PB420E APAP - I'm Officially Impressed

Y'all know I'm new to this, but I'll throw in my 2 cents anyway.

I have beautiful graphs, most days. My titrated pressure was 10 cm. But, if I leave my lower pressure below 9, I do not have nice graphs. Lots of accoustical vibes, lots of runs, higher AHI. My theory is that if the lower pressure isn't high enough to stop my snoring, the machine ramp-up doesn't help, and then it maxes out. For instance, with a lower setting of 9.5, the pressure varies from 9.5 to 10.5. With a setting of 8-12, it varies from 8 to 12. I suspect if I had the higher setting higher, the pressure would still max out. So, FOR ME, it's important to keep the snores from beginning, else they set off a 30 minute period of instability. I have IFL1 on.

Thanks once again for some really informative reading.

Snoredog, is this the coupler you use? I will buy one and see if the whistling stops.

https://www.cpap.com/productpage/respir ... lings.html

Cathy

Thanks, RG, for the info!
Have been struggling with GERD as of late -what a pain in the drain!

Well, results from last night's experiment with nasal irrigation were interesting. I also decided to use the humidifier for the first time last night, even turned the heater for the humidifier ON, and I left FL1 ON again

The result is that I didn't have nearly as many flow limitations last night, and the pressure never quite got to the max of 10 cm. I woke up early because of congestion though, with my sinuses fully clogged, literally unable to breathe nasally although it wasn't obvious in the data that the machine even responded to the congestion.

My conclusion is that I still have congestion issues. (Well, duh!!!) In the past year I got over the problem of being fully congested at bedtime, but sleep has not been that good since I quit using steroid eye drops quite a few months back. I just never made the connection before now that the steroid eyedrops draining through the sinuses as they do would lessen the effects of congestion. I was assuming some other subtle effects from the steroid drops. It seems more likely though that the steroid drops directly reduced inflammation in the sinuses. (Spectre of an ENT visit looms large . . . )

Tonight I think I'll continue the nasal irrigation, but won't use the humidifier. I've sensed before that the humidifier actually contributed to congestion.

I've got one technical question about the Silverlining software though. When I look at the data, all the nights run together and I can only really tell the nights apart by rolling the mouse pointer across the time data. (I've had multiple sessions per night.) Is there a more obvious way to distinguish the nights? It occurred to me that maybe collecting each night into a separate file would be a way, but I'm not sure that would work without erasing the earlier data before each session.

Regards,
Bill

I think the 420E is an excellent machine -I like it far better than the Respironics tank that I also own.

willsucceed,

may i ask, since you're just up the 401 from me, did you get your 420E through a canadian supplier or did you order it on-line? i'm planning to talk to my sleep doc about upgrading but it seems like every time i mention a product to my RT at medigas, she tells me it's not availabe through them...??? just wanted to go there forearmed, if possible

thanks
sharon1965

Interesting that you should ask... I was in a Medigas supplier today and talked with my friend who works there about equipment. Here is what he told me:

They DO carry the PB line and absolutely can get the 420E. Advantages of buying from them are mostly around warrenty. If you buy through the US, you will have to take/send the device to the US for servicing, should you ever need it.

If you are buying an APAP machine and are eligible for purchase through the Assistive Devices Program (this means that you have not accessed ADP in the last 5 years), then you can, with a script from your Dr. for APAP (with a pressure range showing on the script) go to Medigas (or any other provider) and tell them that you want an APAP basic setup and that you are aware that they are capped at $1040., with ADP paying $780.

They will give you a big song and dance about APAP not being covered, they don't carry them, they have to charge more because of the price difference between CPAP and APAP, blah, blah, blah but, the reality is, that ADP codes CPAP and APAP as being the same creature. The assistance of $780. and the price cap for a basic setup (machine, heated humidifier, mask and hose) of $1040. are the same. They will want you to pay more for the APAP with the hope that you, or your employer insurance benefits, will just pay up. If you don't have benefits, it comes out of your pocket.

If you HAVE made a CPAP purchase using ADP in the last 5 years, then ADP will not give you any help. In this case, the supplier can charge you whatever they want and, your insurance benefits are unlikely to help you as most insurance plans tend to go along with the ADP schedule of one machine every 5 years.

I bought my 420E from Shopper's Home Health here in Toronto, and got them to meet the CPAP.com price (converted into CAD) by showing them a printout from the CPAP.com website. I think I was extremely lucky that they honoured this comparison. I then submitted the Shopper's Home Health receipt to my insurance and they, after a LONG fight, reimbursed me; I was lucky again.

I bought the humidifier for the 420E in the US as they were not yet available in Canada when I got my 420E APAP. Rather than pay the big shipping fees, I just drove to a supplier in Buffalo and drove home with the new humidifier. I've done this with some masks as well. I take my APAP with me when I cross the border on a day trip just in case I/we decided to stay overnight (you never know when you might get overly-refreshed while having wings at the Anchor bar) so, carrying home a new mask, etc., is not a big deal. In fact, one could go to Buffalo with all of your equipment EXCEPT the piece that you plan to buy in the US and then, when coming back across the border, all you have with you is a complete set of equipment, with no extras.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): 420E, humidifier, hose, cpap.com, CPAP, APAP

By the way, Sharon 1965, VitalAire has recently lost their exclusive status regarding ResMed. You can now get the full ResMed line at Medigas. You can also get the full Respironics and PB line of equipment at Medigas.

It is highly likely, I'm told, that Medigas will again have the whole line of Fisher-Paykel equipment. They seemed to cut down on FP when they brought in the ResMed line, but are wanting FP back. Further, FP is planning to come out with an APAP.

Good luck getting an APAP!!

willsucceed

thank you so much for taking the time to share all that info with me...

i am wondering about one thing though: when i emailed my RT i asked her if it was possible to switch one setup for another, what was involved in getting a new one, etc...of course she didn't reply to my questions specifically, she simply told me that there were machines out there, cost blah blah blah, and to talk to my doc to see how he feels about an upgrade...if he were to ok that and give me a new prescription, am i still eligible for the ADP? like a return/replacement sort of thing? i've heard of people having to switch from apap to bi-pap and i've wondered if they are still covered in that circumstance...again, i just want to have some info before i talk to her and she tries to sell me a bill of goods, like she did with my current cpap (that looked like this: "here's your machine and your mask, call me if you have any problems, i'm here for you" and i was too much of a noob to know any better )...i have to say, though, they've been great about the mask exchanging

thanks will, i appreciate your experience and input

sharon

(by the way, i have friends here who go to the anchor bar in detroit, mich...is it a chain or something? they like to go there after mids. because they are open with full bar and full kitchen at 7 am! it made me laugh when you mentioned going to the one in buffalo)

If you already have your equipment, I would not hold my breath on the supplier being at all open to the idea of taking it back for an exchange. They are not allowed to re-sell used equipment and, if you have taken it out of the store, they will consider it used.

If you have NOT picked up your equipment yet, and the paperwork is not signed (the patient has to sign the ADP paperwork) then I'd say you should have a shot at changing your mind regarding vanilla CPAP in favour of APAP.

If you need bi-pap, but NOT with a back-up rate, you get the equipment, also assisted by ADP (but with a higher dollar value of assistance) from the local equipment supplier, and pay the extra or, send the bill to your employee benefit plan.

If you need bi-pap WITH a back-up rate, this comes from the ventilator pool in Kingston and is fully paid for by a government system (I forget what it is called -might be ADP). This is because bi-pap with a back-up rate is consider non-invasive ventilation rather than CPAP support.

If you have to switch from CPAP to bi-pap, I don't know what the rules are. If you do a web search for Ontario Assistive Devices Program, you can contact them and find out how things work. I would not tell them about your "desire" to switch from one system to another, but just ask specific questions about the program. I do know that there are some equipment suppliers that are considered "ADP approved." These suppliers will be better informed about the ADP rules and, less likely to withhold information from the patient.

Hope this helps!

willsucceed

thanks again for your response...i have already been using my cpap for 5 months, so i guess i'll likely be s.o.l. for coverage...

If you need bi-pap, but NOT with a back-up rate/If you need bi-pap WITH a back-up rate,

sorry, will, i don't know what this means

care to elaborate?

thanks in advance,

sharon

Back-up rate (sometimes just called "a rate") has to do with treating those folk who have central apnea.

For some folk, their brain stem does not always send the message to breath. The bi-pap used by these folks actually tracks how many breaths the person takes per minute (or some other methodology) and delivers a breath if the specific number of breaths per minute is not met.

Feel free to send me a private message and I'll give you my phone number if you want to talk further about how to get what you want from your supplier and insurance company. I went through the mill with both of these groups and learned lots. I'd be happy to help you as needed.

Good luck!

thanks, willsucceed, i really appreciate the help...i don't see my sleep doc till mid july--tried to move it up but no luck--so i'll be in touch as the time approaches

it's very kind of you to offer the extra assistance

sharon

No problem, happy to help! I think that I incurred HUGE karmic debt when I started on CPAP, having received huge help from people on this site (thanks RG & SWS, and others who I have forgotten to mention) so, I have a HUGE karmic debt to pay back.

[quote="NightHawkeye"] .<snip>
My conclusion is that I still have congestion issues. ....
Tonight I think I'll continue the nasal irrigation, but won't use the humidifier. I've sensed before that the humidifier actually contributed to congestion.

I've got one technical question about the Silverlining software though. When I look at the data, all the nights run together and I can only really tell the nights apart by rolling the mouse pointer across the time data. (I've had multiple sessions per night.) Is there a more obvious way to distinguish the nights? It occurred to me that maybe collecting each night into a separate file would be a way, but I'm not sure that would work without erasing the earlier data before each session.

Regards,
Bill

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Hi, there friends....

FL1: Mine is off because of runaway pressure. My flow limitations are usually in the 20s -- higher on worse nights and have partially to do with nasal congenstion. They seem to be slightly better with nasal irrigation - though like Bill, and without steoridal drops, my basic congestion has become better after two years on cpap. My snores are handled perfectly by the machine - my fls - those that are not congestion, I assume are structural.

By the way - a few nights nights ago I was so congested I couldn't breath through my nose at all - the machine clocked 4 apneas in 5 mins, shot the pressure up to the max - and I was out of bed with my heart banging. this was one of the very very few night I didn't even use the machine again -- and I told myself it was time to return to nasal irrigation (which I stopped last year when my tennis elbow made it so painful...).

Silverlining:
1. In the begining I diligently saved the file for each night, with its own date, so I know where to find the night I want to look at. The files are not big, and doing it that way means you won't start loosing data when the 201th session slips in instead of the first.

I usually clear all data at about session 195 - 197 and just keep on saving, though I no longer do it daily.

2. In the first (synthesis screen) you can either export all the nights in it (up to 200) to a decriptive text file, or else, you can click on the preferred date, and when only that is blue, you'll get the (descriptive) data for that night only, which you can export.

3. The details screen lets you select your view by sessions, settings, or a 96 hour record -- you use the pencil for that.

4. You also export data into files that are are easily imported into Excel - again, in the beginning I did this daily, creating a main data file (with lovely multi colored charts eventuall...) into which I cut and pasted the nightly session data.
The exports are *.se for the session data, *.24h for a 24 hour collection and *.96h for 96 hours - the most time you have for detailed data.

If you use the .SE file you get you sessions one by one. The nice part about using Excel was that I created a rule not to calculate the session AHI for sessions shorter than an hour, since that squews the data.

5. The data exported is sightly different from the data presented, there's a mishandling of mixed apneas - see my Jabberwocky thread if you're interested...

Great to see so many oldies together in this thread! I missed you guys.

O.

ozij !!!
Hey, it's great to see YOU posting again. Have thought about you so many times, O.

Folks, I've learned so much from ozij's posts over the years. She's a heckuva smart lady and has helped so many people. I can't begin to tell you how happy I am to see her post!!

Welcome back, friend. Hope you, your family, and friends have been safe and well.

'Fess up. You've been lurk-reading from time to time, haven't you?

Hi Ozij! Nice to see you back!