Ontario CPAP Newbie - little help?

Hi everyone,

So late last year I ended up going for a sleep test, and midway though they woke me up and put a mask on me. From what I understand, this was my "titration" test. I made it through the holidays, and once I'm back at work again, I'm wiped again, and finally decided to do something with what they gave me. Problem is, my local DMEs aren't being much help, so I'm coming here with questions. I've only got 3 to choose from, unless I want to look out of town (which I'm willing to do if necessary). When I left the sleep test, they gave me paperwork that had CPAP circled (NOT Auto), my AHI is 30/hour, at 10cm of water pressure.

When I call my local DMEs, two of them won't talk to me on the phone (Vitalaire and Medigas) and have both told me to come in "to get all set up".

The third spent a long time talking to me, but I'm unsure of his answers. He recommends to set me up with a PR-461TS. He said he can't get me an auto unit unless I get a prescription from my sleep doctor. I'm unclear on if the paperwork I currently have is a prescription (it doesn't say prescription, but it does have my family doctor's signature on it). We don't have any sleep doctors in town, they come in periodically to do clinics, and to the best of my knowledge I'm not scheduled to meet with them.

The DME that would talk to me said that I need to get the PR-461TS and use it for 30 days at 4 hours a night to qualify for the grant (for those unfamiliar, the Ontario government pays 75% of a pre-determined fee). He's familiar with my insurance, and says that'll cover the remainder. It looks like I have to pay everything upfront though, and get reimbursed.

So... questions.

Do I have a prescription? Or is the DME trying to mislead me a bit and give me a loaner until I do get a prescription?
Is the PR-461TS "good enough", or should I be pushing my family physician to prescribe an auto unit (or get a referral to a sleep doctor)?
I know from reading the forums that there's a bit of a ResMED bias on here, but based on the differences I think I'd prefer a Philips-Respironics. If I have to go non-Auto, I like the CPAP-check feature. If I'm able to go with an Auto at some point, I understand the PR to be a little more gentle. Can anyone explain the bias? Both are available, but if I want the S9 it'll be an Elite (again, the DME said I can't get an Auto unit unless the paper I've got had Auto circled).
Should I even consider the two DMEs that wouldn't talk on the phone? They may have excellent service with poor reception... if it is a good idea, I have no problem putting in a few hours and/or saying no to a hard sell.

Hi - You want an auto machine with full data, rather than just compliance (that's usually only for insce. co's to vet that you're using the machine, nothing to do with how well you're doing and why or why not). Plus autos can do plain Cpap mode, but not the reverse, so don't get stuck with plain Cpap if at all possible, not these days (and the cost to the insce. co. is usually the same, whatever $*()*# the DME tries to tell you). Vitalaire's not a bad company, but may be confused about what you want (as you don't seem to be sure yourself ). I have no idea what a Cpap check feature is but I have an idea it's nothing you need, though perhaps you could explain it in case I'm wrong? The diffs between ResMed and Phillips is so personal and people like both... then again, I'm happy with the machine that I have (see below). You need a separate script (you probably have one just for a Cpap) to get an Apap vs cpap, so get your MD to write you one... not complicated, just regs. And get him to write you one for a 'Mask of patient's choice', even though you may well end up trying various ones til you're happy.

NewbieCPAP wrote:there's a bit of a ResMED bias on here

I had no idea there was a bias here.

I switched from PR to ResMed because my pressure requirement take large swings during the night. The ResMed machine's algorithm responds more quickly to airway difficulty. By that I mean, for example, my needs may be 10 cm for some time and then the airway starts to partially collapse and ResMed will raise the pressure more quickly, to say 16 cm, than the Respironics machine.

I am able to sleep at 10 to 12 cm pressure for much of the night, but when the pressure requirement increases, the ResMed machine responds quickly.

This could be a disadvantage to some people who do not have widely varying pressure needs and would find their sleep interrupted by the quicker pressure changes of the ResMed algorithm.

If I were you I would fight like hell for an auto machine like this one - https://www.cpap.com/productpage/respir ... ations-tab

or this one - https://www.cpap.com/productpage/resmed ... idair.html

NewbieCPAP wrote: I ended up going for a sleep test

You are getting advice from people who don't know what your diagnosis was.

What WAS your diagnosis?

one thing to keep in mind, this OP is in Canadia and thus has different rules than we usaians are used to.

keep your stick on the ice!

NewbieCPAP wrote:Hi everyone,

So late last year I ended up going for a sleep test, and midway though they woke me up and put a mask on me. From what I understand, this was my "titration" test. I made it through the holidays, and once I'm back at work again, I'm wiped again, and finally decided to do something with what they gave me. Problem is, my local DMEs aren't being much help, so I'm coming here with questions. I've only got 3 to choose from, unless I want to look out of town (which I'm willing to do if necessary). When I left the sleep test, they gave me paperwork that had CPAP circled (NOT Auto), my AHI is 30/hour, at 10cm of water pressure.

When I call my local DMEs, two of them won't talk to me on the phone (Vitalaire and Medigas) and have both told me to come in "to get all set up".

The third spent a long time talking to me, but I'm unsure of his answers. He recommends to set me up with a PR-461TS. He said he can't get me an auto unit unless I get a prescription from my sleep doctor. I'm unclear on if the paperwork I currently have is a prescription (it doesn't say prescription, but it does have my family doctor's signature on it). We don't have any sleep doctors in town, they come in periodically to do clinics, and to the best of my knowledge I'm not scheduled to meet with them.

The DME that would talk to me said that I need to get the PR-461TS and use it for 30 days at 4 hours a night to qualify for the grant (for those unfamiliar, the Ontario government pays 75% of a pre-determined fee). He's familiar with my insurance, and says that'll cover the remainder. It looks like I have to pay everything upfront though, and get reimbursed.

So... questions.

Do I have a prescription? Or is the DME trying to mislead me a bit and give me a loaner until I do get a prescription?
Is the PR-461TS "good enough", or should I be pushing my family physician to prescribe an auto unit (or get a referral to a sleep doctor)?
I know from reading the forums that there's a bit of a ResMED bias on here, but based on the differences I think I'd prefer a Philips-Respironics. If I have to go non-Auto, I like the CPAP-check feature. If I'm able to go with an Auto at some point, I understand the PR to be a little more gentle. Can anyone explain the bias? Both are available, but if I want the S9 it'll be an Elite (again, the DME said I can't get an Auto unit unless the paper I've got had Auto circled).
Should I even consider the two DMEs that wouldn't talk on the phone? They may have excellent service with poor reception... if it is a good idea, I have no problem putting in a few hours and/or saying no to a hard sell.

First off, WELCOME to cpaptalk. You've come to the right place to get help. You might note a few curmudgeons on this board, but by and large, there are a LOT of very nice people here. Don't be put off by a the few you might run across who are a little rough around the edges. Most here are helpful and are first and foremost people just like you! You'll also notice quite a few off topic threads - marked OT - this is a community and this is part of the value here.

I live in Ontario too and the rules have changed a bit since I started on xpap some 7 years ago. I'll try to help with what I know and let others fill in the blanks based on their experience.

Firstly, my experience with Vitalaire was not good. When I first started a trial of cpap (a loaner) with them back in 2008, the lack of help and professionalism caused me to RUN to another DME. I never really found one that I liked. I've not heard anything to make me think that others, including Medigas, are much better. All I can advise here is that it might depend as much on the individual helping you at the DME as which DME company you go to. Also, you are strongly advised to read and learn as much as you can in places such as cpaptalk, keep your eyes open, and always count your fingers when dealing with these companies. Question everything.

Yes, you have a prescription from your sleep doctor. Keep that paper handy because you should have it when you travel and you may need it to buy supplies, later (especially so if you order supplies from online sources in the USA). Better yet, ask your sleep doctor to write you a script on regular Rx notepad paper.

You asked about getting an auto-pap (apap). This is difficult to achieve in Ontario unless you are willing to pay the entire cost out of your own pocket, and even then, there seems to be a bias against any apap therapy by some sleep doctors. To get one that is paid by ADP (Ontario's Assistive Devices Program) and your insurance you will need to qualify under the ADP rules. You can find them online but suffice to say, your sleep doctor must sign off that the minimum criteria are met and that you need an apap for medical reasons. There appears to be no getting around this requirement.

There is no harm is asking your sleep doctor if you qualify for an apap. You'll likely have to accept whatever he/she tells you. There's no point arguing this out with your DME because in Ontario they are not the ones who will have to sign the ADP forms to justify its need.

You should note that apaps are not always desired. There are many threads on cpaptalk by people who have set their apap to operate in cpap mode because that gives them better therapy! It's an individual thing.

On the subject of payment for your equipment: payment from ADP for the equipment is made directly to the DME. The DME will bill you for the difference between that and the total owing. You will have to pay the balance owing and then submit a claim to your own supplementary insurer. Before getting to this point you should make yourself familiar with the ADP rules for payment (see link, below) which cover not only what they will pay but also what the DME can charge you (I've seen reports where some DMEs have tried to make people over-pay).

ADP manuals and information can be found here: (the respiratory devices manual contains prices)
http://tinyurl.com/pv2jbht


Philips Respironics (PR) seems to keep changing its model numbers so it's hard to keep up with the differences between models. There also may be differences in models available in USA and Canada. Others on this board may be able to help you here. It appears to me that the PR-461TS model that you mentioned is a an apap for the first 30 days of therapy and then it automatically reverts to cpap mode. Failing an ability to get an apap under insurance, this is a good fall back machine because it at least allows your titration to be fine-tuned by the machine for the first month (and checked periodically later).

It also appears to me that the PR-461TS model collects full efficacy data on your therapy. If I'm correct (you need to confirm this) then it also is a good thing. Cheaper models (often referred on cpaptalk as "bricks") only collect compliance data: e.g. what dates and how many hours you use your cpap each night. Efficacy data includes the compliance data but also includes a host of other very important information such as AHI, mask leak rates, etc etc. This efficacy data is necessary to allow you to monitor your own therapy (using free software such as Sleepyhead), understand how you are doing, and to fine tune it so that that you get the most out of it. Don't settle for less than a full efficacy data cpap (I believe that's a "Pro" model in Philips Respironics speak). The PR-461TS model appears to be a hybrid that falls between the Pro line and the fully auto lines of PR.


I hope that answered your questions. Keep posting! And hang around! Help is here!

And most importantly at this point in your therapy, read, read and read some more! Start with Pugsy's pointers at the top of the forum list and work your way down.

Hose_Head wrote:Philips Respironics (PR) seems to keep changing its model numbers so it's hard to keep up with the differences between models. There also may be differences in models available in USA and Canada. .

I believe, from what I've read, that the only difference in the models is that the us models end in zero, the canada/uk models end in 1.

so
560/561 PR System One REMStar 60 Series Auto CPAP Machine
760/761 PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
960/961 PR System One REMStar 60 Series BiPAP autoSV Advanced
660/661 PR System One REMStar 60 Series BiPAP Pro with Bi-Flex
260/261 PR System One REMstar 60 Series Plus CPAP Machine with C-Flex
460/461 PR System One REMStar 60 Series Pro CPAP Machine
220/221 PR System One REMStar 60 Series SE CPAP Machine

the 460/461 is, as you said, a straight pressure with the autoiq self titration mode.

Hose_Head wrote:

NewbieCPAP wrote:Hi everyone,

So late last year I ended up going for a sleep test, and midway though they woke me up and put a mask on me. From what I understand, this was my "titration" test. I made it through the holidays, and once I'm back at work again, I'm wiped again, and finally decided to do something with what they gave me. Problem is, my local DMEs aren't being much help, so I'm coming here with questions. I've only got 3 to choose from, unless I want to look out of town (which I'm willing to do if necessary). When I left the sleep test, they gave me paperwork that had CPAP circled (NOT Auto), my AHI is 30/hour, at 10cm of water pressure.

When I call my local DMEs, two of them won't talk to me on the phone (Vitalaire and Medigas) and have both told me to come in "to get all set up".

The third spent a long time talking to me, but I'm unsure of his answers. He recommends to set me up with a PR-461TS. He said he can't get me an auto unit unless I get a prescription from my sleep doctor. I'm unclear on if the paperwork I currently have is a prescription (it doesn't say prescription, but it does have my family doctor's signature on it). We don't have any sleep doctors in town, they come in periodically to do clinics, and to the best of my knowledge I'm not scheduled to meet with them.

The DME that would talk to me said that I need to get the PR-461TS and use it for 30 days at 4 hours a night to qualify for the grant (for those unfamiliar, the Ontario government pays 75% of a pre-determined fee). He's familiar with my insurance, and says that'll cover the remainder. It looks like I have to pay everything upfront though, and get reimbursed.

So... questions.

Do I have a prescription? Or is the DME trying to mislead me a bit and give me a loaner until I do get a prescription?
Is the PR-461TS "good enough", or should I be pushing my family physician to prescribe an auto unit (or get a referral to a sleep doctor)?
I know from reading the forums that there's a bit of a ResMED bias on here, but based on the differences I think I'd prefer a Philips-Respironics. If I have to go non-Auto, I like the CPAP-check feature. If I'm able to go with an Auto at some point, I understand the PR to be a little more gentle. Can anyone explain the bias? Both are available, but if I want the S9 it'll be an Elite (again, the DME said I can't get an Auto unit unless the paper I've got had Auto circled).
Should I even consider the two DMEs that wouldn't talk on the phone? They may have excellent service with poor reception... if it is a good idea, I have no problem putting in a few hours and/or saying no to a hard sell.

First off, WELCOME to cpaptalk. You've come to the right place to get help. You might note a few curmudgeons on this board, but by and large, there are a LOT of very nice people here. Don't be put off by a the few you might run across who are a little rough around the edges. Most here are helpful and are first and foremost people just like you! You'll also notice quite a few off topic threads - marked OT - this is a community and this is part of the value here.

I live in Ontario too and the rules have changed a bit since I started on xpap some 7 years ago. I'll try to help with what I know and let others fill in the blanks based on their experience.

Firstly, my experience with Vitalaire was not good. When I first started a trial of cpap (a loaner) with them back in 2008, the lack of help and professionalism caused me to RUN to another DME. I never really found one that I liked. I've not heard anything to make me think that others, including Medigas, are much better. All I can advise here is that it might depend as much on the individual helping you at the DME as which DME company you go to. Also, you are strongly advised to read and learn as much as you can in places such as cpaptalk, keep your eyes open, and always count your fingers when dealing with these companies. Question everything.

Yes, you have a prescription from your sleep doctor. Keep that paper handy because you should have it when you travel and you may need it to buy supplies, later (especially so if you order supplies from online sources in the USA). Better yet, ask your sleep doctor to write you a script on regular Rx notepad paper.

You asked about getting an auto-pap (apap). This is difficult to achieve in Ontario unless you are willing to pay the entire cost out of your own pocket, and even then, there seems to be a bias against any apap therapy by some sleep doctors. To get one that is paid by ADP (Ontario's Assistive Devices Program) and your insurance you will need to qualify under the ADP rules. You can find them online but suffice to say, your sleep doctor must sign off that the minimum criteria are met and that you need an apap for medical reasons. There appears to be no getting around this requirement.

There is no harm is asking your sleep doctor if you qualify for an apap. You'll likely have to accept whatever he/she tells you. There's no point arguing this out with your DME because in Ontario they are not the ones who will have to sign the ADP forms to justify its need.

You should note that apaps are not always desired. There are many threads on cpaptalk by people who have set their apap to operate in cpap mode because that gives them better therapy! It's an individual thing.

On the subject of payment for your equipment: payment from ADP for the equipment is made directly to the DME. The DME will bill you for the difference between that and the total owing. You will have to pay the balance owing and then submit a claim to your own supplementary insurer. Before getting to this point you should make yourself familiar with the ADP rules for payment (see link, below) which cover not only what they will pay but also what the DME can charge you (I've seen reports where some DMEs have tried to make people over-pay).

ADP manuals and information can be found here: (the respiratory devices manual contains prices)
http://tinyurl.com/pv2jbht


Philips Respironics (PR) seems to keep changing its model numbers so it's hard to keep up with the differences between models. There also may be differences in models available in USA and Canada. Others on this board may be able to help you here. It appears to me that the PR-461TS model that you mentioned is a an apap for the first 30 days of therapy and then it automatically reverts to cpap mode. Failing an ability to get an apap under insurance, this is a good fall back machine because it at least allows your titration to be fine-tuned by the machine for the first month (and checked periodically later).

It also appears to me that the PR-461TS model collects full efficacy data on your therapy. If I'm correct (you need to confirm this) then it also is a good thing. Cheaper models (often referred on cpaptalk as "bricks") only collect compliance data: e.g. what dates and how many hours you use your cpap each night. Efficacy data includes the compliance data but also includes a host of other very important information such as AHI, mask leak rates, etc etc. This efficacy data is necessary to allow you to monitor your own therapy (using free software such as Sleepyhead), understand how you are doing, and to fine tune it so that that you get the most out of it. Don't settle for less than a full efficacy data cpap (I believe that's a "Pro" model in Philips Respironics speak). The PR-461TS model appears to be a hybrid that falls between the Pro line and the fully auto lines of PR.


I hope that answered your questions. Keep posting! And hang around! Help is here!

And most importantly at this point in your therapy, read, read and read some more! Start with Pugsy's pointers at the top of the forum list and work your way down.

Thank you for the very detailed and helpful response. The model appears to collect efficacy data, and it can be programmed to go into Auto mode for up to 30 days at a time. The CPAP-Check feature will check every 30 hours of use to determine if the pressure is appropriate, even after trial use. I've gone ahead and picked one up, and the DME was kind enough to let me bring the manual home with me (which means I can access the provider mode screens and also set the unit to Auto for 30 day periods). Of course, none of that funny business until I understand what's going on, and the thing is fully paid for via insurance and the grant.

As you stated, the DME is taking care of the grant paperwork, and will bill me the remainder which my insurance will pick up (I'm not fortunate enough to have direct billing).

The manual describes this unit as a REMstar Pro C-Flex+. It also says that it collects therapy hours, blower hours, large leak, AHI, periodic breathing (CSR), 90% pressure, and a few other things (mathine hours, humidifier/heat tube settings, etc). It also detects apneas and hypoapneas: Obstructed Airway Apnea/Clear Airway Apnea, RERA, Periodic Breathing, Flow Limitation Detection, Hypopnea Detection, and snore detection.

So it seems I have a decent unit, and now I just need to start using it

I'll be lurking and doing lots of reading, and thank you again for your detailed, helpful response.

It is a good machine and you can read the data using Sleepyhead software. See the first thread above "Pugsy's tutorial..." on where to download and how to use it.

The 461 is a fine manual CPAP machine with full data. Not quite as good as the Auto machine, but delivers good therapy for many people, especially if you have a good doctor who checks the data and adjusts it or get the software and learn to read it yourself.

Unfortunately, it's hard to find a doctor who actually looks at the the therapy data and many of us find we have to manage our own therapy. Many doctors just check whether you're meeting the 4 hours a night needed for insurance to pay.

You can get online copies of the setup manual from apneaboard dot com.

I upgraded from a brick to an APAP, but I use the APAP as a CPAP (if you understood that, you've been reading too many of these messages!). I am happy to have an APAP in the event my therapy begins to have problems, but, for now, my therapy wouldn't be any different if I had a machine such as the one you are getting. ResMed and Philips both make good machines - there are other manufacturers that some forum members have and are very happy with. I use ResMed because that is what my first DME gave me. I upgraded from the S9 Escape to the S9 Autoset - I wouldn't have to buy a new humidifier if I stuck with the ResMed's.

Since my username is "Ontario CPAP" I thought this post was directed to me...

Anyway, the process I went through was this.

I went for a sleep test (no machine) hooked up to all the bells and whistles (EKG, EEG, O2 monitor, breathing monitor, video of sleeping position through the night, etc.) Based on this, I was diagnosed with severe OHA on my back (AHI > 50) and moderate on my side (AHI of 10 to 15.) I was then given an APAP (Respironics) loaner to take home.

I used the APAP for 60 days, then brought the card back to my DME, who prepared a report for my doctor. I already had downloaded the data into SleepyHead, so I knew the results -- I was averaging a pressure of ~7 to 8 cmH2O with swings as low as 4 and has high as 16. I then had a full night titration.

My doctor took the titration test and APAP results and gave me a prescription for a CPAP with a pressure of 9 cmH2O. I really liked the APAP and asked if I could get one instead of the CPAP. The doctor explained the Ontario Assistive Device Program (ADP) would only subsidise an APAP if there was a significant change in pressure required throughout the night. Although I had a high AHI on my back and a low AHI on my side, the 9 cmH2O prescription would cover both positions, and therefore I didn't meet the criteria for an APAP. I could get an APAP if I wanted, but the government wouldn't cove the cost. The Ontario ADP pays 75% of the cost of the machine, so this was not trivial. She said she rarely sees a patient that qualifies for an APAP.

Although initially disappointed, I got a Respironics CPAP with a fixed pressure of 9 cmH2O, and I've been very happy with the results. What I found makes a much bigger difference for comfort is the CFLEX+ feature rather than APAP capability.

I hope this helps.

Ontario CPAP wrote:Since my username is "Ontario CPAP" I thought this post was directed to me...

Anyway, the process I went through was this.

I went for a sleep test (no machine) hooked up to all the bells and whistles (EKG, EEG, O2 monitor, breathing monitor, video of sleeping position through the night, etc.) Based on this, I was diagnosed with severe OHA on my back (AHI > 50) and moderate on my side (AHI of 10 to 15.) I was then given an APAP (Respironics) loaner to take home.

I used the APAP for 60 days, then brought the card back to my DME, who prepared a report for my doctor. I already had downloaded the data into SleepyHead, so I knew the results -- I was averaging a pressure of ~7 to 8 cmH2O with swings as low as 4 and has high as 16. I then had a full night titration.

My doctor took the titration test and APAP results and gave me a prescription for a CPAP with a pressure of 9 cmH2O. I really liked the APAP and asked if I could get one instead of the CPAP. The doctor explained the Ontario Assistive Device Program (ADP) would only subsidise an APAP if there was a significant change in pressure required throughout the night. Although I had a high AHI on my back and a low AHI on my side, the 9 cmH2O prescription would cover both positions, and therefore I didn't meet the criteria for an APAP. I could get an APAP if I wanted, but the government wouldn't cove the cost. The Ontario ADP pays 75% of the cost of the machine, so this was not trivial. She said she rarely sees a patient that qualifies for an APAP.

Although initially disappointed, I got a Respironics CPAP with a fixed pressure of 9 cmH2O, and I've been very happy with the results. What I found makes a much bigger difference for comfort is the CFLEX+ feature rather than APAP capability.

I hope this helps.

Which specific model did they give you? Is it data-capable?


Den

.

Wulfman... wrote: Which specific model did they give you? Is it data-capable?


Den

.

Respironics System One. Yes, it's data capable using a regular SD card. I can pop the card into my laptop and view the data using SleepyHead. I can also view AHI data on the display itself (after I activated the Clinician's menu.) As mentioned before, I find its CFLEX+ system works very well.

The SD card is the only thing I had to pay for myself in the entire process. The Ontario government and my employer benefits covered the cost of everything else -- two sleep studies, three physician consultations, two DME consultations and all of the equipment other than the SD card. The DME charged me $75 for the SD card which is rather steep, but given that was the only out-of-pocket expense I had, I didn't complain. Much.

Wow, That is very pricey. I bought an extra SD card for under $10. at an electronics store. I think it was Future Shop or London Drugs. If it dies on you don't pay another $75. Also, don't forget to lock it when you take it out of the machine and unlock it when you put it back. I kept forgetting to do that and my old computer wrecked the card...thus the new cheap one.

Best of luck with your new gear. I hope you like it as much as most of us.