Question regarding Cost of Equipment in Canada

[SleepWrangler]

It's not that there isn't 'sales tax' if you buy from e.g. Cpap.com in the US, but that you don't pay any duty because it's a 'medical device'.

Incorrect. Duty is entirely different and depends on the country of manufacture. Medical devices prescribed by a medical practitioner are exempt from Goods and Services Tax / Harmonized Sales Tax.

For example, I paid no US sales taxes having purchased an APAP in MN and shipped to NY. I paid no Canadian sales tax or duty when importing the unit from NY to ON. I declared the machine as a medical device prescribed by a physician.

[ShelaghDB]

I havent been posting for I thought i finally had the right settings but i am discovering that the SLIGHTEST change in anything throws me right off.

The first 2 nights I finally got through the night without any nose blocking were perfect but I had chosen to sleep in the living room those 2 nights.
I moved back to my bedroom and now I sleep one night perfectly and the next night I don't and its back and forth.
If I have the A/C on too high one night, i rip my mask off after 2 hours of sleep, unknowingly and then sleep another 6 hours or so without it afterwards not aware i have taken it off.

I've read to put tape on my mask but if i can't breathe because my nose is stuffy I don't want to be struggling in my sleep to do so, hence, I am not yet ready to try tape.
I am stubborn and want to be able to master this without having to use a ton of gels, rinses, tapes, etc and just wish to GET IT.

So last night my room was very cold, although very comfy under my duvet but its no good for the CPAP it seems.
I think i have to sleep without the A/C on at all which is great for the CPAP i think but not my preferred way to sleep LOL ( i like the cold )

Im struggling to get up to 13 which is supposed to be my proper pressure ( when I had the ESCAPE the DME set it to 10 and I didn't know so thats what i was using but I tried setting it up to 12 last night and it seemed to high

So when I read your message of trying to do it from 8-20 I can't imagine how that could work BUT i reached a point about 4 weeks ago where I honestly no longer knew what to do as nothing i was trying was working. Seeing as I finally got 2 nights in there in a row when i slept in the living room and slept perfectly both nights.....i am trying to replicate that and if i can, then I will hopefully FINALLY understand what works best for me at least in the way of comfort so I slew with my mask on all night and don't get stuffed up.
But my AHI is very high. I have severe sleep apnea so I DO have to get this damn thing under control and am admittedly very annoyed when I see how some people seem to get it right in a few nights and here i am 3 months in and still struggling daily with it---but no wish to give it up or abandon it......

( I also have vertigo when sleeping on my side which I always did until diagnosed but then Istarted sleeping on my back and then was diagnosed with S. apnea so but right now thats all I can do)

So I am going to try it my way for another night or two and if that does not work, I will give up again and then try your method........8 - 20

Plus it's likely your 'condensation' is caused by a too-high (or any) humidifier setting - try turning it down or even off, as it's only for your convenience, and not therapy.

Thats what I have done. I have turned off both the temperature and its actually a bit cold going into my nose and turned off the humidity and I "think" that is what works. Tonight I have to make sure that the AC is turned off as well and if i make it through the night without clogging up then i KNOW thats the right setting for this time of year....I hope to know better tomorrow and the next day..

I don't know how ANYONE could get through this without a forum of advice to turn to for now in it, I am shocked at the lack of support when given these machines.......by everyone involved.

Full FAQ here: http://www.health.gov.on.ca/en/pro/prog ... 131218.pdf

Thank you SleepWrangler I have asked this question a few times elsewhere and never got the right answer. It definitely helps to be in a Sleep Apnea forum that has other Canadians in it

One last question though IF you know the answer....Any idea WHAT determines a doctor prescribing the AUTO SET to you rather than the ESCAPE?

I was told by an American that if you have Severe Sleep Apnea as I do and ones pressure is written at above 10 on the prescription this will get you one?
I have since purchased my own here in Toronto, on Kijiji May 28. I got a brand new one in the case with a heated hose, and a brand new Swift FX Nasal Wisp mask for $650 and I sold my Escape machine to someone else for $200 ( you can't get any more for the Escape even though it was brand new LOL )

So when it came time to get my machine he refused and would only give me the ESCAPE. I mentioned that i had heard above 10 I was to get an Auto Set and i have no idea what he said to me about that but on my prescription he wrote in big letters ESCAPE but if I wanted an AUTO SET I WAS to pay 100% for it myself....LOL
I am curious for the next time i need a machine in 5 years or so time what one must do to get the AutoSet.....what determines an AutoSet for one person and an Escape for the others?

It's not that there isn't 'sales tax' if you buy from e.g. Cpap.com in the US, but that you don't pay any duty because it's a 'medical device'.

As stated I got mine 6 weeks ago for $650 everything and the mask and the fellow selling them now, works in a hospital and is now buying shipments of them with plenty to sell if anyone else here needs one. I can always dig up his phone number if needed. I picked it up at his condo at Square One in Mississauga.

For a third study, one would need to convince the physician there are residual problems to be addressed, or go back to your GP and convince them to make a new referral.

I had a terrible doctor and a terrible DME and the doctor even told me that the first sleep test was a failed test and I gather that the second test was questionable.
I just hope i am not struggling unnecessarily due to a failed test which has my numbers all wrong.
The second test was the one they gauged it from but they only had FF masks and I can't use those so i had nothing but leaks all night and every 45 mins the person had to come in the room to change masks. She must have put me on 15 different ones that night to test out and none of then worked. She was taping them down so tight I had a splitting headache and was unable to sleep and finally came in and told me that I HAD to fall asleep at least another 45 min to pass the test as they did not have enough time.........but who the hell could sleep with her coming in all the time? Then she put me on my side for that 45 but I don't think i fell asleep but just lay there and then finally i got so angry I just stood up and said I had had enough and damn it if they didn't get enough so i really can't see how they could have got the correct numbers from that night.
I will wait until a year is up and I am going to push for another one at a far better place that i research ahead of time, next time.
They were an absolute disaster with both my husband and myself.



SORRY FOR THE LONG post of answers but thank you very much for clearing up info I havent been able to find out about until your answers.

Off to bed soon and really hoping i will sleep through the night tonight....just waiting to get 2 more consecutive nights that work, without any changes so I can then start going up one pressure point number at a time and t hen if that works once i get to 13, then slowly switching off the CPAP and going to AutoSet and finally getting somewhere

[ShelaghDB]

After answering the above answers, and I thank you all again for your help, I am curious about one more thing.........

I live in Toronto, therefore its summertime and its hot out. Do other Canadians, living in a climate such as mine, feel the need to use the Climate Controlled tube that i have or should I just be using the regular white cheaper hose???

I don't want to be creating a problem using that hose in the summer if it does work against me?


TIA

[Ontario CPAP]

I live in Toronto, therefore its summertime and its hot out. Do other Canadians, living in a climate such as mine, feel the need to use the Climate Controlled tube that i have or should I just be using the regular white cheaper hose???

I don't want to be creating a problem using that hose in the summer if it does work against me?

I'm assuming you use a humidifier on your CPAP. If so, whether-or-not to use a heated hose depends on the humidity and temperature you maintain in your bedroom. If you have a cold, dry room you will probably require a heated hose. A warm, humid room does not. The purpose of the heating in the hose is to keep the temperature of the airflow above the dew point of the humidified air being pushed through the hose. The higher the humidity of the airflow, the higher the dew point, and thus the higher the heating in the tube required to avoid condensation in the tube.

Specific to the Toronto climate (where I am as well) if you don't use air conditioning, you probably won't need a heated hose in the summer time (the dew point in your room will be higher than that of the CPAP humidifier -- in fact you may not need the humidifier at all), but you probably will need hose heat in the winter (dew point in the room is below that of the CPAP.) If you have AC, you may need it in the summer as well especially if you have the AC cranked (i.e., below 23C.)

I keep my AC setpoint at 25C in the summer and my furnace setpoint at 20C in the winter, and use a heated hose year-round.

[SleepWrangler]

One last question though IF you know the answer....Any idea WHAT determines a doctor prescribing the AUTO SET to you rather than the ESCAPE?

The following text describes eligibility for APAP vs CPAP.

Escape (CPAP Brick) vs Elite (CPAP with Advanced Data Collection) is completely at your discretion. Just have to make it clear to the vendor that a brick will not be accepted.

From Respiratory Equipment Policy and Administration Manual, September 2012: http://www.health.gov.on.ca/en/pro/prog ... manual.pdf

335 Medical Eligibility Criteria for Positive Airway Pressure Systems (CPAP/APAP/BPAP)

The ADP provides Funding for positive airway pressure systems for individuals with a diagnosis of obstructive sleep apnea syndrome (OSAS) and the presence of significant symptoms or medical risks without treatment, and the absence of symptoms or risks with treatment.

The ADP has additional Medical Eligibility Criteria for APAP (see 335.01) and BPAP systems (see 335.02).

335.01 Auto-Titrating Positive Airway Pressure Systems (APAP)

Individuals requiring APAP systems must meet the Medical Eligibility Criteria for a positive airway pressures system (see 335) and the Medical Eligibility Criteria outlined below. The individual must have polysomnographically documented OSAS where there is a change in pressure of a minimum of 4 cmH2O on a prescribed fixed CPAP level of 10 cmH2O or more; and the change must occur between REM vs. NREM sleep or supine vs. sleeping on their side.

[library lady]

ShelaghDB, You mentioned that you are a mouth breather and use a nasal mask. You also mentioned that you were told a FF mask would be better for you. Did they tell you WHY? The why is that if you are mouth breather using a nasal mask, you will be losing therapy air that is intended to help your airway get the air into your lungs. Many people who use nasal masks or pillows also have a FF mask for when they have colds and their noses are stuffed up and they need to breathe with their mouths. If your nose is stuffy with a nasal mask, then you won't get the benefits of cpap - hence the need to use a FF mask so that it will allow you to get the benefits of cpap by breathing with your mouth - the mask has to cover your mouth in order for that to happen.

[ShelaghDB]

I'm assuming you use a humidifier on your CPAP. If so, whether-or-not to use a heated hose depends on the humidity and temperature you maintain in your bedroom. If you have a cold, dry room you will probably require a heated hose. A warm, humid room does not. The purpose of the heating in the hose is to keep the temperature of the airflow above the dew point of the humidified air being pushed through the hose. The higher the humidity of the airflow, the higher the dew point, and thus the higher the heating in the tube required to avoid condensation in the tube.

Specific to the Toronto climate (where I am as well) if you don't use air conditioning, you probably won't need a heated hose in the summer time (the dew point in your room will be higher than that of the CPAP humidifier -- in fact you may not need the humidifier at all), but you probably will need hose heat in the winter (dew point in the room is below that of the CPAP.) If you have AC, you may need it in the summer as well especially if you have the AC cranked (i.e., below 23C.)

I keep my AC setpoint at 25C in the summer and my furnace setpoint at 20C in the winter, and use a heated hose year-round.

Thanks for this. I am now taking off the heated hose and just putting the white one back on.
I have been struggling with CPAP since I started May 28th but with the summer weather thats when I found myself getting stuffed up etc.
Long story short its taken me until now to figure out that I CANNOT use this machine and sleep well as i get a stuffed up nose the minute i turn on the AC in my bedroom so I have to unfortunately sleep in a warmer room than I like but its the only way I can get through the night with out taking off my mask.

Im one of the few who have discovered high humidity stuffs me up so i have turned off my climate control and am not using the Humidifier on my S9 Autoset so with your post i will now remove the heated hose as it is definitely not needed then.

Thank you for that info.
I am amazed at how long it took me to figure this out since everyone suggests higher humidity but I apparently am the opposite....
NOW I can FINALLY sleep through the night!

ndividuals requiring APAP systems must meet the Medical Eligibility Criteria for a positive airway pressures system (see 335) and the Medical Eligibility Criteria outlined below. The individual must have polysomnographically documented OSAS where there is a change in pressure of a minimum of 4 cmH2O on a prescribed fixed CPAP level of 10 cmH2O or more; and the change must occur between REM vs. NREM sleep or supine vs. sleeping on their side.

Thank you for that. Now i just need to figure out IF i fall within that or not but armed with this information you kindly dug up for me, to which i am very grateful, I shall figure it out and know for future.

ShelaghDB, You mentioned that you are a mouth breather and use a nasal mask. You also mentioned that you were told a FF mask would be better for you. Did they tell you WHY? The why is that if you are mouth breather using a nasal mask, you will be losing therapy air that is intended to help your airway get the air into your lungs. Many people who use nasal masks or pillows also have a FF mask for when they have colds and their noses are stuffed up and they need to breathe with their mouths. If your nose is stuffy with a nasal mask, then you won't get the benefits of cpap - hence the need to use a FF mask so that it will allow you to get the benefits of cpap by breathing with your mouth - the mask has to cover your mouth in order for that to happen.

Yes I have always been a mouth breather which was why I first got a FF mask but since i opened my mouth and it became awfully dry and i was breathing out of my mouth, my therapy was not working.

For Some reason I cannot explain yet, with the nasal mask I KEEP my mouth closed.

I have since discovered that if I use humidity on my S9, rather than turn it right off, or turn on my AC in my bedroom, 90 minutes into my sleep I become so clogged in my nose that in my sleep i take off my mask and sleep the rest of the night without it.
As long as I have the AC off and the humidity turned off, I sleep through the night without getting clogged up, or opening my mouth and the therapy seems to be working.

With a nasal mask IF i open my mouth while air is being pushed up my nose, the sensation is just to weird it would wake me up immediately or at the very least cause me to take off my mask so I could breathe properly and with comfort.

I now believe I might have been becoming stuffed up long before a diagnosis of Sleep Apnea as given, which was why I was opening my mouth to breathe as I have always slept with the AC on in my room.

[BlackSpinner]

After answering the above answers, and I thank you all again for your help, I am curious about one more thing.........

I live in Toronto, therefore its summertime and its hot out. Do other Canadians, living in a climate such as mine, feel the need to use the Climate Controlled tube that i have or should I just be using the regular white cheaper hose???

I don't want to be creating a problem using that hose in the summer if it does work against me?


TIA

You can get rainout (due to condensation) depending on the room temp and humidity. The climate hose prevents that, which means you can sleep comfortably under the air conditioner. If you don't get one then you need a hose cozy to prevent the cold air from touching the hose. The climate hose handles all contingencies. I use mine in Edmonton all year around.

[BlackSpinner]

L

ong story short its taken me until now to figure out that I CANNOT use this machine and sleep well as i get a stuffed up nose the minute i turn on the AC in my bedroom so I have to unfortunately sleep in a warmer room than I like but its the only way I can get through the night with out taking off my mask.

Maybe it is time to focus on your air conditioner. When was it last completely cleaned? Is the filter new? Is there mould in it? It makes sense to focus on the actual object causing the problem rather then the cpap machine.

[Hose_Head]

L

ong story short its taken me until now to figure out that I CANNOT use this machine and sleep well as i get a stuffed up nose the minute i turn on the AC in my bedroom so I have to unfortunately sleep in a warmer room than I like but its the only way I can get through the night with out taking off my mask.

Maybe it is time to focus on your air conditioner. When was it last completely cleaned? Is the filter new? Is there mould in it? It makes sense to focus on the actual object causing the problem rather then the cpap machine.

Along the same line of reasoning, when have you last changed the filters in your apap? I've found that when I haven't changed mine in a while, my nose gets a little irritated. Filters do need to be changed periodically. How frequently depends on the user: some will say "weekly", others will quote much longer periods. For me, about once per month works.