Would appreciate input on machine situation

I'm trying to decide what to do and I would appreciate some input.

My CPAP is currently being rented. I have a REMStar Pro M Series with C-Flex. The pressure is set to 10 which is my titrated pressure. My AHI bounces around between 1.0 and 4.5.

My first follow-up with the sleep doc was in Feb. I was still feeling off-the-charts tired. I asked if I should have the machine purchased yet. I wondered because the form you sign to say you want it purchased implies CPAP is also making you feel better, which it clearly wasn't. The sleep doc said I should wait to have the machine purchased until we figure out what's going on with my fatigue. In hindsight his motives might have been a bit clouded by the fact that the DME is within his practice.

I now have a new sleep doc who is methodically investigating my fatigue. He wants me to see a psychopharmacologist to have my antidepressant meds evaluated and likely changed, do a sleep diary, lose weight, and eventually get into his sleep lab. He didn't seem to trust the results from the first sleep lab. That's a long story but suffice it to say I'm confident that his desire to get me into his sleep lab is not financially motivated. Clearly, the cause of my fatigue is not going to be figured out or fixed overnight.

I'm sitting here today thinking I really need to have a machine purchased. I've had it since December and my insurance has probably already paid more for the rental than the cost of the machine on cpap.com.

But, before I have the machine purchased I'm wondering about an Auto since it seems like it could be a better machine to have long-term for more effective therapy.

I'm in a state of confusion now not knowing if I should wait until the new sleep doc figures things out and continue with the rental or make the leap and have a machine purchased. And if I'm going to have the machine purchased maybe I should have it be an Auto. But I don't know how hard it would be to get the DME to give me an Auto.

I definitely don't think I need a Bi-Level Auto. I don't have any trouble exhaling. Plus, I don't understand the Bi-Level EncorePro reports

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com, C-FLEX, CPAP, DME, AHI, auto

SleepySandy wrote:I'm trying to decide what to do and I would appreciate some input.

I have had the Basic M-Series (useless machine IHMO), the M-Series Pro, and the M-Series Auto.

Personally I think an Auto is the way to go. It just gives you more flexibility. I like the fact that I can start at a lower pressure (more comfort) and have it adjust up. Also if your trying to self-titrate the auto makes it much easier. Even if in the end you end up running it in strait CPAP mode (which can actually provide better treatment in some cases) at least you have the options there if you need them.

Of course now that I have tried a BiPAP I think they provide even more comfort but not everyone finds exhalation a problem and they may not be suitable for everyone due to other factors.

I would purchase an auto and stop paying rent. You know you have apnea. You may have other sleep issues as well. You should work on those issues while using the cpap. Apap gives you extra flexibility. In my non-medical opinion that is what I would do.

SleepySandy wrote:The sleep doc said I should wait to have the machine purchased until we figure out what's going on with my fatigue.

This portion of your post would give me great skepticism about your first sleep doctor.....so, I'm glad to hear you got a different one.

Do you have your CPAP prescription?
Talk to your insurance provider and see if they'll reimburse YOU for an out-of-pocket purchase from CPAP.COM. Tell them about your situation and see what they can do to help you.

On the other hand, you're showing that you have Encore Pro in your profile. What is it showing? Have you shared these reports with your new doctor? Does there seem to be any reason why you're seeing such swings in your AHI?

Best wishes,

Den

Someone who has more knowledge about insurance ins and outs can chime in here, but my DME and Insurance have led me to understand that I pay rent on my machine for 10 months, then I own it, but that I can choose to pay for the machine only after I have rented it for at least 3 months, to make sure I have the right machine.

I think that means that renting longer does not add to the price when you buy it, but is credited to your purchase price. Check this out, so you don't rush into something that is not quite right, when more time could be a benefit.

Go for the auto. also I'm glad you are being worked up for the fatigue, I was told I had chronic fatigue syndrome but it turned ou I had a blocked coronary artery. I was so tired I would just sit in my car for 20 minutes when I got home from work because I couldn't find the energy to walk into the house. good luck, pat

I just purchase a new machine with my own money. My old machine died.

I opted to get the automatic, after using a Respironics machine for 2 1/2 years.

For the few dollars it cost, (more) you are going to have peace of mind later on if you think that you may need to change your pressure, or experiment..

Less than 10 days in, with the new machine, I decided to go back off automatic. I am still very happy with the machine that I have. I don't regret the few dollars that it cost.

You can't use it if you don't have it. You don't get many choices.

Thanks, everyone for the great advice. It's exactly what I needed. I really appreciate the thoughts on the various ways to handle purchasing the machine. I had also forgotten that an Auto can be set to straight CPAP. It definitely makes sense to get the Auto.

Now, who wants to call the sleep clinic to ask for a copy of my prescription and tell the DME I want an Auto? I HATE doing stuff like this.

Wulfman wrote:On the other hand, you're showing that you have Encore Pro in your profile. What is it showing? Have you shared these reports with your new doctor? Does there seem to be any reason why you're seeing such swings in your AHI?

Many questions

My new sleep doc knows I have EncorePro but we haven't reviewed the reports yet. I've been trying to figure out why I see the swings in my AHI while I wait for my next appointment. It could be tied to leaks. Not large leaks - just larger than average. When the possibility of my leaks causing issues was brought up to me by RestedGal and blarg, I looked for ways to improve the seal of my mask. I'm using a skin-safe adhesive right now (yes, I know I'm shortening the life of my cushion). At the moment I would say the results are inconclusive. Most days my AHI is <2. The highest it's been since using the adhesive is 3.4. I haven't been able to figure out why it jumps, but I'm working on it. Last night was 1.8 with a total time in Apnea of 1.8 minutes (that's funny - 1.8 and 1.8 ). That's about average for me right now.

Wulfman wrote:

SleepySandy wrote:The sleep doc said I should wait to have the machine purchased until we figure out what's going on with my fatigue.

This portion of your post would give me great skepticism about your first sleep doctor....so, I'm glad to hear you got a different one.

I'm glad too My new sleep doc is fabulous. My old sleep doc is the exact opposite. You should have heard my new sleep doc when I asked his opinion regarding what to do about my machine since it's being rented. He couldn't believe the DME is within the practice of the first sleep doc. When he expressed his astonishment I pointed out the fact that his clinic also has a DME. He said that the DME is part of the hospital, not the sleep clinic. There's no financial motivation for him. Because of this and a few other things he said, I felt very validated about my opinion of the first sleep doc.

Sandy,

You're entitled to your prescription (it's good for life) and a copy of your sleep study.
If you get your prescription, you shouldn't have to deal with THAT DME again.
OR....get your new doctor to write a prescripiton for an Auto.

Den

Sandy....Download a copy of jskinner's "Encore Analyzer" program. It's first rate......I find it very useful....and I sent him a few bucks to help him keep it up to date.

Gerald

Gerald wrote:Download a copy of jskinner's "Encore Analyzer" program.

Thanks for the tip, Gerald. I actually do have EPA and you're right - it's great. I also view the raw data of EncorePro. I'm able to see my exact leak rate when each event happens. The majority of apneas happen with the higher leal rates. But, the higher leak rates don't always result in apneas. And I have apneas at the lowest leak rates. So, my results are pretty inconclusive.

Wulfman wrote:You're entitled to your prescription (it's good for life) and a copy of your sleep study.

Den, you're right but being entitled to them and getting them are not the same. I got my sleep study but never got the graphs. They don't seem to give up stuff willingly. The law requires them to release the information but I don't think it requires them to be nice about it or do it in a timely manner.

I'll just have to put on my turtle shell and make the phone call tomorrow.