Need to purchase APAP--ASAP

[Linda3032]

Wow Bill,

Great analogy. Absolutely what I would have liked to have said, but not articulate enough to have said it.

You expressed it so well. Thank You.

[Snoredog]

[quote="DreamStalker"]Not sure how they do things in Iowa, but around where I live, people can rent washers and dryers and APAPs too. I chose to buy both of my APAPs cuz I wanted to have a backup and test differences for myself. Being as how I got so addicted to PAP treatment, I would find it very difficult to go without even for one night. Anyway, my DME offered to lease a machine to me for up to a year under insurance coverage before I decided to buy. I'm pretty sure if I paid the price I could rent for as long as I wanted but after a while you are just better off buying the darn things rather than renting. I suppose it is a matter of priorities and options ... some people have more than others and newcomers don't neccessarily have to have fewer than the more experienced PAPers.

When I first got here I actually came back because I quickly discovered how many treatment options were available to me and I wanted to learn as much as I could about each of them ... including trialing more than one APAP. As time and money permit I intend to trial the PB420e ... just like I am trialing several masks.

Not flaming you Bill as I respect your thoughts and I have learned much from you and so many others here.

[DreamStalker]

your DME is more the exception than the rule, that all sounds sweet and a nice concept, but in reality it isn't a viable option for a newbie cpap user.

First most DME's, even those in Texas are going to balk and fight you every step of the way in obtaining autopap. They see an autopap as taking revenue away from them. Then, trialing an autopap to see which one works best for you? That is a concept completely over their head. It has been said here a million times we only follow what the doctor puts on the prescription. So are you going to go get a prescription for every machine you want to try? No doctor would ever agree to that, it puts their liability insurance through the roof.

Most DME's would only have Respironics, maybe Resmed and possibly the PB420E. While those would be better than not trying anything at all, one has to KNOW how to set them up correctly and then for what purpose, otherwise if you rely on the DME to set them up they are probably going to set them to cpap mode if they can get by with it, or leave them running wide open which can be problematic for some. So your pressure is 9cm and they set Minimum to 9cm. What are you going to see in the trial? Same thing you would see with a cpap at 9cm.

At my own expense, I purchased every autopap on the market at the time, some 3 times over. Some I knew right away they wouldn't work for me, I even played with the FL1 settings on a 420e. It still ranaway with pressure in any mode you set it at.

What I found it is not what the machine detects but how it responds that matters.

Everyone's sleep patterns are different, the various machines out there trigger on different parameters. Some on snore, some on flow limitation, others on hypopnea and snore. So if you are a chronic snorer combined with the risk of central apnea seen on your PSG, there is one brand of machine you should avoid at all costs. It is not how it detects those snores, it is how it responds to them. If the machine blindly responds to snores with pressure increases as long as the snore exists, and you have that CA you are in trouble. The 90-95% pressure becomes a moving target and it will run up to any set Maximum pressure including 20cm if let be.

It took me several years to trial all the machines and at great cost, there is no way a newbie cpap user could go rent a machine over a period of months and determine which is best for them to use. You can make nearly all of the autopap machines work if you know what you are doing, but if not you are just wasting your time and money.

This is where these forums can help, it is best if the poster dumps their PSG diagnostic data for us to look at where we can see the problem areas and then based on common experience suggest the correct autopap to use.

Respironics wins more than it loses because out of all the autopaps on the market its key feature is how it responds. It limits any response no matter the event (Flow limitation, Hypopnea, Snore, Apnea) where others don't. Even it screws up from time to time but it screws up less than the others.

You can't go wrong with the top 3 autopaps out there, some have features and functions that the person has to weigh to see which is best for them. Again, the Remstars have an advantage due to the Cflex feature, it can be used in any mode or turned off. Resmed only in cpap mode does EPR work, for the PB420 and Devilbiss it has no exhale relief. The smallest machine out there remains the 420E, but it is getting years behind the others as it relates to features and function. But a great machine to travel with if size is the only thing that matters.

All very excellent points SD. I won't argue that your own experience suggests that the Remstar APAP fit your sleep patterns best or even that Remstar APAPs appear to win more than they lose for the majority of folks who post on this forum.

However, you yourself admit that "everyone's sleep patterns are different" and you yourself trialed several different APAPs before finding the Remstar to be the best fit for your CA characteristics. Furthermore, this forum has many more Remstar users than the other brands and could well be what causes the Remstar machines to appear to be the best APAP machine for all users.

I did not show CAs in my PSG except for one triggered by the tech during titration. Having used both ResMed and Remstar APAPs, neither one appears to be running away on me. I have noticed that 3 months on the ResMed showed my sweet spot to be just a little over 11 cm while 3 months with the Remstar my sweet spot is just under 12 cm and the lab tech titrated me at 10 cm with a ResMed machine. I am not nearly as educated on this technology as you are and so I have no explanation for the minor differences since both appear to be equally calibrated based on my mamometer testing. Both were used without exhalation relief and both set at same pressure settings.

So you are right, for some PAPers, it may just come down to selecting between features and functions. I agree that one cannot go wrong with the top 3 selling APAPs on the market and I agree that unless a newbie is willing to educate themselves as you have or as I am attempting to do, they will not benefit from trialing the different APAPs ... So from now on I will qualify my statements that "one should trial all the APAP machines provided they are willing to educate themselves about their PSG and how each machine works and be prepared for an expensive endeavor if they do not have a DEM willing to rent them different machines".

So in summary, I still think newbie PAPers should be told about their options and/or encouraged to learn about their treatment as you have and discover which APAP is best for them.

[NightHawkeye]

Wow Bill,

. . .

You expressed it so well. Thank You.

You're welcome, Linda. Thanks for the kudos. I'll try not to let it go to my head.

Regards,
Bill

[Sleepy Dog Lover]

I'll admit it, I haven't read all the way through this thread, I tuned out somewhere at the end of the first page and picked it back up on the 3rd page. Kent, I just wanted to add in case somebody else didn't that there are straight CPAP's that have data recording capability too. I love my auto, but it isn't the only machine that will give you the data you are looking for.

[preemiern]

*Sigh.*


As I told you in chat, I personally prefer the RemStar Auto. Yes, different Autos have different algorithms, and they treat people differently. Some people respond to one algorithm and not another.

But the fact remains that this is the "real world," and in the real world very, very few places will allow you to try out different brands of auto machines. I have seen very few people on the boards say they were allowed to do this. In fact, only one that I can remember off the top of my head in the two years I've been here (again, this doesn't mean there weren't more, but does mean there were few, because if many people posted that they were allowed to do this, it would be memorable).


The RemStar Auto is an excellent machine. One thing it offers that others don't is the ability to use C-flex (exhalation relief) in auto mode. No other manufacturer offers that.

As someone else previously stated, solely based on what I have seen on the boards, the majority of people that post here and that end up switching from one auto to another end up switching TO the RemStar Auto. If I personally had to take a chance on an auto without being able to try out several kinds (and for most people, this is going to be the case), I would personally look for the Auto whose algorithm and features seemed to work for the most people. Again, solely based on what I've read from many, many posters to this forum, that machine appears (overwhelmingly) to be the RemStar Auto.

I wish you luck in finding one quickly so that you can find a better pressure that will stop the events you are still experiencing. As I suggested in chat (and as someone else suggested in this thread), Yahoo Auctions is a good place to keep an eye on.

Good luck, Kent. Many of us have been where you are, and are pulling for you.

--CG





I just have to throw in my two cents worth and say-I agree with you, CeeG. While I have a BiPap auto, I must say it has worked out better for me than another brand of machine I had tried before my Remstar. On the other machine I used, my AHI's were always greater than 10. Now I am consistently below 1.

it is apparent that other posters to this thread must agree as well as they have had problems with the algorithm of the resmed machine for one...

and again-not everybody will have the chance to try out the various machines out there, that is just NOT realistic... While other brands are also top competitors in the market, it seems that alot of people who start out with one machine, or that do have the chance to trial other machines--it seems they always come back to remstar. I'm not saying the other brands are not good machines, but it would seem to me that Remstar seems to have really hit the nail on the head with their algorithm.
If I HAD to choose one particular machine, and if I had the chance to read of others experiences--I would definitely choose the machine that most other people end up with here.
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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap, C-FLEX, AHI, auto

[Guest]

Thanks preemiern,

I really appreciate everyone's posts. I am using all of the information to make an informed decision. I am usually a slow and meticulous shopper, trying to gather all relevant information before I make a purchase.

I am leaning toward remstar auto for my first auto and that doesn't mean that I won't change in the future.

I just need to breathe and I need some unobstructed REM sleep. I had to take a two week leave of absence from work just so that I can get this thing figured out. I am still having a lot of anxiety--general and sleep onset, insomnia, and general confusion. So my ability to make a choice about a machine needs to be relatively simple and a safe bet for me. I know I can make a mistake in choosing, I just can't afford not (in any sense of the word) to choose wisely.

The best to all of you!!!

Kent

[oldgearhead]

..hummm..I find it interesting the person who started this thread has
not provided us with more information...like:

1) What's the hurry?
2) Does he have a script?
3) Is it a money issue?

[CollegeGirl]

ogh, that's info he provided in chat, but you're right - I don't think he stated it here. I commented on his situation a bit in my own post, though.

The hurry is that he was incorrectly titrated and is still experiencing events (something he's also stated in other various posts he's made around the board). He's still snoring, waking up with pounding heartbeat, etc.

He has a script and insurance; however, his insurance forced him to buy the RemStar Plus the DME stuck him with outright, so there's no trading it in for him, and obviously they're not going to pay for a second machine. He wants an auto so he can find his correct pressure ASAP.

And yes, money is an issue, like it is for many of us around here.

Hope that helps. I don't know him outside of chat, so can only say that in that context he seems legit and sincere in his desire for an auto and his reasons for it.

Hope that helps.