Which machine to get?

[Sleepless in Ca]

I am about to be evaluated by Kaiser after using their CPAP machine for a week. I am unclear how much say I will have in picking a machine. I will be private pay since I do not have coverage for durable goods. I am not concerned with saving money at the expense of sleep comfort and the best machine.

I am trying to figure this all out. At first look it seemed like a bilevel machine would be best but because it covers both inspiration and expiration. But what do I know? Nothing. Will the 1 week test I just did reveal if I need a bilevel machine? Is it not good for the DX of severe obstructive sleep apnea?

I noticed many on this board use the S9 AutoSet™ CPAP Machine. Is that better than the S9 Elite? Are these 2 used for different kinds of sleep apnea? Is the S9 Elite set at a certain pressure while the AutoSet machine changes with the patients's needs? It would seem that the AutoSet would be more flexible. How does the doctor determine his prescription?

Evidently, Kaiser has a deal with Apria to cover all their sleep apnea patients, whether Kaiser is going to pay for the equipment or not. Apria told me there is a better price for Kaiser patients but they would not tell me their regular price. So I am unclear how good this price it. Anyone know about this? I am not sure if I should buck their system if I find their prices to be higher than I can get online.

Also are there newer and older models of the S9 series? I read a warning somewhere to be careful I did not get an older model without the latest features when I ordered a machine, that companies move their old stock out first. Wouldn't older models have a different name?

I am a bit stressed. Even though I do not love sleeping with the CPAP I am now afriad to sleep without it. LOL I have to turn my machine in today and will be without one for 5 to 10 days for their reading and then however long it takes me to get my own.

Thanks for your help.

[kaiasgram]

I'm a Kaiser patient in northern California (Sacramento area) and like you I have no DME coverage. You are not limited to Apria or any other supplier. You can purchase from whomever you like. I've bought from our forum host, cpap.com, and also from secondwindcpap.com, and have had very good experiences with both.

If you let the prescribing doc know that you're buying out of pocket he or she is more likely to be amenable to your preference in machine since it isn't costing Kaiser anything. And if there's any other silver lining to having to buy your own machine, you won't have to deal with compliance monitoring.

The dx Severe refers to how often on average you have apnea events and has nothing to do with what pressure you will need. The pressure is about your anatomy and what's needed to hold your airway open. Bipap is good when you need a high pressure and with certain other situations.

The S9 machines are ResMed's current line.

Do not stress! When you get your prescription but before you buy anything, let us know and we'll help you navigate the waters.

And feel free to send me a PM if you're in my Kaiser area and want more help navigating Kaiser sleep medicine.

[LSAT]

I am about to be evaluated by Kaiser after using their CPAP machine for a week. I am unclear how much say I will have in picking a machine. I will be private pay since I do not have coverage for durable goods. I am not concerned with saving money at the expense of sleep comfort and the best machine.

I am trying to figure this all out. At first look it seemed like a bilevel machine would be best but because it covers both inspiration and expiration. But what do I know? Nothing. Will the 1 week test I just did reveal if I need a bilevel machine? Is it not good for the DX of severe obstructive sleep apnea?

I noticed many on this board use the S9 AutoSet™ CPAP Machine. Is that better than the S9 Elite? Are these 2 used for different kinds of sleep apnea? Is the S9 Elite set at a certain pressure while the AutoSet machine changes with the patients's needs? It would seem that the AutoSet would be more flexible. How does the doctor determine his prescription?

Evidently, Kaiser has a deal with Apria to cover all their sleep apnea patients, whether Kaiser is going to pay for the equipment or not. Apria told me there is a better price for Kaiser patients but they would not tell me their regular price. So I am unclear how good this price it. Anyone know about this? I am not sure if I should buck their system if I find their prices to be higher than I can get online.

Also are there newer and older models of the S9 series? I read a warning somewhere to be careful I did not get an older model without the latest features when I ordered a machine, that companies move their old stock out first. Wouldn't older models have a different name?

I am a bit stressed. Even though I do not love sleeping with the CPAP I am now afriad to sleep without it. LOL I have to turn my machine in today and will be without one for 5 to 10 days for their reading and then however long it takes me to get my own.

Thanks for your help.

If you are "private pay"...DO NOT PURCHASE THE MACHINE FROM KAISER OR ANY OTHER DME. Purchase the CPAP on line. You will save many $$$ and get a better machine.

[Sleepless in Ca]

Thanks Lsat, I will definitely shop around! It appears that this is going to be an ongoing big expense for me.

Thanks kaiasgram! I am in the Bay area. I have only been looking at S9 models because most people on here seem to have them. I assumed they must be good.

I see you have the S9 VPAP™ Auto BiLevel Machine. I was initially interested in that one. But I read a report online comparing the BiLevel with the CPAP and it said in a study more people had heart attacks with the BiLevel but it also said there might not be a correlation. But that scared me. I also could not tell what exactly the people were being treated for with the machine.

So if the reading tells them I do not need such high pressures, then perhaps a BiLevel is not necessarily a better machine? Why did you get that one?

Once I figure out the machine I will have to move to masks. I need a full face one. I am noticing my current one is drying out my eyes too much. And today I had such blurred vision. Can it cause blurred vision?

Woe is me.

[kaiasgram]

Happy to explain why I'm now on VPAP, will do when I get home from work in another hour or so. Meantime would you post a link to the report you read about Bipap vs. cpap? On the face of it, the conclusion drawn from the report makes no sense. I'd really like to see it. Thanks.

[Sleepless in Ca]

Well shoot. I just went thru any possible searches I had done the other night looking for the study. I did see a few articles highlighted that let me know I had already read them. But not the study. I wonder if it still would be in my history. I will look.

[martinsr00]

Thanks Lsat, I will definitely shop around! It appears that this is going to be an ongoing big expense for me.

I see you have the S9 VPAP™ Auto BiLevel Machine. I was initially interested in that one. But I read a report online comparing the BiLevel with the CPAP and it said in a study more people had heart attacks with the BiLevel but it also said there might not be a correlation. But that scared me. I also could not tell what exactly the people were being treated for with the machine.

First, you want a data capable machine. Than you can keep stats on yourself night by night and be forwarned of problems. You can also experiment around a bit if you wish and optimize your pressures. This won't work when your DME or physician locks down your equipment.

I paid also out of pocket. My sleep study showed the need for a Bipap machine. After receiving it, though, I discovered why you would want a data capable Bipap machine over a data capable Cpap. An auto bipap machine can be "dumbed down" to be a non-auto bipap machine or a plain CPAP machine. With data capability and extra capability, you can better react to any future changes. After fooling around with pressures for about 3 months, I dumbed down my machine to a non-auto bipap machine. All works well.

[kaiasgram]

Hi sleepless -- I did a real quick and dirty search, the only study I came across was a 2006 meta-analytic study where they found a statistically insignificant trend toward new onset heart attacks in a cohort of patients with pulmonary edema. Does this sound like the study you looked at? Honestly, as prone as I am to worry and anxiety in general I'm not even raising an eyebrow over this. I don't know your health history or age, so I can't know what your concerns might be about this issue, but I have to wonder if it's worth even a second thought.

Moving on -- I started a little over a year ago on a ResMed S9 Autoset (auto-adjusting cpap). My machine pressure often wanted to go up to 9 or 10, but above a pressure of 8.5 or so I was getting painful aerophagia (swallowing air) which was causing sleep disruption and pain in the morning. I switched to the S9 VPAP Auto which allowed for more pressure relief during exhalation and resolved my aerophagia. Some pressure relief is available on regular cpap and apap machines but it's limited to 3 cms difference between inhale and exhale. With bilevel you separately set inhale and exhale pressures and can have a much greater difference between inhale pressure (IPAP) and exhale pressure (EPAP). But another plus for me with my VPAP is simply that it responds more sensitively to my breathing rhythem as it switches between inhale and exhale pressures compared to when I was on APAP using the exhale pressure relief feature. This alone makes it worthwhile for me.

Not everyone has problems with aerophagia, and some people only have a problem with it at much higher pressures than what triggers it for me. I can tell you I'm not the only person who could technically have effective apnea treatment on cpap or apap, and at relatively modest pressures, but who chooses bilevel for the additional breathing/sleeping comfort it affords.

I hope this helps.

[Sleepless in Ca]

So what you are saying martinsr00, is that with a data capable auto Bipap machine, you have the flexibility to have 3 types of machines in the one so more of a choice going forward?

kaiasgram, I looked thru 10 long pages of history. I had no idea I visited that many sites in the last week! I so need a life. I could not find the study. The one you mentioned is not it. It was not talking about a specific disease. It did talk about being in the hospital and then going home with the machines. I do have some cardiac issues because of my sleep apnea plus I was severely anemic for a long while. I have had 7 transfusions and 3 iron infusions in the last 2 months and my hemoglobin is still not in the normal range. Between that and the sleep apnea, I wonder how I ever got out of bed.

I guess I need to wait to see what my pressures were all week. I do not have a lot of confidence in Kaiser. It reminds me of paint by numbers, care by numbers.

I do have a question though. With the machine I got from Kaiser, the air would only blow out when I was taking a breath. Not all the time! Though last night when I first got on it, the air was blowing out all the time which I did not like. It took about 10 minutes for it get into the rhythm of my breathing. In reading today, I see where it says you have to breath out with the air blowing on you and it is more work to exhale that way. Well my machine was not doing that. Was it broken?

Wish me luck tonight. I am not looking forward to sleeping tonight without a machine, as I was also not looking forward to sleeping with a machine all last week. LOL. Tough place to be in. I told my husband my most favorite activity, sleeping, has now been ruined for me. When trying to nap today without it, as I fell asleep, I kept getting the feeling of suffocating. It happened 5 times and then I got up. That is what has been happening for months, but only as I fell asleep. I had no clue I had sleep apnea for I never woke up with that feeling though I would wake up every 2 to 3 hours and have to get up. I just didn't know why.

[kaiasgram]

I do not have a lot of confidence in Kaiser. It reminds me of paint by numbers, care by numbers.

Yeah, I'm with you on that. My "sleep study" consisted of wearing a fancy oximeter at home for a night. Then a week at home with a ResMed S9 Autoset for titration. The fact that the machine doesn't know whether you're awake or asleep apparently is not of great concern for them -- very little of the time I spent on the machine that week was true asleep time. And no humidifier, no choice of mask, they did nothing to try to make the experience even approach slightly comfortable. But I digress...

I do have a question though. With the machine I got from Kaiser, the air would only blow out when I was taking a breath. Not all the time! Though last night when I first got on it, the air was blowing out all the time which I did not like. It took about 10 minutes for it get into the rhythm of my breathing. In reading today, I see where it says you have to breath out with the air blowing on you and it is more work to exhale that way. Well my machine was not doing that. Was it broken?

Probably not -- the pressure stays low as long as you're awake because you're breathing and don't need the machine's help. And because the pressure is low, it could well feel like there's no incoming air when you're exhaling. But there is.

There is actually a steady flow of air coming out from the port holes on the mask (your exhaled breath has to escape somehow). Once you're in the rhythm on the machine, the air flow from the port holes will feel stronger when you exhale, and lighter when you're inhaling. I think that being unfamiliar with the whole setup you probably thought things were going wonky when it's really just that you're totally unfamiliar with how it's supposed to feel. Either that or Kaiser sent you home with a lemon. But probably not!

Wish me luck tonight. I am not looking forward to sleeping tonight without a machine, as I was also not looking forward to sleeping with a machine all last week. LOL. Tough place to be in. I told my husband my most favorite activity, sleeping, has now been ruined for me.

Don't worry sleepy, just try to relax with this whole deal. The tough place you're in now, we've all been there. And one good thing about not having to buy your machine from Kaiser is that you won't have to wait as long as those KP patients who do have to wait on Kaiser. I've heard the wait time is really long. I sent a note along with the titration machine when I turned it in after that first week, with the cpap.com prescription form, and I asked the doc to please fax it in asap since I'm buying out of pocket. I think cpap.com had the Rx within a day or two, and I had my machine a couple of days after that. No weeks and weeks of waiting. Be sure to let the sleep dept. know that you don't need them to order your machine for you and that you need the Rx sent to you directly. Otherwise you'll likely get herded into the wait line because they'll assume that you want to go through them to get your machine. I think most Kaisers dispense Philips Respironics machines anyway -- they're perfectly good machines but since you sound like you want the ResMed S9, you'll likely be ordering on your own anyway.

Oh, and yes, your understanding of auto bilevel is correct -- you can use it in straight cpap mode, or auto cpap mode, or fixed bilevel, or auto bilevel. Maximum flexibility. Higher price too.

Keep asking questions, we'll be here for you.

[Sleepless in Ca]

Thanks kaiasgram.

Kaiser just called me. I had written a note in with my machine when I returned it to please call me and surprisingly they did. What the gal said was that I had 5 episodes of apnea every hour with CPAP and she was happy with that. Though from reading on here, that seems high. She said the pressure used most of the night was between 5 and six. To reduce that 5 shouldn't I have higher pressure? With a pressure of 5 to 6 (which is low isn't it?), I am thinking I do not need a BiLevel or is there still some worth in getting that one over the auto CPAP?

She was against the BiLevel but agreed to the S9auto CPAP. Though she did say she would write on RX Patient's choice.

I had meant to ask her about CPAP and Pulmonary hypertension. I am wondering if one machine type is better than another with this DX. But of course I forgot. So I called back and left a message but who knows if I will get a call back.

I am also wondering if I should rent a SP Auto CPAP to just try it.

Any thoughts on all this?

[forthguy]

Evidently, Kaiser has a deal with Apria to cover all their sleep apnea patients, whether Kaiser is going to pay for the equipment or not. Apria told me there is a better price for Kaiser patients but they would not tell me their regular price. So I am unclear how good this price it. Anyone know about this? I am not sure if I should buck their system if I find their prices to be higher than I can get online.

I don't know their exact prices (fortunately, my DME is fully covered by my Kaiser policy), but they put replacement prices on my titration-loaner authorization form. I think the PRS1 CPAP Auto was around $1000, with the BiPAP Auto around $1500. So, based on what I've read around here, maybe better than your average person walking into a DME, but certainly not better than some of the online prices I've seen.

And for reference, I'm in the Diablo/Solano Kaiser region.

[kaiasgram]

To reduce that 5 shouldn't I have higher pressure?

Possibly, but it depends on what kind of apnea events you were having. We'd need to see the breakdown of your apnea events -- obstructive/hypopnea, and "clear airway" or "central" events (if there were any of those). The cpap/apap doesn't treat central apneas, so in that case higher pressure would not be relevant. If it's all obstructive stuff, then a pressure increase might help. Once you get started with your own machine you can download free software and begin to see exactly what's going on.

With a pressure of 5 to 6 (which is low isn't it?), I am thinking I do not need a BiLevel or is there still some worth in getting that one over the auto CPAP?

Yes 5-6 is a low pressure, so low in fact that a lot of people feel uncomfortable ("not getting enough air") with pressure that low. (No wonder it felt at times like there was no air flow as you described in your earlier post.) The lowest the machine can go is 4, so you're almost at rock bottom! If you're comfortable with it and it's effectively treating your apnea, then cool! And if it turns out you want to try to bring your AHI down below 5 by increasing your pressure, you may be able to do that and still be within a very modest pressure range. Which leads to your bilevel question -- you could push for it but your pressure requirements (even if you adjust upward a little) are so low that it really may not be worth pursuing.

I had meant to ask her about CPAP and Pulmonary hypertension. I am wondering if one machine type is better than another with this DX.

It's good that you called them, let us know what they say. If the issue is keeping the pressure as low as possible while still treating your apnea, then I'm imagining that auto mode would be good because the pressure only goes up when you need it and goes back down when you don't. The other aspect of keeping pressure as minimal as possible would be exhalation relief. At your currently prescribed pressure of 5-6 you could use EPR (exhalation pressure relief) with the S9 Autoset, which would bring your pressure down to 4 when you exhale. The machine can't go lower than 4, and that's true for both cpap/apap and bilevel. So as far as exhalation relief, in your situation with your low pressure settings a bilevel machine would have no advantage over cpap or apap. I hope this makes sense.

[lastlib]

In Columbus there are CPAP stores in at least 2 shopping centers. They look like apple stores and have many CPAPS and accessories on display. They do not take insurance or medicare. The people work in them are generally very knowledgeable. Take your sleep study into the store they will help you by showing many machines that meet your needs. Then call your Doctor and ask him to prescribe the machine you want or explain why it does not meet your needs. If he refuses remind him that if he picks a machine you will expect that he is guaranteeing the result and you will now sue him for malpractice for any unfortunate circumstances because he has taken the choice from you and chosen to play God.