Newbie prescribed APAP w/ pressure 6-17. Machines?

Husband just got titration study done. He needed a pressure of 15 at the study and the doc gave a script for an APAP with a pressure setting of 6-17.
We are going to pay for everything out of pocket one way or another since our deductable is ridiculously high. So, I'm trying to set hubby up for success from the beginning and get a good machine (and mask) without having to buy and return a bunch or be frustrated with something that doesn't meet hubby's needs.) It seems best to go through a DME locally (vs online) that our Doc loves to work with because they are a bit flexible on trying out some machines. Nonetheless, I have some reservations.

The DME is suggesting a Fisher & Paykel ICON Auto. The DME also says that we will be locked out the the data readouts and only Clinician access (e.g. the Doc.) will be able to see it. His explanation is that since we don't know how to read it, we would interpret it incorrectly.

A few questions:
1. If we push the doctor to allow us access to hubby's data, will the DME unlock our access? Or even the doc unlock it himself?
2. Is there a better APAP machine out there? Other than knowing it has a "data" feature, "heated humidifier" and is "quiet", what else do we go on? It's so hard to tell from reading reviews on cpap.com if the $900 machine is so much better than the $500 machine.
3. I read how BiPaPs are so well rated, is it worth pushing for a BiPap if we can get a script for it without another titration? Or are the APAP's sufficient if they self-adjust on a breath by breath basis (assuming it is breath by breath basis)?

thanks,
Dk

If his cpap pressure is pegged at 15 cm then we would assume that using apap it would like go up there and stay up there and that puts him in the category where a bilevel machine would probably offer substantial exhale relief.....and that's what I would push for.

If I couldn't push hard enough to get a bilevel then I would go with the ResMed Autoset...either the S9 or the newest AirSense 10 Autoset because ResMed's EPR (Exhale Pressure Relief) will feel like bilevel exhale relief. It won't go higher than 3 cm but that 3 cm is going to be a substantial relief over the Icon's way of doing exhale relief. The ResMed machines when using EPR work like a bilevel machine works. Sometimes we refer to them as the poor man's bilevel machine.

The locked out of data BS because we wouldn't know how to interpret it....horse poop. They will try to do it with any brand machine but we know how to get around that little hurdle.
If it was my husband I wouldn't go for the Icon at all. I think that the sensawake feature would likely disturb sleep due to the big drop that it will do when it thinks a person is awake and the exhale relief on the Icon can't hold a candle to the ResMed exhale relief.

A real bilevel machine would offer the greatest comfort range but the ResMed using EPR at 3 would come real close and that's what I would get if I couldn't get anyone to listen to me about bilevel.

then we would assume that using apap it would like go up there and stay up there and that puts him in the category where a bilevel machine would probably offer substantial exhale relief

EPR -- this info is enormously helpful. Thank you! One wonders why a doctor wouldn't consider this.
thank you also for the suggestions of auto's that can offer it as well. It makes sense to me that even though more $$, my husband is a good candidate for a bilvel machine and I'll make sure to get an Rx for one.

I am pretty new at the whole CPAP lifestyle as well. My advise to you is that you do a lot of reading on this forum and educate yourself rather than simply trust what the Doctor or DME tell you. What I have learned here saved me from a disastrous start and possible early termination (of both CPAP therapy and life). The people who write on this forum are well informed and are not pushing an agenda other than that you need to be empowered to choose how to manage your health.

dkeller,


I am one of the odd ducks here on this forum that has both the machines mentioned above (Icon Auto & ResMed Airsense 10 Autoset)...........what Pugsy wrote up above comparing the two is spot on...........I could not have written the comparison better if I tried...............of course we all know how darn Eloquent Pugsy can be!

It is my understanding from reading the flow chart for cpap titration that when someone hits 15 cmh2o they are usually recommended a bi-level or bipap machine, so I would certainly push for that.

I don't have much BiPAP machine experience so I won't speak to that, but in the APAP line the ResMed S9 Autoset or the newest model Airsense 10 Autoset would be the way to go as explained above by the other posters.

Welcome, dk.

There is a lot of information in the Useful Links in my signature line at the end of this post. It has machine info and info on dealing with DME's.

The Icon is good, but IMHO, the right models of ResMed S9, A10, or Philips Respironics PRS1 machines are a big step up, especially in terms of data access.

If it's midnight and and a DME tells you it's dark outside, go and look for yourself.

I have a 10 year old Fisher and Paykel dumb CPAP. It is still working and working well.

When I got my new CPAP about a week ago I went for a PR System One model 560 and love it. I chose the System One over the Resmed Airsense 10 because the PR System One runs on 12v which makes it a much better camping CPAP for me.

I am confident my DME gave me a Fisher and Paykel all those years ago to maximize their profit from the insurance company. The Fisher & Paykel ICON Auto looks like a good CPAP for $500: https://www.cpap.com/productpage/fisher ... chine.html It has a USB memory stick, humidifier and a heated hose all of which I would want in a CPAP. I would check to see if the Fisher & Paykel ICON Auto is supported by the free sleepyhead software. In my experience a good mask is more important to success than the CPAP itself as long as the CPAP has the functionality listed above.

I would have no qualms about saving money by purchasing a good used CPAP... and have purchased a used PR series M with great results in the past.

Insurance companies have caps on how much a DME can charge for a CPAP. If the DME gives you a $500 CPAP or a $1000 CPAP the DME will get the same $1200 (for example) from the insurance company. This might make it worth it to get a top end CPAP through your insurance company even though you will pay for all of it with your deductible.

Welcome, Dk! You are so far ahead of the game just by being here and doing a lot of reading - it should be required before anyone starts the process of getting a machine.

I will just mention, since I don't think anyone else has yet, that there are other options for getting machines besides the DME. The most popular are craigslist and secondwindcpap.com and it's possible to save a substantial amount of money but it requires doing a lot of research, asking questions, and investigation. Nine out of ten machines on craigslist have prices that are too high because they base it off the fantasy "list price" that few people end up paying. I was lucky to get the machine in my signature for $100 but there's a big element of luck involved. Even though it's an older machine, it still has the memory card, detailed data, and three levels of exhalation relief an only had 95 hours of use on it so was close to new condition.

So do your homework! See what's on your local craigslist. Check the prices of machines you're interested in on our host, cpap.com and for used machines on secondwindcpap.com. cpap.com will show you what a good, no-insurance price is. Find out what you will have to pay if you get it from the DME. Also, there are often machine for sale by members of this forum - many people will keep an eye out for good deals for machines they might want to try or have as backups and it is not unusual for machines to be available from them. Just make sure that you get an auto-adjusting machine with a data card that is usable with the wonderful, free SleepyHead software so that you'll be able to monitor the therapy.

The stuff about the DME wanting to lock you out from even being able to see your information concerns me. If you decide to go with a DME, find out what other DME choices you have and contact them and ask the same questions. It's common to have at least several choices of DME available. Sometimes, the DME and Doctor are more concerned about the hours of use, so that everyone gets paid, than how effective the therapy is. But you can get help with that from the wonderfully helpful people here.

I think I can get the doc to give us a script for a BiPaP.
If that is the case, I'll file insurance because I assume the allowable cost will likely be cheaper than paying new out of pocket. (I don't think I'm confident enough as a newbie to source a machine 2nd hand and troll craigslist, etc. just yet). So might as well get the best of the line BiPaP if it's going to cost the same.

From looking at cpap.com,
PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
and
S9 VPAP™ Auto BiLevel Machine
are the cream of the crop.
Any ideas why someone would choose one over the other?

I will have to do my homework and find out if the in network (United) DMEs (Apria, Lincare, Rotech) carry either of them and confirm the allowable cost.

dkeller wrote:From looking at cpap.com,
PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
and
S9 VPAP™ Auto BiLevel Machine
are the cream of the crop.
Any ideas why someone would choose one over the other?

Add AirCurve 10 VAuto to the choices as that is the latest model version of the ResMed S9 VPAP Auto...so if a DME happens to offer it you will know what it is. They are new...released just late last December.

I have personally owned and used both the PR S1 60 Series BiPap Auto and the S9 VPAP Auto (about a year of use with each brand). Now that Respironics offers the heated hose it really is pretty much a toss up between those 2 brands.
There are some very minor setting adjustment variables with either but none are deal breakers or deal makers.
If a person was buying totally out of pocket...the PR S1 60 Series BiPap Auto is usually significantly less costly and the VPAP Auto isn't worth the price difference IMHO.

If insurance is footing the bill...either one will do the job very nicely and cost you the same.
I haven't had a chance to use the new AirCurve model line but I don't think that the actual function or ability to do the job was changed or improved over the S9 models.

I have a used Respronics DS760p bipap for sale that I can sell you for $550 shipped to you

http://sfbay.craigslist.org/eby/hab/4871799117.html

Pm me if intrested