How do you try a new mask if they cannot be returned?

[rock and roll]

I am buying out of pocket because I just don;t want to scew with my DME anymore. I file with my insurance myself. But they don't seem to appreciate it.

[jbelnap]

My primary job is to fit patient's with masks. I do 8-15 fittings a day and our company buys masks from all manufactures. WE are non-profit and we do allow our patient's to exchange their masks within the 1st 30 days (we use FDA approved resterilization guidelines for the masks that have them). I also use CPAP for my sleep apnea. I've attempted to fit approximately 20 patient's with the comfort curve, and have only sent two patient's home with it. Both patient's brought it back and reported that if they stayed completely still on their back it worked ok, but the slightest movement jarred the mask and made it leak. I tried to sleep with it myself and after an hour of sleeping on my back, my cheeks were sore (I have an average face, not fat or slender). I could not lay on my side at all due to leaking. Of the 20 some masks on the market it is not my first choice. Have you considered the nasal snap? It might meet the criteria you've listed. If you do buy it and have success with it, please let us all know any tricks that helped.

[rock and roll]

jbelnap,


What are the most successful and compliant masks you fit, just curious to hear from the other side?

[MaskedMan]

When you find one MaskedMan, please post it for all. Also Guest, have you looked at the packaging on your mask? I'm looking at the Comfort Classic now, item 1007964, Country of Origin, Made in China!!.. So you tell me, how much do they actually pay for them? And all the research...

that's what I'm saying sthnreb, if they could actually produce a product that met its claims then I would willingly spend $100 on it. If they guaranteed it would last a couple of year - even $150.

[sthnreb]

It does make them difficult to buy. If you believe all their sales hype, pitches and promises. But, once you buy it and open it, it's yours. China is know for their cheap labor and inferior material products, therefore I have to believe there is a huge markup in the price of masks, because, it is listed as medical supplies. I checked all of mine, made in China. Has to be the US retailer making the big bucks on the markup. To those that support the pricing, go buy yourself some tools made in China. A few skint knuckles should awaken you if OSA doesn't!

[hockeydad]

I wasn't going to comment on this, but since its gone on for so long, thought I'd put my 2 cents in.

I don't entirely disagree with you sthnreb & maskedman, mask prices are high, and I hate how once you buy one to try, you own it forever, regardless of whether it works for you or not. Somebody needs to come up with a better way of describing masks so us end-users can decide for ourselves which one is best for us BEFORE we buy it.

But I have to disagree with your comments on the costs, that these things should cost $10. Yes, the actual material cost is probably in that range, but remember, its not just the material you are paying for.

I happen to work at a manufacturing company (completely unrelated to anything to do with CPAP machines or any medical equipment), and anyone that works on manufacturing knows there is a lot more that goes into the cost than just the material cost. Even in my business, which doesn't have to deal with the whole medical quality supply compliance testing, we have engineering costs to recoup, specialized tools that are used to make it that have a cost that has to be put into the product, reliability testing, quality control, and then the biggest cost of all, all the labor you have to pay for your assemblers, your design engineers, your quality technicians, your sales and marketing staff, your customer service, etc.

Can you make a mask that does what it needs yourself for a lot cheaper? Probably, if you have some creativity and are handy (and not too tired from lack of sleep), But then ask your self if you can make that same mask, over and over again, to the exact same specs everytime, and make sure it meets FDA requirements every single time, and be able to make them in some sort of repeatable volume, and get the word out that you have them for sale (marketing and advertising), set up a shipping and distribution network, and still make some sort of profit (remember, that's the goal of any business, to actually make a profit), after all the middle man mark ups are made. I bet you can't.

One final thought, remember that cost is set in a large part by volume. The more you make, the less it should cost. But how many people actually use CPAP masks? A very, very small percentage of the population. And with so many different styles, sizes and types, I can't beleive that any of them are manufactured in any real volume. Lower volume means higher prices, just the way it is.

My problem is really the cost of the mask. I wish it was lower, but understand why it isn't. My problem is not knowing which one is going to work best for me until AFTER I've paid the $130-$150. That's the problem.

[rested gal]

My problem is not knowing which one is going to work best for me until AFTER I've paid the $130-$150. That's the problem.

I agree. And that is exactly why users of these things should be able to return something which is this important to medical treatment -- return it at least for credit if they cannot get their money back.

I don't think there's any way a description of any mask could cover every way that it might not suit some people. Nor can I imagine any manufacturer of masks really stating all the possible comfort or leak problems a particular mask could cause. The manufacturers are going to make any mask they offer sound like the best thing since sliced bread.

Message board reviews help, but even when we users post messages about masks we like or don't like, others have opposite experiences. It's still a gamble no matter what other users say. It's still a roll of the dice even if the manufacturers painted more realistic pictures in their advertising blurbs.

I think you brought out a good point here:

One final thought, remember that cost is set in a large part by volume. The more you make, the less it should cost. But how many people actually use CPAP masks? A very, very small percentage of the population.

Be that as it may, I still think the profit margin is HUGE on these masks (and the machines) - for the manufacturers. One look at the growth of Respironics and ResMed in the stock market over the past 5 years makes that very clear, ihmo. Just like pressures...what's a high pressure is relative. What's a reasonably high profit is, too.

Like you, for me the initial price of a mask is not the issue. However, being stuck with it, with no possibility of money back or credit if it gives poor medical treatment, is a big issue to me.

When people lose their jobs due to OSA, can't afford insurance, get turned down for "pre-existing" condition and scrape the hundred dollars together trying to get treatment that doesn't tear up their nose or blow desperately needed treatment air out into the bedroom.... well, you know how I feel about their being "stuck" with a mask that doesn't suit.

There's got to be a better way for the manufacturers and retailers to make a profit and give patients a fighting chance to get good treatment. Looks like Johnny understands that. Hope he can help make that happen.

[sthnreb]

"I happen to work at a manufacturing company. Even in my business, which doesn't have to deal with the whole medical quality supply compliance testing, we have engineering costs to recoup, specialized tools that are used to make it that have a cost that has to be put into the product, reliability testing, quality control, and then the biggest cost of all, all the labor you have to pay for your assemblers, your design engineers, your quality technicians, your sales and marketing staff, your customer service. to the exact same specs every time, and make sure it meets FDA requirements every single time, and be able to make them in some sort of repeatable volume, and get the word out that you have them for sale (marketing and advertising), set up a shipping and distribution network, and still make some sort of profit (remember, that's the goal of any business, to actually make a profit), after all the middle man mark ups are made."


My best friend is employed by a bearing company and travels the world over to their different plants every week. He is responsible for millions of dollars in producing bearings and closing, expanding and overseeing plants. They will not build a plant in China because of the low quality of steel they produce that doesn't meet their specifications. All our masks are produced in China by cheap labor and material and are not under any regulations from the USA. Tooling is a cost of stamping out the plastic but once made, you can produce as many as you want, all exact duplicates. In construction, 17% profit is considered excellent. I have no problem with anyone making a profit. You probably feel the pro athletes are worth the 100 million dollar contracts too. Personally I hardly ever pay the $50 fee to watch a live game. (TV is fine and usually a better view and you don't get beer spilled all over you) Remember, some of us don't make the kind of money others do. Most just ask for a fair shake on the masks and machines. How many people have mask in a drawer they cannot wear that they paid $100 for? I have 3 myself.
I talked to Johnny on the forum last night. I bought the bipap pro II in Feb. 20 for $1569, in April it was $1499. Yet, another company sells it for $1349. These are with the heated humidifier. That's a $220 profit on top for the machine I bought, at least, no telling what their actual cost is. Mine stopped within the first 2 weeks but I couldn't get a response through email about it. After 6 weeks I had to send it back. What do you get? Either a used machine or a long wait for yours to be repaired. Exactly what kind of quality control is this? I just think a person should get what they pay for at a reasonable price and maybe have some options of recourse. Respironics warranties the machine 2 years, but they will not warranty it to the end user, you have to go through the supplier. That could give you a problem. Once again, how do they manufacture those sterile stainless steel needles and formed plastic syringes to exact specifications, hermetically sealed and sterile for 15 cent each? Yet, can't make a mask for less than $50 and usually over $100? I think I will make this my last response to this subject. I don't make as much money as the rest of you do obviously. I do like to get what I pay for and as advertised. Bye.

[jbelnap]

My answer to the best mask is always "the mask that fits that individual is the best one".

But that doesn't answer your question very well, so to be more specific I have the best luck with the following masks:

For side sleepers: comfort lite, activa and nasal pillows
For claustrophobia: swift, snapp, simplicity, comfort lite
For high pressures: Activa, ultra mirage full face, ultra mirage
For all around comfort and stability: comfort gel or profile lite (properly fitted is the key of course)
If someone is sensitive to noise I avoid the nasal pillows, snapp or spiritus.
The ultra mirage full face mask if my first choice in full face, followed by the flexi-fit full face, followed by the comfort full. If someone has a wide bridge on their nose then the comfort full will fit ok, but not as well if they have a narrow bridge.

The flexi fit or acclaim by Fisher & Paykel is ok, but patient's must be aware that they can not wash the foam insert and that they will probably need to replace the foam insert every month to two months if they are wearing it every night, or else they'll have a lot of leaking problems.

One of the best tricks to getting your mask to seal well it to wash the cushion every single day. Oil from the skin is the most common cause of leaking, ESPECIALLY with full face masks.

I keep almost one of every mask in stock, because there is always that one individual that none of these will work for and they need one need one of the other kinds.

The comfort lite is my personal favorite, that's the one I wear. - but if a patient moves around much, it can come off easily.
Hope that helps some of you out there.
Joyce

[mikebomb]

Of the 20 some masks on the market [the Comfort Curve] is not my first choice. Have you considered the nasal snap? It might meet the criteria you've listed.

Which is "the nasal snap"?

Never mind, I found it: SNAPP

[mikebomb]

Once again, how do they manufacture those sterile stainless steel needles and formed plastic syringes to exact specifications, hermetically sealed and sterile for 15 cent each? Yet, can't make a mask for less than $50 and usually over $100?

The reason they can sell those syringes for 15 cents each is that they churn them out by the millions. I doubt any single mask has a production run greater than 30,000 pieces. "Economy of scale" is a very powerful force.

[sthnreb]

Once again, how do they manufacture those sterile stainless steel needles and formed plastic syringes to exact specifications, hermetically sealed and sterile for 15 cent each? Yet, can't make a mask for less than $50 and usually over $100?

The reason they can sell those syringes for 15 cents each is that they churn them out by the millions. I doubt any single mask has a production run greater than 30,000 pieces. "Economy of scale" is a very powerful force.

A little quick math using your figures would indicate to me that less than a half of a million people have OSA according to mask productions. (Especially considering most have several due to falsely advertised and you try it you buy it philosophy) Also, a very unique idea, keep a profit margin whether you sell 10 or 1000 items, same profit. (I assume you mean they throw away the molds and tooling after about 30,000 are produced and start over if they make more) If they sell good, reduce the price, if not, simply go up to compensate so the bottom line profit is the same regardless how many you sell. I guess large companies have to meet their profit goals one way or another. Probably why our senators get full pay at retirement to and never pay a penny into SS. (Makes you wonder why SS is not fixed) Americans are truly generous folks. I apologize adding another comment.

[hockeydad]

Not to keep beating a dead horse, but one comment you made merits a reply.

All our masks are produced in China by cheap labor and material and are not under any regulations from the USA.

Any medical device, regardless of where it is actually manufactured, must meet FDA approval before it can be sold in the US, so yes, they do have regulations to abide by. FDA regulations are some of the most stringent in the world.

This is just one of those area's where we have to agree to disagree. Do I think masks are expensive? Yes. But I think I understand why they are. The actual cost isn't my compaint, its that unlike the company jbelnap works for, my DME stinks, so I can't go in a try out multiple masks and find which one works for me BEFORE I buy it. That's the problem. I can't think of anything else I would buy in the $150 range that I wouldn't try out first, touch/feel/look at or have some idea if its the right one for me, but when it comes to masks, I'm kind of stuck.

As far as the so-called false advertising, I've never seen an ad for a mask that claims it will be the best thing since sliced bread for everyone. As this forum has shown over and over, everyone's face is different, and what may be the best ever for one person may be living hell for another. But, I'm a marketing manager, I create ads and brochures. Maybe I just look at them differently than others.

Remember the old saying, let the buyer beware. Don't believe everything you read.

[sthnreb]

These devices work by exhausting all of the exhaled CO2 out of an exhalation port built into the mask. The user instructions inform the patient that the mask contains an exhalation port and does not require the use of a separate exhalation device. However, the product was distributed without the exhalation port. Without the port in the breathing circuit, it is likely that the patient will experience increased CO2 re-breathing and associated oxygen deficiency. In some cases, suffocation may result.

From the FDA. Seems some get by them.

The USA cannot control what other contries do, as you state, only when it enters the USA. The USA still has no control over what China produces, just what is shipped and distributed in the USA. None of my masks has a FDA seal of approval on them.

[rock and roll]

I import furniture from China. I for 20 years sold domestic goods.
Domestic goods has all kinds of laws and they came to our plant to inspect them before shipment. Our chinese goods have never once been looked at or questioned. It is a voulntary poiicing. So I am suspect of our masks. Now it may be a little tighter for medical goods....but I really don't think cpap gets the same policing that surgery supplies would. I does make you wonder.


I agree that don't believe everything you read but again, most places will let you return soemthing if it is not right or does not work.