Newbie questions

rocketdork · Post by **rocketdork** » Wed Jul 30, 2008 9:11 pm

Hi all.

New to the whole world of CPAP machines, but I have found a great deal of useful information on this forum and a couple other sites.

I'm at the point of having to choose a CPAP machine for the first time and have compiled a list of things that I think are important. Having no experience with these things, I would be very interested in feedback on what you experienced folks think.

Pressure relief on exhale (c-flex or equiv)
leak compensation
12 volt operation (I motor home a lot)
auto altitude adjustment
COST

My insurance is weird and I don't know yet if I have to pay or if they are going to cover all or some of the cost...therefore cost is important, but not the end of the discussion. I would much rather purchase something of quality once, than something that isn't quality twice.

I've looked at CPAP.com and found some interesting items...I'm considering a Resperonics unit with C-flex or a ResMed S8. The primary consideration of these two units is due to the release of pressure during exhale.

During my sleep test, they put the mask on me (it leaked and wasn't very comfortable) and I didn't seem to notice that I had problems exhaling, however, I did find that I opened my mouth on a number of occasions...I attributed this to fighting to exhale...I could be totally off base.

12 volt operation would be a nice to have, but not a firm requirement, I can easily buy an inverter for the motor home use. However I would like to avoid having to buy a pure sine wave inverter and just be able to go with a modified sine wave...

Leak compensation just seems smart.

Altitude compensation seems a convenience for me...although I do travel a fair bit to higher altitudes...how critical is it to adjust?

bdp522 · Post by **bdp522** » Thu Jul 31, 2008 6:43 am

The single most important thing for a machine(at least for me) is Data capabilities. I want all the data. That means you also need a card reader and software. Most of us have found the need to take charge of our treatment and this is how we do it.
The next most important is a machine that auto titrates. An Auto machine will get set to a range of pressures and operate at the optimal pressure for you within that range. It can also be used as a regular cpap machine, using one steady pressure. I use mine in cpap mode most of the time, but I switch to apap occasionally to be sure my settings don't need tweaking.
I do have c-flex and like it very much. The a-flex is supposed to be much more natural feeling.
Leak compensation...I think all the machines have it. BUT, it won't compensate for large leaks. Leaks will ruin the treatment so you have to work at keeping leaks down.
For 12volt operation, there are a couple of battery operated machines. I have the AEIOmed everest2 and love it. But here is a link to battery operation with cpap;

viewtopic.php?t=9682

I can't help with altitude adjustment. I think most of the machines do it automatically, but I'm not sure.
AAHHH cost. Most insurances have certain DMEs that they work with. They have set prices already contracted for the equipment. They usually try to give you the lowest priced machine. Be prepared to demand what you want if need be. If you decide to purchase out of pocket, our host- cpap.com is a great place. They will price match if you find it cheaper somewhere else. Do give them a call to be sure you are getting the best price on a machine.
If you still mouth breathe, or leak with c-flex you'll need a full face mask or you'll have to tape(use polident, etc) to seal the mouth shut. Losing all the pressure out of the mouth is not good.

Hope some of this helped

Brenda

deglorious · Post by **deglorious** » Thu Jul 31, 2008 7:07 am

Since you travel frequently, I would recommend the S8 Elite. It is compact and it is data capable. It has the expiratory relief you are seeking.

I have the S8 Elite and recently purchased a used S8 Escape to use as a travel machine. It is light and also the humidifier is integrated. Overall, I think it is about 12 inches by about 6 inches including the humidifier. It fits well in a small space.

Especially if you travel alot, size would be an important consideration. I would also recommend a full face mask if you mouth breathe. The machine will show on the LCD screen if you have a large leak. It does have a leak alert alarm accessible from the clinicians menu although I've never used it.

I can't remember about the altitude adjustment but I know it either does it automatically or is easy to change. I think its automatic.

Good luck,
Deglorious

Slinky · Post by **Slinky** » Thu Jul 31, 2008 7:37 am

You want MORE than JUST a Resmed S8. Resmed's S8 Compact and S8 Escape are NOT fully data capable. You would want at least the Resmed S8 Elite w/EPR. Or better yet, the Resmed S8 II Elite w/EPR. The S8 IIs are the newest "series" of Resmed devices.

You should take a good look at the product information for each device at cpap.com. Battey operation was never a consideration for me so I've never paid that much attention - but - I "think" the Resmed's require something extra, maybe that sine converter you mentioned, than the Respironics do and in that case you may be happier w/the Respironics. But again be careful. You would want at least the Respironics M Series Pro w/C-Flex. You do NOT want ANY Respironics w/Plus in its name. The Plus is NOT fully data capable.

The Resmeds have the other manufacturers beat w/the ease of access to data via the LCD screen. But if you also intend to get the software and cable reader that's not a problem.

rested gal · Post by **rested gal** » Thu Jul 31, 2008 8:30 am

Welcome to the board, rocket. You've definitely been doing your research.

I feel the same way Brenda does -- full data capability is the single most important "feature" I'd want on the machine. I'd want a machine that had software so I could see detailed data.

Pressure relief for exhaling would be important to me, too. I can exhale fine against the straight pressure I use, but it is much more pleasant to have less coming at me when I exhale.

The Respironics REMstar Auto with A-flex (uses Encore Viewer software) would be my choice. It has both C-flex and A-flex built in. A person can use one or the other (not both at the same time.) Also, both can be turned off.

As Brenda said, an autopap can be used as straight cpap if preferred. A very versatile machine.

Another autopap that I like very much is the Puritan Bennett 420E. It uses Silverlining software...also readily available. Its software doesn't require a card reader. Uses a simple download cable. That machine doesn't have an exhalation pressure relief feature, but if you had no feeling of difficulty exhaling during your sleep study titration, you probably don't really need that kind of feature.

rocketdork wrote:I didn't seem to notice that I had problems exhaling, however, I did find that I opened my mouth on a number of occasions...I attributed this to fighting to exhale..

Possibly, but it's just as likely that you (like so many of us) are apt to have cpap air detour into the mouth and escape as a mouth leak during the full relaxation of sleep. If that's the case, exhalation pressure relief in any machine can't prevent that. There are other ways to deal with that problem (if it is an ongoing problem later) but that's a whole other subject.

Good luck, rocket! You've come to the right place.

DreamStalker · Post by **DreamStalker** » Thu Jul 31, 2008 8:37 am

The AFLEX machine mentioned above offers more options than any of the other APAP machines.

I have tried several machines including a couple of ResMeds and if I had to buy just one it would be the RemStar AFLEX machine.

My AFLEX machine is hooked up to a 12Volt deep cycle battery with an automatic trickle charger. Power went off a couple of weeks ago and it just kept on keeping on like the energizer bunny

ffarmer · Post by **ffarmer** » Thu Jul 31, 2008 10:16 am

I have the REMstar auto with C-Flex - can I read my data with this machine? If so, where do I get the software? Right now, I go to my sleep doc every few months with my card which he reads, but really doesn't give me any information. I once asked him about whether I could read the data myself and he kind of brushed me off. I'm feeling more and more like I need to be able to do this and understand what is going on.

Snoredog · Post by **Snoredog** » Thu Jul 31, 2008 11:04 am

Respironics leads when it comes to exhale relief. Get the AFLEX machine it is the newest and will do AFLEX in addition to CFLEX.

I wouldn't waste my time with the S8, it won't run directly off 12 volt without a special adapter, it is soon to be replaced with a newer AutoSet II models. Current models have EPR but that feature doesn't work in Auto mode (you have to get the AutoSet II for that).

Wulfman · Post by **Wulfman** » Thu Jul 31, 2008 12:30 pm

ffarmer wrote:I have the REMstar auto with C-Flex - can I read my data with this machine? If so, where do I get the software? Right now, I go to my sleep doc every few months with my card which he reads, but really doesn't give me any information. I once asked him about whether I could read the data myself and he kind of brushed me off. I'm feeling more and more like I need to be able to do this and understand what is going on.

Yes, you can.....and you can get it here:

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

Den

sleeplessinaz · Post by **sleeplessinaz** » Thu Jul 31, 2008 1:53 pm

Let me get my 2 cents in --LOL! I have the S8 Elite that was recently purchased by my insurance and I also have a S8 Escape to use as a travel machine. It is light and also the humidifier is integrated. BOTH Machines do have the Altitude adjustments that you can do by accessing the LCD screens--VERY easy to change. Comes all in a nice compact travel bag too --over the shoulder to use when running thru the airports. Have fun!!
Carrie

rocketdork · Post by **rocketdork** » Thu Jul 31, 2008 8:06 pm

So I think I've bought myself some time.

I went to the DME provider...WOW, what a racket they have going on. I won't go into details, but they wanted to charge me for every item in the "kit". Hose, filters, headgear, etc...all prices were 2x to 5x of what is listed on CPAP.com.

BUT, there is light at the end of the tunnel, and possibly some restful sleep too. I talked to a friend at work about what's going on. He gave me some guidance on how to travel the insurance maze and said he has a machine he isn't using anymore. Medical problems caused some apnea for him, but now that the medical problem is resolved, he doesn't need the machine anymore, he didn't divulge what the medical problem was and I didn't ask. He doesn't want to give it up, but rather, will allow me to use it for a month or two until I can navigate the insurance maze and gather information on what I should/shouldn't do.

The good news is that the machine is a Respironics M series APAP machine with A-Flex and a heated humidifier. One of the machines you folks suggested. It'll allow me to "test drive" it to see if I like it.

All I need to do now is get a mask and tube. I tried on several at the DME provider and know the one I like, at least in a sitting position and awake...I'll pby order one from CPAP.com and get the return insurance.

Now to see how the insurance plays out...so far there are only about 5 real hoops to jump through...starting on that right away...What A PITA.

goose · Post by **goose** » Thu Jul 31, 2008 10:55 pm

Very cool loaner!!! I think you'll find you'll like it.

A lot of the time an insurance company will "rent" the machine for you at an exorbitant cost and your cost will depend on your co-pay. Fortunately mine was a freebie, BUT I did have to insist on the Auto machine and have my doc write a make/model specific script with a pressure range (it was no big deal).....Make sure you check with your insurance company on what they cover -- do not rely on any information the DME provides -- they just don't know!!!!!! But get your doc to prescribe the APAP machine!!!!

Snoredog stole my thunder on the 12v situation. Cpap.com has a cable set for the REMStar Auto (as well as others) that will allow you to connect to a cigarette lighter connection cabled to a battery. My one night of non-compliance was a night where the power went out.....the next day I bought a deep cycle battery and had my machine -- power was out for 7 nights!!!! (Hey. It happens in the boonies)....
I use a generator and charger to keep the battery up to snuff and only charge it about every 3rd day. If I was smart, I'd hook it up the way snoredog has it set up and just run it on the battery at all times - perhaps I'll set it up that way one of these days.....

Find yourself a copy of the clinicians manual so you'll have all the programming options. Most of us have had to take control of our treatment and we modify the pressure settings ourselves instead of having the insurance company pay the DME to do it. That said, I don't know anyone that takes pressure adjustments lightly!!!!! It is not a change you just do willy-nilly. There needs to be a good reason, and if you are using a range of pressures on an Auto machine, you'll want to set the range where your data indicates.....

Which brings me to the data capability. GOTTA HAVE!!!!! If you have nothing else, you need to get that data from the card. If you search the archives you'll find sources for the card reader that is less expensive than the bundled set that you get elsewhere (if they're still in business -- I recall a thread that noted the company was not shipping them regularly -- It's a Hong Kong company, but it's the same reader that's in the bundle - - look around). The software is Encore Viewer and it will allow you to keep tabs on your treatment.

While doing your homework (which I can see you are doing with earnest!!!!!) you'll notice the yellow light bulb at the top of the pages -- "Our collective Wisdom" and the red balloon, "CPAP FAQ" -- use them liberally!!!! There is an incredible amount of information there.

You're on the right track and you have seem to have a good attitude -- keep us up on how you're doing and if you have questions, don't hesitate to ask!!!!!

take care
cheers
goose

Machine	Mask

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