Prescription for a CPAP Machine
By Andrew Senske, President CPAP-Supply.com
Last Updated 12/17/2012 1:10:00 PM



If you've just received a prescription for a CPAP machine from your doctor, you might be wondering about the next steps in the process of starting your CPAP therapy. Many people don't know the process for buying a CPAP machine, and people often don't know what they need to buy or where to buy it. Sometimes doctors will send patients to a local home medical equipment supplier to purchase equipment. While many local HME suppliers have good intentions, they don't always have the product selection, product knowledge and competitive pricing of online discount stores. Many HMEs sell a wide variety of medical equipment, from motor scooters to crutches, and so don't necessarily specialize in any individual types of medical equipment. That's why it's important to keep reading, so you know what your options are. Even if you've already been setup with your equipment, I'm sure you'll find the following advice to be useful.

We see a wide variety of prescriptions on a daily basis, with some being very specific and some being very general in nature. The general type might indicate the following:

CPAP machine, 10cm
Humidifier optional
Mask, patient's choice

This SHOULD be a pretty easy prescription for a CPAP user to work with, since it's so general it really leaves almost everything up to the patient. For some CPAP users, though, this generality can cause some uncertainty simply because no one is telling the CPAP user specifically which items to buy.

The specific type of prescription might indicate the following:

S9 Elite with H5i Humidifier, 10cm H2O
Ramp 4 for 20 minutes
EPR 2
Swift FX Nasal Pillows Mask, medium

A prescription for CPAP really doesn't get much more specific than that. But does it mean you really have to buy the products exactly as they're listed on the prescription? Isn't that sort of like your optometrist or ophthalmologist not only prescribing a correction for your eyesight, but also telling you that you must buy the Ralph Lauren frames in blue?

Sure. That's actually exactly what it's like.

However, the prescribing doctor may have some reasons for prescribing a specific model of machine, humidifier and mask. Let's take a look at a couple of those reasons, and then we'll continue discussing your options.

Typical doctors in the United States are familiar with Respironics and ResMed CPAP equipment. This is because the local HME suppliers to which they refer patients almost always carry equipment from these two manufacturers. These two manufacturers also have large sales organizations which engage with sleep clinics and doctors regularly. Smaller manufacturers just don't have the sales horsepower to get in front of doctors all the time, so their products aren't necessarily well known. Familiarity and brand recognition - even at a fairly superficial level - often play a key role in a doctor's recommendations for CPAP equipment.

Some doctors who specialize in sleep disordered breathing including sleep apnea have software installed that allows them to analyze compliance and event data from certain models of CPAP machines. For example, the doctor who wrote the specific prescription above may already use ResMed ResScan software to track compliance for all his patients. If he does, then he's very likely to recommend a ResMed CPAP machine (and maybe even a ResMed CPAP mask or other ResMed items) simply because doing so will make his life easier if he ever wants to look at the data from the machine he's prescribing.

Of course, there are other less legitimate reasons for doctors prescribing certain brands of CPAP machines and CPAP masks, but we'll leave that discussion for another day.

So the question remains. Do you have to buy exactly what the doctor lists on the prescription? The answer is: not necessarily.

The most important aspect of CPAP therapy is your compliance with it. It's not important for you to buy a specific CPAP mask or machine if you're not going to use it. It's not important to get exactly what your doctor prescribed if you can't afford it, or if you believe there's a better option for you. As a CPAP user you need to feel empowered to do whatever necessary to comply with your prescribed therapy.

And when it comes to software that your doctor may or may not already be using, you must ask yourself about the likelihood of your doctor ever needing to see a compliance report from your CPAP machine. In fact, you should probably ask yourself if you'll ever talk to your doctor about CPAP therapy again. Another conversation about your sleep apnea may never come up once you start using CPAP therapy and once it starts working for you. Any future compliance checks might become part of the conversation only if you're struggling with acclimating to CPAP therapy. And even then, a compliance check doesn't do much good beyond you reporting back to the doctor that you're not complying with your therapy. No one needs a machine or software for that type of information.

Some machines do record much more than basic compliance data. Compliance data alone simply shows hours of use. It's particularly useful for some types of jobs. As an example, professional drivers (i.e. truckers) often have to submit compliance reports to their employer in order to continue driving. In addition to recording basic compliance data, automatic CPAP machines record detailed information about apnea, hypopnea and snoring events throughout the night. These types of machines record when those events occur and what the machine does in response to those events. This brings up two very interesting points:

1. Perhaps you want to be able to have access to the detailed information recorded by an automatic machine, but your doctor didn't prescribe such a machine; and

2. Perhaps your doctor prescribed that type of machine that provides detailed information, but you're not interested and want to buy a different machine with fewer features.

In either case, buying a CPAP machine that's different from one specifically recommended by the doctor is perfectly acceptable.

It's also worth noting that CPAP machines all share the same insurance code of E0601, regardless of make or model, and regardless of feature set. You can buy a CPAP machine for $165 or a CPAP machine for over $800 and they'll both have the same insurance code. They have the same code because they're basically the same machines. That is, the core function is the same. In my opinion, if a doctor orders one CPAP machine, any other CPAP machine with same insurance code would be considered equivalent. The same holds true for CPAP masks. In the end, the choice is yours whether the prescription indicates it or not.

Some machines designed for sleep apnea aren't "standard" CPAP machines. Bilevel machines are different in that two pressures are programmed into them instead of a single pressure. These machines differentiate between an inhalation pressure and an exhalation pressure. The insurance codes for bilevel machines are different from the code for a standard CPAP machine, and bilevel machines are generally more expensive. So, is a substitution acceptable if a bilevel machine is prescribed, or a if a standard machine is prescribed but the patient would prefer a bilevel machine? This time the answer isn't quite as simple.

Some "standard" CPAP machines have an exhalation pressure relief feature which mimics the functionality of a bilevel machine. The only real limitation with these types of machines is that the exhalation pressure relief is limited to about 3 units of pressure. If you are holding in your hand a prescription that states IPAP 12 and EPAP 9, then yes, of course, a substitution for a machine with an exhalation pressure relief feature would be acceptable. If your prescription indicates IPAP 18 and EPAP 8, then substituting for a standard machine might be a little bit more problematic, and would be worth a discussion with your doctor to see if the difference in inhalation pressure and exhalation pressure really needs to be so great. The bottom line is if you can handle a higher pressure during exhalation, then the choice really should be yours since the issue would really be about your comfort level. Similarly if your inhalation pressure is prescribed to be over 20 cm H2O, then you'll likely need a bilevel machine since standard CPAP machine pressures max out at 20 cm H2O. The exception here is if your prescribed pressure setting is just barely over 20. If, for example, the prescribed pressure is 21 or 22, then it's quite possible that using a CPAP machine at a level of 20 would work for you. Obviously, your doctor has no control over whether or not your prescribed pressure must be significantly greater than 20. With all that said, in almost all cases substituting one bilevel machine for another bilevel machine would be perfectly acceptable.

If you've got a prescription for CPAP, you've also got choices. We can help you make those choices because we're CPAP specialists. Sure, we also sell oxygen equipment and pulse oximeters, but our main focus is CPAP equipment, including CPAP masks and CPAP machines, and that's been our main focus for the last 12 years. We're experts at helping you get exactly what you need. Nothing more. Nothing less. So please continue looking at our website, or feel free to give us a call at 1-888-955-2727. We're here to help.

When you're ready to send the prescription to us, you can fax it to 1-509-448-1540 or you can email it to rx@cpap-supply.com.

Andrew Senske
President
www.cpap-supply.com

CPAP-Supply.com is a leading online retailer of CPAP equipment. Located in Spokane, WA CPAP-Supply.com has been serving thousands of customers around the world since 2001. Founded on a belief that patients are their own best primary care providers, CPAP-Supply.com understands the importance of educating patients and customers on both the effects of and treatment for obstructive sleep apnea. For more information visit CPAP-Supply.com or call toll free 1-888-955-2727.

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