CPAP Rental vs. Purchase?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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sleepquest21
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CPAP Rental vs. Purchase?

Post by sleepquest21 » Mon Jun 06, 2022 12:47 pm

I am new to this forum. I am a heavy snorer and have been using a ResMed VPAP Adapt machine for over 10 years with varied results. My sleep doctor says it is time to replace the old machine with a newer model. My new script is for an adaptive machine, so I was looking at AirSense 10 on CPAP.com website. My local vendors all want to charge monthly rental fees, but my insurance will reimburse 80% of purchase up to $1K. The online cost is significantly lower than local vendors because they aren't marking up prices to maximize their insurance payments.

My local equipment supplier many years ago rated me as "non-compliant" because I have a tendency to remove my mask to make bathroom trips and often fall back asleep without putting the mask back on. Or sometimes I knock mask off and sleep right through it. As a result, I rarely get more than 3-4 hours of CPAP therapy a night. I am concerned that a supplier will repeat the non-compliant label if I don' t purchase enough overpriced supplies from them, and my insurance will stop reimbursing me.

Is there some advantage to "monthly rentals" versus purchase that I am overlooking?

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Re: CPAP Rental vs. Purchase?

Post by Pugsy » Mon Jun 06, 2022 1:06 pm

Where are you located?

What was your diagnosis that earned you the adaptive model machine? If it was central apnea or complex sleep apnea the AirSense 10 models won't give you adequate therapy.

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Re: CPAP Rental vs. Purchase?

Post by palerider » Mon Jun 06, 2022 2:42 pm

sleepquest21 wrote:
Mon Jun 06, 2022 12:47 pm
Is there some advantage to "monthly rentals" versus purchase that I am overlooking?
Not to you.

But for the company providing the rental, it's a continued source of revenue.

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Re: CPAP Rental vs. Purchase?

Post by Janknitz » Mon Jun 06, 2022 2:51 pm

Can you write exactly what it says on your prescription?

An APAP is an "AUTOMATIC Positive Airway Pressure" machine, not an "Adaptive" pressure device. It automatically adjusts the pressure in response to apneas and hypopneas.

An ASV is an "ADAPTIVE Servo Ventilation" device which is a sort of non-invasive ventilator for people who may stop breathing because of central nervous system dysfunction, even when the airway is not obstructed.

It's important to understand if your doctor prescribed an ASV or an APAP.

The VPAP ("Variable Positive Airway Pressure") you have now allows two settings to be automatically adjusted--the minimum and the maximum pressure automatically adjust. It's also called a BIPAP or Bilevel adjusting CPAP.

All three are different and have different purposes. I just want to clarify whether you have actually been prescribed an APAP or an ASV? The A in APAP could be mistakenly thought of as "Adaptive" pressure, but in CPAP world, those terms have very specific meanings, and an APAP is not "adaptive".

That's the first thing to tackle, understanding your prescription.

Second, if you are getting up to toilet a lot at night, it suggests you are not getting effective therapy. That should be explored. Has your doctor done so?
And, you can simply disconnect the hose, leave the mask on when you get up at night. That will be a good reminder to hook it back up to your machine before you go back to sleep.
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Re: CPAP Rental vs. Purchase?

Post by Pugsy » Mon Jun 06, 2022 3:53 pm

sleepquest21 wrote:
Mon Jun 06, 2022 12:47 pm
have been using a ResMed VPAP Adapt machine for over 10 years
The ResMed VPAP Adapt is now called AirCurve 10 ASV.
New model name but essentially functions the same.

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Re: CPAP Rental vs. Purchase?

Post by clownbell » Mon Jun 06, 2022 3:58 pm

If you do a purchase, the insurance company will not need to monitor you for compliance. One hit, and done. Then it's just expendable supplies.
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Re: CPAP Rental vs. Purchase?

Post by sleepquest21 » Mon Jun 06, 2022 7:46 pm

Thanks so much to everyone for the advice. My original diagnosis from around fifteen years ago is "Obstructive Sleep Apnea," and the machine type says "CPAP or APAP." I have not seen the results of my most recent sleep study, but the original sleep study was done in a lab setting with lots of monitoring leads (e.g., respiration and heart rates, EKG, etc.). The most recent sleep study was a home study with only a monitor attached to my forehead. Again, I have not seen the most recent results, but I will follow up with my doctor to get a copy. Generally, I stop breathing about every two minutes according to the most recent sleep study.

The reason that I have the VPAP Adapt machine is that my original CPAP did not provide significant benefit, so I had a follow-up sleep study in a sleep lab after a couple of years on the regular CPAP. I am pretty sure that the doctor said my sleep apnea was complex, and set me up with the VPAP Adapt machine, which as I recall was several thousand dollars of out of pocket expense, going though insurance company. It worked fairly well, and I used it for several years until the humidifier stopped working. I am a mouth breather, so without the humidifier, my mouth and sinuses are like the Sahara Desert. I got a replacement humidifier through cpap.com website, and went back to using the machine again. There are times when I feel like I get "decent" results, but the reality is that I never get the type of benefit that I had hoped for (e.g., wake feeling fully rested). Though my wife does benefit from my lack of snoring while using the machine, which makes life much nicer.

For most of past 20 years, I was working as a high school science teacher, which basically means burning the candle at both ends (e.g., in bed around 11pm and up at 5am) so I never got more than 6-7 hours of sleep during a typical night on a school week. I now have a desk job at the Dept. of Education, so when COVID turned into 100% work from home, I could sleep in until 8am. Sadly, even with the extra time in bed my iWatch app still shows that I rarely slept more than 6-7 hours, though I felt much more rested than I ever did in my entire life. I have since had to return to work two days a week, which pretty much ended my honeymoon period with sleep (at least for two night a week). A bout with atrial fibrillation and some recent neurological symptoms has me thinking that, now that I am in my 60s, I can't continue to treat sleep like I did when I was younger.

I will follow up with my doctor to get a copy of the latest sleep report. Sounds like, if my current diagnosis is complex sleep apnea, that I might need the BIPAP or Bilevel type machine. I will let you know what I am able to find. I am still leaning toward purchasing and monitoring myself. I had a bad experience with one local provider before, and I cannot even get the new provider to answer my calls. I googled them during the time I was on hold and almost every rating was 1 star and started with the phrase, "If I could I would give them a negative rating..."

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Re: CPAP Rental vs. Purchase?

Post by sleepquest21 » Mon Jun 06, 2022 7:47 pm

Pugsy wrote:
Mon Jun 06, 2022 3:53 pm
sleepquest21 wrote:
Mon Jun 06, 2022 12:47 pm
have been using a ResMed VPAP Adapt machine for over 10 years
The ResMed VPAP Adapt is now called AirCurve 10 ASV.
New model name but essentially functions the same.
Thank you! It sounds more like the machine I have now.

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Re: CPAP Rental vs. Purchase?

Post by Janknitz » Mon Jun 06, 2022 8:04 pm

. I am a mouth breather, so without the humidifier, my mouth and sinuses are like the Sahara Desert.
What mask do you use? If you aren't in a full face mask, that alone may explain why you have "variable results" and frequent nighttime bathroom trips.
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Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
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Re: CPAP Rental vs. Purchase?

Post by sleepquest21 » Mon Jun 06, 2022 8:33 pm

Janknitz wrote:
Mon Jun 06, 2022 2:51 pm
Can you write exactly what it says on your prescription?

Second, if you are getting up to toilet a lot at night, it suggests you are not getting effective therapy. That should be explored. Has your doctor done so?
And, you can simply disconnect the hose, leave the mask on when you get up at night. That will be a good reminder to hook it back up to your machine before you go back to sleep.
Thanks, I will submit a follow-up once I get a copy of my report.

I typically have to make the sleepwalk to the bathroom 3-5 times a night. I take Flowmax, but it has not really helped. If I don't drink enough during the day, I get kidney stones so it is sort of the price I pay to avoid that pain. I would rather wake up having to go, than to wake up having already gone... I have to wear the mask [ResMed full face mask] fairly tightly to prevent leaks, so taking it off to go to the bathroom allows my face to cool off and dry out a little. I am pretty good about putting it back on after an early night run, but if it is close to morning I usually just leave it off.

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Re: CPAP Rental vs. Purchase?

Post by sleepquest21 » Tue Jun 07, 2022 7:20 am

I got a copy of my sleep study. My diagnosis is severe, positional obstructive sleep apnea, but recommendations are for Auto CPAP and avoid sleeping on my back. I added the graphs because they show that most of my apneas occur when I roll over onto my back during sleep. Maybe something that keeps me off my back would be helpful. Anyone have suggestions on avoiding sleeping on my back?

Thanks again for your help! :D

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Re: CPAP Rental vs. Purchase?

Post by Janknitz » Tue Jun 07, 2022 12:40 pm

Thanks, We know more now:

The prescription is for an APAP--an "Auto-Adjusting" machine, not an "adaptive" machine. This means your insurance will NOT cover an ASV, regardless of purchase or rental. If you feel you still need an ASV, you need a different prescription, OR you can buy a used one. A member here, LSAT, often has used ones in good condition at a decent price, so you can pm him. Based on the results of this sleep study, even with a prescription for an ASV, you might not meet your insurer's coverage criteria for one.

If you stay off your back, you will have an easier time treating your apnea. Are you able to sleep on your sides? Have you made any effort to stay off your back? Do you want tips that may help keep you off your back?

As far as buy or rent, consider that you may want to TRY an APAP machine to see if it works better for you now, especially if you stay off your back. That might be worth considering a rental (or finding a good used one) because an insurer is unlikely to buy you two machines if you decide now you want an ASV. Otherwise an outright purchase makes sense, and your DME doesn't get to decide that, it's between you and your insurer. If the DME doesn't want to do business with you because you won't rent, there are other DME's. Right now, it's a seller's market because of the Philips recall--it's hard to get a machine and DME's are thinking they can call the shots. But there are ways if you are determined.

And it doesn't matter whether a DME wants to make life difficult for you if you don't buy their supplies. Compliance is reported by your machine--it records hours of use objectively, not subjectively. You are either compliant or you are not, and if you don't meet the criteria for your insurer, you are at risk of your insurer not covering a rental and possibly refusing to pay it's share of the purchase price (some insurers require you to prove compliance before they will pay their share). If you are going to bed late (assumed because it's less than 4 hours before you toilet), getting up to toilet and making a conscious decision not to put the mask on again, that's on you. You need to at least get the hours needed for your insurer's compliance requirements, and moreover, the machine can't help you if you aren't using it. With such severe apnea, that's NOT an option. Personal responsibility has a role. Would you have accepted an excuse like that from one of your students when you were teaching??? "Oh, I got tired of the assignment so I only did 2/3 of it, why did you give me such a low grade?" (bet some students tried to pull that!).

One other thing I noticed in your sleep report was that you "wake up choking". Have you been evaluated for Gastroesophageal Reflux Disease (GERD)?. GERD can be caused by sleep apnea (the struggle to breathe can cause a pressure gradient that sucks stomach juices up into the airway) AND GERD (also laryngeal reflux or "LPR") can cause sleep apnea by causing inflammation of the upper airway that contributes to sleep apnea. Sometimes you need to treat BOTH to be successful with either.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
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Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

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Re: CPAP Rental vs. Purchase?

Post by sleepquest21 » Tue Jun 07, 2022 2:30 pm

Janknitz wrote:
Tue Jun 07, 2022 12:40 pm
The prescription is for an APAP--an "Auto-Adjusting" machine, not an "adaptive" machine. This means your insurance will NOT cover an ASV, regardless of purchase or rental. If you feel you still need an ASV, you need a different prescription, OR you can buy a used one. A member here, LSAT, often has used ones in good condition at a decent price, so you can pm him. Based on the results of this sleep study, even with a prescription for an ASV, you might not meet your insurer's coverage criteria for one.

If you stay off your back, you will have an easier time treating your apnea. Are you able to sleep on your sides? Have you made any effort to stay off your back? Do you want tips that may help keep you off your back?
I was thinking of getting a new machine before June ends, since I start a new deductible in July, which means all of the cost would be out of pocket [though it would wipe out my deductible for next year in one fell swoop]. I really do not know that I "need" an adaptive machine, since like you said my prescription is for an auto adjusting model. I have tried the old constant pressure CPAP, but I never got the same benefit from that one as from the adaptive one that I have now.

I was shocked to see the information about how my apnea becomes a lot worse when I roll over onto my back. I am a bit surprised that sleep position did not come up in conversations with my doctor. I actually prefer sleeping on my side, but it is harder to do that comfortably with the full face mask gear on. Maybe I need something other than a flat pillow. I am open to suggestions from the group about ideas that have worked for them.

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Re: CPAP Rental vs. Purchase?

Post by palerider » Tue Jun 07, 2022 3:54 pm

sleepquest21 wrote:
Tue Jun 07, 2022 2:30 pm
I was shocked to see the information about how my apnea becomes a lot worse when I roll over onto my back. I am a bit surprised that sleep position did not come up in conversations with my doctor. I actually prefer sleeping on my side, but it is harder to do that comfortably with the full face mask gear on. Maybe I need something other than a flat pillow. I am open to suggestions from the group about ideas that have worked for them.
I spent years just sleeping near the edge of my plain old pillow while wearing a FFM and sleeping on my side.

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Re: CPAP Rental vs. Purchase?

Post by Janknitz » Tue Jun 07, 2022 5:02 pm

There are some tricks to staying off your back. Some people sew tennis balls in the back of their PJ tops, or sleep in a stuffed backpack that prevents them from lying comfortably on their back. You could also tuck a soft pillow behind your back.

I used to be a side sleeper, always on my right side, all night, and I was wearing a FF mask. To stop leaking, I had to have the mask really tight at my chin, and there was pressure from my pillow (despite efforts to try to sleep on the edge of the pillow as Palerider suggests) on my teeth. It actually moved my teeth a few mm's and has caused me endless dental issues. I'm back on a nasal mask now, but the only suggestion I have is to use one of those C-shaped neck pillows to support your head where it won't put pressure on the mask itself.

I'm having some hip issues and actually sleeping on my back a good part of the night now. I use the same C-shaped pillow in front of my neck to support my jaw and head position (sort of like a soft cervical collar would) when I'm on my back. Fortunately, my apneas are not increased on my back.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm