is less aggressive with the For Her model. I posted the specifics a month ago, but have no idea what thread. :?:

Demmom wrote:
I found something out about compliant at a DME. because I have had a cpap over 5 years ago, I do not have to do any compliant quals.
Excellent! Also glad to see that you have an Autoset.

Demmom wrote:
The DME also says when I select a mask it is mine and that only the company will allow a replacement within the first 30 days. Any thoughts on how to handle this. I know that I have 3 DME locally that accept medicare.
Try on several while you are there, then rank them in the order you like them. Take the one home first that you like the best. If it works, stick with it. If not, on to the next. Give each mask 5-7 days or so to evaluate unless it's a clear loser.

My favorite nasal masks right now are:
1: DreamWear
2: Swift FX Nano
3: Wisp.
4: Eson

If you find that you're mouth breathing or leaking, then try a full face mask. I like the Simplus, AirFit F10, and the Quattro Air.

(That's what I get for answering as I read) The Airfit F10, you should use the larger size. It should also be worn just loose enough that it doesn't leak. People tend to overtighten....including technologists.

Have you tried a nasal mask? Most people do better with them and ARE able to wear them despite what DMEs will often tell people. (Sleep Labs too). Ignore this if you have chronic congestion or a deviated septum.

@seanconnery. Welcome to the Forum! :)

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Demmom
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Tue Nov 17, 2015 8:17 am

Joined: Fri Oct 23, 2015 12:09 pm
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My SS has 15-16 cm as my optimum pressure. Why is the range setting 5-15? I was in REM for 25 min @ 9 cm with 5 OA and 10 Hypopnia. At 15 cm REM for 30 min no OA or Hypopnia. On my back. Only looking at Summary graph.


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Demmom
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Tue Nov 17, 2015 5:02 pm

Joined: Fri Oct 23, 2015 12:09 pm
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Location: AZ
PAP Mask: Resmed F20 Air Touch FFM with travel pillow
PAP Machine: Resmed AirSense 10 Autoset
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Pressure Setting: 10 20

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Talking with the DME's in my area is very interesting. They all have special niches that they focus on. 2 of them stock the Resmed A10 Airsense Autoset, 1 will not let me try on masks the other will.

Another DME features the Dream Station but will order the Resmed A10, it will also get you a Dream Station if you want. It allows me to try out masks at the office.

If a product is not stocked and they have a comparable product they all make noise that it will be difficult to get. I just say that it is time to change my DME, OOOPS I forgot they have the PAP support.

I learned that Medicare requires a compliance visit with the doctor after a month or 2 on all first time Medicare purchases.

I also found out from my SS company that the 15 cm was recommended to prevent the Central apnea happening at 16 cm.

Decisions, decisions, decisions. I am glad that I had oral surgery today that will give me a week to evaluate these DME's. Any body want to help?


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Demmom
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Wed Nov 18, 2015 5:26 pm

Joined: Fri Oct 23, 2015 12:09 pm
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Location: AZ
PAP Mask: Resmed F20 Air Touch FFM with travel pillow
PAP Machine: Resmed AirSense 10 Autoset
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My oral surgery went well yesterday but I resemble a chipmunk with his winter stash in his cheeks. I have finalized my evaluation of 3 DME's in my area that accept Medicare. I learned that if they don't stock the product that I want they say I will need a doctors prescription for it. The one DME that did not stock the Resmed Airsense A10 auto set told me that my prescription was not signed properly and I would have to get a new signature. These statements were made on the Swift FX Nano and the Airsense 10 for her and any other equipment that I wanted and they did not stock.

My DME of choice changed their position on sampling masks and said that they would have masks available for me to test next Monday when I go to the office to set up my order and pick up my equipment. I will post my final report after I receive my equipment next week. I want to review for my record the equipment and supplies that I seek to have. Your comments are welcome:

1. Resmed Airsense A10 Autoset with built in humidifier and a heater hose. I believe that it comes with a modem.
2, A Hose hanger that is wall mounted.
3. Dream Wear nose mask. Not sure what size yet. I will order a medium Airfit F10 full face mask as my second mask. And a swift FX Nano as my 3rd mask.
4. A Ruby and Pro chin strap to help with chin drop. I also have a double byte mouth piece for boxers with heated byte set for my teeth.
5. I have completed the auto install of the sleepyhead software for 64 bit CPU running windows 10.
6. I have a hard copy of the sleep study papers to submit to the DME. I also have a CD of the Sleep Study data files.

If I missed anything please let me know.


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sleepylynn
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Wed Nov 18, 2015 7:29 pm
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Sounds like you've got things covered. I will say, though, be prepared for them to tell you you can choose only one mask, or that you have to buy additional ones out of pocket. Insurance varies, but both my mom and my stepfather (he has really good insurance through his county job) were allowed only one mask each. It's actually been a sticking point, because my mom's DME was super difficult about letting her even try out any mask other than the one they originally gave her.


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Demmom
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Wed Nov 18, 2015 11:14 pm

Joined: Fri Oct 23, 2015 12:09 pm
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PAP Mask: Resmed F20 Air Touch FFM with travel pillow
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Thanks sleepylynn you are absolutely right that I can only get 1 mask at a time. I can get another mask every 3 months with my insurance. I didn't make that very clear.


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sleepylynn
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Thu Nov 19, 2015 8:17 am
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No worries - just didn't want you to be disappointed when you went mask shopping. ;)


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trish6hundred
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Thu Nov 19, 2015 9:23 pm

Joined: Tue Apr 14, 2015 12:10 pm
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PAP Mask: Fisher & Paykel Simplus
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Hi demmom,
Just make sure you keep a copy of your sleep study report and your prescription, make copies for the DME so you will have the original and I would keep your CD, too.
Good luck to you with your mask and machine decision.


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TheLankyLefty
Unread post  Post subject: Re: Want to Restart sleep apnia treatment the right way  |  Posted: Fri Nov 20, 2015 10:39 am
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Site Admin

Joined: Mon Aug 15, 2011 10:22 am
Posts: 4684
PAP Mask: Practically tried them all.
PAP Machine: Use Phillips Respironics System One APAP with Aflex for mask testing
Humidifier: None
Pressure Setting: When testing, I use APAP with a range of 5-10

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Demmom wrote:
1. Resmed Airsense A10 Autoset with built in humidifier and a heater hose. I believe that it comes with a modem.
2, A Hose hanger that is wall mounted.
3. Dream Wear nose mask. Not sure what size yet. I will order a medium Airfit F10 full face mask as my second mask. And a swift FX Nano as my 3rd mask.
4. A Ruby and Pro chin strap to help with chin drop. I also have a double byte mouth piece for boxers with heated byte set for my teeth.
5. I have completed the auto install of the sleepyhead software for 64 bit CPU running windows 10.
6. I have a hard copy of the sleep study papers to submit to the DME. I also have a CD of the Sleep Study data files.

1.) Sounds like a great choice!
2.) Sounds great.
3.) Another excellent choice. No worries about the size. All sizes come in each pack. Small, Medium, and Large "headgear". Small, Medium, and Large Cushions. You can mix and match until you find a fit. AirFit F10 is a great choice, but can be difficult for some people. The Quattro Air is the same cushion, but easier to adjust in my opinion. Try the AirFit F10 though. The Simplus may be a better Full Face Mask. Really they're all good! :) The Nano is an excellent backup nasal mask choice.
4.) You may not need the chinstrap with the mouth guard, but the Ruby is a great one.
5.) Excellent with the SleepyHead Software.
6.) You've struck the holy grail of "gettin' stuff." It's very difficult to get the raw data from your sleep study.

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