Another newbie trying to choose a machine! HELP!

[Yael]

Hi Guys,

Another CPAP newbie here! Sorry in advance about the length of this post!

I've recently been diagnosed with idiopathic hypersomnia (somewhat similar to narcolepsy), along with sleep apnoea (hypoapnoea). It's been a long time getting to this point (as I'm sure it is for most of you!). I've always needed more sleep than most people, can easily sleep 12-14 hours per night etc, but was getting by. Then I had to give up caffeine (only drank like 2 cups a day) as I developed an intolerance to it (thought my life was over!!), and noticed my sleep got so much worse, felt like I was living in a daze the whole time. I could sleep for 18 hours and still wake up not feeling at all rested, and still needed to nap for around 4 hours every day. My psychiatrist (I suffer from depression), suggested I get a sleep study done as over 50% of people with depression have an undiagnosed sleep disorder.

So last December I went and saw a repository specialist (my husband has sleep apnoea and is on CPAP, so I saw his specialist), who sent me off for an overnight study. Showed I was having quite a few hypoapnoeas. I was getting my tonsils out anyway 2 months after that (chronic tonsillitis), so the specialist told me to wait to see if that helps. It got worse after that, so I did a CPAP trial for 2 months (even though the sleep apnoea is technically mild so most people wouldn't bother with CPAP, my sleep problems are really interfering with my quality of life. I can't splint as I grind my teeth at night and have bad TMJ pain)
Anyway, I used it for 2 months, building up to a pretty good compliance rate, but felt no difference. My husband has extremely severe sleep apnoea due to a small set back lower jaw, and the first night after using CPAP he felt like a new person. I had none of this, which was really disappointing.

I was going to give up and just accept this, but did some research on the internet and decided to try another specialist who is supposed to be the guru of sleep problems. Apparently a lot of people are undiagnosed as just having sleep apnoea when there are other problems going on also.
Anyway, did another overnight study, and a daytime study (multiple sleep latency test). It showed I was having hypoapnoeas (waking up 45 times an hour), and that I also have idiopathic hypersomnia (that was from the daytime sleep test). I'm about to start modafanil for the hypersomnia, and I also need to go on CPAP for the sleep apnoea.

I went and had another sleep study done for a titration study. It was really good, they tried 3 or 4 masks on me (and I had also tried some during my 2 month hire), and they woke me up a few times in the night to try different masks when there were leaks or I started to mouth breathe (and the chin strap didn't fix it). It was great they could do it in real time and watch what effect the masks etc were having on the pressure levels etc. They could also see what pressure I could go to before I started to hyperventilate and woke up ripping the mask off as I couldn't breathe (scary way to wake up!)

I saw the specialist last week, and got the prescription. Which is:
CPAP pressure: 11 cm h20
C-flex/Epr: optional (any setting)
Heated humidification: yes
Auto-titrating CPAP: no
bi-level pap: no
chin strap ptional
recommended mask: Redmed quattro air (small)

Anyway, I had some questions for you guys out there.

1) If you are prescribed and planning on using CPAP, do most of you buy the CPAP only machines (which between the Resmed s9 autoset and elite mean you save some $$), or did you buy the one with APAP function and use it on CPAP just in case?

2) I'm looking between the Resmed s9 (elite or autoset) and the Phillips-Respironics Remstar auto system one 60 series.

a) Can somebody please explain to me the difference between the different PR Remstar models – I honestly can’t work out what the difference is (other than some are CPAP and some are APAP). Some have c-flex, some have c+-flex, some have a-flex. I’m so confused!!!

b) Also, can anyone tell me what the difference is in features between the Resmed and the PR Remstar.

3) Does the Resmed have auto on/off (so that the machine sits in hibernate mode and when you put the mask on and start breathing, it starts pumping air)? Some websites say it does, and some they it doesn't.

4) My specialist said in terms of data recording the Resmed is the best, followed by the Respironics. Is that everybody's general consensus?

5) Can anyone share what else compelled them to go with 1 particular brand of machine? Which machine do people think is better between the Resmed and the PR Remstar?

Thanks in advance for your help!

[Lazer1234]

1# I have a S9 AutoSet but using it as cpap (Elite) Have got my machine for only $ 90 though.
3# Yes, Resmed has that feature. However, it is a bit limiting, depending on the pressure you have set. S9 AutoSet was 7 cm, I think, will not work under it.

[Pugsy]

Welcome to the forum.
Are you going to be using insurance to purchase a machine or are you self pay?

did you buy the one with APAP function and use it on CPAP just in case?

We often do suggest that people get an APAP mode available "just in case". There can be situations when APAP mode is useful.
Sometimes people need more pressure either during REM stage sleep or when sleeping on their back and using APAP mode lets a person use a lower pressure during the times where lower pressures are sufficient and then the machine goes higher only if needed.
I have first hand experience with this range because my pressure needs vary a lot and REM stage sleep seems to be my primary culprit.
I might have a night where I never need much more than my minimum pressure 10 or 12 cm setting and then some nights I bump 20 cm. I see it in my reports fairly often and almost always within a time frame where REM stage sleep would be present.

Some have c-flex, some have c+-flex, some have a-flex. I’m so confused!!!

http://aflex.respironics.com/
The above link explains the minor differences in the flex options available.
Also check out mollete's explanation here below
viewtopic.php?f=1&t=88991&hilit=+CPAP+Basics+re%3A

I have had a chance to use both the S9 machine and the PR S1 machine. The exhale relief functions for the 2 brands are different but both work well. It's hard to put into words as to how each differs in terms of what you actually feel but either EPR or Flex gets the job done.

Does the Resmed have auto on/off

Yes, the S9 machine has this feature...it's called SmartStart.

My specialist said in terms of data recording the Resmed is the best, followed by the Respironics. Is that everybody's general consensus?

Actually I think that both are pretty much equal. The Respironics machines flag RERAs and present Flow limitations and snores a little differently but overall I think both do a great job. I actually prefer the Respironics way of presenting data as it lets the snores and Flow limitations be evaluated more easily but that is just me.
Also Respironics offers wave form flow rate graphs in a real easy to get format but ResMed's flow rate graphs can be altered to get the same data but takes a few clicks of the mouse. Not a deal breaker though.

Can anyone share what else compelled them to go with 1 particular brand of machine? Which machine do people think is better between the Resmed and the PR Remstar?

Not too many people have had the chance to use both brands of machines. Most people will tell you that the brand that they use is the best brand. Most of us who have had a chance to use both brands will tell you it's a toss up. There are minor pros and cons with either brand but none are deal breakers.
I think that most people would do well with either brand. There may be a few people who would do better with one brand's algorithm and way of doing things over the other brand but I think most people would do just fine with either brand.

If buying a machine out of pocket...get the Respironics because it costs less and there is no loss of quality.
If insurance is paying they pay the same no matter which brand (also they pay the same no matter the model...they pay the same for an APAP capable machine as they pay for cpap only mode machine).

You really can't go wrong with either brand. Also, while apap mode is an advantage for some people it isn't a deal breaker. I could use a fixed pressure machine but I just would have to use a much higher pressure all night every night to get the job done for those REM stage sleep events. It can be done but obviously I prefer to use a lower pressure whenever I can.
Now some people find that apap mode actually disturbs their sleep some because of the changing pressures. I am lucky in that I can sleep through changes from 10 cm to 20 cm but if the changes bothered my sleep then I would have to make some compromises and use a fixed pressure.

What brand machine did you trial for the 2 months that you felt no improvement?