wife of a newbie needs machine advice

[mamagoober]

My husband had his titration study last night. I have been lurking here for a week or two learning what I can to help him adjust to sleeping with the machine. I am happy to note that he did well last night. He was able to sleep most of the night and felt a smidge better even just after one night. When we get to the point of 'choosing' a machine, I'm afraid it's going to be tempting to decide something on the spot even though I(he) really need(s) to research first. He wants a machine in our home as soon as possible so he can get restorative sleep.

The machine used last night was either a ResMed VPAP™ S with H4i™ Humidifier or a ResMed VPAP™ Auto 25 with H4i™ Humidifier. They look the same to him. I'm sure the difference is in the data capabilities.

Two questions: First, are these machines 'good'? And second, what's the difference between the two and which do we want. I like data. I also like being able to get things figured out without waiting for an appointment with the sleep doc for everything.

Also, if there's a better machine, what would you recommend. I know this question may be impossible to answer without knowing his prescription (which we don't, yet).

[Julie]

Hi - As the machines you listed are not 'standard' Cpap machines that only address obstructive apnea, you may need to wait for a diagnosis to see if that's what he has, or if he has complex apnea (obstructive with central events as well), or mostly only central events, in which case another type of machine may be needed... plus it's a good idea to know what your insurance will cover (or not), but call them directly if you can as the DME may or may not give you a straight answer.

[mnfe]

Definitely read the posts at the top of the page for the newly diagnosed. Especially the ones about dealing with DMEs. It really helps knowing your rights and what to ask for. A lot of people don't get to "choose" their machine, the DME offers them one. Whether or not you take it depends on the research you've done and how prepared you are.

[big_dave]

The machine used last night was either a ResMed VPAP™ S with H4i™ Humidifier or a ResMed VPAP™ Auto 25 with H4i™ Humidifier. They look the same to him. I'm sure the difference is in the data capabilities.

Two questions: First, are these machines 'good'? And second, what's the difference between the two and which do we want. I like data. I also like being able to get things figured out without waiting for an appointment with the sleep doc for everything.

Also, if there's a better machine, what would you recommend. I know this question may be impossible to answer without knowing his prescription (which we don't, yet).

You really can't identify ResMed x-PAP machines by their physical appearance since ResMed uses the same housing for all machines in the product line. Both machines you listed are in the S8 series, which is discontinued. My S8 Autoset II is serving me well. VPAP machines are generally used for treating more severe types of sleep-disordered breathing rather than OSA. However, a sleep lab may choose to use a VPAP machine for sleep studies since it can be set to simple CPAP mode. That way, the sleep lab can simply change the therapy mode rather than switching out the machine if they determine that a more advanced type of therapy is needed.

Many people on the board will recommend the S9 Autoset, which has the auto CPAP mode and full data capability. I would probably purchase one myself if I had need of a new machine. There are comparable machines made by Phillips Respironics, but avoid other manufactures.

[RandyJ]

Read Janknitz's blog here:

http://maskarrayed.wordpress.com/

"Data Capable Machines" and "What you need to know before meeting your DME" are essential reading.

[chunkyfrog]

Machine with the prefix S8 are not the current models; Current models are all S9's
Similar, but newer.

[mamagoober]

Thanks for all of the responses so far. Clearly I have loads to still learn. I have kept busy with the links provided.

I just want him to sleep well.

[archangle]

Definitely learn which machines are acceptable. Right not, I wouldn't accept anything but a ResMed S9 Elite or AutoSet or a Philips Respironics PRS1 Pro or Auto. Avoid "Escape or Escape Auto" in the name for ResMed. BTW, there is no S9 Auto, you want S9 AutoSet.

Some DMEs are terribly unscrupulous and will try to sell you a dud machine because they make more money on them. You need to find out which DMEs are "in network" for your insurance, and try another one if the first one tries to screw you.

If he needs a "bilevel/BiPAP/VPAP" (all the same thing) machine, they are all data capable from ResMed S9 or PRS1.

[mamagoober]

Thanks all

[mamagoober]

I have a probably stupid question. Is EPR ResMed's name for C-flex used by Respironics? And if so, what makes A-flex different? Is is that C-flex is for straight cpap and A-flex is for apap? Also, at the titration study, my husband complained a lot about fighting to exhale and having the exhaling be stuttered. Does this description make sense? And if so, might he like one brand of exhale technology better than another?

I totally appreciate this forum and all of the helpful knowledge I've gathered. I hope to be able to help my husband adjust to his treatment as quickly as possible.

[Pugsy]

Is EPR ResMed's name for C-flex used by Respironics?

Pretty much. They are both forms of exhale relief.
EPR is mainly a per cm per setting straight up reduction in pressure during exhale.

Respironics have multiple Flex options and their reduction is NOT a per cm per setting like Resmed's is.
Instead it is a more complex reduction base on the flow of breathing or force of breathing. If person who has a more forceful breathing pattern they will have a greater reduction during exhale than a person who breathes rather shallowly even at the same setting.
You can read about the Flex options here
http://aflex.respironics.com/
And yes, it seems AFlex is available on the APAP but I think APAP mode also offers CFlex...can't remember for sure
CFlex for CPAP mode and BiFlex for the Bilevel machines.

He might like one form of exhale relief over the other brand. It also might not make any difference.
I have used all the forms and while different..they all seem to get the job done quite well.
When I was using the PR S1 APAP I used AFlex and really liked it.
When I had a chance to try a S9 ResMed I tried EPR and liked it too. It's different but neither was necessarily superior to the other from my perspective. Now there are some people who says that they definitely prefer one over the other.
Unfortunately most people don't have the opportunity to test drive both to see which one they like.
If the DME happens to have a demo of each set up...that would be really nice to try at the prescribed pressure.

[mamagoober]

Thank you so much for the excellent clarification. I had no idea there were so many variables. I just thought you got a machine that did one thing and it worked for everyone (like some DME's think, right?) Boy was I wrong! lol

[mamagoober]

Well, I don't know what to think now. At his follow up appointment today, the results of the titration showed a dramatic increase in central apneas. They were confined to two separate blocks of time. One was right as he was falling asleep at the beginning of the study and the other was right as he was falling back asleep after lying awake for about 30 minutes. The doc was concerned with the increase in centrals on cpap and with the low 02 sats (80%) that accompanied them. He was reluctant to prescribe the APAP at all, since his apnea is mild/moderate, but I had read here that some people have an increase in centrals while adjusting to therapy or to a new pressure. I pushed for the APAP and the doc prescribed and ordered it -- along with a pulse oximeter. He wants to check the data in 30 days. Now that I get back here, I can't seem to find the thread which included the situation about the increase in centrals. Did I make that up??

So...now I'm starting to 2nd guess myself and how bold I was with the doctor. I have copies of the sleep study info (well, sort of -- they are black and white copies of color coded pages and some of the info is hard to read) but I don't know if I have done the right thing. I'm sure James would rather sleep with an appliance than a mask, but if he needs the APAP, I wanted to get a few rentals in before the deductible resets.

[chunkyfrog]

Nothing to worry about; if he gets a FULL DATA (important!) apap, it can be run on straight cpap mode;
with the ability to run apap mode once in a while to confirm his pressures--
as opposed to additional $leep $tudies--(expen$ive--insurance may not always cover)

[archangle]

Don't worry about having an APAP vs. a CPAP. The APAP can be set to run in full manual CPAP mode if necessary. You should be sure it is NOT set to wide open mode with the full pressure range of 4-20. You can limit the upper pressure range. If, for instance, he wanted 12 cm pressure with a manual, you could set it to 10-14 auto, and it won't "run away" and cause high pressure.

The APAP can work exactly like the manual CPAP.

If he has enough problems with centrals, he may need a bilevel (also called BiPAP or VPAP) machine, or even an ASV machine, which are more expensive. Most insurance wants you to try a CPAP or APAP first and "fail," before they'll pay for the more expensive bilevel or ASV machine.

BTW, make sure the doctor looks at the data from the CPAP itself. Many doctors are pigheaded about only looking at data from sleep studies. Get the software and look at the data yourself. If you get the S9 AutoSet (Not Escape Auto) or PRS1 Auto, it's like having a mini sleep study every night. It will tell you if he's having apneas and give you a good indication whether he's having centrals as well.