Greetings - need help w/machine selection

[Master_P]

Hi everyone.

I'm new to this forum but not new to sleep apnea. I was diagnosed in 2009 with mild-moderate OSA and began CPAP therapy at a pressure of 11 cm3 H2O. The DME company set me up with a ResMed REMStar M-Series w/humidifier, and a nasal pillow mask. I tried the full nasal mask, but woke up with pain on my nasal bridge. The initial results on therapy were an improvement from my prior sleep quality, but not as stellar as some random mornings where I woke up feeling very refreshed and alert. I started exploring more options.

One was surgery. My sleep doc referred me to one of the best ENT's in town. He claims to have done >5k OSA surgeries. He did a laryngoscopy to find my obstructions. His surgical recommendation was a UP3 plus a genioglossal advancement. Some of my obstructions are in the soft-palate region. He would do a uvula "tuck", remove some tissue on the sinus-side of the soft-palate, and the upper tonsils. The other obstruction is the base of my tongue. In an awake and relaxed state, he measured the airway at ~3mm, compared to 10mm in a healthy person. The advancement was the correction for this. He estimated a 75% chance of success.

A second option was a dental appliance. I have bruxism, and have worn a mouth-guard for several years. I worked with my regular dentist for an anti-snoring appliance. Unfortunately the strength of my jaw broke the anti-snoring device repeatedly. Then I did some research and found the SomnoMed MRD, and a qualified local dentist who takes my insurance. I received the device last December and have noticed a significant improvement. Working with my sleep doc, I have lowered the CPAP pressure down to 6, and could probably go even lower.

Lately I've been experiencing a tremendous amount of rainout. After inquiring with my DME provider, I discovered that the only compatible solution to my CPAP is the ResMed Hybernite tubing. Problems with this are: a) the DME provider never has it stocked, b) it requires a separate power supply which means more stuff I have to carry when traveling for work, or when I go to SWMBO's place.

Fortunately, my insurance benefits allow me to get a new xPAP every 3 years, so I started researching and found this forum. I set an appointment with my sleep doc for Monday, and will talk to him about switching to a new machine.

I am thinking about going to an APAP after reading this forum. As an engineer, I am used to reading lots of different data and experimenting with settings to find out what works the best, so an APAP will fit my needs better, especially with the ongoing adjustments to the MRD. Right now if I need to change the pressure, I have to get approval from the sleep doc, who then faxes the Rx to the DME, and then I have to bring my CPAP in so they can reprogram it. It's quite a hassle.

The device I'm looking at is the ResMed S9 AutoSet with the Climateline tubing, paired with an appropriate nasal pillow mask such as the Swift FX or Swift FX Bella Gray.

Here are my questions:

1. Does the Climateline tubing require an additional power supply, or does it draw power from the base unit? It would be soooo nice if it could plug straight into the base unit.
2. Compared with other machines on the market, does this machine give me access to the most data of my sleep disturbances? Can I access that data myself?
3. I read several threads about the S9 tubing being flimsy and breaking/leaking easily. Most of those threads were from 2004-06. Has ResMed improved the quality of the tubing since that time?
4. Any other machines you think I should look into... the main concerns for me in a device are a) quiet b) data retrieval, c) portability

Thanks!!

[dlanbro]

I can answer about the S9 and the climateline questions, not the rest. I have an S9 with an H5i climate control and the tubing does plug into the H5i, no seperate power needed. The tubing appears steady and without issues. I had to replace mine but it was due to something that I did, not the tubing being flimsy. I use the proram "Sleepyhead" and have access to more data than I've learned to interpret so far, being new to the machine (about 6 weeks). My understanding is that this machine is one of the best on the market and I can tell you that I'm very happy. The biggest issue so far is the mask which I'm getting a refit on tomorrow.
Good luck with getting a new machine. I was told as a reply to a post that I made once that the S9 is a "very coveted machine". Guess I got lucky with it and got it the first time out.

[Master_P]

Thanks for the feedback!

I never thought about software to interpret the data. I'm going to look into Sleepyhead software!!

What kind of data does your S9 output?
Are you using an APAP or CPAP?

I have read that 90% of CPAP compliance is tied to mask fitment. This is good information. The newer masks looks a little different from my current mask so I'll pay close attention to fitment and comfort.

Thanks!

[Pugsy]

The S9 will do what you want and do it quite well.
Full data...easy to access...easy to obtain and use software.

The problems with the ClimateLine hose being frail seem to have been eliminated. Haven't heard many complaints about the hose for a couple of years now.

Here's a link for the manual that we are never suppose to see because it tells us all the stuff we aren't supposed to know.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf

The other comparable machine would be in the Respironics line...they now have heated hose machines. The PR System One 60 series Auto CPAP model 560 would be equivalent to the Autoset.

If you can get the S9 Autoset.. don't get the S9 Escape Auto though...I think you will be very happy with what you get.
You would probably be happy with the PR S1 560 but since you have researched the S9 Autoset and seem to like it...go ahead and get it. There are minor pros and cons with either brand but none are deal breakers.
Both are excellent machines. I usually recommend the PR S1 when someone is paying out of pocket for a machine only because it costs less. ResMeds are nice but not twice the price nice.

BTW I did buy the Hybernite 2300 heated hose to go with my PR S1 machine (pre 60 series) and it does a good job.
I also have a S9 machine now and I love the Climateline hose.

[Master_P]

Thanks for the reply Pugsy!

Can anyone recommend a good DME provider in the Bay Area? Right now I go through Pulmonary Solutions and cannot stand dealing with them!

Every time I talk to them, it's like dealing with the DMV. Every request is met with a "Oh we can't do that... you need to first do this [insert red-tape]" reply... they just don't get it! *I* am the consumer. I am paying them! If I ask for something, you need to give me a straight answer! They just don't care!!! Allow me to illustrate with an example.

Below is a concise e-mail summary when I asked them about solutions for rainout with my current machine:

PS: You can use Hybernite tubing to your machine but we don’t have it in stock.
Me: How soon can you get it?
PS: I have no idea but I will check with the Inventory control and I will let you know.
Me (2 weeks later): Do you have the Hyernite tubing in stock now? I am still experiencing rainout.
PS: We are out of stock of Hypernite tubing and will let you know when we received shipment. Thank you! Have a great day.
Me: What about the ClimateLine product? Do you have this in stock?
PS: Thank you for your inquiry, the climate line product is available but unfortunately the item is not compatible with your machine. Once we get our order of hybernite tubing you will be notified, you can also order this online from cpap.com if you think you are in need of the item sooner

I then wrote back and asked them to per-authorize my insurance for a new machine... which they still have not done. If they actually gave a d4mn, they might say something like: "We don't have it stocked now. Would you like us to order it for you?"

It's time to fire them and get a new supplier. I tried switching to Apria, but they were worse! I couldn't believe that was possible but it was!!

Who are you guys using for your DME needs??

[dos coyotes]

I can't help with the DME question because I'm self treating with no insurance. BUT I did just want to add another positive input on the ResMed S9 and climateline hose. I have that setup with the humidifier and use the Swift FX nasal pillows. As noted, the machine, along with SleepyHead software gives me more data than I can interpret, all on a convenient SD card - and it is Windows and Mac compatible. The cimateline hose must be vastly improved as I've accidentally stepped on mine (more than once) and I'm a BIG guy and it works perfectly.

I can't speak highly enough about the machine, it's made a great difference in my life!

[Kenwood]

Can anyone recommend a good DME provider in the Bay Area? Right now I go through Pulmonary Solutions and cannot stand dealing with them!
Who are you guys using for your DME needs??

I would ask your Sleep Doctor or some of the employees at your sleep doctor. They have a good idea of good/bad DME. I recently fired my DME and just starting the process over with a new DME the sleep doctor recommended.

[Master_P]

Thanks for the replies fellas!

I have a better feeling about the DME I chose this time. They called me on Tuesday and left a voice-mail. I've been slammed at work all week so I forgot to call them back. They called again today. After some phone tag, I explained to them what I was after. He said he'd call my insurance for a pre-authorization and call me back.

Well, that call happened at 2:20pm. At 3:45 he called back and left a message saying the insurance approved the device, and now I just have to schedule an appointment to come by and pick it up. Right now I'm quite happy!!

Hopefully I'll be on this machine in the next day or two!!

[archangle]

Thanks for the replies fellas!

I have a better feeling about the DME I chose this time. They called me on Tuesday and left a voice-mail. I've been slammed at work all week so I forgot to call them back. They called again today. After some phone tag, I explained to them what I was after. He said he'd call my insurance for a pre-authorization and call me back.

Be sure it's the S9 AutoSet. The Escape Auto has much less data. Some DMEs will lie to you about it. Look for the name AutoSet next to the power button.

[Sheriff Buford]

Master: keep us updated on how it goes. On your Resmed S9, you can use the climatline hose (if you use your humidifier.... trust me... don't use the humidifier unless your need it for comfort or sinus issues). That being said, get a humidifier just in case you may need it later on. Without the humidifier, a standard hose can be used or Resmed makes a slimline hose, which is a smaller diameter hose. It is a little easier to work with. Hoses are relatively cheap, and some folks can go a whole year on one. I place a strip of duct tape on the connection of the plastic hose and hose coupling (the end of each hose - where the hose fits on the mask or mask fitting and where the hose attaches to the machine). This will provide reinforcement at probably the weakest portion of the hose.

Sheriff

[dlanbro]

Dang, I fell down on the job and didn't get back to you. Sorry. Looks like you have some great info here though so I don't feel too bad. Yeah, the S9 Auto gives you EVERYTHING on the data card. Every night's individual stats (mask leak, AHI, tidal volume, number of breaths, snoring, types of apnea events, and much more) and it gives averages for the last week, last month, last year. Sleepyhead is a free download, just google it. I'm hoping by now that you've been on your machine and am interested in how that's going. I just went for my first split study on tuesday night. By yesterday afternoon my doctor was working up the paperwork to put me on a BiPAP. I called the DME and was told that they were just waiting for the papaerwork from the doctor. I have a really good team it seems.

[Sam793]

Why do DMEs lie about the S9 Elite not being covered? You think that they wouldn't want to lose the business of those smart enough to question it like I did.

[Sheriff Buford]

Why do DMEs lie about the S9 Elite not being covered? You think that they wouldn't want to lose the business of those smart enough to question it like I did.

I am thoroughly convinced that DME's make money by selling products in volumn. Though you may find one here or there (diamond in the rough) that really wants to help you, we should not expect anything more than a financial transaction. If you look at it this way, you have zero expectations and you never "wonder why?".

Sheriff

[Sam793]

My first DME didn't want to sell me what I wanted but was nice enough to give me a quote to submit to see if I may be covered for the "upgrade". She said I would have to pay the $500 difference out of pocket. The quote was written in a way that would have ended up costing me the $500. I got a quote on the exact same setup from another DME who first asked me who my insurance company was. The quote came in lower and all written so all of it was covered.

[Sheriff Buford]

My first DME didn't want to sell me what I wanted but was nice enough to give me a quote to submit to see if I may be covered for the "upgrade". She said I would have to pay the $500 difference out of pocket. The quote was written in a way that would have ended up costing me the $500. I got a quote on the exact same setup from another DME who first asked me who my insurance company was. The quote came in lower and all written so all of it was covered.

Sam: looks like us cops are taking over this forum over. Everyone watch out.... ! By the way.... I like Apple Fritters....

Sheriff