Hi everyone,

I just got my machine last week, but unlike everyone else i read about, nobody came to my house to fit me for the mask.  I received everything in the mail.  As a  matter of fact I didnt even know I was getting it.  I was sent for my initial sleep test by my ENT.  I then went for the titration and never heard from my Dr.  I called and was told they would call me when they got the results, and then one day this machine shows up.  Anyway I started using it, a Remstar series M with a select comfort mask.  I have a setting of 15, which I ramp.  I have had to make the mask very tight or it leaks like crazy.  My husband said it sounded like a wind tunnel.  Is it right that it should be this tight?  It presses my top lip in and pushes a little against my eyes.  Also, who should I continue to go to the ENT or is there a different Dr. I should be seeing?  Am I suppose to do any follow up sleep studies?  I see people talking about how many apneas they have in an hour, my machine doesnt show that.  I can only tell how many hours it has been on & used.
What should I do next???

graceb59 wrote:

Hi everyone,

I just got my machine last week, but unlike everyone else i read about, nobody came to my house to fit me for the mask.  I received everything in the mail.  As a  matter of fact I didnt even know I was getting it.  I was sent for my initial sleep test by my ENT.  I then went for the titration and never heard from my Dr.  I called and was told they would call me when they got the results, and then one day this machine shows up.  Anyway I started using it, a Remstar series M with a select comfort mask.  I have a setting of 15, which I ramp.  I have had to make the mask very tight or it leaks like crazy.  My husband said it sounded like a wind tunnel.  Is it right that it should be this tight?  It presses my top lip in and pushes a little against my eyes.  Also, who should I continue to go to the ENT or is there a different Dr. I should be seeing?  Am I suppose to do any follow up sleep studies?  I see people talking about how many apneas they have in an hour, my machine doesnt show that.  I can only tell how many hours it has been on & used.
What should I do next???

You need to contact your DME, the people who sent the equipment.  You need to get a little training on it and it also sounds like the mask is not quite right for you.  Might be the style of mask, might be the size of the mask.  I would give them a call and see if they can come out and work with you.

Sounds like a !@#! way of doing business - both the sleep lab, doctor and DME supplier. Where are you located? What country?

If you are in the USA you have a LEGAL RIGHT to a lot more information than you've been provided with!

I'd start w/calling your insurance company if insurance is providing a good share of the cost of your equipment. I'd ask what local DME suppliers they are contracted with, what local doctors specializing in sleep medicine they are contracted with and what local sleep labs or clinics they are contracted with.

My experience has been in the USA w/Medicare (national type health insurance) and a good secondary insurance.


_________________
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 live on Long Island, NY.  I have Cigna, which paid for 90%.  I will make some calls today.  Should I need to make the mask very tight to work or should I ask to try a different kind of mask.  Any suggestions of good masks?

Fitting our masks TOO TIGHT is THE most common mistake newbies to CPAP therapy make. The mask cushion NEEDS to fill w/air to better seal to the face.

NEVER tolerate a leak around your eyes. NEVER. At the top or near the top of this forum is a Sticky w/mask fitting tips, try them. If they don't help ask to try a different mask. And, ideally, you would be allowed to try AT LEAST ONE of all 4 styles of mask: full face, nasal cushion, nasal pillows and a "hybrid" style that is a combination of nasal pillows and a mouth piece.

The new Resmed Swift LT is very much liked by many nasal pillows users. On the other hand, the ComfortLite 2 has also been popular and is rather like getting two masks in one as it comes w/a set of 2 sizes of nasal pillows AND 2 sizes of a simple nasal cushion OR two sizes of nasal pillows and two size of nasal seals.

My personal prefernece (and every face is different) is for one of Respironics' oldest masks, the Simplicity simple nasal cushion in the Petite size. My second preference is for the new Resmed Mirage Micro in the Small size. Both are nasal cushion style masks.

The Resmed Mirage Quatrro is their newest full face mask, similar to the Micro except a full face, and it has been well received by many. However, the Small just is NOT small enough for me. The Resmed Mirage Activa is another popular mask among xPAP users.


_________________
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.

graceb59 wrote:

Should I need to make the mask very tight to work or should I ask to try a different kind of mask.  Any suggestions of good masks?

It may sound counterintuitive but tighter does not mean a better seal.  In fact sometimes if you overtighen the mask the silicone cannot seal properly and will leak more, not to mention the fact that it will probably hurt.

As for the type of mask, it depends on some factors which is why you probably want to have someone with different types to show you.  But there are some basic types,

full face - pretty much covers the nose and mouth area, good for people who breathe through their mouth
hybrid - a subset of a full face that will cover both nose and mouth, slightly different design
nasal - fit over the nose (sounds like what you have)
nasal pillows - small pillows that fit into the nare of the nose and seal against the nare
nasal prongs - basically like straws that stick up your nose
oral - a mouth only type

What will work for you might not work for me.  I use the nasal pillow type (Swift LT).  I like them and they work for the shape of my face and the type of sleeping I do.

Take a look at the public sites of some of the big manufacters (Resmed, Respironics).  I am not saying they are the best mask for you, but at least you will see the types of masks.

Thanks for all the help.  I did try a new mask, the optilife nasal.  The DME said that they now come with masks, but he doesnt like them, so they just gave me the pillows.  When I came home I looked at the other cushions & I think I'd like them, has anyone used them?  He seemed to offer me very few options, I'm going to see if I can get a different DME.  Do I really need one, or can I just order the equipment on my own?

Also I woke up last night & my mounth & throat felt like they were on fire, so I took the mask off.  I'm a little congested & think I might have been breathing through my mouth, I want to also try a full face, was thinking of the hybrid since I didnt like the nose mask I first tried, It bothered the bridge of my nose.  Any ideas on full face masks?

One more question.  I've had the machine for 2-1/2 weeks.  As I stated earlier I was all mailed to me without me even knowing it had been prescribed.  Can I still call my insurance company & ask for a machine with more information.  After reading this board I see some machines tell you how many apnea's you've had & other useful info. BTW, I called my ENT (who prescribed CPAP for me) and never got a call back, so it's time to find another Dr.

Thanks Again.  I;m determined o learn & get this working !!!!

I'm not holding out much hope for you but call your insurance company and ask if there are any other local DME suppliers they are contracted with that you can get your supplies from.

Also ask them if you are considered "in network" and if you purchased your equipment elsewhere and submitted the paid invoice including the CPT and HCPCS codes at what rate would they reimburse you.

Your insurance company does not pay by brand of model, it pays strictly by HCPCS code and all CPAPs are coded as HCPCS code E0601. (Bi-levels, SVs, etc. are a different HCPCS code).

Also be sure to mention that while the OptiLife mask is SUPPOSED to come w/4 cushion sizes your local DME supplier only provided the one size.

Is this ENT who hasn't bothered to return your call in anyway affiliated w/the supplier you received your equipment from?

If you have any options w/your insurance company for other local DME suppliers it could well be worth your while to return your current equipment and ask your family doctor to write your equipment script for the exact CPAP you want.

To do that you will have to WRITE to your lab and ENT and request a copy of 1] the doctor's dictated results (1-2 pages each), 2] the full scored data summary w/condensed graphs (5+ pages each) from BOTH your sleep evaluation AND your CPAP titration study AS WELL AS a copy of your equipment script. FAX to both the sleep lab and ENT. Give them two weeks to comply. If you don't receive them send a second WRITTEN request via CERTIFIED MAIL, RETURN RECEIPT REQUESTED and CC'd to the state licensing board and the local medical society. Be sure to retain all your proofs of mailing including the returned green card w/signature verifyng their receipt of your request. You have a LEGAL RIGHT to copies of your medical records if you are in the USA under HIPAA and the above are a part of your medical records.

I am afraid tho that most likely the shoddy and shorted equipment you've received are due to your less than ideal insurance coverage and insurance company.

The OptiLife should have come w/all 4 cushion sizes.

Quote:

... 4 Cushion Sizes. The OptiLife comes with four cushion sizes, from large to petite for a more comfortable fit on a wider variety of noses. ...

_________________
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.

graceb59 wrote:

Also I woke up last night & my mounth & throat felt like they were on fire, so I took the mask off.  I'm a little congested & think I might have been breathing through my mouth, I want to also try a full face, was thinking of the hybrid since I didnt like the nose mask I first tried, It bothered the bridge of my nose.  Any ideas on full face masks?

Did they give you a humidifier?  Sounds like you don't have one.


Sleeping

Yes, I did get a humidifier.  I called my insurance company & I'm going to be able to change DME & the ENT, so opefully I'll have some better luck with them.  I also requested another new mask.  The type that cover your mouth & have the nasal pillows, I should know tomorrow if it got approved.  I also requested a new machine with data capabilities, so I'll find out about that also.  Some days I wake & cant believe how much better I feel all day.  I guess those are the days that everything works right at night.  Hopefully I can get it to be like that every day !

Thanks for all the help.

Does anyone have any other suggestions for nasal congestion?  I use a nasal rinse, have tried afrin & sudafed.  Nothing seemd to work.  I'm hoping my new Dr helps.

Thank again

Okay, the fully data capable CPAPs are:

1] Resmed S8 Elite w/EPR
2] Resmed S8 II Elite w/EPR
3] Respironics M Series Pro w/C-Flex

You do NOT want ANY Respironics w/Plus in the name. There are two new ones out that I'm not all that familiar w/that you should do a web search on:

4] DeVilBiss IntelliPAP
5] Covidian (formerly Puritan Bennett) Sandman Info

I don't know that either of the last two xPAPs are fully data capable, and if so WHAT data, nor if they require software to access the data or whether a good share of the data is available via the LCD screen like the above Resmed and Respironics xPAPs. Those are questions you are going to want to be sure to ask.

Pay close attention to the names as the xPAP manufacturers don't seem to have much imagination when it comes to naming their xPAP models. I've highlighted the IMPORTANT part of the names.

Go to the Sleep Apnea Help forum and see my post in the Sinus Congestion - New CPAP User thread for some tips and also the Sticky on Mask Fitting in this CPAP Mask/CPAP Machine forum.


_________________
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.