Resmed vs. Respironics - Help

[Needsdecaf]

Hello all!

Newbie here, so pardon the possibly repetitive questions. I have done a search, but this forum isn't sub-divided and there are a LOT of results to sift through!

My story...

I am just starting CPAP treatment for high-moderate Apnea. I have gone through two sleep studies and have titrated at 8 cm. I used a Resmed Mirage Swift IInasal pillow that worked wonderfully. NO leakage (all night), no mouth breathing problems, and no discomfort from the headgear.

My sleep lab handles the perscription send out to DME suppliers. They set me up with a local supplier who offered me very limited choices of equipment and was very rude and condescending. They wanted to come visit me and gave me 3 choices, but I was supposed to pick ONE and only ONE that they would show up with. WTH? When I asked about other models, they told me that "my insurance probably wouldn't cover it".

I am fortunate enough to have good insurance and after speaking to them on multiple occasions, have found out that for an in-network provider, all I need is a scrip for a machine and it is covered 100%, no deduct. And I can order any machine which fits my scrip. I have not seen my scrip, but based on what was told to be by DME #1, I would guess that it is for straight CPAP, not auto, if it is that specific at all.

I am onto DME #2, who I have dealt with before for my son's need for a nebulizer. They are a national company with a fairly close local office. They stock Respironics products.

After doing research and looking on this site (great info) I have come down to thinking either a Resmed S8 Escape or Elite, or a Remstar Plus or Remstar Pro. My questions:

1) I hear a lot of talk about APAP machines. Are they that much better? Should they only be used when specifically perscribed? Most APAP's can operate in straight CPAP, correct?

2) Of the above options, any recommendations, opinions? I do not travel a LOT, but don't want something that's difficult to take with me on overnight car trips, which we do often.

3) Humidification. Opinions on each brand's built-in humidification? Reading on here, many people are down on built in humidification. Why? Non-transferibility to other models? Better performance from stand alone? I am kind of a streamlined guy...if they make a compable product, I want that one generally. The less extra wires / hoses / etc. the better!! I have a sensitive nose, prone to nosebleeds, so good humidification is essential.

Sorry for the long post, but it's my first! I'm torn over which machine to get. I tend to want to go for all the bells and whistles, but in the end realize that just good solid performance is valued over other things.

Please, educate me!

Thanks!

Oh, BTW, the screenname (Needsdecaf) is not a reference to any sleep problems...it goes back a LONG time, before I had any sleep issues. Thanks!!

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, nasal pillow, newbie, CPAP, DME, auto, APAP, Travel

[RiverDave]

needsdecaf,

Welcome to the forum.

Here's my attempt to answer your questions. Others will chime in soon.

#1 APAP machines are better in that they off both CPAP and APAP modes of treatment. Some people do well on APAP, others not so well (and vice versa).

#2 There are pros and cons to each manufacturer. The majority of people here seem to use respironics machines - not sure whether its because the brand it better or just more popular. Each brand has its loyal supporters. I really can't offer any solid advice because I have only used one brand of machine (I like it, by the way).

#3 The reason people are down on built in humidification is that: 1) respironics machines either leak or have a very small reservoir, and 2) Resmed machines tend to be less powerful.

The most important feature on any machine you get is to have access to the data (other than that, it's a ford vs chevy arguement, IMO).

Good Luck

[Wulfman]

Welcome to the forum!

First thing......get the physical piece of paper with your prescription on it. They should have given it to YOU. Don't let them herd you to some DME that they've got cozy connections with.

If you want a machine with all the "bells and whistles", that would be the Respironics REMstar Auto w/A-Flex.

An Auto CPAP and a straight pressure CPAP have exactly the same insurance code. In some cases it's the insurance provider that balks at letting you have the Auto, however it's usually the DME, because they'll make more money by giving you the cheapest equipment in their inventory.......the insurance provider ultimately gets billed for the same amount since it's the same insurance billing code.

You might also check with your insurance provider to see if they'll reimburse YOU for an out-of-pocket purchase.....like from CPAP.COM. Many will.....and that saves both of you money......plus, you get to pick which machine you want to use.

If you haven't yet, I'd suggest going up to the yellow lightbulb icon above and read "Our Collective Wisdom".

Take charge of YOUR therapy, right from the start......if you don't, you'll probably be sorry.

Den

[Needsdecaf]

Thanks for the quick responses guys, keep 'em coming.

To get full insurance coverage, the DME must be purchased through a "registered supplier" or whatever they call it. If I go out of network, I have to pay a $300 copay and only get reimbursed at 80%. I'll be fine with having the national DME order what I want.

It's just a question of finding out what I want!!!

In reading the Collective wisdom, it seems that APAP really tends to be somewhat of a personal preference. Based on the articles and the subsequent rebuttal, self-titration seems possibly overrated? Yes? No? Maybe so?

In any event, in doing the research, I would think that if I went with an APAP that I would lean toward the RemStar Auto M because the AFlex is active in Auto Titration mode, wheras the S8 Auto Set Vantage cannot use EPR in Auto mode.

But for a fixed CPAP machine, it seems like there's a slight preference of CFlex over EPR, but not much.

I should say that I wonder if I should stick with fixed CPAP...during my sleep study, each time the tech increased the pressure by more than 1 cm at a time, I woke up. Perhaps a machine adjusting all night might not be a good idea...

In any event, research continues and keep the personal wisdom coming, much appreciated!!



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CPAPopedia Keywords Contained In This Post (Click For Definition): DME

[dieselgal]

If I were you I would try to get either the ResMed Auto or the M Series Auto w/ aflex. That way if you want just strap CPAP you can have that or if you want EPR or A flex down the road you can have that too.
Why not get the best machine you can get to start with?

[Claire]

Welcome...

Well, as I'm sure you've realized, everyone is different. I have the Resmed 8 Elite and like it very much. I particularly like the EPR function which lessens pressure as I exhale. I've gotten very used to the sound of my inhaling and exhaling...my husband, too. In fact, it's kind of soothing.

I have the built-in humidifer, but I just keep it at 1...I don't seem to want warmed air actually and this isn't because I live somewhere warm. I'm in Canada, we've had a wretched long and cold winter, and we keep our bedroom cool. So the humidifier is not a big issue for me so far. And you make a fair point that the built-ins take up less room.

I've also travelled for a month in the mid-East with this machine and it was easy to carry around and worked like a charm.

Best of luck with your choices...

[Needsdecaf]

Doing more research has also created yet more questions:

1) Software. The big light bulb doesn't have any articles. Do you need software to fully view all your breathing events or can you view them on the machine?

2) Built in humidifiers....Claire brought up a good point. My sleep study was done with the humidifier on cool. I liked it. It didn't bother me one bit. Warm air dries me out worse than cool. Anyone have a review of Resmed or Remstar at low heat levels?

Thanks all!

[ozij]

...self-titration seems possibly overrated? Yes? No? Maybe so?

We may be having a terminology problem here: Self titration, that is, finding you own best pressure by making systematic changes and noting the results is very highly rated by most members of this forum. The process is also called tweaking you own therapy.

Auto adjusting therapy is not the treatment of choice for everyone, and often too broad a range, or too low a bottom pressure will defeat therapy.
You can use an automatic machine to help you discover which fixed pressure is best for you.
O.

[NightHawkeye]

Needsdecaf,

I'll offer my opinions in non-sequential order. I'll also be specific in my recommendations, so don't be surprised if some flames erupt. (I trust, Needsdecaf, that detail is what you want.)

1) I hear a lot of talk about APAP machines. Are they that much better? Should they only be used when specifically perscribed? Most APAP's can operate in straight CPAP, correct?

The first thing you need to know is that sometimes an APAP is essential for effective therapy, but usually not required. If you suffer from aerophagia (CPAP induced gas), APAP can often help tremendously with that. I went with an auto machine initially and didn't really care if insurance paid for it or not.

Yes, all APAPs (at least so far as I'm aware) also can operate in CPAP mode.

3) Humidification. Opinions on each brand's built-in humidification? Reading on here, many people are down on built in humidification. Why?

Why? Because the current Respironics built-in (integral) humidifier is a faulty design prone to leaking and damaging both the machine and environs ...

Other manufacturers don't seem to have problems with their integral humidifiers, nor did the older Respironics models. I've used both the older Respironics integral humidifier and the integral humidifier for the Puritan Bennett 420E. Both of these integral humidifiers have worked great for me.

2) Of the above options, any recommendations, opinions? I do not travel a LOT, but don't want something that's difficult to take with me on overnight car trips, which we do often.

As with most things, the machine you'll be most satisfied with depends on what you want and/or need.
The Puritan Bennett PB420E APAP is the best of the bunch as a travel machine because of its light weight, data monitoring capabilities, and fast response excellent therapy.

Most (maybe even all models now) of Respironics machines offer exhalation relief (C-flex & A-flex), which many folks enjoy. It never benefitted me much though. C-flex is probably the main reason folks here have gravitated toward Respironics machines. C-flex can help you breath out when you have a high titration pressure. At your pressure of 8 cm, I personally doubt that C-flex will matter much to you, but I'd recommend you try it before factoring it in or out as a decision criterion. Personally, I couldn't tolerate C-flex. Others posters to this forum indicate intolerance to C-flex, as well. It suits most folks though, and is a major reason for a strong preference toward Respironics on this forum.

I've never used any other manufacturer's machine, besides Respironics and Puritan Bennett, so will leave it to others to describe those to you.

Perhaps the most important thing you need to know is that you really, really want to get a machine that records data and allows you to monitor your therapy. Nobody's titration value remains the same for long. Having the data will let you easily optimize your therapy. Neither your physician, nor your DME will be able to optimize therapy for you nearly as well as you can yourself. That's why so many folks here have the more capable machines, because the benefits are real.

Regards,
Bill

[Julie]

Just to repeat - you don't NEED to operate your machine in auto mode or with A-flex, but the options are there if you get the right machine.

[SleepyInIndy]

However, not all machines with data "smart" cards are created equal. Some machines only record your "compliance" data - the number of hours you use the machine.

The general consensus I have read is you need a machine that is fully data capable meaning you have access to your mask leakage rates and AHI counts in addition to compliance. This applies to either the APAP or CPAP modes. It pays to know which models are data-capable and which are only compliance data models from your perferred manufacturer.

[DreamStalker]

Ditto what most everyone else has said.

If they titrated you in the correct ball park, the exhalation comfort relief may not be such a big deal at/or around your 8 cm titration. As others have noted, having data monitoring capabilities is by far the most important consideration and all APAP machines have that capability but not all CPAP machines do.

As for your nose bleed sensitivity, humidification will largely depend on the climate where you intend to use your system. I suspect NY can be cold and dry at times and that will require a good HH. You can always add the stand-alone HC150 later should the integrated not be enough.

My choice would rank as follows:

1) M series auto w/AFLEX (best I have used so far).
2) P&B 420e auto (although I have yet to trial this one, some of the wiser old timers have good reviews of this one even though it has no exhalation relief).

[Needsdecaf]

Someone mentioned a "blue light of death" from the Respironics unit in another thread.

Is there a lot of light coming out of this unit? How about the ResMed.

Noise doesn't bother me, bright blue lights do.

If so, anyone ever cover it up?

[Pineapple]

I'll help you by telling you which one NOT TO GET. Whichever one you decided on, do not get the RemStar PLUS. It is just a box that blows air (alright in does have C-Flex and Ramp which is a plus for us Newbies). If later down the road if you start having problems with your therapy, it can not give any information that is usefull and you may find yourself fighting with your insurance over whether you need to upgrade your machine.

BTW - Yes the RemStar's have the BLOD:) I have a small wash cloth that I fold and place on top of the buttons as a soultion to that problem.

[MrGrumpy]

[quote="Needsdecaf"]Hello all!

Newbie here, so pardon the possibly repetitive questions. I have done a search, but this forum isn't sub-divided and there are a LOT of results to sift through!

My story...

I am just starting CPAP treatment for high-moderate Apnea. I have gone through two sleep studies and have titrated at 8 cm. I used a Resmed Mirage Swift IInasal pillow that worked wonderfully. NO leakage (all night), no mouth breathing problems, and no discomfort from the headgear.

My sleep lab handles the perscription send out to DME suppliers. They set me up with a local supplier who offered me very limited choices of equipment and was very rude and condescending. They wanted to come visit me and gave me 3 choices, but I was supposed to pick ONE and only ONE that they would show up with. WTH? When I asked about other models, they told me that "my insurance probably wouldn't cover it".

I am fortunate enough to have good insurance and after speaking to them on multiple occasions, have found out that for an in-network provider, all I need is a scrip for a machine and it is covered 100%, no deduct. And I can order any machine which fits my scrip. I have not seen my scrip, but based on what was told to be by DME #1, I would guess that it is for straight CPAP, not auto, if it is that specific at all.

I am onto DME #2, who I have dealt with before for my son's need for a nebulizer. They are a national company with a fairly close local office. They stock Respironics products.

After doing research and looking on this site (great info) I have come down to thinking either a Resmed S8 Escape or Elite, or a Remstar Plus or Remstar Pro. My questions:

1) I hear a lot of talk about APAP machines. Are they that much better? Should they only be used when specifically perscribed? Most APAP's can operate in straight CPAP, correct?

2) Of the above options, any recommendations, opinions? I do not travel a LOT, but don't want something that's difficult to take with me on overnight car trips, which we do often.

3) Humidification. Opinions on each brand's built-in humidification? Reading on here, many people are down on built in humidification. Why? Non-transferibility to other models? Better performance from stand alone? I am kind of a streamlined guy...if they make a compable product, I want that one generally. The less extra wires / hoses / etc. the better!! I have a sensitive nose, prone to nosebleeds, so good humidification is essential.

Sorry for the long post, but it's my first! I'm torn over which machine to get. I tend to want to go for all the bells and whistles, but in the end realize that just good solid performance is valued over other things.

Please, educate me!

Thanks!

Oh, BTW, the screenname (Needsdecaf) is not a reference to any sleep problems...it goes back a LONG time, before I had any sleep issues. Thanks!!