Need help with ordering a machine

[merhaba12]

I am going to talk to the doctor today about requesting a different machine. I need exhale relief and data capability (not compliance). I was told the Pr Resmed DS450HS was good. I need a reasonably priced machine because my insurance will only cover so much (I am unemployed).

I am confused with all the different types. I have researched the web and found some explanations but I want to know what you users recommend. I learned about C-Flex (which I'm sure I need). I get major leaks every night and am often getting 3 hours of sleep a night because of the leaks. I have a pressure of 14. I am working on getting a nasal mask with a chin strap because I am a mouth breather.

I am wondering if I should ask for an APAP so the pressure is variable. This feature sounds great! How do I know I need a 14 all night? What brand would you recommend? I want to be specific to the doctor and not have the DME give me a lousy machine. I understand the PR DS450HS does not have this pressure variability. Of course with any of the machines I need a heated humidifier.

To complicate things my doctor is on vacation until mid-July. I am waiting for a PA to call me back. I want to be specific with her.
Thank you!

[chunkyfrog]

Have you read Janknitz' blog?
http://maskarrayed.wordpress.com/what-y ... me-part-i/
You can also read the machine comparison pages on CPAP.com

[Pugsy]

If you want to stay with the Respironics brand.

The PR S1 Pro CPAP with CFlex...is the model 450...straight fixed pressure like you are using now but with CFlex exhale relief and offers full data. You could use your existing humidifier with it.

The next step up in that line is the APAP...The PR System One Auto CPAP with Aflex (just a little different than cflex) and the model number is either going to be a 550 or 560 depending on what is in stock. The #560 has the heated hose humidifier thing.
With the #550 you can again use your existing humidifier.
With the #560 you have to get a new humidifier to go along with the heated hose feature.
Heated hose is nice..but not life or death...we got by for years without it.
The #560 machine has replaced the 550 which is now discontinued...so again depends on supplier's stock or if something needs to be ordered. We can get you software even for the new 560 model...so that is not a deal breaker. SleepyHead doesn't work with the 560 model yet...but will later. In the meantime, Encore Basic for sure works now.

If you want to go with a different brand...go with ResMed S9 and make sure of the names.
S9 Elite is a full data..straight cpap with fixed pressure like you have BUT it has EPR exhale relief which will allow up to 3 cm reduction in pressure for exhale.

The APAP model with auto adjusting pressures is called the S9 Autoset. Avoid anything with the name Escape in it. Not full data machines. The S9 also has EPR and I imagine you would like it.

When someone can get an APAP over a CPAP machine I always say go for it. Never know when it might come in handy and the APAP can always be used in straight cpap mode..so it is like 2 machines in one.

There are a couple of other brands but these 2 are the 2 main players, have easy to get software, comprehensive data available and you have lots of people here using them to offer ideas.

[merhaba12]

Lots of great information. I will ask for the APAP machine if it is not too expensive. Which is better - C-Flex or Aflex?

[Pugsy]

The APAP machine has both AFlex and CFlex available. The differences are minor and really both are good...some people just prefer one over the other. I have used APAP with both available. I preferred AFlex but I know others prefer CFlex.
You will find that with almost everything related to cpap...there are highly individual varying preferences. What I might love someone else would hate and what I hate...someone else loves. It is just the way it is with cpap stuff.

You can read about all the Flexes here.
http://aflex.respironics.com/

[merhaba12]

Thank you Pugsy for all your great information. Just when I thought I had understood CPAP's I am realizing I may need an APAP, so I appreciate your input. That is the next step in my saga!

[merhaba12]

Hi Pugsy,
I know you are busy with your family, but should you get this post...
I am waiting to hear from my doc (who is on vacation) to see if he can write an Rx for an APAP. His nurse says she doubts it. So the DME might consider it an upgrade and try to find me a discounted price (whatever that means).

I am looking at the Resmed S9 Autoset Cpap with A-flex with a heated (climate controlled) humidifier (if they offer such a thing)
or
PR DS560 w/heated humidifier

It's probably personal preference, but would you recommend one over the other? If I have to pay for it on my own, I guess I might consider the cheapest unless you say cone is better than the other.

Thanks!

[Pugsy]

I happen to have been fortunate enough to actually use a Resmed machine after 2 1/2 years on a Respironics APAP machine.
Either one will do a great job for you. The differences are minimal. Given your pressure needs and already a problem with exhale.... you might like the ResMed a little better for exhale relief. The Flex exhale relief options on the Respironics machines offer a different type of relief. Flex doesn't drop the pressure as dramatically as EPR on ResMed machine does.
It is flow based reduction and not a per cm reduction per setting like ResMed. A CFlex or AFlex setting of 3 doesn't drop the pressure 3 cm...no where near that. The Flex option just goes about exhale relief in a different way...I used AFlex all the time I used APAP and it was extremely comfortable..pretty much just like natural breathing and my pressures started at 10 cm minimum. So while different...it is very comfortable..just not the dramatic drop available with EPR.

Respironics machines typically cost about one third less than for the comparable ResMed machine. ResMed doesn't allow discounting....that is why. They are both great machines.
If money permits...get the ResMed, you are already leaning to it anyway and I know that what we want and end up with pays a huge part in how we perceive success.
If money doesn't permit...well like I said..AFlex (on the APAP machines) ends up feeling pretty much as comfortable as EPR and I have used EPR to try it to compare. It isn't a deal breaker for sure. There are some other minor pros and cons but the PR S1 machine is not a crap machine by any means. It is a really good machine.

If it takes food off the table to get a ResMed...get the Respironics. AFlex is hard to explain but the machine learns your breathing rhythm and the exhale relief is very smooth...so smooth you don't hardly notice it....ResMed EPR...is pretty dramatic with the pressure drop and not as smooth but not uncomfortable though.

Either machine would serve you well.

[Janknitz]

But do consider that if you get a ResMed you will have to pay for both the blower and the humidifier, whereas if you get a Respironics you only need to pay for the blower. If money is an issue, it's a big difference.

[archangle]

But do consider that if you get a ResMed you will have to pay for both the blower and the humidifier, whereas if you get a Respironics you only need to pay for the blower. If money is an issue, it's a big difference.

I don't understand what you mean. Both ResMed and PR sell blowers and humidifiers separately. I have seen the PR machines offered as a bundle, but cpap.com, for instance, offers them separately.

I do think that ResMed does charge you separately for the heated hose, and PR doesn't.

Online advertised prices for S9 machines are higher, but you always need to check the final price to you once the seller and insurance get finished. Through a DME and insurance, blower and humidifier are often the same price to the patient no matter the model or manufacturer.

[Janknitz]

Archangle, Merhaba already has a Respironics machine, more than likely purchased outright by her insurance, regardless of whether or not the blower part was a rental. So if she gets a Respironics blower, then she will not have to purchase a new humidifier and chamber--saving a few hundred dollars.

[merhaba12]

I wasn't able to read all your posts. The nurse at the doc's office just called and said the doc was contacted (while on vacation) and he OK'd an APAP! I had to make a decision "on the spot" because of the urgency to get relief before my surgery on Tuesday. Even if it is all approved and I can get my machine when I get home, it is all good! So, I asked for the PR DS560 with all the bells and whistles. Unfortunately with the "60 series" the humidifiers have to be purchased because they are not compatable with the "50" series." But I don't care about the DME anyway!

If it is approved, it sounds like I'll be fine with the PR560 and I won't regret that I didn't ask for the S9 Resmed (like I said I didn't have time to read your suggestions).

Thank you for all your help! Now I just have to keep my fingers crossed!

[merhaba12]

The PA agreed to write an Rx for a specific machine. I was put on the spot so chose the PR 60 series, DS560 which means purchasihng a new Humidifier. The one I have for the DS150 is not compatable.

However, I had earlier sent a Fax to the DME (when I heard I was approved for an APAP) and told them I would accept a DS550 (no longer made) and I could keep the humidifier I have. The DME called me back and said they have a DS550 which they can send out today! I didn't know what to say. The Rx said a DS560. I don't know if it is a better machine because it is newer and I would regret accepting the 550. I told the DME to follow the Rx and send me the 560. Well, of course, it is not in stock and the warehouse manager is out until Monday. The DME will then find out how long I have to wait to get the 560.

My question is since the 550 is in stock today, should I go ahead and accept it and forget about the 560?

The machines are:
PR System One REMstar AUTO 550 AUTO CPAP & a-FLEX with heated humidifier

PR System One "60 series" REMstar AUTO 560 AUTO CPAP with A-flex & heated Humidifier.

It sounds the same to me. It's just that one is a newer model.

[archangle]

The main difference is that the 560 has a heated hose. The 550 doesn't have a heated hose. I don't think we've figured out any important improvements other than that.

The heated hose helps keep water from condensing in the hose (rainout), which can be a problem if use a lot of humidity and/or keep the room cold. It may also keep the air warmer.

I'd take the 550 and save spending the money for the new humidifier.

If you take the 550 and have major problems with rainout, you'll be sorry. With me, it's never been a problem.

Does anyone know of any other major advantages of the PRS1 60 auto (560) vs. PRS1 auto (550)?

Right now, the free SleepyHead program doesn't yet work with the 560. The author is planning to fix this, but it's unknown how soon this will happen.

Replacement heated hoses are considerably more expensive vs. unheated hoses, but you don't have to replace them that often.

[lazer]

I believe it is the 550 I currently have on loan from my DME and I'm pleased with it. I also like the fact that it is compatible with "SleepyHead". The "560" is what I had sitting in my cart in the event my insurance doesn't come through for me but I've since got a hold of that AutoIQ one so wont be pursuing the "560".

I'm not familiar with the "heated hose" but can tell you that I've had zero issues with the 550 and humidifier running at settings anywhere from 2 -4.

Edit: Yes, Confirmed. It is the 550 model I have now.