What should I get?

Dan01 · Post by **Dan01** » Fri Apr 22, 2005 12:52 am

I have some questions before I buy a CPAP:

Doe the doctor need to prescribe an AUTO CPAP in order for me to get one? I will get a prescription tomorrow, but am not sure what he will do. His price is way high and would like to shop around.

Does the Auto CPAP have the manual setting, I guess set with a card?? Sorry, not sure how they are set. I would probably never use the Auto, but maybe it would be a good idea?

Which is the best brand? Goodnight, ResMed or Respironics?

What is the best model? I would probably want a heated unit where I can turn the heat off during the summer?? Is price always the best indicator for quality?

Now the Mask: This is probably important right? What should I look for? A friend said he uses a full mask when he is congested – should I get one of those initially, and which one?

During the first sleep study they found I had 17 obstructive events and one central. I only could sleep for an hour and half and the tech told me that sometimes people do have a central one in the first hour.

During the second test he needed to get to 8.5 cm to stop the snoring. I had not trouble falling asleep with the nasal mask. What about falling asleep with the full mask, is it harder?

Lots of questions: If anyone can answer any of them let me know.

Thanks in advance.

Dan

Dan01 · Post by **Dan01** » Fri Apr 22, 2005 12:59 am

A couple more things: I will for sure get the nasal mask, but was wondering if I should get the full mask for when I am sick.

Also, I have awaken three times unable to breath for 30 seconds or so in the past 3 or 4 years. This made me do something about apnea. The CPAP will help prevent that right? This has always happened within the first hour of sleep and when I was very tired and sick twice.

Dan

Guest · Post by **Guest** » Fri Apr 22, 2005 9:19 am

Dan01:

See my other post ("Found A DME..."). I was preparing to buy the unit I wanted (Respironics RemStar Auto) myself because the original DME I was referred to wanted to charge me $300+ AFTER INSURANCE! I went to another DME (Apria) and got the same thing FOR FREE! It probably helped that I explained to my doctor why I wanted an auto-titrating machine and why C-Flex was so important to me. After our conversation though, my doc was happy to change my prescription from a basic CPAP with cold passover humidification to exactly the machine I asked for with a heated humidifier.

Good luck with the mask selection. I'm going with Rested Gal's recommendations (Aura or Breeze) as a starting point when I go for my fitment.

MartiniLover · Post by **MartiniLover** » Fri Apr 22, 2005 11:51 am

Dan, I think everyone will agree, The Automatic CPAP is the preferred way to go, as it will save you a lot of problems if the first diagnosis doesn't quite work for you. Sleep studies are very expensive and one should be enough to get you close. With the Automatic it will give you a better range and help you when you need help.

Most DME's only get reimbursed for a set amount for the machine they give you, so they want to put you in the cheapest machine, which means the most profit.

If it was me, I would look at the Respironics, although I am sure there are other good ones.

The mask, I would try what they have available and get the one that is the most comfortable. TAKE YOUR PILLOW. I wouldn't jump into more than one for a while until you get used to it. The longer you do this, the wiser you become. I have three, and still use the very first one I got, ninety percent of the time.

Heated Humidifier is the only way to go. I personally never use the heat, but it is there for the time that I am going to need it.

I have never heard of a DME helping you with the software and card reader. Best to just get it on your own from CPAP.com.

This is journey. Take it slow. One step at a time and good luck. We are here to help you, but you must help your self first.

Titrator · Post by **Titrator** » Fri Apr 22, 2005 12:33 pm

Greetings Dan,

I understand how you feel. Lots of questions and choices to make. I work for cpap.com and I have a few recommendations.

The auto-cpap is the best way to go. It is the most comfortable and could potentially save you return visits to the sleep lab.

The best selling auto-cpap is the Respironics Remstar Auto Cflex with a heated humidifier. We have sound loads of this machine and have not heard one complaint. All the feedback has been positive. To have a cool humidifier, just don't turn on the humdifier heating plate.

https://www.cpap.com/productpage/1623

The best selling, and most popular, mask we have is the Resmed Mirage Activa. This is an easy mask to wear. You do not need to tighten it very much and it rests comfortable in its place. This may help with going to sleep with a mask on.

https://www.cpap.com/productpage/1795

If you would like to try a full face mask, we have had quite a bit of luck with the Fisher and Paykel Flexifit HC 431 Full Face Mask.

https://www.cpap.com/productpage/1410

I hope this helps out.

Regards,

Ted the Titrator

Guest · Post by **Guest** » Fri Apr 22, 2005 12:57 pm

Thanks you guys. I will print this out and show the doctor today if he does not want to give me a prescription for an auto CPAP.

This is very important to me. My insurance does not cover the device (just major medical) so I will just pay cash for it. It is that important. I have seen results in others, and felt really different the day after the study - no sleepiness.

I was considering buying a mask online, but would not be able to try it one first. Maybe I should look at the local stores before I do that.

I will keep you updated. Thanks again.

Dan01 · Post by **Dan01** » Fri Apr 22, 2005 1:11 pm

The above post is mine. I thought it would log me in again. automatically.

Liam1965 · Post by **Liam1965** » Fri Apr 22, 2005 1:24 pm

Liam, pretty close to buying a used auto from someone on an auction site (unless someone else bids in the next day or so).

Um... I should say, the reason I'm extolling the virtues of CPAP.COM but buying my own used is because I've already tried CPAP once and failed miserably. To me, this greatly lowers my chances of making it work, so it doesn't make sense to buy a new unit which may end up sitting idle after a month's trial.

If I had reasonably good reason to expect that I would be able to make this work and would be using this machine for years to come, I'd be buying it directly from CPAP.COM. Also, even though I'm buying the MACHINE used (if I win the auction), I still plan to buy the SOFTWARE, etc, from cpap.com.

(I just didn't want to leave the impression that I wasn't taking my own advice.)

Liam, not really talking out of both sides of his mouth. Honest.

rested gal · Post by **rested gal** » Fri Apr 22, 2005 1:35 pm

Dan, you're doing a good thing...researching thoroughly in order to be able to make some informed suggestions to your doctor about what you'd like to try for your treatment.

I agree that an autopap is generally the most useful, versatile machine to get. Especially if you get a Respironics REMstar Auto with C-Flex and heated humidifier. That's what I use. I also find the Encore Pro software/card reader to be absolutely essential since I want to see for myself what goes on during my nightly treatment.

In the nasal mask category (covers the nose), the Activa is my favorite, hands down.

My favorite nasal pillows masks (deliver air through little cone shaped soft silicone "pillows" right at the nostrils) are the Aura and the Breeze. Many people also like the Swift.

My favorite full face mask (covers nose and mouth, not the whole face) for times when I have a cold and simply cannot breathe through my mouth is the ResMed Ultra Mirage FF. This is an excellent mask, imho, to have stashed away for congested times when a person really has to breathe through the mouth to get treatment.

You mentioned this:

I was considering buying a mask online, but would not be able to try it one first. Maybe I should look at the local stores before I do that.

Some local DMEs (Durable Medical Equipment) providers will let you try masks - some don't. If you open it, "it's yours" is the policy of some DMEs, but you're right about there being a better chance of being able to try out some masks with some DMEs.

Dan, actually, there is a unique offer by one online store on one particular mask - the Aura.

cpapsuperstore.com sells the Aura online with a full money back guarantee if a person buys it, tries it at home, and is not satisfied with it for any reason. That store will take back the Aura and refund the purchase price. The buyer is out only a few dollars shipping if the Aura doesn't suit them.

It would certainly be helpful to patients if every mask were sold that way by every online store. But at least that's one additional mask you could try at no risk. With some tweaks, the Aura is my favorite mask of all...it's the one I've been using almost every night for over a month. It's the most comfortable nasal pillows interface I've used.

Liam1965 · Post by **Liam1965** » Fri Apr 22, 2005 1:38 pm

Wow, odd. I posted a response to my own message, and apparently "edited" it, instead of replying to it...

My message above was in reply to this message of mine...

------------------------------------------

Dan,

First thing I'd suggest is buying from CPAP.COM if at all possible. They are our hosts, but no lie they're also about the cheapest place I've found for the equipment, and they're great people to deal with.

(Do the math carefully, some people find that even if CPAP.COM is not in their insurer's covered list, they end up out of pocket less buying it outright, than going through a DME and paying more in copays and deductibles...)

As to what to get, all you LEGALLY need is a scrip for CPAP, because an AUTO is short for Auto TItrating CPAP. In other words, they are essentially the same thing. On the other hand, if you go with a DME, if the doctor doesn't specifically mention Auto on the scrip, they won't likely give you one, because they cost more and the insurance pays the same regardless of make or model.

Which of the three is best is personal taste and also other factors which you really can't answer without trying them.

Only Respironics Remstar has CFLEX (although the new model of ResMed unit is rumored to have somehting like it). The 420e is the smallest and lightest, and also the most configurable (it has some switches you can set to customize it's algorithm as needed).

Any of the Autos can be set to fixed pressure mode if you find the auto algorithm doesn't work for you, so pretty much all you lose if you buy an Auto is the extra money, if you find straight pressure works better for you.

I think that's everything....

Liam, pretty close to buying a used auto from someone on an auction site (unless someone else bids in the next day or so).

Thomas · Post by **Thomas** » Fri Apr 22, 2005 1:53 pm

You should also ask the sleep techs at your local sleep clinic if they will let you borrow some masks to try. Mine does this and it has been very helpful. Then you will know before you buy.

Tom

rested gal · Post by **rested gal** » Fri Apr 22, 2005 1:55 pm

Only Respironics Remstar has CFLEX (although the new model of ResMed unit is rumored to have somehting like it).

I think the Polaris cpap also has an exhalation pressure drop feature called "SoftX". But of the major three brands of cpap (PB, Respironics, ResMed), you're right, Liam.

It's true that the Respironics REMstar Auto with C-Flex is the only autopap that currently can also give any kind of pressure drop for exhalation relief at the same time it is operating as an autopap.

The rumors I've read about the new ResMed S8 autopap (yet to be released) is that it will have "EPR". I suppose that stands for "Expiratory Pressure Reduction" or some such acronym... anyway, it will be ResMed's answer to Respironics' C-Flex for giving exhalation pressure relief.

But, from what I've read (wish I could find the links) the ResMed S8 autopap will not be able to use "EPR" when it's being run in autopap mode. It's my understanding that the S8 will offer the "EPR" exhalation relief only when the S8 autopap is switched into cpap mode -not in autopap mode.

If that's so, then the Respironics REMstar Auto with C-Flex will remain the only machine that can give exhalation relief at the same time it is working as an autopap, using varying pressures within a range.

Dan01 · Post by **Dan01** » Fri Apr 22, 2005 2:26 pm

Wow, that was the info I was looking for Everyone.

I have another question: Do all the Auto CPAPs have a feature, when in non auto-mode to start out at a low pressure and bring it up to the max pressure slowly. The tech told me that is important because it helps you fall asleep.

I will be leaving in an hour to pick up my prescription. I will investigate to see if there are local vendors I can see for the mask.

Rested Gal, you sound like you use your CPAP in Auto mode all of the time. Why?

Another thing, my wife is getting jealous and might want one. I felt so good yesterday after being hooked up to the CPAP. I told her she could have a sleep study also. She was considering trying the CPAP in Auto mode without the study. Is that a bad idea?

Liam1965 · Post by **Liam1965** » Fri Apr 22, 2005 3:25 pm

The feature you're talking about is called "Ramp". I don't know if they all have it, although I'd guess that they do.

But it also depends on your pressure. I found that at the 9cm that I had, I was better off just starting it out at full pressure. The Ramp for me had two problems: First, starting out it felt like I wasn't getting ENOUGH pressure, and so I felt like I was suffocating, and second, it was kind of like chinese water torture, I couldn't stop focusing on the feeling of it slowly increasing, and wondering if I'd reached maximum (for me) pressure, etc.

Your mileage may vary, but if your pressure is under 10, Ramp is probably not as vital a feature as some others.

Liam, who also got the "slippery slope" feature.

rested gal · Post by **rested gal** » Fri Apr 22, 2005 4:32 pm

Do all the Auto CPAPs have a feature, when in non auto-mode to start out at a low pressure and bring it up to the max pressure slowly. The tech told me that is important because it helps you fall asleep.

As far as I know, all the major autopaps can be switched to cpap mode, if you want to. And in cpap mode, yes, they'd have "ramp" available.

I think the tech overrates the value of "ramp" somewhat, although there are people who really do need an easy start. You can achieve the same low pressure while waiting to fall asleep with an auto, though, just by setting the low pressure to whatever you're most comfortable with. The autopap's pressure won't go up until there's a reason to. There's usually not a "reason to" until you're asleep. Thus, no need for "ramp" when in autopap mode....probably that's why there is no "ramp" for auto.

I fall asleep easily and have never needed or wanted to use "ramp". I want my machine to be treating me when I turn it on -- not be waiting for something like a ramp time to be finished, even if I were using cpap instead of autopap.

I use my autopap in autopap mode all the time, yes. If I didn't....if I were using it in cpap mode, I'd have to set my pressure probably at either 11 or 12. I don't want 11 blowing at me all night if 8 or 9 can take care of things more than half the night.

There's less chance of mask leaks at lower pressures. Less chance of aerophagia (swallowing air which can cause painful bloating). There's just more comfort in general if one can spending more time at lower pressures. Autopap lets me do that.

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