New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
starfish36
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New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by starfish36 » Fri Apr 29, 2022 7:08 am

New to CPAP as of last week, hoping for some initial advice -- tried to make this as concise as possible! This forum has been SO helpful so far so thanks in advance for any advice!
  • mild OSA with pAHI of13.2 diagnosed via a "nightowl" HST by my PC dr.
  • waiting for appt with an actual sleep specialist for further eval
  • prescribed & purchased Resmed Airsense 11, 5-20 pressure, and got a p10 nasal pillows mask for her.
I bought the machine out of pocket due to DME delays but I'd like to get supplies through insurance for now since I've already hit my out of pocket max for the year so they'd be very inexpensive through insurance.

Supplies questions:
  • Which DMEs are worth a dang? I liked Apria initially since it looks like you can order supplies through their website, but this forum made me 2nd guess using them. Other options from my insurance are: Rotech, Medical Services of America, Sleepmed Therapy Services, Lincare, and Family Medical Supply.
  • How often do you *actually* replace your supplies? Recommended schedule seems excessive.

Newbie "help me sleep!" questions:
  • Using the P10 nasal mask - how do I tell if pillows are sized right? Been swapping between XS and S and still unsure. No leaks on either from what I can tell.
  • My skin feels claustrophobic with it on- will I just get used to it? I tried remZzzs nasal pillow liners but could *not* figure out how to get them to stay on and gave up the first night.

So far (5 nights) I've only been able to sleep for about 1-1.5 hrs before waking up and tearing the mask off out of frustration / lack of ability to get back to sleep. (Falling asleep goes OK -- melatonin, using headphones to drown out / help me ignore my breathing noises, and I have bumped lowest pressure up to 6, turned ramp off, and have been alternating trying EPR at 2 and EPR at 3..)

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Machine: AirSense 11 Autoset
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Humidaire tub 11 with Climatelineair 11

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Pugsy
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Re: New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by Pugsy » Fri Apr 29, 2022 9:19 am

starfish36 wrote:
Fri Apr 29, 2022 7:08 am
Using the P10 nasal mask - how do I tell if pillows are sized right? Been swapping between XS and S and still unsure. No leaks on either from what I can tell.
Mostly we tell people go by how it feels or comfort when it comes to sizing. That's a bit difficult on your end because you don't really have any way to measure something in terms of comfort because none of this is really all that comfortable is it?
Most people can probably successfully use more than one size if truth be known.
I can almost use the XS but I find that there are times that the XS P10 wants to crawl up inside my nostrils. Doesn't happen all the time but it happens some of the time and when it does it isn't so comfortable and when it does that I find that the pillows get squished and I can't move enough air...... So I would use the Small.
Both, for me, are leak free but the Small doesn't try to crawl up inside my nose.
I can also successfully use the Medium size...and most likely if push came to shove I could make the Large size work.
starfish36 wrote:
Fri Apr 29, 2022 7:08 am
How often do you *actually* replace your supplies? Recommended schedule seems excessive.
It is excessive for most people. Nasal pillows will last for months and months with common sense care.
The DME "recommends" replacement of everything according to how often insurance will pay for it. It's a cash cow for them. That's the real reason DMEs urge replacement so often of anything.

When I was using the P10 (using the Bleep now...check the link to it in my equipment profile) I actually could and did use the nasal pillow for well over 6 months and usually retired it only because it got yucky looking. Not because it wouldn't seal.

Check out the Bleep nasal mask. No headgear to mess with. No worries about sizing either because nothing at all goes inside the nostrils. It is a bit fiddly at first to learn how to attach the ports but with time and practice it gets a lot easier.

Check out the P10 barrel cozy from padacheek.com if you want to try to continue with the P10.
https://www.padacheek.com/barrel-cozies-1
Since you don't care for the feel of the silicone next to your skin you might like the barrel cozy. It feels like silk against the skin.

The P10 is an excellent mask. About as minimal as one can get in terms (except for the Bleep) of having stuff touch the face and head and it is still my number 2 mask. I don't understand how you are hearing a lot of breathing noises with it because it is essentially silent unless you are hearing some conducted noise. Is your hose touching your bed or pillow at all?
Are you hearing what we call the Darth Vadar noises? Those are usually conducted noise.

More thoughts later.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

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Dog Slobber
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Re: New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by Dog Slobber » Fri Apr 29, 2022 9:49 am

starfish36 wrote:
Fri Apr 29, 2022 7:08 am
How often do you *actually* replace your supplies? Recommended schedule seems excessive.
Since February, 2018, I'm on my seconds humidifier tank, I dropped the first one. I'm also on my second heated hose, the first one doesn't grip the mask attachment tight enough.

Since November, 2017, I'm on my second P30i nasal mask.

My current set of nasal pillows have been used since June 2021 [Fixed date so department of Temporal Investigations doesn't get upset]

Yes, the "recommended" schedule is excessive. It is *NOT* recommend because the items need changing. It's recommended because the companies want to make more money. That schedule is the minimum timeframe that insurance will pay for replacements.

After receiving your equipment:
Order a replacement item (Mask, hose, humidifier, cushions) as soon as you are eligible. But, continue using your originals. Now you have a spare of everything.

Then when an item actually wears out or fails, swap in your replacement and re-order another.

Depending on the item and your comfort level, you may want two, three or more replacements.

Then start thinking about about a spare device. I bought my spare off Kijiji. When getting a spare try to get an identical device, now you have more spare supplies, including a spare power supply for problem solving.
Last edited by Dog Slobber on Fri Apr 29, 2022 10:14 am, edited 1 time in total.

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SJ-Paddler
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Re: New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by SJ-Paddler » Fri Apr 29, 2022 9:55 am

Dog Slobber wrote:
Fri Apr 29, 2022 9:49 am
My current set of nasal pillows have venn used since June 2022
I knew Dog Slobber was a time traveler. That is why he knows so much. :lol:

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Mask: Dreamware Silicone Nasal Pillows
Machine: ResMed Airsense 10 Autoset (For Him)
APAP Pressure: 10 cm - 15 cm / Average 11.5 cm / 3 cm EPR Pressure Relief

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Dog Slobber
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Re: New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by Dog Slobber » Fri Apr 29, 2022 10:11 am

SJ-Paddler wrote:
Fri Apr 29, 2022 9:55 am
Dog Slobber wrote:
Fri Apr 29, 2022 9:49 am
My current set of nasal pillows have venn used since June 2022
I knew Dog Slobber was a time traveler. That is why he knows so much. :lol:
John Titor is a fake.

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Miss Emerita
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Re: New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by Miss Emerita » Fri Apr 29, 2022 11:29 am

I replace stuff only when it doesn't work any more or looks yucky even after cleaning. If you have a backup for each piece of equipment, this strategy should work well for you, as others have mentioned.

I do keep a good supply of filters on hand and change them once a month even though I never see schmutz on them. There's a little filter dealie on my mask, and I change it once a week, since it does get dirty.

Recommended cleaning schedules are also sometimes excessive. I have pretty much stopped washing my long hose and humidifier chamber, though I do wash the mask gear once a week.
Oscar software is available at https://www.sleepfiles.com/OSCAR/

starfish36
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Re: New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by starfish36 » Sun May 01, 2022 7:52 am

Thank you all SO much for the tips and thoughts and fast responses! I tried a few new things last night but still woke up after about an hour in a panic.. Checking my sleep data in oscar and mostly to my untrained eyes it looks uneventful and I'm still unsure why I'm waking up.. a few followup questions below
Pugsy wrote:
Fri Apr 29, 2022 9:19 am
Check out the Bleep nasal mask.
I have seen this but wasn't ready to give up on the p10 yet and/or add more variables... Do you get irritation from the adhesive? I have a pretty poor reaction to bandaid adhesive. It does look appealing since it's so minimal.
Pugsy wrote:
Fri Apr 29, 2022 9:19 am
it happens some of the time and when it does it isn't so comfortable and when it does that I find that the pillows get squished and I can't move enough air
This makes sense! I tried the size S last night on this advice, still woke up feeling like I was suffocating.. I don't have a particularly large nose but maybe even going up to the M would be a good experiment with the moving air / suffocation feeling. Thank you.
Pugsy wrote:
Fri Apr 29, 2022 9:19 am
I don't understand how you are hearing a lot of breathing noises with it because it is essentially silent unless you are hearing some conducted noise. Is your hose touching your bed or pillow at all?
Are you hearing what we call the Darth Vadar noises? Those are usually conducted noise.
It's darth vador noises -- I have the hose snuggle on the heated hose but not mask hose portion, so the mask hose touches the pillow. I also wear headphones or earplugs to bed, which makes the sound of my breathing with the mask louder inside my ears I think. My sleeping partner snores, so earplugs aren't really negotiable.. slept with them for years. I also do have a sound machine running as well.
Pugsy wrote:
Fri Apr 29, 2022 9:19 am
After receiving your equipment:
Order a replacement item (Mask, hose, humidifier, cushions) as soon as you are eligible. But, continue using your originals. Now you have a spare of everything.
Thanks for all the tips on this everyone! As soon as I finalize my mask fit / compatibility, I'll order up on a few extra supplies. I have an extra humidifier that came with the package I bought, but will plan on stocking an extra hose and extra mask parts/pieces.
Pugsy wrote:
Fri Apr 29, 2022 9:19 am
Then start thinking about about a spare device.
Is there a reasoning behind the spare device? I see that advice a lot here. I bought mine out of pocket due to DMEs being out of stock, but could definitely get a 2nd through insurance and only pay 10% as I've hit my out of pocket max already. I can't figure out what the reasoning is? -- Is it possible to get a 2nd device that's a TRAVEL device or does insurance only typically pay for primary devices?
Miss Emerita wrote:
Fri Apr 29, 2022 11:29 am
I have pretty much stopped washing my long hose and humidifier chamber, though I do wash the mask gear once a week.
Perfect. This is my preferred level of maintenance! Plan is to wipe down mask with wipes daily / every other day, and then if I'm feeling ambitious soap up everything maybe every few weeks. Do you disconnect and dry out the hose / humidifier every day at all? I am using distilled water per instructions, and it's not getting used up every night so I'd hate to waste it by dumping it..
Pugsy wrote:
Fri Apr 29, 2022 9:19 am
Check out the P10 barrel cozy
I just ordered this! And some strap pads to keep straps in place better (my hair is long and they slip around). Thank you! Exactly what I was looking for.
starfish36 wrote:
Fri Apr 29, 2022 7:08 am
Which DMEs are worth a dang? I liked Apria initially since it looks like you can order supplies through their website, but this forum made me 2nd guess using them. Other options from my insurance are: Rotech, Medical Services of America, Sleepmed Therapy Services, Lincare, and Family Medical Supply.
Any advice / thoughts from anybody on which DME to go through?

Lastly, I still keep waking up within an hour of falling asleep and am unable to keep the mask on (feeling like I can't get enough air on waking...) I do sit and read a bit / watch ASMR with mask on before going to sleep, and am still playing a bit with pressure settings / humidity / EPR settings.. usually some combination will feel "sort of OK" while awake. I can't tell WHAT is causing me to wake up, if it's just naturally waking and then I panic because I'm not used to the mask OR if it's the settings aren't right and then I'm waking up. How do I best troubleshoot this to decide what settings to adjust?

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Machine: AirSense 11 Autoset
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Humidaire tub 11 with Climatelineair 11

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Miss Emerita
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Re: New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by Miss Emerita » Sun May 01, 2022 12:08 pm

No, I don't dry out the hose or humidifier chamber every day. The hose, never. The chamber, only when I've pretty much used up the water. Then I will dump whatever little amount remains and let it air-dry.

It is fairly common to wake up after a period of REM sleep, and for many people, that would come at around one hour after falling asleep. But you ask about settings, and for that, we'd need more information. If you have a laptop or desktop computer, could you download the Oscar software? You would also need an SD card in the slot on your machine plus a way for the computer to read the card (either built in or plug-in reader). Once you were set up with Oscar, you could post a screenshot of a typical night.
Oscar software is available at https://www.sleepfiles.com/OSCAR/

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babydinosnoreless
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Re: New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by babydinosnoreless » Sun May 01, 2022 12:25 pm

Re supplies,

I got torqued at the super high cobra costs the insurance was charging me so I let the Dme send me supplies whenever I was eligible. Thankfully I did, because now I've got cruddy insurance but a lifetime supply of masks, cushions hoses etc.
The only thing I need to buy our of pocket are filters. First and only time I ever came out ahead when dealing with insurance vultures.

starfish36
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Re: New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by starfish36 » Mon May 02, 2022 7:35 am

Miss Emerita wrote:
Sun May 01, 2022 12:08 pm
It is fairly common to wake up after a period of REM sleep, and for many people, that would come at around one hour after falling asleep. But you ask about settings, and for that, we'd need more information. If you have a laptop or desktop computer, could you download the Oscar software? You would also need an SD card in the slot on your machine plus a way for the computer to read the card (either built in or plug-in reader). Once you were set up with Oscar, you could post a screenshot of a typical night.
So here's my screenshot from last night... I read in bed for an hour or so before going to sleep -- I think somehow the timezones must be incorrect because it seems to say I started my session at 930EST when it should have been 1030EST.. Not sure how to fix that? Time zone in Oscar is set correctly.

I'm assuming the hyponea is just me adjusting my mask while still awake (first time I've seen that).

https://imgur.com/a/e2kyUjO

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Machine: AirSense 11 Autoset
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Humidaire tub 11 with Climatelineair 11

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Miss Emerita
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Re: New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by Miss Emerita » Mon May 02, 2022 11:21 am

Many thanks for the screenshot. No need to redo this one, but the next time you post one, use the arrow-down key to expand the graphs to the whole recording period. (Your graphs show only the period colored light green on the Events graph.) Also, use the box in the lower left corner of the graphs area to turn on flagging for central apneas.

I recommend that you increase your EPR to 3 and raise your minimum to 7. For many people, this creates a more comfortable and natural-feeling way to breathe. If you hate this, go back to your current settings, but otherwise stick with the new settings for a few days to see how you do with them.

While watching ASMR may feel relaxing to you, watching screens before bedtime is disruptive to sleep, and I recommend that you avoid it. Go to bed when you feel sleepy -- not before -- and turn off the light after you turn the machine on.

About the clock: you'll have to reset the clock in your machine; it doesn't set itself automatically. Do the reset after noon.

I'll be very interested to know whether the revised settings work a little better for you. Please post another chart after you try them, and let us know how your time using the machine felt to you.
Oscar software is available at https://www.sleepfiles.com/OSCAR/

starfish36
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Re: New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by starfish36 » Thu May 05, 2022 8:16 am

So I tried revising, but 7 felt too high -- I settled on 6.8, and most recently the EPR set at 2 (3 felt like it was suffocating me on exhale too much).

Still waking up within an hour or two and not feeling like I can get back to sleep with it.. Maybe the humidity is too high? Or the temp compared to the air temp? One night I did mess with the temp/humidity settings but then I ended up with rain out which was terrible, so I set it back to auto. Last night though the auto mode felt either too hot or too humid compared to the air temp in the room which was nice and cool.. So I couldn't get back to sleep with it again. Here's the last few nights.

Some of the things early on are me wearing the mask while reading / adjusting it being awake still. Usually am asleep after maybe an hour or so of turning it on (trying to practice before going to bed so that it's easier..)

I didn't see a checkmark to make central apneas flagged in either preferences or bottom right or left -- everything on both drop downs is checked. Is there somewhere else I should look?

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Machine: AirSense 11 Autoset
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Humidaire tub 11 with Climatelineair 11
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SJ-Paddler
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Re: New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by SJ-Paddler » Thu May 05, 2022 8:25 am

I will only add that for some reason when it comes to CPAP supplies it is cheaper to buy the parts than the entire item.

I am using the Dreamware Silicone Nasal Pillows. I tried a lot and found them to be the most comfortable over all.

I wanted to get backups of everything so if / when they wear out I had ready replacements. Buying the complete units were over $100 but on Amazon I could get two frames for $12 from one place, elbows from another, cushions from another, head gear from another and the total costs was less than buying a complete item. There can't be many products where it is cheaper to buy parts than the completed item.

I could only imagine what a car would cost if you purchased the parts individually. :lol:

_________________
MachineMask
Mask: Dreamware Silicone Nasal Pillows
Machine: ResMed Airsense 10 Autoset (For Him)
APAP Pressure: 10 cm - 15 cm / Average 11.5 cm / 3 cm EPR Pressure Relief

starfish36
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Re: New to CPAP: Which DME for supplies / typical replacement schedule / comfort tips?

Post by starfish36 » Mon May 09, 2022 6:52 am

SJ-Paddler wrote:
Thu May 05, 2022 8:25 am
I am using the Dreamware Silicone Nasal Pillows. I tried a lot and found them to be the most comfortable over all.
These look interesting -- I saved them to check out if I can't get the p10 to work.

I adjusted settings some more over several nights, and I think I finally found a good set -- 6.8 pressure, no ramp, 1 humidity, and low temp. I realized if I paused when I woke up and paid close attention on waking to WHY I was uncomfortable, it was because it felt too hot/humid. After lowering humidity and temp, I slept five hours with it (mostly) on!

When I did finally give up, this time it was because I kept opening my mouth and it was waking me up.. first time that's happened. I did buy a chin strap but haven't used it yet because so far it was not an issue. Will try and pay attention next time if it's because I'm congested or not & work from there.

That being said, the data from oscar looks.. good? I'm not really sure what to look for. I guess I expected more events or issues or something useful in the data. Do I even have any apneas? Or am I not getting them because the machine is doing a good job? I'm still a bit skeptical of my diagnoses because it was a take-home simple finger test with a light (no other equipment or measurements - likely just pulse ox).

TLDR; medium success! But I'm curious what the Oscar data means and/or what to look for as it looks mostly.. clear? -- any thoughts or advice?
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_________________
Machine: AirSense 11 Autoset
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Humidaire tub 11 with Climatelineair 11