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Permalink Reply by Judy on July 12, 2010 at 3:52pm

Yep, I've now learned all we really need to ask our sleep doctors to include in our scripts is "access to Leak, AHI and AI" and "full face, nasal cushion, nasal pillows or oro-nasal mask of patient's choice".

What were your recommendations, Mike? You didn't mention them.

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Permalink Reply by Mike on July 12, 2010 at 4:05pm

very simple: CPAP mask of patient choice + fully-data capable Auto-adjusting CPAP of patient choice with humidifier.

Judy said:

Yep, I've now learned all we really need to ask our sleep doctors to include in our scripts is "access to Leak, AHI and AI" and "full face, nasal cushion, nasal pillows or oro-nasal mask of patient's choice".

What were your recommendations, Mike? You didn't mention them.

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Permalink Reply by 99 on July 12, 2010 at 4:52pm

Let's start with the first step - where to get your prescription for CPAP equipment. You don't need to go to a sleep specialist or pulmonologist, and you don't need to have slept through a sleep study in order to get a prescription for a CPAP machine. You can ask your primary care physician for a prescription. If he's familiar with sleep apnea - both the symptoms and the common characteristics of people who suffer from sleep apnea - and if he's familiar with you and thinks you fit the profile for someone with sleep apnea, he may feel comfortable encouraging you to try CPAP therapy without any further testing. In this case, an automatic CPAP machine would be the best choice since you wouldn't have a recommended pressure setting from a sleep study. Incidentally, if your primary care doctor isn't all that familiar with CPAP therapy, then you can direct him to our article about automatic CPAP machines. This might convince him that a sleep study isn't necessary.

If you've been using CPAP therapy for a while and if your primary doctor is familiar with your condition and knows you suffer from sleep apnea, then he'll more than likely be willing to write a new prescription whenever you request one. You should always ask if you can get an updated prescription without having to go in for an office visit. The doctor likely has nurses or nurse practicioners who have the ability to write prescriptions, and they'll fax one straight to you, or straight to your supplier of choice.

We generally recommend that you ask for the prescription to indicate a duration of "lifetime" or for whatever the longest period of time with which your doctor feels comfortable. Sometimes doctors or nurses will write "99 months" for the duration. Either way, it's nice to have an open-ended prescription that you can use whenever you need it.

Below, I've listed four examples of prescriptions - one each for CPAP, BiPAP, Auto BiPAP, along with a generic example that would apply to any type of equipment. Keep in mind that all the information provided in these examples isn't necessary (really a prescription just needs to say CPAP equipment, at least) but the details allow us to set the CPAP machine for you before we ship it, and those same details may prove useful when trying to use your prescription at local brick-and-mortar suppliers as well as when trying to obtain insurance reimbursement for the equipment you purchase.


Sample Prescription for CPAP Machine
CPAP 10cm H2O
Heated Humidifier

Nasal Mask

Duration: as needed for lifetime

Note that the units of pressure are represented by cm H2O, or centimeters of water. If a prescription indicates only "CPAP 10", then it's calling for a CPAP machine set at 10 centimeters of water.


Sample Prescription for BiPAP Machine
BiPAP IPAP 12 cm, EPAP 6 cm2O

Note that a prescription written specifically for a BiPAP machine should indicate the inhalation pressure (or IPAP) as well as the exhalation pressure (or EPAP). If you or your doctor don't know what these should be because you haven't been evaluated in a sleep study, then you should opt for an automatic BiPAP machine.


Sample Prescription for Automatic BiPAP Machine
Auto BiPAP
IPAP Max 15 cm

EPAP Min 4 cm

Pressure Support 6 cm

Full Face Mask

Heated Humidifier if Needed Duration: 99 months


In the example above, the pressure support indicates the pressure differential between IPAP and EPAP. So, if the machine is delivering an inhalation pressure of 14 cm, the exhalation pressure will be 6 units less than that, or 8 cm.


Sample Generic Prescription
CPAP, Auto CPAP, BiPAP or Auto BiPAP
10 cm H2O

Patient May Adjust

Please Provide Clinician Manual

Mask, Humidifier, Supplies as Needed

This is useful because it allows you the freedom to choose whatever equipment you want, it gives you explicit permission to adjust the pressure setting (presumably within reason and under doctor's orders), and calls for all the equipment you'll ever need.


Sample Simple Prescription
CPAP machine and supplies as needed

The drawback to this example prescription is that it doesn't include a pressure setting, so we can't adjust the pressure on the CPAP machine before we ship it to you. However, if you already have a CPAP machine and you've faxed us a prescription like the one above in order to buy a replacement CPAP machine, then you can either call us to tell us your pressure setting, or you can include your existing pressure setting in the order comments field on the checkout page when you place your order.

All prescriptions should be written on a normal prescription form and should be signed by the doctor or qualified nurse practicioner.

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Permalink Reply by joe hart on July 12, 2010 at 9:42pm

I was a snorer for a long time. As I got older, my snoring got more frequent and louder. Also, I was overweight, tired a lot, and liked to take naps during the day. People complained about my snoring and I did not want to sleep in the same room with others for fear of keeping them awake.

Finally, I talked with a doctor about the problem. He sent me home with a machine to check my breathing and pulse while I slept. The results really shocked me! The doc said my airway was closing off up to 70 times each hour, and that I stopped breathing for as long as one full minute at a time! I had severe apnea. He strongly recommended I start using the CPAP machine, since I was risking damage to my heart due to lack of oxygen.

I had read a little about CPAP machines, and always thought I would never be able to sleep with one, since I am a little claustrophobic. Surprisingly, it only took me a few minutes to get accustomed, and I was able to start sleeping comfortably right away.

The mask part is just a small nose manifold that covers the nostrils to blow in air. That keeps the throat inflated like a balloon, preventing throat closures and snoring. One problem is with the straps over the head that keep the nose piece in place. They can be a little annoying at first, and if you change sleeping positions at night, it is possible for these straps to move, causing the nose piece to slip off.

I have been using a Dreamhelmet (a combination sleep mask sound-muffling pillow) for years now, to sleep at night and for napping during the day. I always find it hard to sleep without the Dreamhelmet, and was afraid I would not be able to use it with the CPAP mask, but I was wrong.

After using the CPAP machine and mask for a short while, I tried wearing the Dreamhelmet over the CPAP mask, covering up the straps – voila, it worked like a charm! I found that the Dreamhelmet actually helps keep the straps in place when I change positions, so now I can sleep all night in comfort, not being bothered by sound, light, or changing positions. The CPAP combined with the Dreamhelmet are the perfect sleeping combo for me. Dreamhelmets are only sold online at www.dreamhelmet.com

Now I don’t snore, I wake up rested, and I have energy that lasts all day. I’m still overweight, but I don’t feel so run down all the time or always need an afternoon nap. I still carry an extra Dreamhelmet in my car just in case I do need a nap.

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Permalink Reply by Mark Douglas on July 13, 2010 at 3:03pm

99--- thats great! I did not know you could get a CPAP via regular doctor, and I am dumbfouned that a patient might adjust it as needed.

I am thrilled to hear it ---it seems my sleep doctor is dedicated to the proposition that the less the patients know and can do on their own, the better he likes it. He has beds now in his own clinic and tries to fill them up as much as humanly possible. If you went to him for a hangnail, he would check your insurance then order a sleep study, I guarantee it.

He told my neighbor she definately needed a sleep study, to adjust her CPAP setting, until he found out her insurance paid almost nothing, and she could not afford it. So he came back in the room and told her to forget the sleep study, unless she could come up with money up front. And I understand that-- its a business. But its amazing how quickly he changed his diagnosis. He simply refuses to adjust her setting -- she has a fixed machine. So unless she can come up with the money, she has to endure it.

Of course you don't know ANY of this when you are first diagnosed --- I never HEARD of a sleep doctor. I thought that was a funny term. You are suddenly at the tender mercy of a sleep doctor, and you don't really know your options. Thats all good if your sleep doctor is helpful, open, and motivated to return you to health, which probably most of them are.

99 said:

Let's start with the first step - where to get your prescription for CPAP equipment. You don't need to go to a sleep specialist or pulmonologist, and you don't need to have slept through a sleep study in order to get a prescription for a CPAP machine. You can ask your primary care physician for a prescription. If he's familiar with sleep apnea - both the symptoms and the common characteristics of people who suffer from sleep apnea - and if he's familiar with you and thinks you fit the profile for someone with sleep apnea, he may feel comfortable encouraging you to try CPAP therapy without any further testing. In this case, an automatic CPAP machine would be the best choice since you wouldn't have a recommended pressure setting from a sleep study. Incidentally, if your primary care doctor isn't all that familiar with CPAP therapy, then you can direct him to our article about automatic CPAP machines. This might convince him that a sleep study isn't necessary.

If you've been using CPAP therapy for a while and if your primary doctor is familiar with your condition and knows you suffer from sleep apnea, then he'll more than likely be willing to write a new prescription whenever you request one. You should always ask if you can get an updated prescription without having to go in for an office visit. The doctor likely has nurses or nurse practicioners who have the ability to write prescriptions, and they'll fax one straight to you, or straight to your supplier of choice.

We generally recommend that you ask for the prescription to indicate a duration of "lifetime" or for whatever the longest period of time with which your doctor feels comfortable. Sometimes doctors or nurses will write "99 months" for the duration. Either way, it's nice to have an open-ended prescription that you can use whenever you need it.

Below, I've listed four examples of prescriptions - one each for CPAP, BiPAP, Auto BiPAP, along with a generic example that would apply to any type of equipment. Keep in mind that all the information provided in these examples isn't necessary (really a prescription just needs to say CPAP equipment, at least) but the details allow us to set the CPAP machine for you before we ship it, and those same details may prove useful when trying to use your prescription at local brick-and-mortar suppliers as well as when trying to obtain insurance reimbursement for the equipment you purchase.


Sample Prescription for CPAP Machine
CPAP 10cm H2O
Heated Humidifier

Nasal Mask

Duration: as needed for lifetime

Note that the units of pressure are represented by cm H2O, or centimeters of water. If a prescription indicates only "CPAP 10", then it's calling for a CPAP machine set at 10 centimeters of water.


Sample Prescription for BiPAP Machine
BiPAP IPAP 12 cm, EPAP 6 cm2O

Note that a prescription written specifically for a BiPAP machine should indicate the inhalation pressure (or IPAP) as well as the exhalation pressure (or EPAP). If you or your doctor don't know what these should be because you haven't been evaluated in a sleep study, then you should opt for an automatic BiPAP machine.


Sample Prescription for Automatic BiPAP Machine
Auto BiPAP
IPAP Max 15 cm

EPAP Min 4 cm

Pressure Support 6 cm

Full Face Mask

Heated Humidifier if Needed Duration: 99 months


In the example above, the pressure support indicates the pressure differential between IPAP and EPAP. So, if the machine is delivering an inhalation pressure of 14 cm, the exhalation pressure will be 6 units less than that, or 8 cm.


Sample Generic Prescription
CPAP, Auto CPAP, BiPAP or Auto BiPAP
10 cm H2O

Patient May Adjust

Please Provide Clinician Manual

Mask, Humidifier, Supplies as Needed

This is useful because it allows you the freedom to choose whatever equipment you want, it gives you explicit permission to adjust the pressure setting (presumably within reason and under doctor's orders), and calls for all the equipment you'll ever need.


Sample Simple Prescription
CPAP machine and supplies as needed

The drawback to this example prescription is that it doesn't include a pressure setting, so we can't adjust the pressure on the CPAP machine before we ship it to you. However, if you already have a CPAP machine and you've faxed us a prescription like the one above in order to buy a replacement CPAP machine, then you can either call us to tell us your pressure setting, or you can include your existing pressure setting in the order comments field on the checkout page when you place your order.

All prescriptions should be written on a normal prescription form and should be signed by the doctor or qualified nurse practicioner.

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