How did you end up with the XPap you have?

[allinknots]

I've been doing some reading on the forum, and as a newbie I am overwhelmed. I don't have my XPap yet (please see my other post), but I'll be meeting with a DME person this week. I know I need to research the different machines, but it's difficult to decide which is better.

I'm wondering: How did you end up with the machine(s) you have? Did your dr. choose for you? Did you just rent several machines until you found the one you liked? If you had to do it all over again, i.e. choose a machine, what would you do the same and what would you do differently?

Thanks,
All in knots

[WearyOne]

I went to the DME wanting the machine I have, and was pleasantly surprised that that's the machine he had sitting out on the table waiting on me. I like this machine a lot, but I would get the M-series auto machine instead of the straight cpap if I had to do over again.

The insurance I had at the time required that it be rented for 10 months and then it was considered purchased.

Pam

[Bookbear]

I did my homework by reading here.... devouring everything I could read here in the posts. I also talked with some email buddies who have apnea. When I met with the sleep doc to go over the results of the sleep test, I was primed with what I felt would be the best choice for me. I WAS willing to listen to his suggestions, but I was NOT willing to be talked out of having a say in, or being an active participant in, my therapy. My dad died of this, and I didn't want to go the same route.


The doc was ok with writing the Rx specifically for the machine I felt (and he agreed was) the best choice for me. ResMed Vantage S-8 (auto -- my apneas are positional, and I get congested easily, so an auto would have a better chance to coping with changing needs than straight cpap in my case, full data capable so I could monitor my therapy results), heated humidifier (I already knew what dry air does to my nasal passages and the resultant congestion), nasal pillow mask (both the full face and nasal mask the sleep center tried leaked like crazy, the Swift nasal pillow was the only thing that worked). I asked for the Breeze, based on the recommendation of a buddy who uses it and side-sleeps like I do. I alternate between sides, so the Swift would not work for me long term.

The DME refused to fill the Rx as written, saying they only carried the base model of Respironics. "All cpaps are the same," they said. I walked out, Rx in my grubby paw, and bought the stuff at cpap.com. Haven't looked back.

Good luck! Keep visiting here and reading... there are a lot of knowledgeable people here to help!

[JeffH]

From the recommendations on this forum I replaced my old Sullivan V with a "M" series APAP with C-flex. I had no insurance, so I bought it from cpap.com.

[allinknots]

Thanks for the replies!

Bookbear, I have a question.

My apneas are also positional. At my sleep study, I had only one Apnea, but many hypopneas, and they all were positional--only happened when I was on my back. I also get congested easily. A sleep technician showed me a basic CPAP machine when I saw the dr. at my follow-up app't, and tried a few masks on me for a few seconds. It was very difficult for me to not feel like I was suffocating when I had a nasal only mask on, and I felt much calmer with the full face mask since I do a lot of mouth breathing.

You mentioned that you tried different masks. Did you try all of these at a sleep clinic, or did you rent different ones from the DME?

When I had my pre-sleep-clinic app't with a sleep dr., it ended up that he is a "Fellow". I think that means he is doing some type of residency? At the end of the app'ts, his "attending physician" came in to hear a review of what he told me, and then chatted with me for a few minutes, asking if i had any questions, etc. At the time, I didn't.

Then I called back and talked with the "Fellow" to ask about data capable machines. He told me that they only gave info on compliance, and that he knew I would be compliant since I was researching them. (I'm not sure I understand that logic.) When I pushed further and asked if the machines supplied other data, he told me that they didn't.

A red flag went up in my mind. I think that he, like the DME you went to, thinks that all CPAP machines are the same. When I asked him, "How would I know what machine would be best for me?", he told me that the DME would bring out a machine that would work for me.

His game plan for me is this: He wants me to try a CPAP machine on the lowest pressure setting to get used to trying to sleep with it running and a mask on, even though it won't be therapeutic at this point. He'd like me to do this for a month, and then return to the Sleep Clinic where they will do a titration study.

I'm supposed to hear from the DME this week, and someone is supposed to come out to my house. I have a feeling that he is prescibing me a very basic CPAP machine. I have this gut feeling that medical insurance companies are putting pressure on drs. to prescribe basic machines if at all possible in order to keep costs down. This is just conjecture on my part, I don't have proof of that. I have good insurance coverage--and I don't want to be wasteful or abuse the system, but I want a good machine that I'll be happy with in the long run. I keep reading that I should rent a machine on a month-to-month basis until I'm sure it's the one I like, but how will I know even if I like one that there's not something out there that I'd like better?

Sorry for all the questions and ramblings. I'm just overwhelmed, confused, and tired...

All in Knots

[Georgio]

Insist on a fully data capable machine only. Mine isin't....I can't see what is going on with my treatment.....I'm buying a different machine out of pocket. $$$$$$$$$$$$$$$$ Good luck.

[Bookbear]

Thanks for the replies!

Bookbear, I have a question.

My apneas are also positional. At my sleep study, I had only one Apnea, but many hypopneas, and they all were positional--only happened when I was on my back. I also get congested easily. A sleep technician showed me a basic CPAP machine when I saw the dr. at my follow-up app't, and tried a few masks on me for a few seconds. It was very difficult for me to not feel like I was suffocating when I had a nasal only mask on, and I felt much calmer with the full face mask since I do a lot of mouth breathing.

You mentioned that you tried different masks. Did you try all of these at a sleep clinic, or did you rent different ones from the DME?

At the sleep lab. During the second half of the test, they fitted me with three different masks, with only the Swift working at all. Since then I have tried several at my own expense, always coming back to the Breeze. Masks are HIGHLY individual things... what works for on may not work at all for another. Unfortunately, most DME's won't let you 'try' them, since they are 'one patient' use items. Once opened, they cannot be legally sold to another.

Then I called back and talked with the "Fellow" to ask about data capable machines. He told me that they only gave info on compliance, and that he knew I would be compliant since I was researching them. (I'm not sure I understand that logic.) When I pushed further and asked if the machines supplied other data, he told me that they didn't.

WRONG! ABSOLUTELY WRONG

A red flag went up in my mind.

As well it should have! This one obviously does not know what the various models of cpaps and apaps can do. A darker point of view would say that they know full well, but want you to think there is no real data available, so you will be satisfied with a base lime machine that maximizes their profit.

His game plan for me is this: He wants me to try a CPAP machine on the lowest pressure setting to get used to trying to sleep with it running and a mask on, even though it won't be therapeutic at this point. He'd like me to do this for a month, and then return to the Sleep Clinic where they will do a titration study.

IMHO, I would run as far away from this doc and DME as possible, once you have your test results and Rx in hand. (Those are your by Federal law and they cannot deny them to you. Mention HIPPA and the 30 day limit to them. You should have no problem getting them.

I am very worried that either the doc or the DME is risking your health by suggesting that you try the lowest pressure (4 cm/H2o) for a month, "even though it won't be theraputic". They are setting you up for failure, and delaying your treatment. I have never heard of this approach. I think you would be far better served by getting an apap, with the lower pressure set to your titrated pressure from your sleep test, and the top pressure set 4 or 6 above that. Get an auto that has some for of exhale relief to help you become accustomed to treatment.. Use the ramp feature as well for the first few days or weeks until you can manage w/o them.

I'm supposed to hear from the DME this week, and someone is supposed to come out to my house. I have a feeling that he is prescibing me a very basic CPAP machine.

I would be very surprised if that wasn't what happens...

I have this gut feeling that medical insurance companies are putting pressure on drs. to prescribe basic machines if at all possible in order to keep costs down. This is just conjecture on my part, I don't have proof of that. I have good insurance coverage--and I don't want to be wasteful or abuse the system, but I want a good machine that I'll be happy with in the long run.

Actually, all insurances pay a fixed amount for any cpap or apap, regardless of the model you are actually provided. Thus, it is in the financial interest of the DME to give you the cheapest machine possible. If they provide a more expensive machine, they don't get any more money, just the standard amount. (Note that a bi-level pap is coded and paid for at a different level.)

I keep reading that I should rent a machine on a month-to-month basis until I'm sure it's the one I like, but how will I know even if I like one that there's not something out there that I'd like better?

It's up to the insurance whether they rent or buy. Usually after the rental period (usually 1 yr or 13 months), the machine is considered 'purchased' and is yours. You won't know about other machines unless you can somehow arrange for a loan of one to try out for at least a couple of weeks. You CAN get a feel for how the various brands behave by reading up on them here, using the SEARCH function of the board, but ultimately, you have to try them.

Sorry for all the questions and ramblings. I'm just overwhelmed, confused, and tired...

All in Knots

Not a problem... that's what this group exists for....

Good luck!

[Goofproof]

The first one was INS, got lucky got a data capable Remstar Pro 2 (Tank). Then they came out with the "M"series, after looking it over, I decided it was time to stock up on the best while it was avaible, so I bought a new Remstar APAP Classic w/HH off CPAP.Com, and a second used Remstar APAP Classic w/HH off a auction. Now I don't have to worry about them becoming out of stock. I paid for the last two out of pocket. I now have 5500 hours on the used unit, and it still doing fine. Jim

[allinknots]

I think you would be far better served by getting an apap, with the lower pressure set to your titrated pressure from your sleep test...

I don't have that option at this point. I only had one apnea event (yet many hypopnea events), so the sleep clinic didn't feel the need to do a split study on this first study. I won't have a titrated study until after I get a machine. I'm supposed to get the machine this week, try it for about a month at a very low pressure level, and then have my first titrated study in about a month.

IMHO, I would run as far away from this doc and DME as possible, once you have your test results and Rx in hand.

I'm considering cancelling my app't with the "Fellow" dr., and making my next app't straight with the "attending" physician. The attending seemed more knowledgeable.

Actually, all insurances pay a fixed amount for any cpap or apap, regardless of the model you are actually provided. Thus, it is in the financial interest of the DME to give you the cheapest machine possible. If they provide a more expensive machine, they don't get any more money, just the standard amount. (Note that a bi-level pap is coded and paid for at a different level.)

Then if I'd like a higher-end machine, and a dr. prescribes that, does that mean a DME can refuse to fill it if it won't make much of a profit on the machine? And if a physician writes a simple XPap script, can I choose a machine that is higher end, or does that need to be prescribed specifically? (I know that a bi-level would require a specific script, and that would not be covered by my insurance initially. I'm not referring to a bi-level here, but rather a higher end APAP like the Resmed S8 II AutoSet.)

Thanks again,
All in Knots

[cflame1]

The DME can try and refuse it or get it changed. But if you know what it's written for and have the script in hand... if they've changed it, don't sign anything and refuse it.

[Slinky]

After my sleep evaluation and OSA Dx I found this forum and another so I KNEW I wanted a fully data capable CPAP. I had no idea which ones were fully data capable EXCEPT so many liked and said the Respironics M Series Pro w/C-Flex was so when I went in for my titration study I wrote right on the paperwork I had to fill out that I would NOT accept ANY equipment UNTIL I saw the sleep doctor again. When I saw him I told him I wanted the Respironics M Series Pro w/C-Flex and he was agreeable and wrote my script for that. EXCEPT, the local DME supplier brought out an M Series Plus late Friday afternoon. Monday morning I called the DME and told them I was returning the CPAP. They told me I couldn't return it w/o a doctor's order. BIG MISTAKE. I was at their office 1/2 hour later w/the equipment and returned it all. Then it was straight to the sleep lab to tell them what I had done and why and demanding a copy of the script. The script was for the device we had agreed upon.

The sleep lab manager told me that another local DME supplier my insurance was contracted w/had the Resmed S8 Elite w/EPR and what data the Elite was capable of. I agreed to the Elite. And never regretted it. I had a rough time the first 30 nights on CPAP and it was only the data I was able to access each morning that kept me going. I did buy the software and cable reader for it and that kept me going to.

As I kept reading the forums I got "auto fever" and I self-purchased an Respironics pre-M Series Auto w/C-Flex. I only used it 2 nights as I was worried about keeping up the compliance on my Elite for insurances purposes. But I got good therapy w/it those 2 nights - except I was frustrated w/the hoopla you had to go thru to access the limited data via the LCD screen. I was able to obtain the software for it thanks to a fellow CPAPper and the cable reader (got that from twofactors in HongKong for $24 plus $8 shipping which took about 10-14 days).

But then, whilst still keeping up the compliance on my Elite for insurance purposes a lightly used Resmed S8 AutoSet Vantage (505 actual hours on it) complete including Clinicians Manual became available at a reasonable cost I jumped at the change to buy it!! Again I only used it a couple of nights to keep up insurance compliance on the Elite (little did I realize what a sham that compliance bit was as far as actual verification! I was convinced eventually "they" would insist on downloading my data card and verifying what I had attested to on the form they sent me to fill out about my compliance!) But I was so much more happy being able to so easily access my data via the LCD screen on those Resmeds.

Then my sleep doctor brought me back in for a bi-level titration (I have COPD). When told I would be better off w/a bi-level I insisted on the Resmed VPAP Auto that had just come out two months before. I did have to upgrade the software from AutoScan 5.7 to ResScan 3.4. I LOVE this VPAP Auto w/its EasyBreathe technology!

But .... I had also gotten spoiled having a backup xPAP for travel. So when the opportunity arose to purchase a lightly used Respironics pre-M Series Bi-PAP w/Bi-Flex I didn't waste any time buying it. I anticipate its arrival today. Personally, altho there were several opportunities to purchase the M Series Bi-PAP I had absolutely NO INTEREST in having an M Series AT ALL. But I AM looking forward to this pre-M series Bi-PAP's arrival and the opportunity to use it and compare it to the VPAP Auto. And since I will be traveling for 2 weeks next month I'm looking forward to again being able to just walk out the door w/an xPAP ready to go and arriving back home and falling into bed w/an xPAP sitting there ready to go and no packing and unpacking to do before I hit the bed!

I just wish in a way that I hadn't had to be switched to a bi-level as I really would have liked to try that new Sandman Auto. (I had always wanted to try the Puritan Bennet GoodKnight 420E and Silverlining software because everyone who had one liked it and I never saw a complaint about one). I was also intrigued by the new DeVilBiss IntelliPAP Auto but had no desire to buy one because of the questionable software issue.

By the way: I did sell my beloved Elite but do have the Respironics pre-M Series Auto w/C-Flex (the "tank", complete) for sale. I'm not ready yet to part w/the Resmed S8 AutoSet Vantage.

[DreamStalker]

I've been doing some reading on the forum, and as a newbie I am overwhelmed. I don't have my XPap yet (please see my other post), but I'll be meeting with a DME person this week. I know I need to research the different machines, but it's difficult to decide which is better.

I'm wondering: How did you end up with the machine(s) you have? Did your dr. choose for you? Did you just rent several machines until you found the one you liked? If you had to do it all over again, i.e. choose a machine, what would you do the same and what would you do differently?

Thanks,
All in knots

If I had to do it all over again, I would listen to the veterans of this forum and just avoid the DMEs altogether, get the original copy of the Rx from the doc and order an APAP direct from an online vendor like cpap.com.

Most of the sleep clinics are nothing but cash cows and are ok for diagnosis but terrible for treatment of OSA. DIY treatment is the best way to go if common/standard OSA is the diagnosis.

[Bearded_One]

My first CPAP was an old, oval, REMStar that I had for about 12 years -- it was what the DME carried. At that time, there wasn't much choice anyway. My second CPAP was a F-P with integral humidifier, which allowed me to discover that I strongly dislike humidifiers. After that, I bought several machines out of pocket. I didn't really like any of the machines until I got an IntelliPAP, and I found that it is perfect for me.

My second favorite is a Series M auto that I used to use on occasion to check my numbers. I keep it ready to grab and go in its case along with a mask, filters, extension cord, outlet adapter set, and a one month supply of my prescription medications. My IntelliPAP case is also ready to go; I keep a spare cord, filters, hose and mask in the IntelliPAP case, the only thing that is missing from the case is the machine itself.

[allinknots]

First of all, I'd like to thank ALL OF YOU for taking the time to respond to my questions! You have no idea how much I appreciate your time to do this! I am devouring your responses: studying them as though I were going to be tested on all of this!

To summarize the posts so far, this is what I'm finding: Most of you have strong preferences on your machines. You often own several masks. You love the data capable machines. You're wary of DME's because they sometimes have ulterior motives. It pays to be pro-active in your treatment. XPap therapy can be a pain, but it's worth it. How am I doing so far? OK, now who wants to come with me and help me figure out what machine would be best??

Two related comments by different people here:

Bookbear said:

I am very worried that either the doc or the DME is risking your health by suggesting that you try the lowest pressure (4 cm/H2o) for a month, "even though it won't be theraputic". They are setting you up for failure, and delaying your treatment. I have never heard of this approach. I think you would be far better served by getting an apap, with the lower pressure set to your titrated pressure from your sleep test, and the top pressure set 4 or 6 above that. Get an auto that has some for of exhale relief to help you become accustomed to treatment.. Use the ramp feature as well for the first few days or weeks until you can manage w/o them.

and DreamStalker said:

Most of the sleep clinics are nothing but cash cows and are ok for diagnosis but terrible for treatment of OSA. DIY treatment is the best way to go if common/standard OSA is the diagnosis.

I'm wondering if I should see if I can get a Data-capable machine, buy or rent the SmartCard and reader or whatever, and then try and find a pressure setting myself that seems to work without going for a titration study in a month? And then perhaps set up another study if I have trouble finding a correct setting on my own? What do you think?

(By the way, I realize your advice is your personal advice and is not a substitute for medical care, and all the other usual disclaimers. )

Hugs to all of you!

All in Knots

[jmaziarz]

I ended up with my M-series machine as a result of suggestions and research on this forum.

This is a bit off-topic but I know what you mean about being overwhelmed. My advise is try to stick with it no matter what. Try to learn at least one thing every time you visit. I made progress by learning the answers to these questions (from my notes):

1. What really is sleep apnea?
2. What could happen to me if I stopped using the therapy?
3. What are some realistic expectations I can start to see as evidence my therapy is working for me?
4. What does the C in CPAP mean?
5. What does the A in APAP mean?
6. What is Bi-level therapy?
7. How is CPAP and APAP and Bi-level different?
8. What is C-flex/A-flex?
9. What does AHI mean?
10. What is an "apnea" event?
11. What is a "hypopnea" event?
12. What is a "vibratory snore"?
13. What does "leak data" show?
14. What is the normal, expected leak rate of my mask based on the pressure-flow chart for my mask?
15. How can knowing about these bits of data help me regulate my own therapy?

Looking back, the answers to these questions are the basics that have allowed me to comprehend the other posts on this board. They also helped me to starting speaking the language and asking my own questions to fill in the blanks. The knowledge, advise, and encouragement you can receive from the people in this forum is tremendous. Tap it and don't stop there.