Newbie - Trying to confirm options before buying APAP

[JonathanSQ]

Hi all,
So late September, early October ish, time frame I undertook an at home sleep study test and found I have severe sleep apnea. My AHI score was 123, to be specific, and as such my sleep doctor has prescribed me an APAP machine. After spending the past two weeks playing phone tag with the only DME my insurance company utilizes in my area (Apria Healthcare), I have come to the realization that going through my insurance is not an option. With my deductible, it being near end of the year, and having to “rent to own”, the total cost going through my DME would be over $1,000 or so total. I have found CPAP.com and see there are several options that would result in a cheaper price, paying cash, than utilizing my insurance provider.

Based on lurking in these forums, from the best I can tell, there are a handful of items I need to pay attention to:
1. Buy a APAP that has more than basic data tracking capabilities
2. It has to have some way to save/export via an SD card so I can use 3rd party software (e.g. Sleepyhead) to track my progress and/or discuss with my doctor as needed
3. Be sure it has a heated tube and humidifier
4. The capability to “ramp up” to the prescribed pressure
5. Any sort of feature that would lower the pressure upon exhale, e.g. making it more “natural” to breath
At this point I think I’ve found 3 machines that I believe fulfill these requirements:
Philips Respironics PR System One REMStar 60 Auto
Philips Respironics DreamStation Auto CPAP
ResMed AirSense 10

My questions for the community at large would be:
• Recommended online suppliers?
• Are there other features than the above I should be looking for?

I do appreciate any input and guidance 

[Cardsfan]

There are several models of the Resmed Airsense 10.
You want the one that has AUTOSET in the name. Resumed Airsense 10 Autoset.

Resmed S9 Autoset- look at
Resmed S9 Autoset For Her-

http://www.secondwindcpap.com is an option for gently used, with warranty.

[chunkyfrog]

And BEWARE of Resmed's soundalike line of bricks: AirSTART.
Probably acceptable travel machines, but NOT as a primary machine.

[Julie]

And FWIW the sponsor of this forum Cpap.com has a terrific site where you can read all about the diff. machines, see graphic pix and read reviews (good & bad).

[robysue]

At this point I think I’ve found 3 machines that I believe fulfill these requirements:
Philips Respironics PR System One REMStar 60 Auto
Philips Respironics DreamStation Auto CPAP
ResMed AirSense 10

As others have pointed out: If you go for a Resmed machine, you want the ResMed AirSense 10 AutoSet or AutoSet for Her. You need to avoid the Resmed AirStart 10 Auto.

Both of the Philips Resprionics machines will do everything you want. The System One 60 is a the older model, but it has all the features you need from a quality APAP. If money is tight, I'd suggest going with the System One 60 rather than one of the newer, more expensive machines. There's really not that much difference in terms of therapy settings/features between the Dreamstation and the System One 60. (The Dreamstation's LCD data is a bit better than the System One 60, but if you plan on using SleepyHead, that's really not all that important.)

My questions for the community at large would be:
• Recommended online suppliers?
• Are there other features than the above I should be looking for?

If you want a brand new machine, it would be hard to do better than our hosts, cpap.com. If money is very short, you might want to consider looking at gently used machines and openbox specials from secondwindcpap.com. If you decide to go to secondwindcpap, you can also add the Resmed S9 AutoSet and Resmed S9 AutoSet for Her to the list of possible machines. Avoid the Resmed S9 Escape Auto (or Auto Escape). One drawback to the S9's is that they overwrite the flow rate data every seven days, so if you want it all, you have to remember to download the data into SH at least once a week.

Other features? I think you nailed the whole list of features to look for.

[Holden4th]

Even though the Respironics Dreamstation was available, the price of its predecessor, the PR System One 60 at CPAP.com was just too good to pass up. The machine works perfectly and does virtually what the Dreamstation does.

The same applies to the S9 which I used as a loaner and was very happy with. Basically the change in techjnology between the Dreamstation/System 60 and the A10 Autoset/S9 is minimal.

Pull the trigger and save yourself some money.

[JimW159]

Even though the Respironics Dreamstation was available, the price of its predecessor, the PR System One 60 at CPAP.com was just too good to pass up. The machine works perfectly and does virtually what the Dreamstation does.

The same applies to the S9 which I used as a loaner and was very happy with. Basically the change in techjnology between the Dreamstation/System 60 and the A10 Autoset/S9 is minimal.

Pull the trigger and save yourself some money.

However, don't pull the trigger too quickly. If you are seriously considering the System One Series 60, be aware that one of your stated considerations may be problematical:
Your item 3 - heated hose and humidifier
Please note under Important Tips in the heated tube listing https://www.cpap.com/productpage/pr-sys ... l#tips-tab
All the current ResMed offerings other than the brick-like AirSTART come configured to accept a heated hose.
Your item 5 - comfort -
In addition, I find the breathing relief and reaction to apnea events to feel much smoother with the AirSense 10 AutoSet than with the DreamStation or System One. ResMed uses a more gently probing characteristic called FOT (Forced Oscillation Technique) with which it creates a low amplitude sinusoidal oscillation in mask pressure to gently but forcefully coax the airway open. On the other hand, Respironics utilizes a more forceful square wave to achieve the same result. I liken it to be the difference between picking a lock versus opening the door with a battering ram - it's all whatever you find more comfortable. The algorithms for breathing relief are different, too. I don't understand the specific differences between them, but ResMed's feels more natural to me. I find the range of setup options for the AS 10 to be broader than the DreamStation, giving the user more control (if they want it).

[palerider]

ResMed uses a more gently probing characteristic called FOT (Forced Oscillation Technique) with which it creates a low amplitude sinusoidal oscillation in mask pressure to gently but forcefully coax the airway open. On the other hand, Respironics utilizes a more forceful square wave to achieve the same result. I liken it to be the difference between picking a lock versus opening the door with a battering ram -

you misunderstand the purpose, and operation of FOT and pressure pulses.

no machine that I'm aware of *ever* tries to open the airway during an obstructive apnea, none generate enough pressure, sometimes, depending on exactly where the apnea occurs, it could be like trying to push on a pull to open door, it just makes it worse.... therefore, no machine tries to 'force the issue'.

FOT, and pressure pulses are the way the machine investigates whether you're having an obstructive or central apnea, by increasing the flow, (on a 1cm 4hz basis for fot) the machine looks at the results, if it sees more flow and little pressure change, then it assumes the big balloons, er, your lungs, are on the end of the tube and your airway isn't blocked, therefore a central apnea., if it sees little change in flow, and pressure spikes, then it figures there's a blockage on the end of the tube, and thus an obstructive apnea.

the respironics blower isn't responsive enough to do FOT, so they use the much slower pressure pulses to achieve much the same end result.

see video: https://www.youtube.com/watch?v=4GW97Xk ... tml5=False

[JimW159]

you misunderstand the purpose, and operation of FOT and pressure pulses.

You are right; perhaps I should have written: ResMed uses a somewhat gentler sensing characteristic called FOT (Forced Oscillation Technique) with which it creates a low amplitude sinusoidal oscillation in mask pressure to evaluate the airway status in order to determine the type of hindrance to airflow being encountered. On the other hand, Respironics utilizes a different square wave-shaped pulse of lower frequency and longer duration to achieve the same result.

[robysue]

you misunderstand the purpose, and operation of FOT and pressure pulses.

You are right; perhaps I should have written: ResMed uses a somewhat gentler sensing characteristic called FOT (Forced Oscillation Technique) with which it creates a low amplitude sinusoidal oscillation in mask pressure to evaluate the airway status in order to determine the type of hindrance to airflow being encountered. On the other hand, Respironics utilizes a different square wave-shaped pulse of lower frequency and longer duration to achieve the same result.

Gentler is in the airway of the user.

Resmed's FOT used to drive me insane when it would start up just as I was drifting off to sleep and had a perfectly normal sleep transitional CA. And it would wake me right back up to WIDE AWAKE because it was so irritating to my particular airway. PR's PP? I never feel them and they don't startle me in the same way the Resmed FOTs did.

Like so many things about xPAP therapy, the FOT vs PP is something where your mileage may vary.

[JimW159]

you misunderstand the purpose, and operation of FOT and pressure pulses.

You are right; perhaps I should have written: ResMed uses a somewhat gentler sensing characteristic called FOT (Forced Oscillation Technique) with which it creates a low amplitude sinusoidal oscillation in mask pressure to evaluate the airway status in order to determine the type of hindrance to airflow being encountered. On the other hand, Respironics utilizes a different square wave-shaped pulse of lower frequency and longer duration to achieve the same result.

Gentler is in the airway of the user. Like so many things about xPAP therapy, the FOT vs PP is something where your mileage may vary.

I can see that it is quite possible, maybe even probable, that the vibration of FOT, while a low amplitude, may feel to some users more like a "tickling" in the airway. Thus, it may be more noticeable; as you say, "your mileage may vary".

[JonathanSQ]

Definitely a lot of information to consider

So ultimately it sounds like it will probably boil down to either a ResMed S9 Autoset or the Respironics PR System One REMStar 60 Auto, as it seems the differences between those two and their newer versions, AirSense S10 and DreamStation respectively, are minimal, from a features/setting perspective. Is there anything I am missing, from looking at the differences between the S9 and S10, and REMStar 60 vs. DreamStation, that are truly earth-shattering enough to warrant the newer/higher cost model?

While I am fortunate enough to be able to (mostly) afford this out of pocket, the simple fact is I also have a family that includes a 6-yr old stepson and Christmas is right around the corner, as well as the bill for my Spring college tuition. Any chance to save a buck will probably be taken, as long as it is not shooting myself in the foot from a medical and comfort (e.g. not sabotaging my own odds of sticking with it). Prior to my oldest brother passing, I recall he had briefly starting using a machine (not sure if his was CPAP, APAP, or BiPAP) but was so discomforted, he didn't even make it past the initial 30 days. To be honest, it is something I wish we had discussed in detail before his unexpected passing earlier this year.

I can see that it is quite possible, maybe even probable, that the vibration of FOT, while a low amplitude, may feel to some users more like a "tickling" in the airway. Thus, it may be more noticeable; as you say, "your mileage may vary".

JimW159--
Am I reading this correct that the method that the ResMed machines use could come off as feeling like a "tickling" sensation compared to the Respironics machines?

On another note... beyond the machine, humidifier, and heated tube... I'm assuming the only thing left would be the mask. Is this correct or are there additional details I am not aware of? And are there any recommendations on how to select a first mask or am I better of finding a local store to try on, and purchase, the mask there?

Again I appreciate all of the responses and help!

[palerider]

Am I reading this correct that the method that the ResMed machines use could come off as feeling like a "tickling" sensation compared to the Respironics machines?

there are a few people that seem to be bothered by the resmed FOT, there are a few people that seem to be bothered by the respironics pressure probes. most people aren't bothered at all by either. I've got the resmed, and while I can tell that fot kicks in when I purposely hold my breath, and can even see the small hose from my mask wiggle a bit from it, it's doesn't feel like a tickle in any way, to me. it's also very unobtrusive, to me... like, i have to be consciously paying attention to feel it.

On another note... beyond the machine, humidifier, and heated tube... I'm assuming the only thing left would be the mask. Is this correct or are there additional details I am not aware of? And are there any recommendations on how to select a first mask or am I better of finding a local store to try on, and purchase, the mask there?!

selecting a mask is very personal, what fits one person and is great for them sucks for the next person.

ps, PM grayghost4, he often has a line on good deals.

[JimW159]

I can see that it is quite possible, maybe even probable, that the vibration of FOT, while a low amplitude, may feel to some users more like a "tickling" in the airway. Thus, it may be more noticeable; as you say, "your mileage may vary".

Am I reading this correct that the method that the ResMed machines use could come off as feeling like a "tickling" sensation compared to the Respironics machines?

This is an example of my being unable to be so precise in what I write that no one could possibly misunderstand what I mean. I apologize for my lack of clarity and precision. Perhaps I should have said "I can see that it is possible, though not necessarily likely, that the vibration of FOT, being of such a low amplitude, perhaps could feel to some users more like a "tickling" in the airway if it is felt or observed at all. Some persons feel things others don't; that fact should not be construed as indicating it will be felt. I can't feel such changes with my AS 10, but I could feel changes with the DreamStation I trialed.

[stephennic]

Hi,
It probably different for different people but found the Dreamstation APAP gentler for breathing than the airsense 10 and the airsense 10 for her model. I found the dreamstation more smoother and natural to breath on. I found the airsense 10 a bit harsher at higher pressures. For some reason I tended to get more gas/wind the airsense 10 too.
Others prefer the airsense 10 so probably if you can test before you buy. From what I have read both are the top 2/3 auto machines.
All the best.
Cheers
Steve