CPAP Machine and Mask

Tex · Post by **Tex** » Fri Oct 12, 2007 12:55 am

Hi. I am new to this board, but have read many posts for the last couple of days. I have had the two sleep tests done and will get a prescription from the doctor tomorrow. The nurse told me on the phone today that my prescription is for a setting of "pressure at 8". That sounds like a fairly low number to deal with? I am looking at all the cpap machines and masks available and would appreciate any advise on the proper one or maybe the best one to get. My insurance deductable is $2000, so I will be paying for this out of pocket. The mask I used in the study was a Somno Plus nasal with a chin strap (the chin strap was seperate from the mask). The mask was quiet and comfortable, so I will start with that and see if anything is better or if thats the one for me. I did have a sore nose bridge the next day. I think the sleep tech thghtened it down a little too much.

I want a quality, quiet, durable machine to meet my needs. I can pay what I have to, but would like it to be reasonable and competative. The two machines I keep looking at on line are the Resporonics RemStar Pro 2 C-Flex and the new M Series Auto CPAP with A-Flex. I don't want overkill, however I expect I will use this machine for quite a long time, so it makes sense to get a good one. The DME rep I spoke on the phone with today said the straight CPAP was better and provided better therapy in her openion and I should not get a c-flex or a-flex without special needs and prescription requiring them. She also said that a machine that provided data was not necessary, since I would know if I was getting a restful nights sleep. I appreciate your suggestions. I am looking forward to getting something and getting started ASAP. I hope I can get some openions before I meet with the DME tomorrow.

ApNoob · Post by **ApNoob** » Fri Oct 12, 2007 1:10 am

Well, I'm in roughly the same situation as you, I'm new here and trying to decide what to buy out of pocket. My doctor--for what he's worth--suggested the APAP as being the most flexible. It will run in CPAP mode and can be adjusted in more ways if you need to in the future--and since you are paying out of pocket you won't be getting any "free" upgrades or exchanges so you may wish to go with the more flexible model up front rather than having to upgrade to one later.

However, most people here seem to agree that fully data capable is a must. It will not only quantify your AHI, it also shows you things that are hard to guess like your mask leakage rate.

I haven't placed my order yet but I, too, am leaning towards the A-Flex. Although the C-Flex and A-Flex modes reduce the therapy slightly, I'm figuring compliance is vital. Well, that and a heated humidifier...

Hopefully you'll get more experienced posters in time for your visit

bdp522 · Post by **bdp522** » Fri Oct 12, 2007 7:14 am

WELCOME!!
Go for the auto. It can be used as a straight cpap if you do better that way. The data IS important. How does anyone know whats happening with your therapy if they have no data? You might know that you aren't sleeping well, but is it an event or a leak that is causing the problem? The data helps with most of the issues you might have.
If you are going to be paying out of pocket anyway, check the prices on cpap.com, you will most likely save a bundle.

Brenda

Lepeu63 · Post by **Lepeu63** » Fri Oct 12, 2007 7:20 am

Hi to both of you!

Whatever you get make sure it has some kind of exhalation relief! Some folks don't seem to need it but it was the key for my successful toleration of the whole shebang! I went from barely 2 to 3 hours a night to 6.5 the night they turned it on and within a week was at 8.

Best of luck!

bdp522 · Post by **bdp522** » Fri Oct 12, 2007 7:22 am

The c-flex can also be turned off if you find you do better without it. But if you get a machine without it you will never know!

Brenda

DreamStalker · Post by **DreamStalker** » Fri Oct 12, 2007 7:25 am

If you are paying out-of-pocket, forget the DME and buy online (that can also be said even when insurnance is not an issue). Get the AFLEX machine and the software. Finding the mask interface may be your most difficult hurdle.

Tex · Post by **Tex** » Fri Oct 12, 2007 7:51 am

Thanks for the feedback. I only see one A-Flex machine the M series Resperonics. I think that is their newest model out. I see a lot of machines with C-Flex. I'm thinking maybe it is a good idea to meet with the DME rep to see the machines and masks and get another openion and if they can be close to internet prices i'll buy there if not then get it somewhere else. At least give a local company a chance and learn a little. Are all the machines quality wise about the same, so just look for features? Seems that getting unneeded features adds to things that can break. Another thought is to buy the cheapest and smallest first to get familure with all of this and it can be used as a back up or travel unit later, then after a few months when I figure things out I can buy a more top of the line daily use unit? I don't know?

Slinky · Post by **Slinky** » Fri Oct 12, 2007 8:17 am

I understand your way of thinking but in the case of xPAP machines ..... buy the Respironics M Series Auto w/A-Flex ONLINE. Your local DME supplier can't begin to meet the online price at cpap.com.

I think it is a wise idea to shop your local DME supplier, in fact, if you have the option of more than one local DME, shop them all. Get an idea of what they have to offer and their advice and suggestions. Just keep in mind, they have "ulterior" motives. We have NOTHING to gain w/the advice we give you. They do.

Try as many masks as you can at these local DME suppliers. Before you go, read the Mask Fitting thread under the Red Ball w/the Question Mark at the top of this page so you know what a proper fitting by someone who knows what they are doing and has been provided w/the proper facilties consists of.

Then BUY ONLINE. Lots and lots cheaper. Price out the Respironics M Series Auto w/integrated humidifier and the Somno Plus nasal cushion at cpap.com and print out the info and prices and take them w/you when you go local DME shopping. The comments you receive from the local DMEs should be an interesting experience in itself.

Here's the machine and humidifier "we" are recommending to you:

https://www.cpap.com/productpage-advanced.php?PNum=2486

https://www.cpap.com/productpage-bundle ... undle.html

And here is the mask you used during your titration study:

https://www.cpap.com/productpage/somnot ... dgear.html

By the way, the local DME suppliers will most likely tell you that you can't buy an autoPAP w/a CPAP prescription. FALSE. For insurance coding purposes an autoPAP is the same thing as a straight CPAP, exact same insurance code for billing purposes, exact same reimbursement by insurance. A straight CPAP script WILL be good for an autoPAP at cpap.com or other online DME suppliers and "should be" at local DME suppliers except that most won't honor that due to the reimbursement.

The DME rep I spoke on the phone with today said the straight CPAP was better and provided better therapy in her openion and I should not get a c-flex or a-flex without special needs and prescription requiring them. She also said that a machine that provided data was not necessary, since I would know if I was getting a restful nights sleep.

Here is the CPAP that DME rep was trying to con you into:

https://www.cpap.com/productpage-advanced.php?PNum=3

Or this one:

https://www.cpap.com/productpage-advanced.php?PNum=2114

and here is the other one YOU were considering:

https://www.cpap.com/productpage-advanced.php?PNum=2170

Print them out, take them with you, after the local DME Reps make their recommendations and give you some prices whip out the equivalent printout and compare their prices and information w/what is on the printout. You're in for an education.

Don't forget: check out the prices for buying the humidifier and xPAP bundled, cheaper prices yet. Not so, from the local DME's, no discount for buying the integrated humidifier w/the xPAP.

Regarding humidifiers: the heated humidifier can be used as a passover humidifier (no heat) if you so choose, you can adjust the amount of humidity needed or turn it off entirely if you wish. MOST need heated humidity most all the time. If you don't travel much, the Fisher & Paykel HC 150 stand alone heated humidifier is the epitome and a more efficient unit than any of the integrated humidifiers.[/quote]

jaybee72 · Post by **jaybee72** » Fri Oct 12, 2007 8:23 am

If you want to buy the "smallest / cheapest" first to try it out go with a used one on cpapauction.com - at least for the flow generator. When you visit the DME do not sign anything and do not leave with anything - just gather your data. They have already started out by lying to you with the crap about not needing cflex or aflex without special needs and a prescription. That is a total line of BS - the exhalation relief is simply a feature that the cheapest machines don't come with (but should). The line about not needing data since you know you've had a restful nights sleep is ridiculous as well. I've seen it used over and over on here but the analogy is great - a diabetic monitors his treatment by checking his blood sugar levels - why would you not monitor your breathing at night as well?

Anyway, I'm not trying to talk you out of visiting the DME, I just want you to be aware that they've already started lying to you and that is a bad sign. Also - they will probably charge double what you could buy the machine for online. I highly recommend you come back to the forum and post what you find out from them so the forum can help you make the best choices. This forum is great about that - and unlike the DME the members here have no financial gain to make off you.

FWIW - I've had my machine about a month now, and happen to get along with it real well. Like you I was prescribed 8cm, and after a couple of days I was used to it to where I didn't even need ramping to get to sleep. But, thanks to this forum, I have a good machine with full data, the software, and even that exhalation relief your DME says you need a prescription for. If I hadn't found this forum I would have gotten a cheap no-features non data machine from a DME at exactly the same cost to both me and my insurance company!

Good luck!

DreamStalker · Post by **DreamStalker** » Fri Oct 12, 2007 8:32 am

I disagree with the "smallest/cheapest" machine strategy. The flow generator is the most expensive single part of your equipment and you should go for the best ... hence suggestions for AFLEX machine.

In addition, I would recommend you NOT get the Respironics integrated heated humidifier (HH) which is optional for the AFLEX machine and instead get the HC 150 (much much better HH) then you are all set except for mask interface which will be the part of your equipment for which you may well end up having to try many different ones of.

ozij · Post by **ozij** » Fri Oct 12, 2007 8:50 am

I agree with DreamStalker.

This is not a case where "smallest and cheapest" will be good enough for a beginner, on the contrary.

As a beginner, you need the most comfortable therapy you can find - and while it is true that some are less sensitive than others to some of the therapy issues - you won't know till you try. Running a cpap trial under less than optimal conditions is a way of shooting yourself in the foot. The beginnig is when you really need all those top of line features:
Most of us evnentually get used to breathing out against pressure that seemed overwhelming in the beginning - hence the advantage of cflex or aflex.
Some of us need the data monitoring to find out if the pressure Rx is correct - there are surprises, both in the oringinal pressure being too high and being too low - and it's those first week or months of therapy when you need the data tracking.
And some of us discover they do much better when the supplies pressure is variable.

All those are things you won't get with "smallest and cheapest".

So, I would keep the "smallest and cheapest" option for a backup machine - for when you're used to the therapy, have got all the kinks ironed out, and know you can sleep fine with what a small cheap machine gives you.

Good Luck
O.

O.

roncron · Post by **roncron** » Fri Oct 12, 2007 8:57 am

Dear Tex,

I have had a very positive experience with the M series APAP with A-flex. It is a very versatile machine: It can do straight CPAP or auto CPAP, and it can do either with or without C-flex or A-flex.

In your initial post, you said you were concerned that a pressure setting of 8 might not be high enough. That's a good reason to go with an auto CPAP machine (or "APAP" for short). You give it a range of pressures (say, 7-15), and while you are sleeping, it will find the minimum pressure needed to relieve your apnea, which might indeed be 8, or might turn out to be 10 or 11, and will probably change during the night.

A data-capable machine will tell you these kinds of things - it will keep track of and report the pressure the machine applies, the number and duration of apneas, mask leaks, and other useful info. Having the ability to monitor this information is, for many of us, an important part of successful CPAP therapy.

Regarding C-flex and A-flex:

C-flex is Respironics' brand of exhalation relief, a comfort feature, and it definitely makes CPAP therapy more tolerable for many of us.

A-flex is Respironics' latest comfort feature. I'm not exactly sure how to describe it but I'll try: it combines exhalation relief and inhalation relief. It seems to anticipate the phases in my breathing cycle and provide all-around comfort to make CPAP as natural as possible. With A-flex, sometimes I can't tell I'm on CPAP (other than having a mask strapped to my face).

While many here love A-flex, some try it and like C-flex better, or neither of them. That's the beauty of the M series machine - it has all these options so you can find what works best for you.

DreamStalker recommended against getting the M series integrated heated humidifier, and has good reason for this recommendation: there are many reports that it leaks.

However, I have this humidifier, and it hasn't leaked at all for me in 110 consecutive nights of use.

The nice thing about this humidifier is it attaches to the machine and looks like it's part of the machine, rather than being a separate, freestanding unit. This means the whole package takes up less space on your nightstand and is easier for traveling.

Of course, if it leaks, that doesn't do you much good.

So I'd suggest this (if you decide to go with the M series w/ A-flex):

Call CPAP.com and tell them you're interested in the M series w/ A-flex plus integrated humidifier, but that you've read on this forum that many people have problems with leaks. Ask them what they will do if the unit they ship you has a leak problem. Will they replace it at their own expense? Will they give you the option of returning it for a credit toward the purchase of another, such as the HC 150 that DreamStalker recommends?

Good luck!

-Ron

DreamStalker · Post by **DreamStalker** » Fri Oct 12, 2007 9:10 am

Actually, I recommend the HC 150 because 1) it has a bigger reservoir capacity (don't need to refill as often); 2) it has ambient tracking for humidity (it adjusts the heat/humidity according to the room's humidity; 3) easier to clean and fill (although I have only cleaned once or twice during past year with quick rinse) ... plus 4) it has a fully varialbe setting control instead of discrete 1, 2, 3, etc. setting of the integrated models.

I think the leaking Respironics integrated HH issues have been resolved unless you try and buy used from an auction then you may get one of the old leaker versions.

BTW - I have two HC 150's ... I got my second on auction for $35 brand new in unopened box

Wulfman · Post by **Wulfman** » Fri Oct 12, 2007 9:24 am

Tex,

The two machines you have listed are excellent machines. I have the Pro 2 and love it.....it's fully data-capable. You can also use older versions of Encore Pro if they happen to be available or the Encore Viewer program which IS available. The Auto with A-Flex is, of course, their newest Auto with lots of bells and whistles and requires version 1.8 of Encore Pro or the Encore Viewer program.
If your pressure is in fact "8", I'm not sure how many "bells and whistles" you'd really need (as far as an Auto goes).....but I'd definitely get a machine with the "Flex" technology (at least C-Flex as it DOES make breathing a lot easier and seems more natural).....AND, data recording capabilities.
In order to monitor your therapy, you'll want to get the software and reader, so depending on your financial situation, a Pro 2 and the software would only be about $65 more than the Auto with A-Flex WITHOUT the software.

In the beginning, I opted for the Pro 2 and spent the difference on the software.....and have no regrets for doing so. (of course that was 2 1/2 years ago, too)
About a year later, I got an Auto and found out that I really didn't need it as I did much better on straight pressure.
On the other side of this coin, I'd never try to talk anyone out of actually getting an Auto, either......because they are multi-mode machines and CAN be operated in single-pressure (CPAP) mode.

I noticed yesterday that CPAP.COM has "bundled" the card reader and the Encore Viewer program and is the same price as what I paid for my software/reader bundle 2 1/2 years ago.

https://www.cpap.com/productpage-bundle.php?BundleID=64

Good luck.

Den

CPAP Machine and Mask

CPAP Machine and Mask

another vote for M series APAP w/ A-flex