Help me pick a machine!!!

[all_4_my_son]

I posted that I was having difficulties with my F&P ICON Novo in another thread: viewtopic/t92821/I-cant-do-it.html

I just got off the phone with the DME/homecare office where I got my machine and the nurse stated I CAN trade my ICON Novo in - WOOT!!!!

She wanted to know what machine I wanted instead, stating that they carry 3 "major brands" - F&P, ResMed and Resperonics. I told her my main issue is not the incoming pressure, but feeling as if I am fighting against the exhale. I asked if she could switch to a machine where the exhale pressure could be lower and she stated that was a Bi-pap machine and that required a whole other sleep study AND another script from the doc AND that insurance wouldn't pay for a Bi-pap machine. I then asked for an autoset, which I see alot of people talking about on here and she stated again, that took another script from the doctor. I asked her if there was ANY type of machine that could help me, and she stated I needed one with "C-Flex". Since I am very very new to CPAP, I need guidance.....

Like I said before, I have no problem with the incoming pressure, or problems with my mask (I do love the nasal pillows!) - it's just the exhale pressure is too much. In everyone's opinion, what machine would work best for me? Right now, I have the pressure turned down on my NOVO to 8, when it should be 12 so it's not really treating the apnea and I DO want to treat it.

thanks!

[Pugsy]

Sounds like they will dig in their heels on getting an apap mode machine. Not the end of the world.

Tell them you want a Resmed S9 ELite or Autoset....tell them you don't want anything with "Escape" in the name.
They will likely bitch about the AutoSet since it has cpap mode and apap mode available but the Elite is a good machine.
I think you will like the ResMed exhale relief better than you will like the CFlex exhale relief of the comparable Respironics machine.
The EPR (exhale relief on the S9) actually will let the pressure drop up to 3 cm on exhale and it functions pretty much like a bipap machine. It is more noticeable than the relief offered by the CFlex relief machines.

Both the S9 Elite and AutoSet are full data machines...and software is easily available..but don't go talking much about the software because they will just dig in their heels more because we are supposed to be too stupid to use it.
Just tell them you want leak data to make sure you aren't leaking so much it affects therapy. That's a reasonable request and any machine that offers leak data offers the other data.

While APAP machines are nice when we can get them...the fixed cpap machines are great machines and they do a great job so it isn't the end of the world to get one. I have a fixed pressure machine as my back up machine. I had to do a little more tweaking with it to get the pressures just right but I managed to get it done and I am someone who actually needs a wide range of pressures during the night because of REM events. Not everyone needs a wide range of pressures.

I have used both the S9 machine and the comparable machine in Respironics...so I have used EPR and Flex...I think that EPR will do you a better job in giving you the exhale relief you need because it is much more pronounced.
AFlex does a great job and feels more natural...but it is only available in the APAP mode machine. CFlex is good but not as good as EPR IMHO.
BTW I do use a bilevel machine now...and EPR at 3 (3 cm drop on exhale) feels almost identical to same setting difference on the bilevel machine.
I think 3 cm drop would probably make things a WHOLE lot more comfortable for you. Besides...the S9 also has EasyBreath technology. Even without EPR it would feel better.

[fordjx4000]

make sure the machine is data capable i have used resmed and resporonics machines in the hopitals i have a pr system one bipap auto sv advanced 50 series and a pr system one remstar auto with a flex 50 series

[Hawthorne]

There is also the Devilbiss machine. Maybe your DME does not or will not carry them. They come in a Standard ( like the Elite in the Resmed and the Pro on the Philips Respironics) and Auto.

I have the Auto and really like it but the Standard machine also has exhalation relief so that breathing out is easier, just as in the Elite and the Pro. The Devilibss also has "rounding" which makes customizing the exhale even better in my opinion.

[all_4_my_son]

From what the DME nurse said, they only carry ResMed, Respironics and F&P machines and if I want an S9 AutoSet (which I requested), then I have to have a new script which my neurologist is unwilling to write

There is also the Devilbiss machine. Maybe your DME does not or will not carry them. They come in a Standard ( like the Elite in the Resmed and the Pro on the Philips Respironics) and Auto.

I have the Auto and really like it but the Standard machine also has exhalation relief so that breathing out is easier, just as in the Elite and the Pro. The Devilibss also has "rounding" which makes customizing the exhale even better in my opinion.

[Janknitz]

If you want the autoset, the prescriptions does not need to come from your neurologist.

First, you don't REALLY need a script for the Autoset, but since your DME is playing games, you can get a specific prescription from ANY MD. It doesn't have to be a "sleep doctor".

I don't know why some neurologists are so dead set against APAP's which CAN STILL BE USED IN CPAP MODE! I think they don't like a machine to be smarter than they are. They don't personally trust the data, but so what? They make their decisions based on what--a best guess? A little trending data, even if not perfectly precise, can still be helpful.

Given your discomfort, the more bells and whistles which allow you to tweak the settings so you will USE the machine are important. The machine does nobody any good sitting and gathering dust because you can't tweak it to find a level that both works and is comfortable for you.

That said, the ResMed Elite is a perfectly good machine if you don't want to have to go into full-on battle mode for the Autoset.

[robysue]

I agree with Pugsy that since you are having so much trouble with exhaling against the full pressure, the Resmed S9 EPR system is likely to provide you with more comfort since its "exhale relief" is a constant drop of up to 3 cm of pressure rather than a variable drop that maxes out at about 1.5 or 2 cm of pressure.

And as pugsy said: While the S9 AutoSet would be nice, the S9 Elite is a full data (straight) CPAP with the same EPR system that the S9 has. The S9 Elite is a good, high quality machine.

So if the DME is willing to sell you the S9 ELITE (and NOT the S9 Escape) and you don't want a prolonged struggle on your hands, then you should seriously consider just getting the S9 ELITE. And you don't need to feel like you're "settling" for second rate equipment if you do decide to just get the S8 ELITE. Just don't let them snooker you into accepting an S9 Escape.

[Bobshouse]

Someone isn't being very honest with you. A prescription for a cpap is a prescription for a cpap. You do not need a "special" prescription for a S9 "autoset". Just have your doctor write a prescription out for "user's choice"...if he/she refuses, get another sleep doctor. Don't ever be afraid or hesitant to question your doctor's decision. Remember he/she works for you, you don't work for them....at least till Obamacare comes out Now your DME, that's a whole different animal...good luck with those beasts! Seriously though, there is a lot of money to be made if they can give you a lesser machine. Don't let them get away with it, I would fight it out with the doctor and get him/her to specify the machine I wanted.

Remember, its your life, your comfort, and your health! Go here to read up on cflex: http://cflex.respironics.com/

[JamesW6175]

Check out my equipment, have been a CPAPer for about a year and like this machine.

[purple]

If it is not a big money issue for you. Then maybe ask the doc the advisability of doing another sleep study to PROVE you need a Bi Level machine (Bi-Pap is the term Philips Respironics, Resmed calls theirs VPAP).

If I were to buy a machine online, I would prefer to get one from our forum sponsor,

https://www.cpap.com/cpap-machines/bipa ... p#/:::::20:

or for a less expensive, used machine.

http://www.secondwindcpap.com/Used_CPAP.html

Prescription still required for both of them. Might be the doc would be willing to send a generic cpap script to either one of these sites, and the site, (and you can verify they will do this in advance) will supply your chosen Bi machine.

I know I now have a bi machine, and it is a world of difference in ease of breathing.

[hyperlexis]

You do not need to spend thousands and thousands of dollars on a new sleep study to get a machine with exhalation relief. That would be crazy. Most mainstream machines now have exhalation relief. BiPaps are only indicated in specific circumstances and the vast number of users do not need them. Exhalation relief (c-flex, a-flex, etc...) is more than sufficient for most patients. Your sleep study would have detected whether you needed a bipap -- if you did, the MD would have prescribed it.

The F&P Auto is a great, high-quality machine with very good features, would be easy for you to get familiar with, and it has a form of exhalation pressure relief they call 'SensAwake'. When it detects you are awake, it dramatically cuts the pressure to allow you to go to sleep. When you are asleep, it kicks up the pressure to keep your airway sufficiently open. And, because you are sleeping, you don't feel it... When you wake up, the machine detects it, and cuts the pressure until you fall back to sleep. You should ask your DME for a demo.

>>>>>>>>>>>>>>>>>>>>>>>>>>>
Do Fisher & Paykel Healthcare CPAPs have pressure relief?

Yes. Pressure relief has traditionally been provided in the form of expiratory pressure relief - Fisher & Paykel Healthcare offers a different form of pressure relief called SensAwake. Given patients are only intolerant of pressure when they are awake, SensAwake ensures relief is provided during these critical times. When a patient wakes up, SensAwake drives the pressure towards the minimum set pressure for enhanced comfort.

[robysue]

The F&P Auto is a great, high-quality machine with very good features, would be easy for you to get familiar with, and it has a form of exhalation pressure relief they call 'SensAwake'. When it detects you are awake, it dramatically cuts the pressure to allow you to go to sleep. When you are asleep, it kicks up the pressure to keep your airway sufficiently open. And, because you are sleeping, you don't feel it... When you wake up, the machine detects it, and cuts the pressure until you fall back to sleep. You should ask your DME for a demo.

I'm sure the Icon Auto is an excellent machine. And SensAwake is definitely a form of pressure relief, but it works very differently from exhalation relief. And SensAwake is only going to provide relief if you are comfortable breathing at the minimum set pressure without exhalation relief.

But the OP specifically wrote:

Like I said before, I have no problem with the incoming pressure, or problems with my mask (I do love the nasal pillows!) - it's just the exhale pressure is too much.

Since the OP says she has no problems with the pressure on inhalation, but cannot exhale against the full pressure, it makes more sense to have exhalation relief rather than pressure relief when the machine thinks you're awake. In other words, SensAwake may or may not relieve the OP's problems of exhaling against the pressure; whereas a system like Resmed's EPR or PR's Flex will most likely address the specific problem she's complaining about. Moreover, since the OP has no problem handling the pressure on inhalation, using SensAwake may swap one problem ("exhaling against the pressure") for another very different, but equally bothersome problem ("feeling like I can't inhale enough air through the mask when I'm awake") if the minimum pressure is set low enough for her to comfortably exhale.

[jerryez]

I got my Primary Care Physican to write a prescription and had brought in how I wanted it worded. She complied without a problem. I get all my meds from her,so I do not have to see the expensive specialist every year.

[robysue]

I don't mean to take this thread off topic, but the whole idea of using the Icon Auto's SensAwake rather than a traditional exhalation relief system has raised some curiosity in me.

Do Fisher & Paykel Healthcare CPAPs have pressure relief?

Yes. Pressure relief has traditionally been provided in the form of expiratory pressure relief - Fisher & Paykel Healthcare offers a different form of pressure relief called SensAwake. Given patients are only intolerant of pressure when they are awake, SensAwake ensures relief is provided during these critical times. When a patient wakes up, SensAwake drives the pressure towards the minimum set pressure for enhanced comfort.

As I said before, I'm sure the Icon Auto is a good machine. But I'm still curious about how well SensAwake works in real use for large numbers of patients.

1) How low do you set the minimum pressure if a patient has trouble exhaling at anything close to their titrated pressure level? If the min pressure needs to be set 5-6 cm below the therapeutic setting to guarantee the patient has no discomfort while exhaling while awake, will that potentially cause problems of feeling like there's not enough air coming through the mask at the start of the night?

2) How accurate is SensAwake at detecting when a user is awake? If the machine misreads the breathing pattern then one of two things happens:

1. The user wakes up, but there's no relief because the machine did not detect the wake.
2. The user is not really awake, but the machine thinks the user is awake. Hence the machine lowers the pressure (perhaps in the middle of a REM cycle?) at a time when the user may be experiencing a cluster of closely spaced events.

In A, the biggest problem is discomfort; in B there's a good chance that the efficacy of therapy could be compromised.

3) How sensitive is the SensAwake algorithm? Is it going to lower the pressure every time you have a post-event arousal? Or is it really going to wait for several minutes of "wake-type breathing" before lowering the pressure?

Finally I also have to say that I disagree with the F&P claim that "patients are only intolerant of pressure when they are awake". I say this as someone who suffered significant aerophagia problems while using straight CPAP with EPR and APAP with EPR. On CPAP I would wake up in the morning or in the middle of the night with a huge, rock hard distended abdomen on multiple nights a week. Obviously something was happening while I was asleep that triggered the swallowing of air. In retrospect, the pattern seems to have been a positive feedback loop with the beginning of it being a chicken and egg question. In other words, when using CPAP and APAP there was a bad positive feedback loop that looked like this:

==> swallowing air ==> aerophagia pressure ==> mini arousal (not a full wake) ==> swallowing air ==> aerophagia pressure ==> mini arousal ==>

Eventually the "aerophagia pressure" would become great enough to trigger a full wake rather than a mini arousal. If this kind of feedback loop is NOT indicative of "a patient who is intolerant of pressure when they are asleep", then how would you describe it in English?

For what it is worth, the first proposed "fix" for my aerophagia was to max out EPR to minimize the pressure my tummy was subjected to each night. The second proposed "fix" was to reduce the pressure and switch to Auto. The third proposed "fix" was the switch to BiPAP. The fourth proposed "fix" was reducing EPAP and switching to BiPAP Auto. The fourth fix finally worked.

[hyperlexis]

But the OP specifically wrote:

Like I said before, I have no problem with the incoming pressure, or problems with my mask (I do love the nasal pillows!) - it's just the exhale pressure is too much.

Since the OP says she has no problems with the pressure on inhalation, but cannot exhale against the full pressure, it makes more sense to have exhalation relief rather than pressure relief when the machine thinks you're awake. In other words, SensAwake may or may not relieve the OP's problems of exhaling against the pressure; whereas a system like Resmed's EPR or PR's Flex will most likely address the specific problem she's complaining about. Moreover, since the OP has no problem handling the pressure on inhalation, using SensAwake may swap one problem ("exhaling against the pressure") for another very different, but equally bothersome problem ("feeling like I can't inhale enough air through the mask when I'm awake") if the minimum pressure is set low enough for her to comfortably exhale.

Have you ever used SensAwake? I'm sure there are a lot of folks who have, likely quite successfully. I have not, but I wouldn't presume to discard the technology off-hand and presume the OP couldn't deal with the low, fixed start pressure used in that system. Actually, it would be interesting to try out. The OP is complaining about a high fixed start pressure on a cpap unit (Not an auto machine). So that person is getting full pressure, all the time. Sure if you are being hit with 20 cm on cpap, it can be tough (or fun depending how you look at it....), but 4? Like what one would get using a ramp setting? Not nearly as bad even without a-flex. A lot of people at 4 or 5 are gasping for more air, so likely that level would not be too much for the OP. And as far as I know, expiratory relief (c-flex, a-flex, etc.) drops pressure 1-3 cm on exhalation. But it simply cannot go below 4. So if the machine is already down at 4, fixed, expiratory relief does nothing. If you cant take 4 or 5, you have some serious respiratory issues anyway. So if SensAwake works by dropping the pressure down, a lot, possibly to 4, then it should be ok for the OP. No way to know but by trying.

I have a machine with c-flex and a-flex and whatnot but I certainly wouldn't want to impose it on the OP as the be-all-and-end-all of machines. The OP has been using an F&P and is familiar with using it's controls and whatnot. So that alone is a good reason to simply switch to the F&P Icon + Auto.

Honestly, SensAwake sounds like a great idea -- when I have set my 560 to do a 'split night' (Half cpap and half auto) my numbers have been better, and I wake up more rested than with regular old auto + flex. Perhaps the straight cpap pressure keeps my throat open better? And if I'm asleep and cant feel the constant pressure while in cpap, what do I care. It's too bad that PR or ResMed don't offer a similar setting to SensAwake. It may be helpful to some patients.