Sleep study necessary? Humidifier? Auto? Mask?

[Guest]

I am M, 48, a CPAP user since dinosaurs left the planet, starting in about 1990. I worked at the Kansas University Medical Center and ended up in the Ear Nose Throat dept with the classic symptoms. I was told I had a deviated septum and needed surgery, done. It was really quite painless, until they removed the LONG plugs out of my nose. No help and I did a sleep study. The "study" lasted about 2 hours maybe, in a motel across the street. They woke me up, said I had a lot of episodes or something, here's your machine, it's set up, bye. I have had exactly 2 machines. The first was about 12"Hx8"wx8"D, didn't really fit into a suitcase, and weighed about 20lbs, siezed tight in the end. I miss the squirrels and other little critters that lived inside that beast. The REMstar LX (set on 12), much smaller but must be about 6 years old now. I have not had many masks in that time either, the current broken, rubber banded, Ultra Mirage is by far the shortest lived one, over a year old.

I'm a side sleeper and my only real problem is waking every night between 3am and 5am, go to the bathroom, turn on the PC, do some stuff, and blow my nose about 20 times. After an hour or so, I go back to sleep. If I go to bed at 10pm, I wake at 3am, if I go to bed at midnightish, I wake at 5am it seems.

I talked to the nice benefits people in my company and they recommended another sleep study, new machine, etc. Although it has been a long time since I had this done, it's obvious I have apnea, and my machine works fairly well. To be honest, I don't want another study, even if it is "like a hotel".

Would you do another sleep study?

I went to the place where they do the studies to see what equipment they have. Everything they had was Resmed stuff, which I want to boycott after reading info here. They said "A little S8 Escape Travel CPAP, Nasal Swift or Activa is what we sell everyone". Not many choices it seems. Also "ALL masks wear out in about 3 months" didn't sound good. They also said "Your congestion is cause by a dry nose, get a humidifier".

Would you agree, and get a humidifier?

I have never had a humidifier and am not sure it is needed after all this time or if they are trying to make a sale. I am not one for doing a lot of maintenance on this stuff. Distilled H2O would be ok.

It would seem that an Auto CPAP would do the trick nicely, adjusting to my needs. Again, I am not sure because I have never had one, and don't really want to do a lot of monkeying around with it if possible. That said I am a computer geek, built my own for a very long time, have a dual Opteron Linux server, a WinXP laptop, 5 AMD64 Linux PCs networked. I am also a programmer/hacker, and worked on every system imaginable. Smart cards with data sound tempting, very, very tempting.

Would you get an auto after all these years on a regular CPAP? After all a regular machine can be patient reset now evidenlty.

Another thing that is intriguing is the nasal type masks like the Comfortlite2. It must seal well in my large round nares, works ok, low maintenance too. I hate the stripes across my face every day.

Would you try the newer style masks with nasal pillow thingies or say with the old style only?

I know I have exceeded my allotment of questions, but do people here really change machines and masks as often as it appers? I hope to make some kind of decision on this over the weekend and order stuff from CPAP.COM for having this nice site. I'm thinking of a REMStar CFlex (auto?), ComfortLite2, another nasal mask (Comfort Classic?). Keeping the old rig for a backup, fixing the mask.

Thanks in advance, Jim

[Goofproof]

A lots of things have changed it 6 years,(I got old even), The establishment will want you to get another sleep study, but if you can get the script without one, I would go for a Remstar Auto with the heated H, the old model, from cpap.com for $709, I got one three week ago and love it. You need the software and reader to go with it and probably a new mask, it sounds like you have retreaded it a few times, so have I. By using the Auto and the software, you can tell what the machine is doing for you and the pressure you really need, even the sleep study can't get that right sometimes. If you have strange sleep problems, the sleep study might find that out. It's about time to put the old machine out to pasture, gentle, it's served you long. Jim

[NightHawkeye]

Would you do another sleep study?

No, not unless there's value added by doing one. You already know the verdict, and an APAP will titrate you better than the lab can. The APAP will also less costly than a sleep study.

Would you agree, and get a humidifier?

Not if you do just fine without a humidifier and are happy that way. Me, on the other hand, I use my heated humidifier religiously. It helps me a lot.

Would you get an auto after all these years on a regular CPAP? After all a regular machine can be patient reset now evidenlty.

Yes, an APAP is more cost effective than a new sleep study. It will also titrate you better than a new sleep study.

Would you try the newer style masks with nasal pillow thingies or say with the old style only?

The ComfortLite 2 is a great mask. I currently rate it as tied for first place along with another of the five masks I've tried.

I know I have exceeded my allotment of questions, but do people here really change machines and masks as often as it appers?

Only the geeks among us who like to play with stuff. .

Regards,
Bill

[linda b]

I also have the Remstar Auto with C-Flex and heated humidifier, both of which I like very much. And I have the ComfortLite 2 nasal interface. I use the simple cushion along with the extra 'pantyhose' strap to provide a little more stability. I can't address the issue of older equipment as I have been on this therapy only two months

As to whether or not to get the humidifier, I can only attest to my experience. Before I started APAP therapy, I had a big problem with at least one nostril stopping up every single night which caused allot of mouth breathing. Since using the APAP and humidifier (mine is set on the lowest heat setting), I've had no more problems with a nostril stopping up. It has really been quite amazing!

[dsm]

NightHawkeye said it all and succinctly.

Ditto that from me

Good luck (PS I think I have one of those old 20lb monsters - bought it to add to a cpap museum. This one still works & works (ell it is a tad noisy)

This unit is 12" deep by 8" wide by 7" high. Being as old as it is (the 1st Bipap brought to market) it only has 1,383 hrs on it. I have an old PB318 with 17,000+ hrs (that still works too - vacuums just as well today as it would have had the fan been used for its original purpose )

Some of the older machines were incredibly well built.

DSM

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[najames]

I'm up right on schedule, 4:45am. Thanks for the quick responses.

I looked up the PB318 and it is FAR more modern than my first machine. As I recall, it only had an on/off rocker switch, no LCDs or anything. I wish I knew what it was.

I am ashamed to admit it, I haven't done a sleep study since the first one in the 90's. When I got the LX, I just told them the settings from the first one and they set it up the same. I don't think I even got script for it, can't remember it's been too long. I think my docs would give me another script. Our clinic at work is open until 6pm, so I went to see them yesterday for one, but the docs had already left.

You all have me sold on the APAP, ComfortLite 2 (willl get another regular nasal mask just in case). I think I will give the humidifier a try, it might help. I assume I can use the system without water if it bothers me.

NightHawkeye, thanks. I am actually an old Iwegian too. I grew up in the little dinky town of Rockford. My two brothers are still there. I migrated south to the KC area, then finally got sick of the winters, and moved to Florida. I have been here for about 10 years.

This forum seems strange (not the people). I registereed, logged on and yet I was listed as the evil "Guest". Now when I scroll down and look below at the history, the avatar info below your names is gone. I'm using Ubuntu Linux and it's the same in both Firefox and Opera browsers. Other tech forums I visit don't do this.

Thanks again, back to bed. Jim

[ghmerrill]

I recently switched from CPAP to an APAP -- footing the cost out of pocket because I came to believe that was what I really needed and the insurance wouldn't pay for it.

I'm thrilled with the result. I got a 420e with an integrated heated humidifier and am very happy with it so far. It has solved all the problems I was having.

I would not get another sleep study. I'd read a couple of articles out there (at least one is a genuine epidemiological study) about patients "self-titrating" with an APAP and conclusions that in general APAPs should be given to patients who are clinically (i.e., sans sleep study) diagnosed with sleep apnea. Since you already went through a sleep study, this will make even more sense to you.

Concerning the heated humidifier ... I could not live without one. When I switched to the 420e, I also got one of those "socks" to insulate the hose from the humidifier to the mask. This completely eliminated condensation in the hose. And the almost immediate result was that my long-term mucous and nasal congestion problem almost disappeared over night.

[Guest]

am M, 48, a CPAP user since dinosaurs left the planet, starting in about 1990.

Would you do another sleep study?

I'm going to break with the crowd here and suggest to you it might be a good idea to have another sleep study. It's been 16 years since your last one. It's probably worth the aggravation to see how you're doing in terms of desats, centrals, hypopneas, PLMs, etc. Apaps are great for titration, but useless for evaluating the aforementioned variables.

Would you agree, and get a humidifier?

Yes, I would. Try it, you might like it. If not, don't use it. Moist nasal passages can actually cut down on the amount of nose-blowing you're doing. Sounds like the opposite would be true, but it isn't.

Would you get an auto after all these years on a regular CPAP? After all a regular machine can be patient reset now evidenlty.

I'd see what the PSG tells you. What you learn might influence what machine you want. For garden-variety OSA, a regular cpap is adequate as long as you get one with software giving more than just compliance info. That way you could adjust your pressure based on your nightly data. If you want something beyond adequate, I'd look at the Respironics Remstar Auto with C-Flex and heated humidifier.

Would you try the newer style masks with nasal pillow thingies or say with the old style only?

I believe in trying new masks. You never know when you'll find one you love. Nasal pillows are great. The Breeze, for instance, leaves no marks on your face.

I agree with you about Resmed products. Buying their equipment is, in effect, condoning their actions. Who, in good conscience, could do that? Respironics has everything you could possibly need or want, so removing Resmed from the equation is inconsequential.

[Guest]

Get the sleep study. 16 years alot can change.

[najames]

I decided not to have another study done.

I actually went to the Sleep Clinic's office/clinc Friday. They were only selling Resmed equipment for "all their patients", which I didn't like obviously. They were really pushing the study, repeatedly saying it was "like a hotel", instead of what I'd gain from it. They also did suggest a humidifier however.

I ordered the new equipment Saturday, Remstar Auto C-Flex, Comfortlite2, Comfort Classic, and hose cover. I will have to likely read up on the settings, jargon, etc. I want it to be simple, so I don't have to spend all my time on monitoring it. After all, I didn't die from the machine with only an on/off switch that I used for about 10 years.

The company administrated insurance here is in shock-and-awe at the price savings available. I am the guniea pig, it it goes well for me, others waiting in the on-deck circle follow. They said another person needs a bi-pap, which they were being billed $3000+ for it vs $1300+ here.

Hmm, I wonder how much it would cost me in Thailand, my wifes home country?? She recently had medical tests done here, costing several thousand dollars. She had the same exact work done in Thailand, as a follow up and second opinion. It cost $87 there, which I gladly just paid out of pocket. The same can be said for dental work, $2500 here, there less than $300. Progressive lens glasses are $400-500 here, about $125 there for the exact same thing. I think medical equipment expenses have gone to the greedy here.

[NightHawkeye]

Hmm, I wonder how much it would cost me in Thailand, my wifes home country?? She recently had medical tests done here, costing several thousand dollars. She had the same exact work done in Thailand, as a follow up and second opinion. It cost $87 there, which I gladly just paid out of pocket. The same can be said for dental work, $2500 here, there less than $300. Progressive lens glasses are $400-500 here, about $125 there for the exact same thing. I think medical equipment expenses have gone to the greedy here.

Please correct me if I'm wrong, but I'm also assuming that your wife received better service and care in Thailand than she would have received here. That's just the general impression I've gotten from reading a little on the subject and having spent some time in Asian countries myself.

Regards,
Bill

[ladytonya]

Since it's been 16 years since your last PSG, I'd still get another one. Just because the sleep clinic pushes a certain brand equipment doesn't mean you have to buy from them. Like one of the guests said, there are a lot of things that can't be monitored by just using an apap. It will give you a ton of information, but still not everything that a new sleep study would give you. Just my humble opinion.....

[najames]

Bill, you are right on. They were very thorough in Thailand, with much more personalized service it seems. She commented how much more careful/considerate they were compared to a doc was here, not to mention they are honest and if something isn't needed, they don't do it. Her "highly recommended" doc here wanted to do surgery, the Thai docs all said "for what, nothing is wrong". Yes, the docs speak English there because they were trained here, and other folks are sooo nice too.

She will likely go to Thailand for all fairly major medical work from now on. I wouldn't hesitate going their at all either. I was seriously considering sending her home for a crown she needs on her teeth and some other dental work too. It was about the same cost. We like our dentish here but I question fixing "pre cavities".

I really don't mind paying the doctors and dentists here. They've worked hard and deserve the money, but the bloated medical supply costs, and stuff like billing $300 for just sitting in a disgusting, peeling waiting room here drives me nuts.

[diddler]

To guest post:

What are you referring to, "Condoning resmed's actions." Also, oversimplified to state respironics has everything you could want. There are differences of substance between the two (respironics and resmed). I am not saying one is better than the other, only that there are meaningful differences.

Look forward to my being educated about what appear to you as unacceptable behavior by Resmed.

Thanks

[Guest]

What are you referring to, "Condoning resmed's actions."

Haven't you heard?

In August the firm plans to implement a 40% price increase on Internet prices to get them in line with reimbursement rates.

ResMed currently is sending letters to its online vendors asking that they agree not to resell the products to other distributors, and not sell them internationally.

The wild card is how all this will play out with consumers and vendors, Warren says.

"What will the competitive response be?" he said. "Does anything ResMed or its competitors do precipitate litigation from consumer groups, or from people who currently sell on the Internet?"

These concerns aside, ResMed's marketing machine is roaring away.

http://www.investors.com/editorial/IBDA ... e=20060620

Internet retailers concern ResMed
by Mike Moran, Editor

POWAY, Calif. - ResMed plans in September to implement strict new quidelines--including mandatory minimum pricing--intended to bring law and order to the Wild West approach some online retailers take when selling CPAPs.

"We are going to be strict about enforcement of our Internet policy," said Hillary Theakston, director of communications. "If we find that an Internet dealer is not in compliance, then we will stop selling to them; it's as straight forward as that,"

At issue: Online retailers who sell CPAPs at prices so discounted that they can't afford to offer follow-up service, maintenance or education. The result: Very low compliance.

"We view this as a quality issue," added Stefan Elterich, vice president of sales, North America. "If the follow up care isn't there, it ultimately reflects on our products and the quality of therapy they provide. From that standpoint, this policy serves our interests in providing high quality therapy."

ResMed estimates that currently about 5% of all CPAP business occurs over the Internet. But as this distribution channel grows and competition increases, the company wants to ensure that patient care is not sacrificed, Elterich added.

Bricks and mortar providers, especially those selling power wheelchairs, have long complained that while Internet retailers often offer great prices because of their reduced overhead, some give little in the way of after-sale service. To counter this, a number of manufacturers have set minimum standards for service and maintenance and don't sell product to any provider--Internet or bricks-and-mortar--who doesn't meet those standards. (See HME News 5/2002).

Several manufactures of sleep products either declined to comment or did not return phone calls for this story. Invacare's vice president of sleep, Ann MacGregor, however, call ResMed's policy "a good thing."

"In every major conversation among manufacturers over the past four years, I've heard complaints that patients end up showing up on at a provider's door because they can't get care from the online seller," McGregor said. "It is commonplace."

Invacare doesn't do a lot of CPAP business with online providers and has not developed a sales and service policy, she said.

In addition to strictly enforcing its suggested retail price, ResMed expects Internet providers to use marketing material as intended, not to resell products intended for the U.S market internationally and to offer education, information and a support team that patients can contact for help.

One Internet provider of CPAP speculated that ResMed implemented the new policy to appease bricks-and-mortar customers upset at losing business to lower-priced Internet providers. ResMed officials denied the charge.

"They look at us as trailer trash or that we stick it in a box and just ship it out, and we don't," said the Internet provider, who asked not to be identified. "They are coming down hard on us."

Tracy Nasca is senior vice president of Talk About Sleep, a resource Internet site for people with sleep disordered breathing that also sells CPAPs. ResMed's new policy, she said, levels the playing field. Some Internet retailers sell products for less than she can buy them.

"We don't offer our retail store just to make a buck," she said. "Or mission is to provide education, information and support. That is the difference between my organization and people who inventory things in their basement and extra bedrooms and just sell on line."

http://www.hmenews.com/index.php?p=arti ... 0607bLUJLJ

If you use the search function you'll find there are numerous previous threads and much discussion regarding Resmed's actions.

Boycott Resmed. Buy Respironics. You won't be missing out on anything except the price gouging.