New OSA Patient looking for some direction :)

[OSHA]

My wife, a CCU Nurse, tells me I wake up sometime with bluish lips and I snore like a freight train. I finally took the plunge and saw the doctor regarding my sleep. After finding out my insurance doesn't cover anything to do with Sleep Disorders, I bit the bullet and found a sleep center who was helpful and didn't rape me for my sleep study. After my GP got the results and freaked that my O2 went down to 67% said, "Dave you have Deadly Sleep Apnea." Wow what a breakthru

Well after the titration study I was told I have a 12 for pressure with a Start up pressure at a minimum of 7. I couldn't get enough air with less.

OK Here come the questions.....

Regular or Auto?

Anyone have an opinion of the following machines?
Coviden/Puritan Bennett -- Sandman Intro & Auto Both with the integrated Humidifiers.
DeVilbiss -- IntelliPAP AutoAdjust CPAP System w/ humidifier.

Also, I was looking at a few nasal masks.....
Coviden/Puritan Bennett -- DreamFit Nasal Mask
Fisher & Paykel -- Aclaim2 Nasal Mask
Invacare -- Twilight II Nasal CPAP Mask
PMI Probasics -- Zzz-Mask Nasal CPAP Mask
DeVilbiss -- The FlexSet CPAP Mask
Resmed -- Ultra Mirage II Nasal
SomnoTech -- Soyala Nasal CPAP Mask or the SomnoPlus Nasal CPAP

I know that's a lot of masks, but maybe get some direction.
I am betting someone here can help....

I am paying for this out of my pocket too. I am looking for durability and portability as I travel often.

Thanks in advance for the help

[ractar28]

Okay, I'm a cheap bastage, so let's clear the air on that .

I have experience with Respironics cpap equipment and have been happy with them.

I bought my machine from https://www.bestcpapprice.com/Respironi ... _38-1.html. It was about $100 cheaper than cpap.com for the machine. I got the Respironics Remstar Auto M-Series A-flex with integrated humidifier for $589. You still have to buy the software which is another $150 if you want to READ the data on the smartcard -- or you can download the software via bittorrent (which would be um, illegal, if you have to split hairs) and still cost $50 for the danged reader.

The cpap (non-auto) version of what I have with c-flex (no a-flex) is $435. The auto can work as a cpap, and the auto with a-flex has c-flex as well (can only use one at a time). There are 3 levels of c-flex and 3 levels of a-flex. They lighten the pressure when you exhale so the machine is more comfortable.

Now, on to masks. Here's what I've found out through my own trial and error.

1. If you want to be able to return the mask because it doesn't fit, you have to go to a DME provider and pay out the nose. Even then, check with your provider to ensure that they will even swap masks.

2. The DME will charge you 2x-3x the price that you can get the SAME MASK for online.

3. If the online site is a "partner" with the mfg, it will cost more than if they aren't. I don't know how the black market for masks works, but there is obviously one out there.

An example would be the ResMed Ultra Mirage II. cpap.com's price is 99.95. Bestcpapprice.com's price is $135. Yes, one's cheaper on the machine and one's cheaper on the mask. Cpap.com will price-match and bestcpapprice.com will do a 110% price match -- but will not price match on Resmed stuff. Go to cpapauction.com and you can get the same mask for $45-$60. The auction site sellers most likely will not let you return the mask due to fit issues (due to being non-authorized outlets and not being able to send the mask back to the mfg). Cpap.com will sell you "insurance" for $19.08 that will allow you to return the mask within 30 days for a full refund minus shipping.

As for Respironics' masks, I don't like the way the headgear attaches to the mask. Resmed uses snap-in clips that allow you to disconnect and reconnect quickly. The Respironics masks require you to pull the connector end past the point where it "rests", causing you to have to pull it too tight (or re-adjust the straps).

That's my "wisdom" on the subject. Others will surely give opinions on their machines and the pros/cons of each one.

I recommend a heated humidifier based on my experience of having a pass-over humidifier and replacing it with a heated one.

[Mile High Sleeper]

Congratulations on being diagnosed. The life you save may be your own!
Check out the articles under the light bulb icon above, Our Wisdom.
You're off to a good start.

[One Tired Puppy]

Hi OSHA,

I have the new Sandman auto. It is a great little machine, one up from 420E PB. The software therapy is great as it will detect CA (cardiac oscillations) central apneas, cnt hypopneas, as well as obst apneas and obs hypopneas, snores, runs, et.,.

They also have a cpap. The auto is better as you can also use it as a cpap if you wish. Therefore if you need an auto up ahead, you already have one. In the mean time you can use it as a regular cpap.

The Introduction sandman doesn't have the same therapy software data that the auto does. I think you would be better off with the auto. Also with your condition being more severe, maybe you need a different type of machine other than a cpap or auto. I don't know. Do you have you lab study reports?

The only other machine I have experience with is the S8 Elite ResMed cpap. It is nice if you just want a straight cpap with epr and the software is nice but doesn't detect CA or cnt hypoponeas.

Since you will have the machine for probably several years, I would pick the best machine with the "best software". For me, software is what would clinch the deal.

A lot of folks like the Respironics and it also has good software. I think that PB and Respironics are the only two that I am aware of that detect centrals.

Best to you,

Anne

[Pineapple]

Any price you find lower, email cpap.com and ask if they'll price match - I've never had them turn me down yet.

[DreamDiver]

Hi OSHA,

I have the new Sandman auto. It is a great little machine, one up from 420E PB. The software therapy is great as it will detect CA (cardiac oscillations) central apneas, cnt hypopneas, as well as obst apneas and obs hypopneas, snores, runs, et.,.

They also have a cpap. The auto is better as you can also use it as a cpap if you wish. Therefore if you need an auto up ahead, you already have one. In the mean time you can use it as a regular cpap...

Anne, first thanks for this excellent post. I'm used to having pressure exhale on relief, and have been looking for a new machine that has all the advantages the Sandman HC Auto has. However, there doesn't seem to be any EPR. The software sounds ideal. So my question goes out to those who have tried both the Sandman HC Auto and the M-Series Auto w/ A-flex: Has the lack of EPR been problematic, or a non-issue?

[goose]

I'm a Respironics fan, but that's because it's what I have.
It sounds like the Sandman machine has some great features to be looked into.....

My only real input for you is get an Auto.....Being able to "self-titrate" is, in my opinion, important. You can always run the auto machine in CPAP mode, but you will have the option of using a range. Whatever makes you feel better!!!
As a side, don't shoot at numbers. Any AHI below 5 is good/normal. Go by how you feel in the morning. If your AHI is below 5 and you're feeling good, stick with it -- set it to a range to self-titrate, but go by how you feel.......Advice based on lessons learned the hard way, and finally listening to the great advice here!!!

Congratulations on getting diagnosed -- your life will only get better once the treatment is working!!!
Welcome!!!

cheers
goose

[nightjar]

Also, I was looking at a few nasal masks.....

I can't give you any help with a new CPAP (mine's 10.5 years old), but one thing I'd mention mask-wise is to figure out how you prefer to position the hose and how the mask will direct your exhalation.

I have my hose coming up over my forehead, totally out of my way while I turn during the night. I wonder if I'll be able to do that once I get a heated humidifier, something I've lived without for all these years; I sure hope so!

But that may impact the direction your exhaust goes. I can't stand to have the exhaust blowing on me. And my wife can't stand it blowing on her.

I use the Mirage Ultra, and like it lots. It seems pretty durable to me, and it's easy to adjust.

But everyone's different: what one person finds comfortable, another may not.

Good luck sorting all this out!

nath

[Babette]

I have my hose coming up over my forehead, totally out of my way while I turn during the night. I wonder if I'll be able to do that once I get a heated humidifier, something I've lived without for all these years; I sure hope so!

Nath, there is no problem with over the head hose routing and heated humidifier. I've been doing that since day one of my therapy.

Cheers,
Barbara

[Goofproof]

You can see my preference listed, on masks remember if you chose a Nasal mask, you may have to deal with mouthbreathing, with a FF mask you don't. Get your script and buy online to save $$$. When you get your equiptment fill in your profile (in Text). In the meantime, read and learn, Welcome! Jim

[nomoore]

The Sandman Auto is a great machine with one downfall (so far as I can see from my research here). As mentioned above it doesn't have exhale relief. This was a deal breaker for me since I had never used cpap before (except for the titration study) and didn't know whether I needed the exhale relief. I ended up getting the Respironics M-Series Auto w/A-flex. It has 2 different types of exhale relief. Some people prefer to not have exhale relief. Most people use it as a "comfort" feature. A few people can't tolerate CPAP without it.

Don't get the Sandman Intro. It doesn't provide data capabilities. There is a Sandman Info which is between the "Intro" and the "Auto". It has data capabilities similar to the "Auto" but is straight CPAP instead of Auto CPAP. Because of the data capabilites you can successfully titrate yourself with the "Info" but it is usually easier and quicker with the Auto. The Auto has other benefits as well.

Basically, any machine will blow a set pressure into your nose. Spending more on a machine will get you A) comfort features which sometimes make or break success with CPAP. B)validation that the machine is effectively treating you or the information to adjust the machine to treat you effectively.

I would recommend the Respironics M-Series Auto w/A-flex for a new user. It has a decent price through cpap.com and has plenty of features. It's not perfect but it's very good. Get cpap.com to quote you the price by email for their best price on the Respironics machines.

[nightjar]

Nath, there is no problem with over the head hose routing and heated humidifier. I've been doing that since day one of my therapy.

Thanks, Babette--that's good to know!

nath

[Snoredog]

Without seeing your PSG results,
Having difficulty breathing at 7 cm?
Having little/no Insurance coverage for OSA?
Having a pressure requirement of 12 cm?

I would say:

1. Exhale relief doesn't offer you any advantage, it doesn't help you at all once you are asleep. If you have chronic insomnia it might help, but exhale relief only helps when you are awake. Most machines that don't have exhale relief have AutoRamp or a similar feature. There are ways around tolerating exhale pressure with an Auto by using a simple Ramp. You can also use a lower starting pressure like 7.

2. Without insurance, if you have a problem you will need to go back to the hospital for another titration. That can quickly get costly. This therapy for the most part is trial and error. An autopap will titrate you with every breathe so there is no guessing if your pressure falls within the working range.

10 cm Pressure Barrier: However, most Autos stop at treating frank apnea at 10 cm pressure, you need 12cm. That means for that last leg the machine you pick may or may not respond to your apnea once you get to 10 cm. Any apnea seen at that point may go untreated. These machines will continue to respond to Flow Limitation and Snore but for the frank apnea they wont. If have a history of snoring, hopefully you will continue to snore so the pressure moves upward.

The reason they do that is to avoid responding to central apnea which some people are prone to having once you get to that magic 10 cm barrier. There is one machine (actually 2) that you can adjust so they DO respond to those apnea above 10 cm pressure and do so decisively. This means you can be chugging along at a much lower pressure below 10 cm and have an apnea, these machines will increase pressure above that 10 cm barrier and respond to the apnea. Those 2 machines are the PB420e and the new Sandman Auto. Both are basically the same manufacturer. If you are traveling, you cannot beat these machines for size. Both of these machines use a patented algorithm to avoid adverse response to central apnea. In other words, they do a better job at distinguishing what type of event you are having.
Other machines like Resmed AutoSet don't respond at all to apnea above 10 cm. Remstars respond to anything and only stop if the event is still there after 3 pressure increases or 6 events, by the time that happens you can be awake and wondering what happened.

3. Being without insurance, you would probably like to have an educated guess as to what is happening to your sleep. Is the machine working? Is it keeping your apnea down to acceptable levels? The only way to know that is by having reports or having the machine display that information on the screen. The Resmed Vantage/Autoset units display that information and you can use them to meet your apnea needs by placing the Minimum pressure up to your 12 cm requirement. They have exhale relief but by using that it effectively lowers the pressure where more apnea are allowed to show up. The Remstar Pro and Auto display results on the LCD but it is only a 7 or 30 day average, 90% pressure and leak. Then the latter is not known to be very accurate with those results. So you need reporting software, you can get that with Resmed, PB420e, SandmanAuto and Remstar. Sandman/420e is the best detailed reporting software, Remstar is good but a PIA to pull reports and it consumes a lot from your computer.

If you want the most flexible machine with excellent software, I'd go with the Sandman Auto. It has AutoRamp, it can address your SDB above 10 cm and you can tweak those parameters if you want for optimal therapy. The M series wasn't really designed to be used by a Patient in my opinion, either that or the people that designed it had no idea what a OSA patient has to go through. LCD is not back-lit. It has bright blue LED's that light up the whole bedroom with no way to turn them off without voiding the warranty. It is prone to being noisy depending on your pressure, so noisy they had to come out with an after though silencer. The hose comes out the back when you need it to come out the front, they don't include an elbow for the hose, it has a past history of humidifier leaks (if you get a new one it may have the redesigned humidifer). It has price protections in place by the manufacturer to inflate the price of the machine. The Sandman Auto is a better machine, better designed and better priced.

Masks are a personal thing, but if I was to having only 1 mask it would be the Soyala, I can't have anything pushing on the end of my nose due to a past deviated septum. Out of all the conventional nasal masks I have bought and used over the years, the Soyala seals the best, is the smallest and lightest and best of all the quietest. I have several of them, close 2nds would be Resmed's UltraMirage II, ComfortGel but the latter are much more noisy. It is good to have a Full Face mask as a backup, I would suggest the Resmed UltraMirage Full Face (even over the Quattro). Quattro has problems in my opinion especially if you are a shallow breather.

Nearly all the Autos can be set to run in CPAP mode. You may even prefer that mode, but a year later if you have gained/lost some weight you might wonder if your pressure is still working, the Auto will tell you that.

I'd pass on the Devilbiss, that machine is pretty dumb it doesn't give you any feedback either from the screen and the software is non-existent as of this writing. The machine treats pretty good but feedback from the machine is not very good. That company always shoots itself in the head with their machines when they don't complete its package. Their spray guns might be good but I'll keep my Binks.

[One Tired Puppy]

Hi OSHA,

I have the new Sandman auto. It is a great little machine, one up from 420E PB. The software therapy is great as it will detect CA (cardiac oscillations) central apneas, cnt hypopneas, as well as obst apneas and obs hypopneas, snores, runs, et.,.

They also have a cpap. The auto is better as you can also use it as a cpap if you wish. Therefore if you need an auto up ahead, you already have one. In the mean time you can use it as a regular cpap...

Anne, first thanks for this excellent post. I'm used to having pressure exhale on relief, and have been looking for a new machine that has all the advantages the Sandman HC Auto has. However, there doesn't seem to be any EPR. The software sounds ideal. So my question goes out to those who have tried both the Sandman HC Auto and the M-Series Auto w/ A-flex: Has the lack of EPR been problematic, or a non-issue?

The lack of EPR is a non-issue for me. Others may feel it is necessary. I like the S8 Elite with EPR and would have chosen an auto Elite if it had software to detect centrals. I am very happy with my choice of Sandaman. I did find a little difference is the pressure between the two. The same pressure on the S8 Elite may be a little more noticeable than the Sandman, or maybe it was just me getting used to a different machine. I notice the difference at first, but not anymore.

I'd like to add that the Sandman can take a lickin and keep on tickin. Maybe I should say it can swollow water and survive ...as long as you turn it upside down. I accidently yanked it off the night table while sleeping.

Anne