OK, I'm a newbie (I'll admit it) and, as such, I'm likely to ask some typical questions. I'll try to avoid "What mask should I buy?" (Although that question is very tempting!)
Background: I was diagnosed OSA just over 4 weeks ago. A week ago I had my titration where 8 mostly took care of things but 10 was required to eliminate all hypopneas. This was done with a REMstar of some sort with CFLEX set to 1.
I had absolutely NO problem sleeping with a mask or breathing air under pressure. I wonder if 35+ years of snorkeling and scuba made me used to such things?
In the time since my diagnosis I've been reading extensively about the effects of OSA and sleep deprivation and also the treatment (CPAP) and the equipment.
My followup with my sleep doc is next week where I'm to be given a prescription for a CPAP (I've already been informed). The followup would be sooner but my doc is on vacation (how dare he!). I want to have all my decisions made by then so I can place an order that day, hopefully for next-day deliver (or ASAP).
Checking with my insurance company I was told that my in-network deductible is $500 and then they pay 80% of the balance. My out-of-network deductible is $1000.
With these amounts it looks like I'd be better off to ignore insurance and just buy direct! With the extortionist rates a DME charges (no flames from any DME employees, please) I'd quickly be paying more to use an in-network DME than buying from cpap.com it seems.
So given that, I will have the flexibility to get whatever I want (that my doc will allow). Even a REMstar Auto with CFLEX and humidifier is "only" $760.
Whatever I get must work on 110 to 240 volts and do automatic altitude compensation; I travel extensively for business, sometimes to mountainous locations.
My reasoning behind wanting a REMstar Auto instead of one of their regular units is as follows:
1. As a new user the more comfortable I can be with it, the higher my compliance will be. Lower pressures are more comfortable. Most of the night of my titration I was able to sleep very well with a lower pressure, only requiring 10 for a few events.
2. I sleep on both sides and on my back, spending roughly half the night on my pack and dividing the rest between left and right sides. My pressure needs are different depending on what position I'm in.
3. My weight is a bit high right now (225lbs for my 5'10" height) but it has fluctuated greatly over the past few years. With OSA controlled and sleep deprivation a thing of the past it would not be surprising for me to drop 30lbs in the next 12 months. If my weight changes it is quite likely that my pressure needs will change.
4. I'm a geek (I'll admit it). I'm VP Research (Software) for a company that does some really cool things with computers. In my previous position I was Senior Designer for a company that wrote an OS that is embedded in some medical equipment -- no CPAP's that I know of though. The opportunity to look at what is happening with me is almost irresistible. I'm aware that I don't need an APAP for that, but ...
Given that the REMstar Auto can also be run in non-auto mode, can anyone play devil's advocate and suggest any reason short of my doc saying "NO" that I shouldn't consider an APAP as my first machine?
Should my first machine be an APAP? (Opinions sought)
Should my first machine be an APAP? (Opinions sought)
The CPAPer formerly known as WAFlowers
I'm wisecracking (probably tired, but I couldn't resist):
You sound very convincing... go and get it.
Oh, and welcome.
O.
Probably yes - but did you try sleeping while snorkeling?I had absolutely NO problem sleeping with a mask or breathing air under pressure. I wonder if 35+ years of snorkeling and scuba made me used to such things?
You'll find the devils advocates taking those positions at any garden variety evil DME place..."can anyone play devil's advocate and suggest any reason short of my doc saying "NO" that I shouldn't consider an APAP as my first machine? "
You sound very convincing... go and get it.
Oh, and welcome.
O.
_________________
| Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
| Additional Comments: Machine: Resmed AirSense10 for Her with Climateline heated hose ; alternating masks. |
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.
Antoine de Saint-Exupery
Good advice is compromised by missing data
Forum member Dog Slobber Nov. 2023
Antoine de Saint-Exupery
Good advice is compromised by missing data
Forum member Dog Slobber Nov. 2023
If we can't joke about our affliction we'd cry and/or curl up in little balls and wait for the world to go away. Wisecracks are welcome here!ozij wrote:I'm wisecracking (probably tired, but I couldn't resist):
Not while snorkelling, but I did zone out for a bit while scuba diving once.Probably yes - but did you try sleeping while snorkeling?I had absolutely NO problem sleeping with a mask or breathing air under pressure. I wonder if 35+ years of snorkeling and scuba made me used to such things?
It was a night dive of sorts where I was required to hang on a line only 3 feet under for over an hour. The water was like glass and the sky was clear. At one point I realized there were the most amazing colors shining in the water. I rolled over to look up through the water and see the northern lights (this was in Northern Ontario)!
The entire dive was like a long meditative trance: slow, regular breathing and lots of relaxation.
I came out of the water at 1:15am feeling like I'd had a good nights sleep!
I've been giving it a lot of thought. Not to mention reading all the info I've been able to find here and elsewhere to help me make an informed decision. I'll keep searching and reading and thinking about it for the next week.You sound very convincing... go and get it.
Oh, and welcome.
The really compelling thoughts running through my head are that I can get an APAP online for the price (or less!) than a regular CPAP from a DME. And I can always disable the auto features if I didn't want them.
Oh, and thanks.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, DME, auto, APAP
The CPAPer formerly known as WAFlowers
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WillSucceed
- Posts: 1031
- Joined: Sun Nov 07, 2004 7:52 am
- Location: Toronto, Ontario
You mentioned that your pressure in the titration was 10. This is not an overly-high pressure. You also mentioned that C-FLEX was set to 1, this is not much exhalation relief. You may find that you don't need C-FLEX at all.
Given that you travel alot, take a look at the Puritan-Bennett 420E machine. It is an autoPAP which, like the other autoPAPs will also work in CPAP mode if needed. Further, the 420E has automatic altitude adjustment, adjusts automatically to 110-240 and is MUCH smaller than the RemStar. Further, there are several people on this forum that think the Silverlining software (data reporting and analysis) is better than the software available for the RemStar.
If you MUST have exhalation relief, you are pretty much limited to the RemStar or a bi-level machine. If you don't need exhalation relief, look at the PB machine. The RemStar and PB are both excellent machines. Some think that the PB is more accurate because it has a sensor line in the air hose such that it is measuring pressure at the mask, but the jury is still out on this. I think that the makers of RemStar (Respironics) would tell you that their system is just as accurate as the PB system and, I don't know of any literature to prove/disprove them. I used a RemStar Auto and found that it did not give me quite as good treatment as did the PB 420E, but this is highly idyosyncratic. What works well for one might not work well for another.
I have both machines, and I use the RemStar bag (it is huge) to carry all of my PB 420E equipment, humidifier, hose, masks, and other stuff, novel, bottle of water, etc., when I travel.
If at all possible, find a way to trial different machines for a week or more each. While all of the machines are good and all of them are likely to give you good treatment, each manufacturer uses a different algorithm in their software. Finding the one that is best for you is the goal. As I mentioned above, Remstar was not quite as good for me as was the PB 420E and the ResMed Spirit. I decided on the 420E because of it's small size, internal sensor line, Silverlining software and, the triggers that can be adjusted to tailor treatment.
Good Luck!
Given that you travel alot, take a look at the Puritan-Bennett 420E machine. It is an autoPAP which, like the other autoPAPs will also work in CPAP mode if needed. Further, the 420E has automatic altitude adjustment, adjusts automatically to 110-240 and is MUCH smaller than the RemStar. Further, there are several people on this forum that think the Silverlining software (data reporting and analysis) is better than the software available for the RemStar.
If you MUST have exhalation relief, you are pretty much limited to the RemStar or a bi-level machine. If you don't need exhalation relief, look at the PB machine. The RemStar and PB are both excellent machines. Some think that the PB is more accurate because it has a sensor line in the air hose such that it is measuring pressure at the mask, but the jury is still out on this. I think that the makers of RemStar (Respironics) would tell you that their system is just as accurate as the PB system and, I don't know of any literature to prove/disprove them. I used a RemStar Auto and found that it did not give me quite as good treatment as did the PB 420E, but this is highly idyosyncratic. What works well for one might not work well for another.
I have both machines, and I use the RemStar bag (it is huge) to carry all of my PB 420E equipment, humidifier, hose, masks, and other stuff, novel, bottle of water, etc., when I travel.
If at all possible, find a way to trial different machines for a week or more each. While all of the machines are good and all of them are likely to give you good treatment, each manufacturer uses a different algorithm in their software. Finding the one that is best for you is the goal. As I mentioned above, Remstar was not quite as good for me as was the PB 420E and the ResMed Spirit. I decided on the 420E because of it's small size, internal sensor line, Silverlining software and, the triggers that can be adjusted to tailor treatment.
Good Luck!
Buy a new hat, drink a good wine, treat yourself, and someone you love, to a new bauble, live while you are alive... you never know when the mid-town bus is going to have your name written across its front bumper!
Actually I am weighing the issues between the REMstar Auto and 420E. The size/weight of the 420E certainly caught my attention given that I spent more than 8 weeks travelling in the first 5 months of this year. But the CFLEX option with the REMstar is also interesting.
I don't know what I'll need exhalation relief, but I want to give myself every comfort advantage in adapting to the new lifestyle I'm about to embark on.
Talking of comfort brings us perilously close to discussing that forbidden newbie subject (best mask).
I wish I knew of some way to do what you suggested and try different machines for a week or so at a time. That certainly would be the definitive answer.
I don't know what I'll need exhalation relief, but I want to give myself every comfort advantage in adapting to the new lifestyle I'm about to embark on.
Talking of comfort brings us perilously close to discussing that forbidden newbie subject (best mask).
I wish I knew of some way to do what you suggested and try different machines for a week or so at a time. That certainly would be the definitive answer.
The CPAPer formerly known as WAFlowers
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rested gal
- Posts: 12883
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
Given the things you mentioned, AWFlowers, especially your self-proclaimed geekiness (and boy, did you do your research! Wonderful!!) I second WillSucceed's suggestion of getting the PB 420E autopap rather than the Respironics REMstar Auto.
Besides the size consideration for travel, the Silverlining software that the 420E uses is "the best" in regard to details, imho.
The 420E is a very sophisticated autopap despite its convenient size.
P.S. Mask
Swift nasal pillows - comes with all three sizes of "pillows"
or
Breeze/nasal pillows - get one size larger "pillows" than you'd think you need.
or
Activa - nasal mask, covers the nose - get the "shallow" size unless you have a very prominent bridge to your nose, or a larger than average "woman's face and nose".
Besides the size consideration for travel, the Silverlining software that the 420E uses is "the best" in regard to details, imho.
The 420E is a very sophisticated autopap despite its convenient size.
P.S. Mask
Swift nasal pillows - comes with all three sizes of "pillows"
or
Breeze/nasal pillows - get one size larger "pillows" than you'd think you need.
or
Activa - nasal mask, covers the nose - get the "shallow" size unless you have a very prominent bridge to your nose, or a larger than average "woman's face and nose".
Absolutely not. Do NOT get an auto . If you do you will not have any way to measure how great the 420E is. You must get a plain cpap as your first unit. At least for a month. How else will you get to experience aerophegia, burning chest, gas pain and flatulance. Just look at it as paying your dues.
Just kidding, By all means get the PB 420E.
You can always use it in straight CPAP mode if you want to see what the EVIL DMEs patients must endure
:twis ted:
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): 420E, CPAP, auto
Just kidding, By all means get the PB 420E.
You can always use it in straight CPAP mode if you want to see what the EVIL DMEs patients must endure
:twis ted:
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): 420E, CPAP, auto
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Fascinated2
In my personal opinion, at a setting of 8-10, the relief upon exhalation C-Flex could provide you would most likely be unnoticed and unnecessary. Because the REMstar Auto with C-Flex is more expensive and bulkier, and because the C-Flex feature would likely go unused, I also recommend the PB420E. Any of these autos can be set in straight CPAP mode, should you so desire. Once you've analyzed your data over the course of a week or two, you'll know which modes and settings provide the best treatment. Then of course you can revisit those decisions as often as you wish by conducting further self-titration experiments in APAP mode. It is definitely a WIN/WIN proposition.
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fifigal
I have just received my remstar auto. I was on a fixed pressure of 13 before the remstar.
I was really looking forward to using the c-flex function on this machine. I too travel quite a bit and was trying to decide between the 2 machines. I decided on the remstar because of the cflex. I did not rush into this. I trawled through the message boards for 6 months reading up all I could about the 2 machines!
I made the wrong choice! I find the c-flex function really weird and it makes me feel sick and I need to have it in the OFF position.
If I could turn the clock back I would definitively go for the PB420E.
I was really looking forward to using the c-flex function on this machine. I too travel quite a bit and was trying to decide between the 2 machines. I decided on the remstar because of the cflex. I did not rush into this. I trawled through the message boards for 6 months reading up all I could about the 2 machines!
I made the wrong choice! I find the c-flex function really weird and it makes me feel sick and I need to have it in the OFF position.
If I could turn the clock back I would definitively go for the PB420E.
I vote for the 420E
for all the reasons ''will succeed'' mentioned.
It has my vote.
[quote="WAFlowers"]Hmmm ... 2 votes for the 420E. Any others?
Masks are something I've yet to take a good look at. My cursory browsing leaves me bewildered with the choices. I guess I should start deciding on a mask to try soon.
It has my vote.
[quote="WAFlowers"]Hmmm ... 2 votes for the 420E. Any others?
Masks are something I've yet to take a good look at. My cursory browsing leaves me bewildered with the choices. I guess I should start deciding on a mask to try soon.
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rested gal
- Posts: 12883
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
Well, sorry it made you feel nauseated, Fifi. But before this scares everyone from getting a machine that has a really good exhalation relief feature (C-Flex), I'd say that most people who experience C-Flex really do like it. I do. (WillSucceed, close your eyes!! lol )
The main reason I agreed with Will's suggestion of the 420E for WAFlower was because she already knows she has no trouble exhaling against the pressure she's prescribed. I think she'll like it for its "3 s's"...size, sophistication, software. I've used both those autopaps, and the ResMed Spirit, too. All three are really good machines, imho, each with its strong points.
Doesn't mean that the 420E is necessarily a better machine for treatment than the Respironics REMstar Auto with C-Flex. C-Flex is a very nice option to have. If it causes any problem, it can be turned off just you did, Fifi.
The main reason I agreed with Will's suggestion of the 420E for WAFlower was because she already knows she has no trouble exhaling against the pressure she's prescribed. I think she'll like it for its "3 s's"...size, sophistication, software. I've used both those autopaps, and the ResMed Spirit, too. All three are really good machines, imho, each with its strong points.
Doesn't mean that the 420E is necessarily a better machine for treatment than the Respironics REMstar Auto with C-Flex. C-Flex is a very nice option to have. If it causes any problem, it can be turned off just you did, Fifi.
Wow! I and the 420E will change my sex too.rested gal wrote:The main reason I agreed with Will's suggestion of the 420E for WAFlower was because she already knows she has no trouble exhaling against the pressure she's prescribed. I think she'll like it for its "3 s's"
Rested, you should look at my signature. Not many girls named "Bill" (short for "William", the "W" of WAFlowers).
Don't worry. I'm amused, not upset. I'm told I have great looking legs.
BTW, keep those suggestions coming. Chrisp, I liked your suggestion ... NOT! But it did make me laugh.
The CPAPer formerly known as WAFlowers
I own a 420E, I have many good things to say about it - and I too do better with PB's auto algorithm than I did with the Resipronics.
The PB reaction habits can be tweaked by the therapist (...) in ways the Respironics' can't.
But, I want to sound a voice of dissent about the Silverlining program, especially for the geekly and scientifically inclined.
1. Silverlining has a bug when exporting data to Excel: It simple drops all mixed apneas from the apnea count. If you have many mixed apneas, you can't trust the output as is. (Read my post The case of the missing Jabberwock) There are ways to get around it, but it's annoying
Data I want and can't get on the Silverlining:
a. Which percentage of my total apneas and hypopneas during the night occur at which pressure. The data you get - apneas etc. as percentage of events at a certain pressure is meaningless: I could have 1 apnea at pressure 8, it might be 100% of events at that pressure, but 6 hypos and one ap at pressure 6, reported as 10% of events at pressure 6. The percent within a pressure level is not informative, because the shorter the time spent in that pressure, the greater the percentage - for simple mathematical reasons. I don't need graphs showing me mathematical laws (which is what I get), I need graphs showing the breakdown of my breathing data.
b. I would like to know how much time - total - I spend in apnea during the night, and how long an average apnea is at each pressure level
c. I would like to know the number of apneas, hypops etc. at each pressure level.
d. The way things are reported now, you will alway find that there are more apneas the higher the pressure - this is an artifact of the simple fact that each apnea causes a rise in pressure - so you can't really make decisions based on that.
From looking at graphs and tables (I never had the programs themselves) it my impression that most of this decision supporting data is available in the Encore data base (which is an SQL database) and has been brought out very clearly be Derek's addition of "My Encore" (which creates some amazing Excel graphs).
In short, the details screen in Silverlining is wonderful - but the generalization options are limited.
That of course shouldn't be the first consideration in buying a machine - but you should know it.
O.
The PB reaction habits can be tweaked by the therapist (...) in ways the Respironics' can't.
But, I want to sound a voice of dissent about the Silverlining program, especially for the geekly and scientifically inclined.
1. Silverlining has a bug when exporting data to Excel: It simple drops all mixed apneas from the apnea count. If you have many mixed apneas, you can't trust the output as is. (Read my post The case of the missing Jabberwock) There are ways to get around it, but it's annoying
Data I want and can't get on the Silverlining:
a. Which percentage of my total apneas and hypopneas during the night occur at which pressure. The data you get - apneas etc. as percentage of events at a certain pressure is meaningless: I could have 1 apnea at pressure 8, it might be 100% of events at that pressure, but 6 hypos and one ap at pressure 6, reported as 10% of events at pressure 6. The percent within a pressure level is not informative, because the shorter the time spent in that pressure, the greater the percentage - for simple mathematical reasons. I don't need graphs showing me mathematical laws (which is what I get), I need graphs showing the breakdown of my breathing data.
b. I would like to know how much time - total - I spend in apnea during the night, and how long an average apnea is at each pressure level
c. I would like to know the number of apneas, hypops etc. at each pressure level.
d. The way things are reported now, you will alway find that there are more apneas the higher the pressure - this is an artifact of the simple fact that each apnea causes a rise in pressure - so you can't really make decisions based on that.
From looking at graphs and tables (I never had the programs themselves) it my impression that most of this decision supporting data is available in the Encore data base (which is an SQL database) and has been brought out very clearly be Derek's addition of "My Encore" (which creates some amazing Excel graphs).
In short, the details screen in Silverlining is wonderful - but the generalization options are limited.
That of course shouldn't be the first consideration in buying a machine - but you should know it.
O.
_________________
| Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
| Additional Comments: Machine: Resmed AirSense10 for Her with Climateline heated hose ; alternating masks. |
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.
Antoine de Saint-Exupery
Good advice is compromised by missing data
Forum member Dog Slobber Nov. 2023
Antoine de Saint-Exupery
Good advice is compromised by missing data
Forum member Dog Slobber Nov. 2023
-
rested gal
- Posts: 12883
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
heheh, good points, ozij. Funny thing is, I've never been interested in long term trends and "averages". I'm more interested in the details that are shown on the Silverlining's 96 hour graph. And am not a bit interested in exporting to an Excel file...don't even have Excel on my computer.
I like to save each of my nightly files separately with a descriptive name that includes the mask I used, number of hours/minutes I slept, pressures I set, and a few other little notes in the filename if something unusual happened. Easy to look back at the filenames if I want to compare, say, a night of long sleep time using the Activa to a night of equal length with the Breeze.
My lack of interest in long term trend info reflects my non-mathy mind, I'm sure!
I've missed the forest for the trees before. Heck, I missed that WAFlower is a "he", for goodness sakes!
I think what Derek has done -- making the "MyEncore" supplemental program to use with Encore Pro is a fantastic accomplishment. I guess I just like looking at the leaves and letting others do the heavier forestry work.
I like to save each of my nightly files separately with a descriptive name that includes the mask I used, number of hours/minutes I slept, pressures I set, and a few other little notes in the filename if something unusual happened. Easy to look back at the filenames if I want to compare, say, a night of long sleep time using the Activa to a night of equal length with the Breeze.
My lack of interest in long term trend info reflects my non-mathy mind, I'm sure!
I've missed the forest for the trees before. Heck, I missed that WAFlower is a "he", for goodness sakes!
I think what Derek has done -- making the "MyEncore" supplemental program to use with Encore Pro is a fantastic accomplishment. I guess I just like looking at the leaves and letting others do the heavier forestry work.