Many of the online providers are "out of network" for various insurance plans and the covered benefit may not be the same as would be received for "in-network" providers. I think this can vary.

Another potential trap for those on Medicare is that if products or services are procured from a provider that has opted out of Medicare, there may be no coverage at all.

Lindsey, I will probably get upgraded to AirSense 11, but I have to go in for another overnight sleep test, so that the machine can be calibrated for me. The S9 that I have now has been discontinued, and so I'm sure I will not get another one of those. If I did get another S9, I would want to leave one of the machines in Cathedral City, so that I would not have to carry it back and forth every time. I do have an extra cord with transformer that I leave there, so that I do not have to unplug that each time.

When we went to Fiji, I left the cord that goes from the transformer to the wall socket at home, but fortunately, the hotel happened to have a cord that someone had left that I could use, and it also had the correct plug, which is the same as what is used in Australia. I did take plug adapters with me however. I had to buy plug adapters when I went to Brazil, and the only way to buy them was from street vendors - stores did not carry them, since Brazilians don't need them.

I always sleep on my side, but not the same side all night. I have at times gotten tangled in the hose and pulled the machine off the table. I have a California King bed in Cathedral City (came with the house), and the hose is not long enough to reach the entire width of the bed, and so I am stuck sleeping on just one side - I cannot even sleep in the middle. The bed frame extends way out beyond the mattress, and so the nightstand cannot be placed that close.

Again, thanks so much for all the information and tips on getting started.

Lindsey -- what great information about masks and the variety available. Yes we are 'on Medicare' -- DH is 84 and I'm 81. His former employer started offering a group plan with United Healthcare for 2023. That's the plan we'll be using for this adventure. (Despite my misgivings about any Medicare Advantage scheme, so far it's been excellent, including the drug plan through Optum Rx.)

I'm hoping DH might qualify for the nasal 'pillow' with or without intrusion into the nostrils.

My DH's headgear has the nose pillow but the hose comes from the top of the head like this one. It's a bit more complicated to put on than a baseball cap as it has to be positioned properly so as not to leak.

That looks bulky but I wonder what the on-off issue is.

My wife uses a model called Philips Respironics Dreamware Nasal Pillows that's very light and flexible, all soft silicone, and very much a slip on/slip off task for her. It looks like this. Maybe he should go back to the DME supplier and check out other options or to check if there's something wrong with the fit/sizing.

I got accustomed from the start to a product that was unfortunately discontinued 10 years ago so no need to describe it. It's also an easy slip on/slip off product to use. I was able to buy-up what I hope to be a lifetime supply (for me) from the remaining inventory of several sellers. So I run my own "storehouse" of spares.

Annie, your husbands head gear is from hell. That Tube across the face is gack.

Elmer, your wive's gear is a nasal cushion not a pillow. I know, I know. It is complicated. The pillow has the cones up the nose. The cushion doesn't. I have investigated both.

The latest head gear from ResMed has the air going up and down the sides of your face as shown by Lindsey. If one side is blocked by your sleeping position it still works. Sleeping on your side is actually the best. That Resmed Airfit is identical to the Respironics.

Insurance dictates what and how often. I have Medicare with back up. I cant change my mask until 90 days has passed and my team sends in a new prescription. This has been dominating my life as I tried to move to the more comfortable mask. I did not get to try different masks every 30 days. I wasnt getting the opportunity to try things out. Medicare Insurance. 90 days to try something new and then stuck with that for 90 days. We opted to just order some samples on line, argue about not needing a prescription (they fold under pressure) and pay for it our selves. We fortunately can afford to do this. It is ridiculous. You cant decide in a doctors office. You do need to trial it in real life. This is the nightmare I talked about. They are supposed to be helping you sleep but insurance isnt about helping you.

unless you sleep in separate rooms ... try not to get one that sounds like a plane landing all night

Patriciae, if you click on the image above to enlarge it, you'll see that the description I used (nasal pillow) is on the photo I'd inserted. It was from a page on Apria's website - Apria being a nationwide DME provider. I didn't pay further attention to the terminoplogy. I accept on its face your correction but don't think it matters to the conversation. My point was that compared to the other headpiece pictured being discussed that looks quite rigid and for which the user described having to make a number of personal customizations to make it comfortable, my wife's equipment as pictured is very soft, flexible, usable as is, and can be quickly and easily taken off and replaced, like a soft cap. As can the one I use.

It was my understanding that the 30 day trial practice was at the discretion of the equipment seller, not because of a Medicare rule one way or the other. Are you sure about your comment? While like most others we have an additional medical policy, the CPAP coverage we have is strictly under Medicare rules. My wife disliked her first-choice headpiece, returned it after a few weeks, and received in its place the one I showed above.

Speaking of "under Medicare rules", I had a dumb experience with them. I'd received a new CPAP machine 4 months before my primary private medical coverage became secondary and my primary switched to Medicare. Because Medicare was financially assuming the "rent to buy" contract already in place for my new machine, I had to retrench and follow Medicare rules for it to pay the remaining monthly payments. Which were - I had to see my sleep doctor after Medicare coverage began for me, have them prescribe a machine (which I already had and had been using for several months), and then have them send a report to Medicare confirming that in a 30 day period, I was using it regularly for at least 4 hours per night. This, after I'd been using CPAP machines consistently from bedtime to wake up time under the care of the same Sleep Clinic for over 15 years. Rules are rules.

@Lars - The "standard" length for a CPAP hose is 6 feet. But, you can buy a 10-foot long hose if that would work for you. (Or an 8-foot or 9-foot hose.) Lots of online CPAP suppliers for CPAP supplies and accessories. Here's a link to hoses available from a supplier in Texas.

Actually, I think he's quite happy with the hose coming in from the front and is quite happy with his bathrooming solution as it minimizes his sleep disruption (as am I as it keeps the toilet so much cleaner!) It may not be what you'd choose, but it works for him.

"unless you sleep in separate rooms ... try not to get one that sounds like a plane landing all night"

Mine is totally silent once the pillows are in place. My biggest complaint about it is that it doesn't shut itself off if I get up and forget, then it continues to operate and heat even if the water chamber dries out - seems like a fire hazard to me.

In a stupid feat of engineering, they make the shut off button light up when the machine is OFF. So, instead of having a light glowing to let me know it's on and I've forgotten to turn it off, it glows when the machine is off - when I have no need to ever find that button. It turns on automatically when I put the mask on. If it's dark and I want to shut the machine off, I have to just grope around to find the off button. If it were lit when the machine was ON, I could easily see it to shut it off.

Lindsey_CA. Thanks for that link - I will order a 10 foot hose and leave it in Cathedral City, as that is the only place I need it.

The masks with nasal 'cushions' and 'pillows' look like supplemental oxygen masks. I thought the whole idea was to force air into the body at some predetermined pressure.

@chisue The machine is set for your pressure readings, it doesn't matter what sort of device is on the end, BElieve me, it blows air thru that pillow.

Chisue, I think many machines have an option to add oxygen, but the pullows style mask can be used without added oxygen. I have only used that kind because the rhought of a mask covering more if my face makes me feel claustrophobic. The force of the air makes it uncomfortable to sleep wth your mouth open, because that air just rushes out, so it trains you to sleep with your mouth closed-the result is no more snoring.

Elmer, what I said was what I was told by both the sleep clinic people and the company that supplies the machine and paraphernalia. Maybe I was short changed?

CPAP is interesting in that you both breath in air blowing at you and out against that pressure. BIPAP adjusts the pressure so you breath out against a reduced pressure letting you empty your lungs more easily. The weirdest part of it all is that when your mask seals properly and you are breathing with the machine you have no sense of air blowing at you at all. With a nasal pillow or cushion you do have a little balloon sort of thing on your face that holds the pressure and you barely can tell it is there. A mask simply holds more air.

You can get little couplers that connect hoses together to customize your hose length. I suspect there is some recommended length. Anyone know about that?

annie, maybe he'll take a look at more comfortable and useful styles when new mask buying time opens up for him. Nighttime bathroom use doesn't need to be a mess producing event. Even in the dark, most people can find their way to a seated position on the toilet and do what they need to do with nothing left behind to clean in the morning. Anything beats using a chamber pot.

As for the lighted switch when off, I think it's to help find it in a dark room.

Those ordering hoses should note the difference between heated and unheated hoses. We use an overnight heat setback in our house during cooler months to around 60 degrees. There's a known effect called "rainout", when the hose gets cool enough to condense the water vapor in the air added by the humidifier and turns it back into water. When this happens, I can get a slow stream of water through the mask and, sometimes, dripping down my face. No worries, though, many machines works with hoses with a heating function and mine does. One just needs to use the correct hose.

A non-heated hose has simple, round silicone fittings at both ends, they're identical in appearance. A heated hose has different appearing ends. One side has a clip fastener to attach at the machine end. And that end has a small plug on it that fits into a socket on the machine side. The level of heat can be adjusted on the machine. Just a slight amount is enough to prevent the condensation.

Chisue - They're a soft material and should create enough of a seal. Yes the air is pressurized. In between breaths or when exhaling you're working against pressure, but not spilling out from that seal. I found it all very comfortable while awake, but the adjustment needed to keep in place when I tossed and turned was not. And just parting your lips has air rushing out your mouth. I don't know if in time I could have trained myself to keep my mouth closed 100%, but the discomfort of the mask didn't allow me to get that far.

This thread has been helpful to me in case I try again, but I'm wondering about that 30 day rule. Does that mean even with a better supplier I'd have to stick it out a month with a bad fit before being allowed another to try? I don't know how that would be manageable without putting it on for four hours prior to bed time to fake compliance before going to sleep for real.

food, how it worked for my wife, was like any store purchase - she could return it anytime up to 30 days later for a refund. The next day, Week 2, up until Day 30.

I have experience with open mouth matters. CPAP suppliers can provide simple and relatively inexpensive (<$20) chinstraps. Often made of neoprene with velcro fastners at the top. Those were effective for me for a number of years, keeping my jaw closed, but then I developed the habit of opening my lips. Mentioning this at my annual sleep clinic checkup, the doctor chuckled and said

"I have a solution for you but you need to have faith to use it".

"Okay, what do you suggest"? I asked.

"I have the same problem", he said, "and my solution is to tape my lips closed with paper tape".

"And what happens if the power goes out?' I asked

"You'll wake up, I promise. I've tested it several times. You'll feel somewhat panicked but you should wake up".

So that's what I've been doing for maybe 15 years now. One strip of 3M Nexcare Gentle Paper tape placed on my lips from end to end. I fold it back on itself to make a little tab on the right side so I can pull it off easily. For backup piece of mind, I have small power failure alarm devices in my bedrooms that make an annoying sound when the power goes out. More than enough to wake me from a deep sleep. These have awoken me maybe a handful of times since I've had them.

The tape leaves no residue on your lips when you remove it in the morning.

Thanks Elmer, clearly I misunderstood. Funny about the tape. Whatever works!

Just seeing this discussion and thought I’d add my experiences.

DH has been using a CPAP for 20 years. He originally had surgery, but that did not help, so was prescribed a cpap. He’s worn it faithfully since then. His headgear has changed over the years from a full mask that covered his nose and mouth to the less evasive nose pillows he has now.

My first experience with a cpap was not good. After a sleep study they prescribed a mask similar to what DH started with as I was a mouth breather. I gave it a try for 30 days but couldn’t tolerate it so it went back. Fastforward 5 years and I went in for another sleep study. This time I asked about the nose pillows. I was determined to train myself to breath through my nose. It worked and I used the cpap religously for 8 years. Then I received a notice that my machine had been recalled and to stop using it immediately. I ignored the warning and contacted my neurologist. I had lost 50 lbs. over the precefing year so they scheduled another sleep study and found I did not require the cpap anymore! It took almost a year for a replacement cpap to arrive, but thankfully I no longer need it.

A key for my success was to change the nose pillows regularly.

Thank you elmer, but please stop trying to fix what isn't broken. He's happy. You may not like it, it clearly wouldn't be your choice, but it works for him. And I'm happy that he's happy. (And I'm delighted that he uses it so faithfully!)

NH- congrats on dropping so much weight. That's a real achievement and it's great that you no longer need the machine.

My Philips Dreamstation was part of the recall and my pulmonologist advised me to continue using it since I had severe apnea. The recall notice also said to stop using the heated tubing until a replacement machine arrived. What a fiasco of a recall - it took 18 months to get a new CPAP machine. Philips used a call center to handle all questions and complaints and in general were very unresponsive. My only other option was to purchase a new machine or just wait it out. But there was never any indication of when a new unit might arrive which was frustrating.

Every 3 months I receive new supplies - head strap, tubing, 6 nasal cushions, 6 disposable filters. The washable filter is replaced every 6 months. Every 2 weeks I replace the nasal cushion and the disposable filter and wash the semi-permanent filter.

Yes, maire, we went through the whole replacement thing too. Very unresponsive...finally found a site where I could add DH to the priority list and it finally came shortly thereafter. He said he never saw any indications of insulation breakdown in the old machine, but who knows? I hope it didn't and that he has no ill effects from using the bad product. But he too felt the risks of not using it were far greater than the risks of using it.

Annie - Good for you for finding that site. I never found any way to find out where I was on the replacement list. Philips wouldn't reveal their methodology - was it by severity of apnea? oldest machines replaced first? or by when you registered your device? Neither my pulmonologist nor the medical equipment provider could offer any information.

@ Patriciae - "You can get little couplers that connect hoses together to customize your hose length. I suspect there is some recommended length. Anyone know about that?"

As I stated, above, the standard length is 6 feet. Machines come with a 6-foot hose, but they will function with any length. As Elmer said, there are heated hoses, too, and your machine needs to be able to utilize a heated hose. If your machine doesn't, you can still avoid the moisture condensation with a tubing wrap, and those are easy to find.

My husband hates a 6-foot hose. He spends most nights, all night long, sleeping on his back. On occasional nights he will turn over onto his left side. His CPAP machine is on the nightstand which is to his right as he's on his back. The machine is at the back of the nightstand, close to the wall. The hose attaches to his mask at the top of his head. So, as you can imagine, a 6-foot long hose is more hose than he needs. Years ago I bought a 4-foot hose for him and it's perfect. They're not always easy to find, so I buy several at a time.

And as Lars said, a standard 6-foot long hose is not long enough for him, because it doesn't allow him to sleep closer to the middle of his bed. So, now he's going to order a longer hose.

I would suggest that you use some yarn (or something similar), and attach one end to your machine (scotch tape will do for this purpose), and then dole out enough length to where you think it needs to end up. Then, measure it.

maire, the site asked several questions which I answered, but I think the thing that helped him most was his age.

I also had a recalled machine and agree with the chaotic process and call center dysfunction. I've spent so many hours on their help line and still have no resolution. Somehow, Kaiser (my Medicare health provider) was able to replace the machines very quickly. I had registered and got a case # with Phillips. The machine just showed up and I was charged my copay, plus had to buy a bunch of new supplies because the old didn't fit it.

I was told to destroy the old machine, which I did. Then I started getting notices from Phillips that I could get a new machine or $50. Since I already have a new machine, I opted for the $50, BUT you have to send in your old machine. The one I threw away as instructed. I called Kaiser, I've called Phillips, I've called the supplier that Kaiser uses (because I no longer have a record of the destroyed machine's serial number, but neither to they). I was told by Philips rep that there was no record of my registration for replacement. I've requested supervisors, been promised a call back but never have gotten one. I finally got another mass email recently that listed my claim #, so I'm going to try again. It's really not worth it for the $50, but I am so frustrated, I want to be compensated. Rant over. Oh, and I hate the new machine. Now over.

Olychick - when Philips sent the replacement device (which was really a repaired model) they also sent a UPS label and instructed me to return the old machine in the same box. I did and kept the UPS label to verify that it had been delivered. That was 2 months ago. This week they emailed me that they never received the unit. I'm not even going to bother to reply to them.

Maire, I hope they don't try to bill you for the new one! Maybe I'll let them send me the label and send them back an empty box - if I tape it poorly maybe it will look like it fell out, lol!

I printed the confirmation that it had been delivered - with the date and location but I guess they could claim the box was empty!

Thanks to all the help here, I feel ready to go with DH to the 'sleep specialist'.

Now, of course, DH has discovered he *can* sleep on his side -- and there's no snoring or startling awake. Maybe he won't need mechanical help?

WIll your family doc not order an in home sleep study? Thats what both my husband and I had. I think where we live not many actually go to the sleep lab. I think the MD's feel that you get a more realistic study in your own bed.

My experience dealing with sleep specialists was the opposite, RNmom. Fewer anatomical sensors are used so less data is provided to aid diagnoses. I asked and that I was told.

It's my understanding that some insurance plans, in particular some HMOs, won't pay for studies at sleep centers and for people with such coverage, take home tests are the only option. Sleep aids are available for anyone having difficulty falling asleep and only a few hours of sleep will usually provide the info needed for diagnosis.

Perhaps a poor analogy but imagine an insurance policy that reimburses only for x-ray imaging and not CT or MRI scans. More information is usually preferred to less.

Elmer, that does make sense but you just hear stories of how poorly people sleep because of being wired to so many things and a strange environment.

I felt hampered having things on my head because I sleep on my stomach and couldn't do that with the sensors. I slept on my back which I thought made me snore more than normal due to positioning,

It would seem sleep aids wouldn't be given because they are going to alter your sleep patterns and perhaps have you sleeping deeper than usual.

RNMom, all I can share is what as a patient I've done and what I've been told. Not professional knowledge.

I've been a patient of the Stanford Med School Sleep Clinic since Day 1 of seeking treatment for my sleep issues (I have 2) nearly 25 years ago. Included among the faculty members over the years have been pioneers and well-known names in the sleep field. Some of these docs have seen me as the attending physician in my annual visits. They train something like 8 already residency-trained specialist doctors in fellowships each year (for them to gain the extra sleep specialty).

I've had 3 sleep tests at Stanford's facilities. Each time I was told that a sleep aid was available if I had trouble falling asleep. I took them up on the offer the first time at about 1:00 am but not the next two. The second test was to confirm the CPAP pressure setting and the third some years later was simply to confirm nothing had changed. I haven't been asked to do another since then, maybe 10 years ago

Chisue, I would suggest you get a Pulse Oximeter. I have a Wellue SleepU wrist oximeter. It was about $130. You can download the information into a cell phone (get an app for that) or computer, there is a differnt app for that. and it will tell you what his O2 levels actually are. I wasn't convinced I had a problem as I had none of the usual symptoms except my Hematocrite was too high. My O2 levels were at 60% and below which is Dear God levels. It is a seriously inexpensive way to judge for yourself. There are less expensive unites but my husband wanted something you could download from and look at the information. Mine had a wrist unit united with a finger monitor. The wrist unit is the computer and the finger thing collects the information. It is rated as good as medical unites. There are other companies. I would get one if I were you.

My pulmonologist told me I could have either but strongly recommended the sleep study center at the hospital. In addition to all the sensors there was a technician monitoring each room on a screen. The room reminded me of a hotel room and I didn't have any trouble falling asleep. I did take my own pillow which was helpful.

DS's insurance only covered an in home study. The report claimed that he didn't have apnea. He switched companies in the fall and his new insurance covered an in-hospital study. He now has a CPAP machine.

Things change but the last sleep study I had the pressure on my CPAP was lowered to an 8. I was told that except in rare instances that is the lowest setting. Since then I have found that the machines can be set lower than that reading but it may be a level where the pressure is not strong enough to keep the air passage of an adult open.

I’m curious how people were diagnosed and what their symptoms were. I have a brother who has sleep apnea and I am sure my father did as well. I don’t have any night symptoms, but tend to have a low respiration rate, maybe 9/minute. I have read the normal rate is 12 - 24. I’m wondering if there is any correlation with daytime respiration rate.

jlsch...how diagnosed? Sleep with someone ... DH always had a snoring problem but it was the apnea...the cessation of breathing because of blocked passages followed by a snort of when his breath intake was strong enough to overcome the blockage ... and the frequency with which it happened made me convince him to go for a sleep study. He had no symptoms he recognized before hand as he was sleeping. With the cpap, he says he doesn't feel like he wakes up with a hangover every a.m. And he's able to sleep longer between potty breaks than he used to. It's also helped him with his GERD.

Snoring is one symptom but not everyone with apnea snores. DH never noticed any obstructive events during the night. I've been using my CPAP for a few years now and I would love to have another sleep study done while I'm on the machine not to measure apnea but to measure my sleep cycles. Last week I traded in my old iWatch for a new one and it has a sleep tracking function. I'm not sure how accurate it might be and I've only used it a few nights - but so far the results are not inspiring. I wake up frequently during the night and often change positions. I'm not cycling through the sleep stages in an optimum manner.

From the Cleveland Clnic..............."When you fall asleep, you typically enter Stage 1, and then move into and cycle between Stages 2 and 3. After cycling between those stages, you’ll ultimately go into REM sleep and start dreaming. After the first REM cycle, you start a new cycle and go back into Stage 1 or 2. One cycle normally takes about 90 to 110 minutes before another begins. Most people go through four or five cycles per night (assuming they get a full eight hours of sleep)................

https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea

I've had asthma for over 40 years, treated successfully with Advair 250/50. I had pneumonia twice, but not since Prevnar vaccination. While cleaning out a closet recently, I found three breath capacity measurement devices; one still works. I blew a scanty 210 -- not surprising. I was surprised that DH only blew 250. Good thing we're seeing this pulmonologist/sleep expert.

maire_cate -- Thanks for the sleep cycle information. I've been interested that DH has been waking and reporting vivid dreams around 1 a.m. for the last few nights. He's very seldom reported any dreams in the past. Evidently, he is getting to REM at least once during the night.

Patriciae -- I could try my finger oximeter on DH a couple of times tonight. Maybe the pulmonologist will prescribe a home sleep study. DH had an away study in June that was inconclusive because he couldn't sleep much in the lab. At the time a neurologist was looking for why DH has very strong leg spasms at night -- way beyond any 'restless leg' jerking; whole body moves. (Those have diminished, but pop up now and then -- only at night, never when he lies down for 20 minutes, even if he falls asleep then.

I'm getting the idea that the spasms are the body fighting for oxygen.

Thanks to all of you for indulging me as we try to find a 'cure' here -- starting with the *cause*!

" jlsch...how diagnosed? Sleep with someone "

Is this a serious comment? Maybe that's why sleep medicine is such a popular and competitive fellowship for doctors to pursue.

It's really hard for someone who sleeps alone or who doesn't snore to know they have a problem. My uncle wasn't diagnosed with sleep apnea until he was in the CICU after heart surgery in his 60s, and the nurses noticed it.......Until then, every doctor just though he was tired and had no energy because he was obese - it never occurred to anyone that he wasn't sleeping or oxygenating well at night. A CPAP machine made a world of difference for him.

Too bad the pulse oximeter is so noisy. Widh DH it's a steady beep, beep, beep, but my weird heart produces beep...beeeep...beep, beep...beepbeepbeep. Our good cardiologist says, "Not to worry." Advair is my sole prescription med, while DH needs three meds to keep BP in order, plus Rexulti 2MG for mood -- a lifelong minor chemical deficit.

Your uncle's medical providers let him down. Maybe their failure to recognize his potential sleep disorder was a function of the limited state of awareness of such problems at that time, or maybe they were simply sub-par.

Just as snoring isn't always an indicator of having apnea or a sleep disorder, and the reverse being true too (having a sleep disorder doesn't always lead to snoring), daytime sleepiness is sometimes (but not always) an indicator that a person is not getting restful and restorative sleep. There is a diagnostic tool to subjectively measure daytime sleepiness called the Epworth Sleepiness Scale. It's as effective for someone who sleeps alone as for someone who doesn't, because this tries to find potential problems from a different direction. Irrespective of what a patient knows or doesn't know about what happens at night, how do they feel during the daytime?

I'm asked to complete the Epworth questionnaire, fewer than 10 questions, for every annual sleep medicine appointment. As another data point used to measure sleep effectiveness. I'm happy to say that my usual score for the past many years has been 0.

@chisue - "Too bad the pulse oximeter is so noisy."

I don't know what type/brand of pulse oximeter you have, but the one I use doesn't make any sound at all. And the ones that the ER and cardiac unit at the hospital have used on me don't make any sound. This is the one I use, and you can get it on Amazon. They have a lot of different models from which to choose.

Yes, elmer sleeping with someone (emphasis on sleep... not sex) was a serious comment because someone else who is trying to sleep will know if you are snoring and snorting or other issues....though I appreciate the humor you injected.

If one does sleep alone, one can make an audio recording of their sleep and listen to it the next day to see if they hear snoring and breathing cessation......probably want to get a full 90 min sleep cycle though certainly DH's breathing cessations occurred many times within one hour. In his case, his apnea would've been obvious in less time.