Newly Diagnosed-Mild Apnea-Help with choosing machine

[jacquesmama]

Hi there, this is my first post! I'm so glad to have found these boards, what a great community!

I need some help deciding on a machine and navigating this new world. I was just diagnosed with Borderline to Mild apnea (only when I'm on my back, otherwise no cases of apneas), I'm a 33 year old female of normal weight and no other health issues except Depression for which I'm on medications for that I understand can interfere with sleep.

I just got checked out because both of my parents have/had sleep apnea, I am more tired than I should be and sleep more than most, fall asleep easily during the day, etc. and I snore sometimes. The Eppworth scale results warranted the study which showed apneas when I'm on my back, enough to warrant a second study with CPAP. The second sleep study showed that the CPAP machine did help and I found there to be no difficulty sleeping with it.

To make a long story short- I have to buy the machine myself, no insurance, and my doctor recommend a top of the line machine that I can't afford so I need help figuring out what is essential.

My doctor wrote the prescription for the "ResMed S9 AutoSet" machine, I think he wrote the Rx and referral this way under the assumption my insurance would cover it. I won't bore you with the details. These are the other specifics I was told when I called the doctor's office back ans spoke to the receptionist about what else the doctor had recommended:

• Heated Humidifier
• Climate Controlled Tubing
• Swift FX Masal Pillows Mask

I'm in a financially very difficult position right now so I can't afford the top of the line machine, but I want to spend the money wisely, can anyone help me with this? I realize the doctor has to write the prescription for the appropriate machine, and I will go to him and see how he feels about the change.

One more note about the study- I don't know what model CPAP I used during the study, but my doctor told me it was not an auto machine like the one he wrote the prescription for and that I would be good with a pressure setting of 7 and I used the nasal pillows mask in small. I don't have a copy of the Sleep Studies, I will get one now after reading posts on these boards about how important it is to have.

Questions/ Concerns-

• I'm nervous about purchasing a device with no option of returning it, is there anyway to test out a machine prior to purchase, or a trial period? The home health care company doesn't do rentals to cash patients, only through insurance. Certainly there must be others like me out there who are cash patients. I'm also nervous that since my apnea is mild to borderline that it may not be that helpful, what if I spend all this money and find out that it isn't helping or I don't like it? I did fine in the study. I can't say that I noticed a huge difference the next day though because the for the sleep study they woke me up at 6 am (way earlier than I get up normally) so I still went home sleepy.
• The biggest determinant of price looks like it's going to be whether I get an Auto machine or not.
  Do I need an auto machine? What's the benefit?
  How much more comfortable is it?
  From what I understand I can go with the DeVilbiss Intellipap Auto or the Phillips PR one Auto, which are both less expensive than the S9, but with that difference in price (the Intellipap Auto is nearly half the price of the S9) am I going to be getting a poor quality machine? What am I missing out on if I go for one of these less expensive Auto machines versus the Resmed S9 he requested? I've read lost of good reviews about all the machines, but not a lot of negative reviews about any of them so I'm a little perplexed that there are no negative reviews.
• Humidity is important to me, are all humidifiers heated?
• What is the climate control tubing that he speaks of and does it make that much of a difference? Is tubing interchangeable from one unit to the next or is it something that is specific to a certain machine or mask?
• Are masks specifically designed for specific machines or are they all interchangeable?
• I understand that the machine technology has come a long way very quickly. I'm guessing what was top of the line five years ago is probably mainstream now, if that's the case, for those of you who have upgraded machines or tried different machines- I would love to hear your opinions on the improvements made and how you did before them and what you feel is worth the extra money for and what you could take or leave.

Thanks so much in advance, and I apologize for any repetition. I just really want to make sure I'm investing my money wisely since it is a huge investment for me at the moment. If it's going to make a huge difference in my quality of life, it'll be worth some expense but I can only afford what I can afford. I will continue to look on the boards for answers to similar inquiries, I've been working my way for the advice for Newbies section.

[Slinky]

Explain the situation to your sleep doctor. Its great that he cares enough to specifically script such a great APAP for you. Given your situation I would 1] price the DeVilbiss IntelliPAP Auto and 2] price the PR SystemOne Auto (call the online DME provider and ask if they have a better, unadvertised price) and then go w/the best price. You really can't go wrong w/either APAP. The Resmed is just NOT worth all that extra money given your situation. Buy your APAP online but your nask from a local DME provider w/a lenient mask exchange policy. And use your insurance NOW for the mask whilst you still have insurance.

In fact, it might be worth your while to call your insurance and ask them if they would purchase the APAP outright for you since its been scripted during your benefit coverage, even tho you won't be covered the entire capped rental period they prefer. There have been a few who have been lucky enough to have their insurance do that.

[cwied]

You're about to get a bunch of responses, I suspect. I'll try to give you some answers for the things I'm familiar with. I did a fair amount of research before deciding on the Resmed S9 Autoset. I do have insurance, though.

[*]The biggest determinant of price looks like it's going to be whether I get an Auto machine or not.
Do I need an auto machine? What's the benefit?
How much more comfortable is it?

The price difference between auto and not is not that big compared to the price difference between brands, as you've already discovered. I would go with the auto because it gives you more flexibility (since the auto can be programmed with just one pressure to make it effectively a straight CPAP machine).

The price difference within brands generally go along with whether or not they can detect and report respiratory events that happen during the night. When you see people here refer to machines as "fully data capable," they mean that the machines can both detect events (apneas and hypopneas) and record them so that you can view a history of the whole night (generally by using some kind of software for that machine and reading from the SD card in the machine). If you want more objective data on how things are working for you, you probably want to get a model that supports this.

The auto part is simply the ability for the machine to change pressure in response to the way you're breathing through the night. Obviously it can't do this if it can't detect events, so the auto-titrating machines are generally higher end. Comfort is only affected if you end up at a different pressure than you were titrated to at the sleep study.

The main comfort feature is actually the ability to lower pressure on exhalations. Each company seems to have trademarked their own name for the feature. It's called EPR (ResMed), C-Flex/A-Flex (Respironics), or SmartFlex (DeVilbiss), for example.

[*]Humidity is important to me, are all humidifiers heated?

[*]What is the climate control tubing that he speaks of and does it make that much of a difference? Is tubing interchangeable from one unit to the next or is it something that is specific to a certain machine or mask?

Most humidifiers that I saw were heated. Certainly each of the brands you looked at has heated humidifiers.

The climate control tubing is a Resmed feature that heats the tube and controls the air temperature and humidity more closely. The heated tube prevents "rain-out" - condensation in the hose in cold rooms. There are after-market solutions to heating hoses if you don't get Resmed's tube. Resmed's climate control tubing works only with Resmed machines that have that feature.

[*]Are masks specifically designed for specific machines or are they all interchangeable?

They all use standard size fittings, so as far as I'm aware they're interchangeable.

If you search on the machine names you're looking at it, you'll find many threads here describing pros and cons of the various machines. There are also several comparison threads so you can get an idea of what people find important in the machines.

FWIW, the DeVilbiss IntelliPAP Autoadjust was my second choice due to price, size, and 12V capability (makes it easy to operate on battery power if necessary - e.g. in a car or airplane). One drawback is that you have to buy an extra module for $150 (including software) to get the data exporting capability.

[Julie]

Hi, welcome to the forum (from someone using the Intellipap Auto). It is an excellent machine, and the price is 'right', plus (like the PR System One which I don't like, you can get basic and important information right from the machine each morning without having to spend on the software (that would give you more info, but especially for you may not be that necessary). My first question would be, especially as you know you snore (at least on your back), do you know for a fact that you do NOT end up sleeping with your mouth open? Because if you do, as many of us do, then getting a "full face" mask (it's just like a nasal one only extends a bit lower to cover your mouth - and there are other designs as well) rather than a nasal one to start with could save you money in the end. If you lose all the Cpap air out of your mouth then you're not going to get treated (or feel better). It also seems to be standard for MD's to order Swift nasal's - they are ok masks and can do the job if they fit you well and you don't need a full face one, but so many people end up switching to others (whatever the type) that if you can find a dealer to let you try various types (of both nasal and FF), preferably lying down, in different sizes, while you adjust and readjust the straps, etc. and with a machine that's ON, you can also find one that suits you best. As well, it's a standard (conservative) move to order a pressure of 7, but again, so many end up closer to 10 in the end, and that's something you'll work out as you go (and learn to experiment a bit on your own). Cpap.com (not Cpaptalk.com) allows you to try out equipment and return it if you buy "insurance" - about $50 per try - which may be more than you can manage, but does let you return unsuitable stuff.

You should also look into various ways to avoid sleeping on your back at all costs, because that seems to be your main problem and is called '"positional apnea", for which everything from those big body pillows to attached tennis balls is tried, and many do work. If you really don't have apnea except on your back, finding a way to sleep otherwise may save you a lot of trouble! I don't think a rental agreement would be a good idea for you, because it costs a lot more in the end, though I don't know enough about those to honestly tell you more (I'm in Canada), so others can do that.

You can run the humidifier at a very low setting and not have a 'rainout' problem (where water gets into your mask or you become congested) though if you're in Denver, you might want a higher setting . And if you don't necessarily sleep with the room very cold, you might not need the Climateline hose either - again, it's personal (and there are other ways to warm up the hose without spending lots of money at all).

I'm going to let someone else explain auto vs straight Cpap, except that with an auto machine you can set it for 'just' cpap, but not the other way around, and it also is more useful in other ways.

[jweeks]

Hi there, this is my first post!

Hi,

Oh no, not another cat person...

I am going to echo some of what Julie wrote. With positional apnea, if you can train yourself to sleep on your sides, you might be able to avoid using the machine, at least maybe for a few years. If you do want to get a machine right now, you sound like the perfect candidate for an APAP machine. That would give you minimal pressure when you are on your sides, and then it would ramp up if you get on your back and start having events.

The "try before you buy" is possible with a rental machine. The issue is that a few months of rental is going to cost more than what a used machine would cost. Since the mainline modern machines are all equally good machines (so long as you get a data capable machine), it really doesn't matter too much what machine you get.

For new machines, the PR system one APAP and the ResMed S9 APAP are great machines. Both are in the $800 or so price range. The forum sponsor, cpap.com, is a go-to place for new stuff. For used, check out a place called Second Wind CPAP. They have the ResMed S8 and Respironics M-Series for between 1/3 and 1/2 of new cost. These are cleaned and tested machines, with low miles (er, blower time), and they have a warranty. You certainly want a heated humidifier, so make sure you include one with any machine that you pick up. Again, the key factor is that you want a fully data capable machine that records AHI on a smart card or SD chip. Just having a card or chip doesn't mean it records AHI. If you are not absolutely sure, please post a note here and ask before putting down cash.

As far as the CPAP goes, having no insurance is not a show stopper. In fact, I have found that my local equipment company over-charges so badly that my co-pay prices are often higher than what I can buy the stuff for on-line when I pay for it myself.

-john-

[Emilia]

Hi... love that cat!! You might want to check out http://www.secondwindcpap.com for either a good deal on a new machine or get a gently used machine that has been refurbished, sanitized and comes with a 6 month warranty. I bought my brand new Intellipap Auto with Smartflex from them on a great combo deal of machine and humidifier. That price is still in effect. You should ask your doctor to give you a more generic Rx that says Auto Cpap of patient's choice and cpap mask of patient's choice with a lifetime expiration. That way you can upload it to online providers and purchase what you want when you need it. Other options are cpapauction.com run by our host site, cpap.com.

If you choose the Intellipap Auto, you will be very happy, and the software is very easy to use to monitor your therapy. Feel free to PM me if you have any questions......

Best of luck!!

[elena88]

Hi there,

this is great news that your apnea is only positional right now.. you can train yourself not to sleep on your back..

If you get a machine you are a candidate for an auto because you have positional apnea..

My insurance did not pay for my machine either, but I got an s nine autoset, and Im so glad I did because my pressure needs have changed

so drastically from my first sleep titration a few months ago..

yours might too..

If I knew I had positional apnea, I would just sleep on my side or stomach.. but you said you had no trouble with the machine?
that is fabulous if your needs change and you need to wear it all the time..

I have had a disasterous time with my apap, not because of the machine, but because my titration pressure was so far off..

If you get a machine, get an auto, if your needs change, its easier to sell, if you need to keep it, it will adjust to your needs..

I was able to borrow a bipap from the hospital where my sleep doctor works, and they didnt even charge me for it..

[jacquesmama]

Thank you all so much for responses, and so quickly! I'm really relieved to see so many of you suggest that the brand isn't all that important and your confidence in many of the machines. I'm also really grateful for all the tips about what to ask my doctor for regarding the RX, the explanation about the comfort tubing, and the suggestions about puchasing a mask elsewhere for a return/trial. I'll see about calling the insurance too.

I don't think I can train myself to not sleep on my back. I can't sleep on my right side for very long because of some shoulder pain so that would mean sleeping on my left side only all night. As it is, I feel like I flip around a lot at night, but I guess it's no more than normal.

My doctor said that I didn't appear to be a mouth breather, so the nasal pillow mask would work well- he said that a lot of people have trouble breathing only through the nose. Maybe that will change later? What do you do when you have a cold if you wear a nose mask?

[jmcanzo]

I had to pay for my machine out of pocket also. I found the DeVilbiss Intellipap Auto to be the best deal. It has a 3 yr warranty one of the longest. You can get some data from it using the smart codes and the DeVilbiss website. IF you want to have more detail you can purchase the data module at a later date. The DeVilbiss also has user upgradable firmware. What this allows is upgrades without buying a new machine. Mine currently does not have the smartflex, but by downloading the new firmware and installing it (via a inexpensive cable) My machine will have all the features of the current ones being sold.

[Justsomeguy]

Hi Jacquesmama,

Regarding the nasal pillow, I recently got a Sleepweaver nasal mask and I like it (mostly). It's a thin, soft, tent-like material and it's way more comfortable than a hard plastic mask. It inflates like a Jimmy Durante nose when the machine is on. You can scratch your nose easily or plug the air hole with your finger if you need to say something. The straps aren't as bad as the hard mask either. It is a little louder than the mask, and unfortunately it seems to lose a lot of the humidity the machine generates. I've woken up most mornings with half the water in the tank gone, but my gums glued to my teeth and my mouth very dry.

I would hope this type of mask would be much cheaper than a hard mask considering it's made with what appears to be about $10 worth of material, but being a medical device I suspect the price will be inflated accordingly.

Good luck

[drkarrow]

This won't be a popular suggestion, but check craigslist. People list used cpap machines for cheap all the time and individuals selling usually don't care to much about prescriptions. Some people with very good insurance will get machines for practically free, never use them, then sell them. Others are from elderly patients who pass away. Just make sure it is a make and model that your medical facility is familiar with so that you can bring it in and have the set the pressure for you. I wouldn't dare use a used machine without taking it in for the doctor to check out and set the pressure.

Used hoses masks can be found on craigslist too. But that goes a little to far for most people. If properly cleaned it's not an issue, but mentally most people have an issue with the thought of used equipment.

Humidifiers, heaters, and all of that are luxuries. They make life better, but you can get by with out them.

I'm sure someone will chime in on all the reasons not to go with used 2nd hand equipment. But if it's all you can afford it's better than falling asleep at the wheel one day causing you to drift off the road and take out a few pedestrians.

[brazospearl]

jacquesmama, welcome to the forum! You've come to the right place to learn how to get the most out of your therapy! Even though you've been diagnosed with mild apnea, beginning treatment NOW will reap many health rewards for the rest of your life.

Many of us have purchased our equipment out-of-pocket, so you're not alone in looking for a bargain. As others have mentioned, secondwindcpap.com does excellent work, and their prices are about as good as you'll find for machines that are certified to work. While the S9 is the current top-of-the-line machine (and lucky you to have a dr. who knows that!) it certainly isn't the only one that can offer you great therapy. It appears that the DeVilbiss IntelliPAP provides excellent therapy and data for minimal price. The key is to have full data-capability, and it'll be handy to have an auto as well. Some people have different pressure needs depending on sleep position, sleep stage, other medical conditions, whatever, and the auto machines (when set to the proper range) work best for them. Autos are also useful for doing a bit of self-titration, which is handy because the pressure from your sleep study might not be best in your day-to-day life. If you don't need the auto, or if the pressure change bothers you, you can turn it off; but if you purchase a straight cpap ONLY you won't have the options afforded by the auto. Exhalation relief isn't just a "comfort feature" for some people, neither is a humidifier. While not strictly essential, they can smooth out a lot of potential problems. I think all humidifiers are heated, although they can be run in passover mode so the air isn't warmed. Mask selection is key, and probably the trickiest component to get right, sort of like finding the perfect jeans--what works best for one might not work best for you. Nasal masks are smaller and lighter, but if you mouth breathe you might prefer a full-face or Hybrid.

It'd be great if your doctor would write the script for "fully data-capable auto-titrating machine of patient's choice" and "mask of patient's choice" so that you can get the best deal possible. Keep reading all you can here, and take a few days to research how to get the most for your money. Ask us anything, we're here to help!