Replacement intervals?

[Sasesusos Orinoco]

I have a Respironics SystemOne REMStar CPAP machine with attached humidifier. I would like to know the recommended replacement intervals for the replaceable items in this system. The instruction book doesn't give this information, and I'd like to get it from a neutral, clinical source--one that neither sells the items nor has to pay for them.

It's just too obvious that the (for-profit) respiratory clinic I go to wants to replace these items precisely as often as the insurer will allow--they have a table on their website! I just don't believe cushions need replacement twice as often in Massachusetts as they do in Rhode Island. Of course, I'm breathing through these items and I don't want to get pneumonia or Legionnaire's, but on the other hand I don't feel right about replacing them just because the insurer will allow it.

How often do these items need to be replaced, for health and safety reasons... under normal household conditions... when there are no visible issues--that is, everything seems to be working and comfortable, looks and smells clean, there are no noticeable air leaks, and all rubberlike parts are still flexible?

[rested gal]

How often do these items need to be replaced, for health and safety reasons... under normal household conditions... when there are no visible issues--that is, everything seems to be working and comfortable, looks and smells clean, there are no noticeable air leaks, and all rubberlike parts are still flexible?

That's pretty much the guideline I'd go by. I am using the same nasal pillows with my Headrest mask that I've used for a year now. However, I'd add that the nasal pillows for my particular mask are extremely durable. Other brands/models of nasal pillows mask might not have pillows that last so long, so well.

If I were you, I would allow at least one (or even two) replacement parts for your equipment when they offer it. Just to have some spares on hand. After you've accumulated a small cache of "emergency" supplies, then you could tell them not to send you anything else unless you specifically request it.

[archangle]

Please fill in the equipment on your profile so we know what kind of equipment you have. Especially what kind of mask you're using.

Do you have insurance? What's your copay? Is your DME a "preferred provider" arrangement where the price is fixed by the insurance company?

Take all of this into consideration.

It's good to have at least one spare of each individual part. Mask, cushions, hoses, humidifier tank, even the CPAP machine. If the price isn't too high, get one or two spares of each item so you'll be OK if one breaks. For all the wet parts like humidifier, hoses, masks, cushions, I like to use one for a week or so, clean it, dry it, inspect it, and then let it sit aside dry for a week while I use my spare part.

Unless the price is too high, take the items on the replacement schedule until you have at least one spare, preferably two spares. Take the old item, inspect it, and clean it. Inspect it and see if it still looks OK. If it's still good, put it into a cleaning cycle rotation.

Filters are too cheap to worry about if you buy them online. Check cpap.com, or even ebay and buy them in bulk. Clean and replace them on schedule.

As for disease, obviously, you don't want to let the parts get overly dirty, but I doubt they're that big of a problem. It's not like you're sharing these parts with other patients in a hospital. Anything on the CPAP parts came from the air you're breathing, the surfaces in your house or from contact with you. Anything that gets on the mask is getting on you all the time anyway.

If you really get paranoid, most of the manufacturers have a multipatient use cleaning guideline for sanitation between patients involving xx degree water for y minutes. Once you have an adequate number of spares, you could take the "suspect" used part, heat up a pan of water to the specified temperature, and immerse it in the water for longer than the recommended period. At worse, you end up ruining the part. Of course, you would want to carefully inspect the part you just cleaned and not use any "yucky" or damaged parts.

By the way, get a pneumonia vaccine if you haven't already done so. It's not 100% effective, but it's cheap and doesn't have to be done that often.

[Alshain]

Think of it like this. With your car, the recommendation by the oil companies is 3 months or 30000 miles, right? Realistically the car manufacturers will tell you otherwise. Why? Simply put, technology improves. New cars keep the oil cleaner (my users manual says 6 mo or 50000 miles). That gets even better if you choose synthetics. So why do they recommend 3 mo or 30000 miles? Three reasons really

1. That standard was once important for older cars and those older cars are still on the road, changing the oil early doesn't hurt.
2. Newer standards are based on the car model and are harder to keep track of.
3. They want money.

All 3 of those items apply to your CPAP supplies as well, older machines use older filter styles/materials that may need replacing sooner, etc. Older masks may need cushions more often, or their hard plastic may become brittle faster. Each brand is going to be different, and of course the DME want's you to buy stuff. (btw, the standard is set by Medicare, most DME's and insurance go with that).

No, not everything needs to be replaced if it is working (I doubt anyone who uses the heated hoses replaces them every 3 months, given their cost but normal hoses aren't that expensive). The hard plastic will get brittle eventually, but not in 3 months. The cushions and filters should be replaced on schedule. Filters are cheap as mentioned and obviously keep junk out of your lungs, however I have heard the newer ones can last twice as long as the 2 per month recommendation and the PRS1 filters are apparently washable. I've noticed the cushions on the FFM's that I have used all tend to leak the closer to 3 months they get, so that is probably the most accurate schedule on the list. Again, the hard plastic on the humidifier chamber will get brittle eventually, but not in 6 months (in fact, if you use the 3-5 year expected life of the machine you shouldn't really need to ever buy one of these unless it just breaks). The headgear lasts as long as it lasts. If the Velcro works, no need to replace it. If you can go longer than 6 months, do it. I can't tell you much about the pillows, I've never used them.

[archangle]

There's a difference in car maintenance vs. CPAP part maintenance.

If you don't change the oil soon enough, your engine will have problems.

The only parts on a CPAP machine that might hurt the machine are the filters or a leaking humidifier tank. The other parts could hurt the user if they're growing nasty germs. Other than that, as the part gets old, if the part breaks, starts leaking, or smells bad, change it. Have a spare on hand in case it breaks suddenly. If it's yucky, ugly, difficult to use, etc, consider the cost vs. the inconvenience and decide whether to change it.

I think all the REMstar machines have a washable foam filter and a (possibly optional) disposable fine filter.

[robysue]

Keep in mind that the insurance replacement schedules are typically written as compromises between studies determine the average life of the part for the average user, the manufacturer's recommendations, the particular state's legal system and regulation of health care and insurance, and negotiated pricing between the insurance company and in-network DMEs. That's why they can and do vary from state to state.

And then there's the other problem: You can count your blessings if you never run into the situation of WANTING and NEEDING to replace a part before the insurance company is willing to pay its share. Sure, for many people, the headgear will last more than six months. But for some of us, it does get stretched out at 4 or 5 months and there's the hard decision to make about paying out of pocket 100% or waiting a month or two limping along on less than great equipment. And some insurance companies have particularly stingy replacement cycles. Or you can play the nasty game of phone tag trying to determine just when your insurance will pay for parts. For example, it took me the better part of 7 or 8 months to try to shake out the replacement schedule for parts from my insurance company. And every time I called to ask about when I could get another set of pillows, the answer was different. And I needed them bad enough where I resorted to E-Bay because I really could not afford to pay the full price out of pocket every single month. And FX pillows do seem to need to be replaced that often for me. Or you can simply NEED the replacement parts far more often than any insurance company seems to be willing to pay for them: Take the "fine filters" for example---the ones that filter out dust and pollen. Yeah, the filters are relatively "cheap"---except that the pollen filter for my PR S1 really needs to be replaced once a week (yes, it's noticeably dirty when I pull it out). They cost $14 for a pack of 6 (plus a $7.00 shipping fee) from cpap.com and my insurance will cover ONE fine filter per MONTH. Yes, it's only about $2.50 per week to replace my filters out of pocket---if I'm very careful and organized. But it adds up: Over the course of a year, I'm spending more than $100 out of pocket on JUST the dang, itty-bitty fine filters---filters I need because of both pollen and dust.

And spare parts are critical: Hoses are durable and can be patched, but having a spare in case the dog or cat completely destroys it on a Saturday NIGHT when the DME won't be open until Monday MORNING is not a bad idea. Same thing with the mask components.

And like archangle, I too like to have a full spare set of all the "wet" things so that I can wash, inspect, and hang them up to dry for a full week before using them again. I also prefer to swap my nasal pillows out every day or every other day for the same reasons.

[Sasesusos Orinoco]

So as far as anyone knows, there are no "invisible" issues, the hose isn't treated with some magic antimicrobial coating that only works for a limited time (like a flea collar), and common sense is a safe guide?

And nobody knows of an official Philips Respironics replacement schedule?

(The unit I have has a washable foam filter and a disposable paper filter. The directions say, I forget how the phrase it, but the paper filters are optional and are e.g. for a room in which people smoke... so I don't use them).

[archangle]

Take the "fine filters" for example---the ones that filter out dust and pollen. Yeah, the filters are relatively "cheap"---except that the pollen filter for my PR S1 really needs to be replaced once a week (yes, it's noticeably dirty when I pull it out). They cost $14 for a pack of 6 (plus a $7.00 shipping fee) from cpap.com and my insurance will cover ONE fine filter per MONTH. Yes, it's only about $2.50 per week to replace my filters out of pocket---if I'm very careful and organized.

I found some very cheap, apparently real, Respironics PRS1 filters on ebay. If you're using one a week, it seems something must be wrong. Is air somehow leaking around your foam filter? Maybe you should try the pollen filters without tabs or simply cut the tabs off. Mine seem to last for months. Are you in a dusty environment?

[robysue]

I found some very cheap, apparently real, Respironics PRS1 filters on ebay. If you're using one a week, it seems something must be wrong. Is air somehow leaking around your foam filter? Maybe you should try the pollen filters without tabs or simply cut the tabs off. Mine seem to last for months. Are you in a dusty environment?

When I get them from my DME, the genuine PR S1 filters do NOT have the dang tabs that the ones from cpap.com have. When I use ones with tabs (from cpap.com or from e-bay), I cut the tabs off.

The problem is: Our house IS old and dusty and full of cat hair. I am not very good at keeping things swept up, let alone properly vacuumed. And I know myself well enough that I'm not magically going to start keeping a dust free house just because of the BiPAP. If and when I ever get my pre-CPAP energy back in full, I've got plenty of more pleasant things to do.

And until today when we finally upgraded our old, ancient 35--40 year old A/C that worked so poorly that we effectively had no A/C, the windows were open all the time. I still prefer unairconditioned air, so whenever the night time temps and humidity are reasonable for sleeping, the windows are wide open. And wide open windows equals a lot more dust.

[robysue]

So as far as anyone knows, there are no "invisible" issues, the hose isn't treated with some magic antimicrobial coating that only works for a limited time (like a flea collar), and common sense is a safe guide?

For the hose, I think the biggest issues are how long will it last before it develops a hole, tear, or leak somewhere? There are plenty of folks on here complaining about the flimsiness of the Resmed Slimline and ClimateLine hoses and their tendencies to develop tears right at the cuffs, for example.

And nobody knows of an official Philips Respironics replacement schedule?

I'll dig through my stuff tomorrow, but I suspect that there are replacement schedules in the user manuals.

(The unit I have has a washable foam filter and a disposable paper filter. The directions say, I forget how the phrase it, but the paper filters are optional and are e.g. for a room in which people smoke... so I don't use them).

The paper filters are also recommended for people with nasal allergies (me) and people who live in dusty houses (me) and people with pets that shed (me). Basically, the fine paper filter does a better job of filtering out the pollen, dust mites, and pet dander, all of which are much too small to be trapped by the foam filter.

[Alshain]

There's a difference in car maintenance vs. CPAP part maintenance.

If you don't change the oil soon enough, your engine will have problems.

lol...

"It's not a perfect metaphor" - Billy/Dr. Horrible

Still, we seem to agree the schedules are bit conservative. I do agree having a backup is a good idea also.

[Sasesusos Orinoco]

I got a phone message from Philips Respironics. Basically they punted. The rep went over the cleaning schedule in detail--which is indeed in the manual and which I already knew. She said something vague about "contacting your provider" on the humidifier reservoir, and that no intervals for the hose could be stated because "it all depends" e.g. on whether you're cleaning it properly. No specific replacement intervals, no specific replacement criteria.

So, having accumulated some spares, I guess I'll just clean what I've got, politely tell the supplies person "no" when they call in three months, replace things if I think they need replacing, and ask my provider if I see something and am not sure.

[Sheriff Buford]

My insurance is Cigna and they replace masks and hoses every three months. I'll be the first to say I'm blessed. I will also say I feel a little guilty getting this stuff before I really need it. The way I look at it, who knows what we will have to do when 'Obama-care' kicks in? It may pay to "stock-pile" equipment for the long run. Just sayin'

Sheriff

[Sasesusos Orinoco]

OK, I rediscovered why I asked this question in the first place. To recap, Philips Respironics is very clear and specific on cleaning, but offers no guidance at all on replacement other than "contact your provider."

Now, my provider, which struck me as being honest but emphatically for-profit--an independent chain of sleep therapy centers that occupy space in hospitals under some relationship I don't understand--gave me their own "PAP Therapy Manual" which says, direct quote:

"How often should I replace my equipment and supplies?
bacteria collect in the mask and tubing despite weekly cleaning. The cushion on the mask breaks down over time, which minimizes the seal and allows leaks to occur. Your mask, headgear and tubing should be replaced as often as your insurance allows, usually every six months."

And I'm saying, tying it to "as often as your insurance allows" seems bogus to me. If it needs to be replaced every six months, than it doesn't need to be replaced every three months even if my insurance allows it--unless of course there's obvious damage or leakage or something. On the other hand, if it needs to be replaced every three months as a matter of respiratory safety, it needs to be replaced every three months even if my insurance does not allow it.

I know it's all indefinite and relative, but I'd to get some objective advice from a disinterested party--not this sleep center chain which provides supplies and has an financial incentive for frequent replacement--and not the insurer, which has a financial incentive for infrequent replacement.

[archangle]

Hogwash.

Buy replacements on your insurance schedule until you have one or two spare masks, mask cushions, humidifier tank. After that, only replace as necessary.

Clean one set, set it aside somewhere clean and dry until the next cleaning cycle and use the other set until the next cleaning. I wash PRS1 humidifier tanks and disassembled Comfortgel masks in the dishwasher and have done so for 7 years or so. I never wash the headgear. The hose gets hooked to the water faucet and I run the hottest water I can get through it.

My old Comfortgel masks would eventually get cruddy on the cushion and need to be replaced, but that's probably every 6 months or so. The Comfortgel Blue cushions look like they'll last even longer.

By the way, lots of DMEs scam you and will try to tell you they can't order just the cushions and you have to buy a whole mask. Most insurance follows medicare guidelines and will pay for a new cushion or flap once or twice a month and don't require you to buy a mask.

I've bought several sets of genuine ComfortGel Blue cushions and flaps on ebay for $20 each and rotate them so they can dry out between sessions. You can get genuine filters cheaply in large quantities there, too.