I had a sleep lab study done in 1998.   Based on that study, my HMO provided me with a low-end Respironics CPAP, which my wife and  I found to be too noisy.  Then in 1999 I purchased a Resmed Sullivan V Elite CPAP (out of my own pocket), and have been happily using it for the past nine years.  Now, I would now like to buy a new CPAP machine.

The problem is that the prescription (which I still have) authorizes only the purchase of a CPAP machine; no pressure setting is specified on the prescription!  I presume that the company from which I bought my machine in 1999 called my doctor to get the prescribed pressure setting.  However, I have since relocated, the HMO who wrote the prescription is out of business, and I can't locate the doctor who wrote the prescription.

I will ask my present doctor if he would write a new prescription based on the 1999 prescription and the sleep lab prescribed pressure setting.  Additionally, the calibration label on my CPAP does show the pressure setting.  If my doctor would write a new prescription, or if I can find a dealer who would sell me a machine based on the info that I have, I would be spared the trouble and expense (sleep lab is not covered by my meager health insurance plan) of a new sleep study.  Does anyone have any experience with buying a CPAP based on an old prescription which does not specify a pressure setting?

Any comments are appreciated.

If it has been that long...many things have probably changed with your SA...it is always suggestd to have a titration every few years.  Some do it using an APAP...but for that long of time..I suggest a new titration study and a new script will follow.

I do not think any Dr will go by records that old...it is like taking meds without checking if it is still needed or without blood work.  I also do not think any DME will take the chance and go by the old either.

So I know what I have said is what you are trying to avoid...


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BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.

I agree w/Mrs Rip. Better you should have the new sleep study. HOWEVER, it MIGHT be, that based on your CPAP use for so many years if you have established some type of relationship w/a new family doctor that he MIGHT write a script for a two week or one month loaner autoPAP to determine any change in pressure needs. IF he is willing to do so, since you know your current pressure setting, it would be wise that the loaner autoPAP pressure range be set 1-2 cms below your current set pressure and 20 cms for the top of the range for a week, then a download of the data and the pressure range could be narrowed to 1-2 cms below the reported 90%-95% pressure and 2-3 cms above that reported 90%-95% pressure for a week, then a download and either they've found your pressure need or can further tweak the pressure range for another week.

Resmed has just come out w/a new Resmed S8 II series of xPAPs. The equivalent of your Sullivan V Elite would be the Resmed S8 II Elite w/EPR. I had the Resmed S8 Elite w/EPR. Great device w/easy access to a lot of your data via the LCD screen. The S8 II Elite is even quieter than the S8 Elite and has the new EasyBreathe technology for even smoother exhalation/inhalation transitions. THERE'S BEEN A LOT OF ADVANCES IN CPAP TECHNOLOGY IN THE LAST 9 YEARS!

The S8 Elite and S8 II Elite can report the pressure and Leak rate AT OR BELOW which you spent 95% of the previous night, week, month, 6 months and year (after you've used it that long), your AHI, AI and HI for the same; the number of hours you used your CPAP the night before, the total number of hours used and the number of nights used via the LCD screen!! They are what we call "fully data capable" CPAPs. You can also purchase the software and cable reader to download and printout via your computer even more detailed information on the above.

AND the next step up in CPAP would be the Resmed S8 AutoSet Vantage and Resmed S8 II AutoSet. Fully data capable autoPAPs.

You might want to call your insurance company about DME CPAP benefits. If they are covered ask them what local DME suppliers they are contracted with and just what your copay and/or deductables are. Many companies require a specified rental period for the xPAP prior to full purchase (rent to own) but pay outright for the mask, humidifier, etc. (By the way, they now have integrated, heated humidifiers they might not have had 9 years ago, units are MUCH SMALLER).

Most important: most insurances pay one set, contracted fee they negotiated w/the "in network" local DME suppliers and that fee is based upon an HCPCS code. They don't actually know what brand and model CPAP you get. AND all straight CPAP from bare bone, compliance data only CPAPs thru fully data capable CPAPs "and" the fully data capable autoPAPs are billed as HCPCS code E0601. Obviously the local DME supplier has a better profit margin if they provide a bare bone, compliance data only CPAP than if they provide you w/a fully data capable CPAP or autoPAP. While you can usually convince them to provide you w/a fully data capable CPAP, sometimes you can even with more difficulty convince them to provide you w/a fully data capable autoPAP. They should NOT charge you the difference in cost.

There is often a "billed" amount, an "allowed" or "contracted" amount, the % of the "contracted" amount your insurnace will pay and your "copay" amount. Your copay "should" be based on your % of the "contracted" amount, but some local DMEs may charge your copay based on the "billed" amount.

IF you still have a copy of your old CPAP script from 1999, most online DME suppliers will honor it despite it has no pressure scripted, AND most will allow you to purchase an autoPAP w/a CPAP script. I only know of one online DME supplier that will work w/"some" insurance companies. Most require self-purchase. SOME insurance companies will recognize you as "in netowrk" and allow you to purchase your equipment out of pocket, submit a PAID INVOICE W/PROPER CODING, and then reimburse you less your copay. But that is something you need to dicuss w/your insurance.

Also, Resmed and Respironics have recently instituted MAP (minimum advertised pricing) policies for online DME suppliers so it is to your advantage to call any online DME supplier carrying the xPAP you are interested in to ask if they have an "unadvertised sale" or "unadvertised" price for that xPAP and equipment. Buying online you get not just the Users Manual w/the xPAP as from the local DME suppliers but ALSO the Clinicans Manual will come with it, even a Quick SetUp Guide (at least w/the Resmeds you also get the Quick SetUp Guide).


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Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

I believe that you may use your Rx for nearly any PAP machine at CPAP.com.  (Mods, can I say this?)

Mine (a Respironics M series AFLEX) had all the info that I needed to set the pressure range appropriately.

Consider getting the data card, reader, and software with whatever machine you buy.  You will be able to ascertain your therapeutic success much more easily this way.

Good luck

Thanks to everyone for all the helpful information.

I have a high deductable PPO, and I probably won't reach the deductable this year (but one never knows) to pay for a machine.  I called a couple of DME's in my PPO network to see if their prices negotiated through the plan could compete with online vendors (was pricing the Resmed S8 Autoset II).  One DME told me outright that I would be better off buying on the web.  The other DME promised to call back with price info;  still haven't heard from them.

I emailed my Dr about the prescription problem, but haven't received a reply.  I'll see him in about a week anyway.

In the meantime I will continue to research auto CPAP machines, since that's what I can buy with my old prescription.  I would go with a fully data capable machine so that I can better understand my needs.

I'm going to be a heretic here and say, why should you need a new sleep study if you are functioning well with the pressure you now have?  If you weren't, I would suggest differently.

I could be wrong, but I believe that if you were using health insurance to purchase the cpap, they might require a sleep study.
If you are lucky, hopefully your doctor will prescribe an auto cpap.  It's the best of both worlds (shy of a full sleep study) -- titration and the use of an auto cpap.

If you purchase online, one way to comparison shop is to use www.froogle.com which is a division of Google, and search for what you want.  


Linda

Frances wrote:

I'm going to be a heretic here and say, why should you need a new sleep study if you are functioning well with the pressure you now have?  If you weren't, I would suggest differently.

THIS.

I agree with this completely.

Frances wrote:

I'm going to be a heretic here and say, why should you need a new sleep study if you are functioning well with the pressure you now have?  If you weren't, I would suggest differently.

Everyone is entitled to an opinion...............but a 9 year old prescription ??

After 9 years, one might feel OK, but this is subjective........it is impossible for a patient to know whether or not cpap continues to give maximum benefit.

Compare this to any other medication or treatment therapy.........a pharmacist will not dispense a 9 year old prescription....why should there be any difference.

Daniel.


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The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

Daniel wrote:

Frances wrote:

I'm going to be a heretic here and say, why should you need a new sleep study if you are functioning well with the pressure you now have?  If you weren't, I would suggest differently.

Everyone is entitled to an opinion...............but a 9 year old prescription ??

After 9 years, one might feel OK, but this is subjective........it is impossible for a patient to know whether or not cpap continues to give maximum benefit.

Compare this to any other medication or treatment therapy.........a pharmacist will not dispense a 9 year old prescription....why should there be any difference.

Daniel.

You also have to consider the cost of the tests. A baseline test (where I work) is 2200 and a split night (or titration) being 2500. IF, and yes its a big if, a patient is not experiencing sleepiness, per the Epiworth scale, then it might be sufficient to continue treatment. Cost, unfortunately, may be an issue.

I think about what patients come into our office and why they come in. They are usually extremely tired or suffering from performance issues (albeit memory, work related, etc). They usually dont come in because they feel they are sleeping great, but could be better. Im sure that you can find exceptions, but im speaking generally. I also respect your opinion. You seem well educated on the subject.

There shouldnt be a difference in prescriptions, but consider a high blood pressure patient. It is entirely possible for him/her to be on the same medication for 9 straight years, with refills of course. Im not trying to argue, but moreso trying to say that it could possibly be that the patient is sleeping well on the same pressure, regardless of time passed. From my experiences, a patient feels the need for titration when their pressure is too low (frequent awakenings, sleepiness) and pressure too high (frequent awakening, sleepiness).

It couldnt hurt to get re-titrated though. We get a lot of over titrates because the lab down the road jumps from a pressure of 5cm h20 (starting) directly to 8 cm h20, if events arise. They skip 6 and 7. Its crazy, but the doc gets his way.

Just an opinion.

RAM_Sleep wrote:

Daniel wrote:

Frances wrote:

I'm going to be a heretic here and say, why should you need a new sleep study if you are functioning well with the pressure you now have?  If you weren't, I would suggest differently.

Everyone is entitled to an opinion...............but a 9 year old prescription ??

After 9 years, one might feel OK, but this is subjective........it is impossible for a patient to know whether or not cpap continues to give maximum benefit.

Compare this to any other medication or treatment therapy.........a pharmacist will not dispense a 9 year old prescription....why should there be any difference.

Daniel.

You also have to consider the cost of the tests. A baseline test (where I work) is 2200 and a split night (or titration) being 2500. IF, and yes its a big if, a patient is not experiencing sleepiness, per the Epiworth scale, then it might be sufficient to continue treatment. Cost, unfortunately, may be an issue.

I think about what patients come into our office and why they come in. They are usually extremely tired or suffering from performance issues (albeit memory, work related, etc). They usually dont come in because they feel they are sleeping great, but could be better. Im sure that you can find exceptions, but im speaking generally. I also respect your opinion. You seem well educated on the subject.

There shouldnt be a difference in prescriptions, but consider a high blood pressure patient. It is entirely possible for him/her to be on the same medication for 9 straight years, with refills of course. Im not trying to argue, but moreso trying to say that it could possibly be that the patient is sleeping well on the same pressure, regardless of time passed. From my experiences, a patient feels the need for titration when their pressure is too low (frequent awakenings, sleepiness) and pressure too high (frequent awakening, sleepiness).

It couldnt hurt to get re-titrated though. We get a lot of over titrates because the lab down the road jumps from a pressure of 5cm h20 (starting) directly to 8 cm h20, if events arise. They skip 6 and 7. Its crazy, but the doc gets his way.

Just an opinion.

I agree, but I think after 9 years the use of an APAP machine over a few nights (at least) would at least confirm the pressure setting. Obviously a retitration is the best option.

I also agree that a patients perception of how they are doing (treatment wise) is very important, as they are the only ones who are aware of things like palpitations headaches etc etc. My main concern is to continue treatment based on a 9 year old prescription which was originally written based on 9 year old medical facts.

Something I have noticed over the past few years, on this forum, is the big question of costs and insurance. I don't want to start a war here or anything.........but a good number of posters based in the US continually bring up the question of costs involved with sleep studies etc. Unfortunately there have been quite a few who have opted out of having a sleep study specifically because they have no insurance and 'can't afford the study'. Other posts mention that their insurers won't cover an replacement mask except every 6 months or so, regardless of need and cpap machines remain on rental for periods of time. I appreciate that you get 'nothing for nothing' but as an outsider looking in there appears to be a very unhealthy position with health insurers deciding what can and can't be done. There is also an unhealthy link between employment and health insurance. EG today I have health insurance, tomorrow I'm fired (or switch jobs) and I have no cover.......and must wait for X number of weeks before my new cover takes over..............Again, as an outsider, this practice flies in the face of human rights (I think I'll be sorry for stirring this up   ).

Just my thoughts.............I think that it's very unfair.

Daniel.


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

Cost of a sleep lab titration is THE issue;  my high deductible policy won't cover it.   As we very well know, many others are in the same boat.

Since my original post, using my old prescription I purchased a Respironics Remstar Auto with A-flex, out of pocket.  For the past week or so I've been using it in auto mode and find that my optimum pressure setting is 9 cm H2O, which is the same as what was set 9 years ago on my Resmed machine.

I am using my new machine with Breeze nasal pillows: I am generally pleased with the operation of that combination.  I'll post more comments later as I gain experience with my new APAP.

Daniel wrote:

    
Just my thoughts.............I think that it's very unfair.

Daniel.

Yeah, the U.S. health insurance system basically sucks (IMHO).


Linda

Cpapdoc-I feel for you!  This is a sticky situation, to say the least!  I think Mrs. Rip Van Winkle and Chronie Too gave the most informative advice.  While is is true that you most likely need a new RX, you also MUST  have something to get you by until  you can get things straightened out.   You have been on CPAP for 9 YEARS! You surely cannot go without, as we know the misery and damage untreated apnea can cause.  It would seem reasonable to me, that your PCP could do as ChronieToo suggested.  Unfortunately, I would think you need another study done as well, as things can change in 9 years.  Things change weekly and monthly for  me!  Weight gain/loss, changes in altitude, health status, to name a few.  Your pressure may need to be increased or decreased, or not changed at all.  But, all things considered, you cannot go without your CPAP-that would be like asking someone who was on O2 or heart meds for 10 years to go without!  Good luck-best wishes that this situation will soon be resolved. Lantern 4 life.

lantern4life,

Actually, if you would carefully read my last post, the auto mode confirmed that my 9 cm H2O pressure setting of 9 years ago is till the correct pressure.  I'm blessed that my weight has been very stable for the past 35 years!

The availability of modern auto-PAP machines is making home titration a viable alternative to sleep lab studies.  This result is simply an expected response to a dysfunctional health care system with out of control costs.