Advice on getting new machine

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
AntisoporificRph
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Advice on getting new machine

Post by AntisoporificRph » Fri Dec 11, 2020 11:23 pm

Hi, I probably will start a new thread once I buy a machine with data recording capability, so I will try to keep this first post as concise as possible. I am a 42 y/o, 185 lbs male (5’ 8”). I was diagnosed with moderate sleep apnea (AHI 16) in June 2019 and suckered into an Airsense 10 CPAP machine by my DME company. Back then I did not know I could have gotten a better machine (APAP) from them. The first couple of months with CPAP were truly horrendous, I was waking up a minimum of 20 times a night with a full-face mask (I am a mouth breather) with AHI 7-10. The DME company was useless and did not seem to care much after the first month and tried to dissuade me from trying out a nasal pillow. However, I have this blog to thank for helping me stick through the problem and figure out solutions. I went on-line and bought a nasal pillow and a chin strap, and for the first time my AHI’s dropped below 5. After 1-2 weeks of use, I started seen AHI’s < 1! All was good for a while, but I kept breathing through my mouth so at times my leak statistics were unacceptably high. So, I started using Somnifix Mouth Strips and that seemed to fix the issue once and for all, or so I thought…

Essentially, I go through periods of particularly good sleep quality lasting many weeks, and then suffer through periods of poor sleep quality characterized by frequent awakenings throughout the night (10 or more awakenings). During the latter, I tend to have 4-5 dreams per night, which I recall well because I usually wake up right after dreaming. As first there was a clear correlation between stress and poor sleep, so that as my stress levels once again decreased, I usually enjoyed good sleep, but lately I have been at a loss as to why I continue to wake up throughout the night. Just some background information:
- I am a very anxious person.
- I work overnights, 10-hour shifts, and I work seven consecutive days on and 7 consecutive days off, and the job is stressful.
- On my 7 days of I stay in overnight mode, but I tend to keep an irregular schedule (I wake up later and stay up later). This has never been an issue when I am not stressed.
- I drink lots (I mean lots) of caffeine. On my good sleep periods, I can drink caffeine a couple of hours before bed and still sleep soundly. Again, if I am not stressed.
- I have chronic gastric reflux. I take omeprazole 20 mg daily. It is usually under control (asymptomatic) unless I am stressed.
- I was 198 lbs when diagnosed. I am now 185 lbs and exercise 5 times a week. I consider myself to be in good shape now.

I know some of the above points sounds like glaring issues, but I can guarantee you that caffeine and irregular sleep hours never were an issue for me in the past, and that stress has been the sole driver of sleep quality. The problem is that my current frequent awakenings, which started 1.5 months ago, do not seem to correlate with stress (I do not feel stressed out now). As an experiment, I have been going to sleep at more regular hours and having less caffeine (at least 10 hours from bedtime). Yet, I am sstill having 10 plus awakenings a night.

So, I have no choice but to obtain a new machine capable of recording data. I want to have a detail report of what is going on, because up to this point everything I have done is guesswork. I have had my CPAP machine for less than 2 years so there goes any possibility of having the insurance company pay for a new one. Additionally, I have a high deductible plan ($1000), the DME company are thieves, and the doctor I went to for my diagnosis is not easily accessible now to obtain my original Rx (long story). So, my plan was the following:
- Go to CpapRx.com and pay $99 for a new prescription (available for people on CPAP already).
- Use this prescription to buy a new machine online for CpapRx.com or TheCpapshop.com

I am not rich, but I do have the means to buy a new machine, so money is not a big concern. My concern is quality and safety.
- Does anyone have experience obtaining a new prescription online?
- Does anyone have experience purchasing PAP machines online from these retailers?
- What is the likelihood they would lie to me and send me a used machine instead of a new one as advertised?
- I was thinking of getting the Airsense 10 Autoset. Can anyone think off a reason why I should not or a reason to buy something else (I am not too familiar with other modes, ie. Bipap)?

Thanks again for sticking through this long read!

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Pugsy
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Re: Advice on getting new machine

Post by Pugsy » Sat Dec 12, 2020 9:09 am

AntisoporificRph wrote:
Fri Dec 11, 2020 11:23 pm
Does anyone have experience purchasing PAP machines online from these retailers?
What is the likelihood they would lie to me and send me a used machine instead of a new one as advertised?
Sorry but zero experience with the retailers you mention but with any retailer there is a way to easily verify run hours to see if the machine is new or used. Just check the run hours....not therapy hours but run hours. Therapy hours can be reset to zero but run hours cannot be reset.

Unless you are using pressures in the mid to high teens there is no reason to go to the added expense of the bilevel models unless you happen upon a screaming hot deal for a good bilevel machine. Won't hurt you to get one but the main benefit for the bilevel machines in your situation would be more exhale relief in the form of greater PS (difference between inhale and exhale is called pressure support) so you may not need it. That said...I use the ResMed AirCurve 10 VAuto (bilevel machine) because even though I don't need higher pressures all that often I do like the fact I can have more PS available. So it's just a personal preference of mine. So I do it with relatively low pressures because I like it and I got a screaming hot deal on a bilevel machine that ended up costing me less than what a new AutoSet would cost me.

I have never used one of those "we will give you a RX" companies so I can't comment on that aspect.

Check out secondwindcpap.com before you buy or do anything. Call up the owner and explain your situation and they might let you bypass the RX requirement in your situation. They sell gently used machines and even have new zero hour open box deals if you prefer brand new. They are trustworthy.....I trust them.

If you end up going with one of the 2 suppliers you mentioned because of the RX thing.....do look at the AirSense 10 AutoSet for Her model instead of the regular model. It has 3 modes of operation as opposed to the 2 modes that the regular AutoSet has available and while I don't know if that additional mode would benefit you or not...it might and I always say it's better to have something and not need it than need it and not have it.

You can read about it here in the manual.....plus it explains how to check the run hours on a machine
https://www.respshop.com/manuals/ResMed ... %20her.pdf
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

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Miss Emerita
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Re: Advice on getting new machine

Post by Miss Emerita » Sat Dec 12, 2020 12:19 pm

It's hard to know which extra feature you might be more likely to need: pressure support over 3, or the For Her algorithm.

But I wanted to press on the question what may have changed around 1.5 months ago. New meds? Discontinuation of old meds? Allergy-like flare-ups? Different bedding? Different noise or light conditions while you sleep? Changes in diet? Timing of exposure to sunlight?

One frustrating thing about sleep is that it can change for reasons we can't track down. It's especially frustrating to solve all of your breathing disorders and still have lousy sleep.

You might look into Cognitive Behavioral Therapy for Insomnia (CBTi). Some good information here:

https://stanfordhealthcare.org/medical- ... omnia.html
ResMed Aircurve VAuto
Bleep mask

Oscar software is available at https://www.sleepfiles.com/OSCAR/

larryn
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Re: Advice on getting new machine

Post by larryn » Sat Dec 12, 2020 1:03 pm

I got my air sense 10 auto set from a forum member, (lsat).Fair price,quick shipping,with only 28 hr.s run time.I am very satisfied. I t now has 600 hrs. no problems. He is located in So. Wisconsin.

AntisoporificRph
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Re: Advice on getting new machine

Post by AntisoporificRph » Sun Dec 13, 2020 1:03 am

@Pugsy:

Honestly, I told myself I would not go with a used cpap company (paranoid about covid 19, etc). But secondwindcpap.com keeps coming up as a recommendation from various sources (including other forums). I may still want to go with a new machine if I buy from them however. Additionally, I do like the pressure support feauture. I had EPR mode on (set on max of 3 mm Hg) for at least 6 months before this ordeal started. I switched it off for 4-5 days as a trial but I kept waking up feeling out of breath at times (or startled). I turned it on again yesterday night, and though I woke up several times in the night (seemed to make little difference), the awakenings were mostly peaceful and without that weird shortness of breath feeling. I dont know if it could be due to less Central Apneas with EPR? That is why I need a data capable machine.

@Miss Emerita:

There are two things that changed around 1.5 months ago:
1) I finally stopped using a pillow (head pillow not nasal :) ) which eliminated my life long chronic neck pain. For a while I was using a towel to provide neck support, which used to hyperextend my neck backwards a bit and still cause some discomfort, but I wonder whether it also helped keep my airway open? I ordered two cervical collars that should be arriving in 1-2 days. Hopefulyy that answers that question.
2) On my 7 days off I would usually exercise and play videogames (as in 12 plus hours of videogames per day). Videogames would help me disconnect from reality and forget about work. I love videogames. The worst that would happens is that I would have a dream or two about the videogame I was playing. But 1.5 months ago I sort of stopped and instead started reviewing calculus (for fun - watching online videos and working out problems), reviewing organic chemistry (I love it, but now work on a different field, so I wanted to reconnect with the subject), listening to science/history podcasts, trying to learn a new language, etc. Essentially I became very intellectually engaged. I cannot accept that something so enjoyable now could be causing me anxiety at a subconscious level? Could it???? Could it???????? :shock:

EDIT: To be honest though, I sometimes do dream about the stuf I read right before bed (i.e. math problems) and have had (bad) dreams about my days in graduate school. Do you guys usually do something speciffic to wind down before going to be (i.e. mediation, yoga, breathing exercises)? I personally do not, but maybe I should?

@Larryn:

I appreciate the info, but as I said, I am paranoid and would prefer to go through a retailer instead.

Thanks!!!

AntisoporificRph
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Re: Advice on getting new machine

Post by AntisoporificRph » Tue Dec 15, 2020 2:03 am

So I contacted secondwind.cpap and it looks like my sleep study documents will indeed suffice in order to obtain a new machine. I plan on getting the Resmed Airsense 10 Autoset For Her (I should have it by next week after I submit my documents Thursday) . My current setting are 11 mm Hg with EPR on on my Airsense 10 CPAP. Do you guys have any initial recommenddations for initial settings on the Resmed Airsense 10 Autoset For Her. I want to allow the machine to titrate my pressures. Thanks!

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Pugsy
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Re: Advice on getting new machine

Post by Pugsy » Tue Dec 15, 2020 8:23 am

If you want to try auto mode with your new machine we pretty much are starting from ground zero since all we know is you have been using fixed cpap at 11 cm without data to tell us what to start with.

If it were me I would start with 8 or 9 minimum pressure....EPR 3 since you like how it feels and max pressure set to 20 and see where it wants to go and what the software reports show.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

AntisoporificRph
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Re: Advice on getting new machine

Post by AntisoporificRph » Tue Dec 15, 2020 9:53 am

Thanks for the recommendation Pugsy, I will make a new post once I have the machine and some sleep data to go along with it.

JDS74
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Re: Advice on getting new machine

Post by JDS74 » Wed Dec 16, 2020 7:43 pm

The only suggestion I have is that to try not dong the intellectual stuff in the 2-4 hours before going to bed.
Then, if (when) you wake up during the night and can't go right back to sleep (10 minutes or so) , get up, go to a different room and read something that is mildly boring or listen to "elevator" music until you feel sleepy (not tired but sleepy).
Then back to bed.
Repeat as necessary.

Having a full data machine will do wonders for figuring out what your needed pressures really are, setting it in Auto mode will allow the machine to track what is needed, and OSCAR will allow you access to your data, something your present machine doesn't provide.\
Best Wishes
Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
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Miss Emerita
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Re: Advice on getting new machine

Post by Miss Emerita » Thu Dec 17, 2020 12:52 pm

It's great that you're studying and solving problems instead of gaming! But I agree with JDS74 -- taper off during the period before bed time. Try reading some fiction or history you might enjoy, especially a book made of paper rather than a book on a screen, or listen to some music that isn't frenetic. Close to bedtime, a regular routine can be very helpful. Meditation, yoga, or a warm bath all work for some people. For me, just the routine of cleaning my teeth and getting my PAP stuff set up seems to help get me ready for sleep. I think "regular" and "routine" are the key words here. Try to do whatever it is every night, at pretty much the same time.
ResMed Aircurve VAuto
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Oscar software is available at https://www.sleepfiles.com/OSCAR/

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lordvader
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Re: Advice on getting new machine

Post by lordvader » Fri Dec 18, 2020 12:11 am

AntisoporificRph wrote:
Tue Dec 15, 2020 2:03 am
So I contacted secondwind.cpap and it looks like my sleep study documents will indeed suffice in order to obtain a new machine. I plan on getting the Resmed Airsense 10 Autoset For Her (I should have it by next week after I submit my documents Thursday) . My current setting are 11 mm Hg with EPR on on my Airsense 10 CPAP. Do you guys have any initial recommenddations for initial settings on the Resmed Airsense 10 Autoset For Her. I want to allow the machine to titrate my pressures. Thanks!
I have a Phillips Respironics Dream Station AUTO with Humidifier and heated hose that I have turned on 1 time. It's a brand new machine and I've never slept with it. I have 3 new heated hose, 3 new water chambers, 18 disposable ultra fine filters and 3 reusable pollen filters. I've thought about keeping it until my other 2 die but my new insurance coverage is great so I will get a new one in 2021. I'm thinking about selling it. What's a fair deal on it?
Machine: ResMed AirSense 11 Autoset
Mask: Fisher & Paykel Zest Q

AntisoporificRph
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Re: Advice on getting new machine

Post by AntisoporificRph » Fri Dec 18, 2020 2:53 am

@lordvader:

Sorry, I already ordered from secondwindcpap and paid for rush delivery so hopefully I will have the machine by Saturday.

@Miss Emerita: Yeah, I am going to incorporate meditation of some sort to my pre-sleep routine, because right now I am all over the place.

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Miss Emerita
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Re: Advice on getting new machine

Post by Miss Emerita » Fri Dec 18, 2020 11:19 am

Glad to hear the new machine is coming soon, along with a cervical collar. Come back to this thread if you'd like some help reviewing your Oscar data.
ResMed Aircurve VAuto
Bleep mask

Oscar software is available at https://www.sleepfiles.com/OSCAR/

AntisoporificRph
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Joined: Fri Dec 11, 2020 10:01 pm

Re: Advice on getting new machine

Post by AntisoporificRph » Mon Dec 21, 2020 3:36 am

Well, after my first night using my new PAP machine (Resmed Airsense 10 Autoset for Her), despite having multiple arousals, I think my sleep was better overall. I will be posting my data as soon as I am off (still have 2 overnights to go at work). Two things already caught my attention however:

1. My settings were 8-14 mm Hg, EPR 3. After my first night of use I looked up at my stats using the machine interface, and it listed AHI = 0.9, Total AI = 0.9, Central Apnea = 0.9. It also listed the (titrated) pressure as 8.6 mm Hg (in contrast to my fixed prescribed pressure of 11 mm Hg). I thought that was a considerable difference in pressure.

2. I have had the same Airfit P10 nasal pillow for 1.5 years . I would clean it daily with lintless CPAP wipes (https://www.amazon.com/stores/page/90E2 ... 6FD275ED94); and every 2-4 weeks with lukewarm water and dish soap. However, it wasn’t until yesterday that I decided to finally use my (new) spare P10 pillow. The amount of exhaust coming out of the new P10 was significantly more powerful and noticeable than in my old one. In fact, I re-tested my old one and to my horror, the exhaust draft was insignificant in comparison (and had been for a while, I just got used to not hearing the usually loud hissing sound). I started reading about clogged exhaust ports in P10 masks in this and other cpap forums and came across multiple reports. While the main cause is obvious (my stupidity), it may lend an explanation as to why I started experiencing multiple awakenings (15-20 plus a night) for the last 2 months. The issue had gotten worse over the last 3 weeks (temperatures have been low around here), which coincided with incidents of bad rainout in my hose (copious amounts despite taking precautions such as using fleece hose covers, etc). I am thinking the extra fluid may have increased the clogging. That would explain why, at times I kept feeling out of breath and had to take my mask off to breathe in fresh air (I tape my mouth). Something just felt off.

Again, I am sure the issue is multifactorial and that the Resmed Airsense 10 Autoset for Her will improve my sleep (hopefully) thanks to its many many features and data collecting capability, but I think I have to be more cognizant of other more obvious issues, like proper mask care.

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Pugsy
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Re: Advice on getting new machine

Post by Pugsy » Mon Dec 21, 2020 9:03 am

The pressure shown on the LCD screen in auto adjusting mode is what we call a 95% pressure. It is just a number...not an average or anything like that. It means you were at OR BELOW that number for 95% of the night. You will see what I mean once you see the software reports.
The fact that your prescribed pressure on fixed cpap was 11 cm doesn't surprise me. They often prescribe a fixed pressure high enough to cover all worse case scenarios so people end up using a much higher pressure all night just to cover random times where we might need more pressure like supine sleeping or REM stage sleep.
You might see on those software reports where you hit 11 cm briefly. 95% of the time you were at or below 8.6...it doesn't show you where it went to that other 5 % on the machine. The software will show you.

And yes...you may have figured out that part of your problem was the clogged vent holes in your P10 mask.
I never had that happen when I used it but then my routine for cleaning was a bit different...I used water as hot as I could stand it for one thing and I also used an old toothbrush to scrub the vent holes and for rinsing lots and lots of hot water....and did it about once a month.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.