Welcome, Judy! The text box on your profile page is an excellent place to tell about your "journey" with PAP therapy. it will also let everyone learn from your experience, and offer suggestions customized to your situation. let me know if you have trouble finding it...

Welcome to the forum!!

Your knowledge should be helpful to other forum members.

Doing good can't imagine livivg without it know

I have had it for a couple of years but still don't like it. I am having them send me a different mask that is smaller and they are going to check my card to make sure everything is working right. I have not used it faithfully but for the past couple of months I have and do not feel rested like a lot of people tell me they do.

Hi...I've had it about 3-4 weeks....of course I'd love to throw it out the window....but I guess it''s better than the alternative. I am having some issues and just emailed my MD. I just, also read about the freq. urination. I thought it was in my head.....I don't feel rested either.....every morning I wake up and it's never on my face......i only can tell how long I wore it by how much water is left in the recepticle.

ok.....I feel not so bad......but here is another issue....I initially got he sleep study because i was going to gastric lapbanding. During the cardiac w/u, i was found to have pulmonary hypertension, Md won't clear me, put me on meds....and the side effects is freq cough. So on top of the mask issues..i pull it off because I cough so much. So ......today my meds were switched, to elliviate the cough......tonight's another night. We'll see.......i think if not for the cough, i'd be ok.....it's one of the reasons i take the damn thing off....try coughing with the mask and pressures......the noise is hysterical.....lol

Lisinopril was the med........today I started on Diovan

last night only lasted about 30 mins..started the "cough" can that was it.......no more mask. Hopefully DR emails me back today....maybe it's the maching making me cough, and not the med.

no to all those tests.......the only extreme test was an emergency chest cat scan to r/o a clot..and i'd refuse a blood gas......you see, i've been an RN for 25 years.....no way. no how....

I just stumbled across your comment about the OptiLife under the picture of the Activa.

You're right about the shin support on the OptiLife. It doesn't come close to functioning like a chinstrap to control mouth-breathing, and depending on the chinstrap you use, it could get in the way.

Funny timing. Last night, I was going to put on my OptiLife and I found that my puppy had chewed the frame where the chin support loops through. The fabric was dangling and there was no way to re-attch it. I should have learned by now to keep a spare mask at home (this is the second time the puppy has chewed a CPAP mask), so I had no choice other than to try the OptiLife with no chin support. For me at least, it was fine. Made no difference whatsoever.

If the OptiLife strap prevents you from using your chinstrap, I suggest you try removing the OptiLife strap and see how you do. By the way, what type of chinstrap do you use, and do you like it?

Good old 302175, aka the Respironics Deluxe, not to be confused with the Respironics Premium, which is black, but has a cup, not a hole, at the chin. I like that one because (thanks to it's width) it provides the most vertical support for your jaw, rather than pulling backwards, which most others do. The fabric is a cotton/poly blend, which breathes a whole lot better than the neoprene ones.

With the Deluxe, I would imagine that you could use it with the Optilife chin support as long as you put the chinstrap on first. I haven't tried that combination personally. With chinstraps, it's often the case that the supplies given to you by the DME are the raw materials for you to come up with the best solution for you. That's especially true regarding the white Velcro braces that come with the deluxe. Some people don't use them at all; others use just one. Don't think of yourself as a lab rat if you don't use it exactly as shown in the diagrams.

Here's what I don't like about the Respironics Deluxe:
- After a few weeks the velcro causes the chinstrap to look pretty ratty
- It's definitely not the most attractive thing out there. When I see one on a patient, it always reminds me either of a 1940's cartoon character with a toothache who has a diaper on his head, or a WWI soldier with a head wound.
- You call it chintzy, but I think the reason they call it the Deluxe is that they charge the DME more for it than other chinstraps. It costs me more to give that chinstrap to someone than Medicare is willing to pay me. I lose money whenever I give someone the Respironics Deluxe.

I don't have the Respironics part numbers all memorized. You are correct about the one I was thinking about. I can see that the Respironics Basic would be kind of incompatible with the OptiLife. If I were you, I'd try removing the Optilife strap and see what happens.

SomniHealth doesn't carry your chinstrap. I've found that the thin straps at the top of the head wind up slipping and sliding for most people. Some get lucky. I think it has to do with the shape of your head.

I was looking at the price differentials on CPAP.com. I previously mentioned that I take a loss when I give a patient the Respironics Deluxe. As a Medicare provider, there is only one price I can bill for a chinstrap. I abhor the idea of charging patients upgrade fees for the model that works best for them. Most providers solve this dilemma by only stocking inexpensive chinstraps and then telling patients that there are no other choices. The other option is to fill out extra paperwork and then charge the patient an upgrade fee. Are they bad providers, or is the system horribly broken?

To provide you with the equipment, all I need is a prescription that specifies how the device is to be set. In order for insurance to pay for it, I am required to have the medical justification for the prescription. In most cases, this means the results of the diagnostic sleep study that shows that the patient has sleep apnea. Usually, a one-page summary that shows an AHI over 15 is enough, but there are lots of variables. Private insurance company requirements vary tremendously and capriciously, depending on which claims examiner is reading the claim. It is my belief that they sometimes reject a claim or hold it up by asking for additional information merely to hold on to their money longer than the 45 days that the law requires them to resolve a claim. Sometimes they ask for complete chart notes and a complete PSG, but that's pretty rare. I usually send whatever I have, and if they ask for more, I try to get it. If I hit a brick wall with the sleep lab, I have no choice but to enlist the aid of the patient. This is done by sending a bill to the patient, explaining to the best of my abilities the reason that their insurance won't pay, and then leave it for them to resolve. I don't believe the equipment provider should be denied payment when someone's insurance company is refusing to pay.

You read it right - AHI of 15. Most insurance companies will only pay if you have moderate sleep apnea or worse. To get a CPAP when your AHI is between 5 and 15, you need additional documentation. As I wrote in the discussion on the validity of AHI,

In cases where AHI is less than 15, Medicare has specified certain instances wherein beneficiaries may still qualify. The provider must have documentation on file from the prescribing physician stating one or more of the following:
- Excessive Daytime Sleepiness
- Impaired Cognition
- Insomnia
- Mood Disorders
- Hypertension
- Ischemic Heart Disease
- History of Stroke

Most private insurance companies also adhere to these guidellines, although it can be an arduous appeal process to get approved. It's pretty easy for a doctor to qualify any low AHI patient under the Excessive Daytime Sleepiness or Insomnia conditions, if they truly want to get a CPAP.

Hi Judy. Maybe your family in Germany liked Opera. Madam Melba was very famous in Europe????? Or maybe they just liked the name.

I was diagnosed with sleep apnea about a month ago....so am still adjusting. I tried the nose cup mask for a while and thought it would be better than a full face mask. However, it seems to slip and I do not feel as if I am getting as much adjusted air flow. It seemed more annoying as my breathing sounds were more pronounced. I am seeing my doctor again in two weeks. I like her very much. I am 62. This diagnosis is amazing as I have struggled with lack of alertness and focus, depression....psychotherapy, antidepressive and the like for many years. She said my best medicine is air....and she is so right. I feel really good and am able to function ....don't need naps etc. I have cut my Ambien in half to 6.25 but have not been able to completely get off of it yet. I work as a Teaching Artist a couple of weeks out of the month with a federal grant in Beaufort SC....I now live in NC. so I travel back and forth. I hope to wean myself off of it when I return as I will have six weeks of "retire" life and do not have to get up at the crack of dawn to go to schools.

I am very interested in others experience. and tips. Thanks for responding. Melba

Thanks for the kind words. With your permission, I'd love to use that quote on my website!

Thanks Judy for posting about the Resmed machines. I was going to pm and ask if you would mind doing this!! You beat me to it!!

I appreciate all of your help here on the forum!!

thanks for all the wonderful feedback on the FAQs. We've incorporated it into the FAQs.

to attach a link to a url in a comment, or elsewhere, copy the url into the text box, highlight it, and then press the link icon in the edit navigation bar (the icon between the strikethrough and the insert image icons)

From what I have read when your jaw comes forward, your tongue gets pulled back. Try extending your jaw and sticking out your tongue. It is possible,but difficult. This will also cause your mouth to slightly open. studies have shown that if you if you measure the collapsible pharengeal segment with the mouth open you are 4cm closer to obstruction. Translation: A person with OSA that sleeps with their mouth open will have 2-6cm more of obstruction, which in turn means that much more pressure to open the airway. I have the studies if you would like me to email them to you. They are way to big for a posting. Please don't ever question challenging, or arguing, anything that I say. It makes me reread the studies and challenge my own words. Your questions are very educational for my process. This as it seems is a learning experience for all of us.

Your going to have to give me a minute on the studies. I am still learning how to download file and be able to send them to others. I have only had 1 experience with asv, and it was not a good one. I am currently looking for educational material. Just not much to find. If you can find a copy of AtoZZZ magazine issue 19 2007. They have a report on the first few studies ever done. I had a copy, But I also have a 1 year old terrorist who likes to rip magazines to pieces. lol

I'm sorry Judy, I was cornfused. I might have some info on those at work. My week starts tonight, so it won't be until I wake up on Monday. I'll see what we have.

Lol that is funny. I also have an 8 year old. Both little women. I am surrounded by them. It is no bother Judy. BiPAP and Auto BiPAP are 2 areas that I need to be stronger in. I was planning on scouring the lab for info anyway. I also have a few other sources that I use that have proven to be most helpful. I should have something for both of us by the middle of next week. Besides, Judy, until I pass my boards educating myself and improving my overall studies are 2 of my highest priorities.

I'll take anything I can get! thanks. I gotta go to work. I am gonna go through blog withdraw. have a great weekend guys.

I guess that would help huh? rockhinkle@yahoo.com

Is there a difference in the way 2 different manufacturers machines titrate? That is a great question! My lab for, some reason, pushes the resmed units. We rarely see the respironics. I will definately put that question to the all knowing sleep gods.

My lab carries very little info on the auto bipap machines. I actually thin you sent me more than I was able to find. I was told that we bring auto machines in on a case by case basis. My boss said that it was because of the rings we had to jump through to actually get insurance to provide them. Also are clinical machines are set up to do a wide variety of test, including BiPaP. We just don't have a need to keep them on site, If I do find anything I will forward it.

Have you ever thought about getting a job in sleep Judy? Local DME? Your wisdom on the end user part is very nice. Your school-n me girl. I know that our local DMEs are always looking for people. GOOD PEOPLE LIKE YOU IS WHAT THEY NEED! Please explain the HCPCS code. Do all DMEs carry all of the equipment needed by varias pts? Do some of them specialise in lets say cpap, or other specific parts of the meedical industry?

any advice on the ResScan software for Ruth?

You should start your own DME that specializes in PAP or respitory treatments. That is very interesting that there is are 2 individual charges for masks. They come in the same package when we get them.

I believe, and hope, that as the industry of sleep evolves that we will see an end to the bare bones machine. They have come along way from the stand alone(in the corner) machines.

figured you might be able to assist on this one: http://www.sleepguide.com/forum/topics/resmed-vpap-auto-25-help

Hi Judy just thought I would let you know that I stopped by your page. Thanks for introducing me to this site! Oh yea do you like my figurine? I carved that, in a sculpture class I took some years ago, we had to do a self portrait sculpture, this was carve out of a solid pine block, other than the cane, and it is bamboo skewer that I soaked in water and bent the handle, I got an award for this piece and it was put in the Parkland College art gallery on display for a few weeks! I miss doing the sculpture, but I have such a difficult time using my arms and hands that I have given it up! Maybe I could put some pictures of my work up in my photo space.
Anyway I don't know how you keep up with all the posting you do, But you sure are allot of help to allot of people! keep up the Great work!

yes we use resmed, we push resmed. it is all about resmed in our lab. To my knowledge I don't believe we have done any titrations with a pt's personal machine. people bring their own masks in, but not machines. Most of my my ts anyay, that have a machine are looking for the upgrade anyway.

we use compumedics profusion II at both of the labs I work at.

I think compumedics is a stand alone company. I have not used alice. I am not sure but I think that Sandman is the resmed program. I will verify all of this tonight if I have a chance as I should know. Also I did some checking half of our lab is set up on resmad lab machines(the half that I use evididently) and the other is on the respironics sychrony lab machine. From what the other techs say the only difference is the name on them. I found this odd because we are practically sponsered by resmed.

I used the resp. rooms when I first trained, for some reason I swithched after using the resmed room. never even noticed that the machines were different. They look the same anyway. I am going to try and lobby for 2 different cpap pts this next week so that I can do an actual comparison

Yes I love binary!!!!! Due to the lack of education at my lab that site has kind of become my mentor. I don't know a whole lot about the programs yet. I have only used compumedics. The new lab I start at on monday is supposed to cross trainme on others. I am hoping to round out my training in the hospital setting. I will work both for as long as i can.

I will check that one out. I am really trying for my family and my patients. My next step is to join the AAST and purchase my books. I just finished the ASTEP program and modules. I will either sit for the boards in Dec. 2009 or March 2010. Not sure which they are giveing me some grief about my 18 mos being up 2 days after the Oct. 30th deadline for the dec. test. Still waiting to here back from the sleep gods of my understanding.

Mine to, but sleep is the game I chose to play.

I am a RPSGT. For seven years as of two days ago. Thank you.

judy, this member posted some ResMed results