Best machine to choose if they all cost 50 cents

Hi all,
Great forum here. I am new to this forum and have only recently been diagnosed with severe apnea. I know very few other details about my own diagnosis, for some reason getting that info out of my clinic is difficult.

I have read through the faq's and some of the excellent articles by the members here, as well as searching a bit and came away enlightened. But I still have questions. I hope that my questions are not a useless rehash of previous ones on this forum that I simply haven't found yet.

Firstly, I find apap excellent. Hate the masks of course, hate the whole idea etc but just loved putting it on from the first day, as sleep and the feeling of choking and suffocation at night had been an issue for me over the last 2 decades. Relief at last!

So mask problems, rain out, pressure marks on my face, all that stuff I can deal with and look on as very small drawbacks. I have found excellent answers for most of them already (some in this forum). I mention these non issues as I feel my attitude is pretty positive and I think I am a fairly compliant patient. In fact I shaved a beard I have had for the last decade just in case it was affecting the nasal pillows.

My question to the clinic has been - what is just the best machine, forget cost? they seem intent on trialling me with cheap machines regardless. I pointed out to them that cpap machines seem to be a cheaper subset of apap. Apap does not offer any drawbacks but offers software feedback and other extras which are useful- so I would simply buy apap (whats a few hundred bucks over the rest of my life?) I then asked, is apap a subset of the functions a bipap has? Should I buy bipap since cost is irrelevant? They really seemed to panic at that stage. My intention is not to shortcut anything. In fact if they suggest that cpap is my best option I would still buy apap (or bipap if I can determine that it encompasses apap) and set it up as cpap, but I would know I have any functions I might need should things change, plus I can optimize my treatment over time. I can see no drawbacks and the extra bucks just don't matter in my reckoning.

I'm by no means rich but have few (expensive) vices. I see the cost like this -Even if I bought one of every mask plus one of each type - cpap, apap and bipap machine plus oxygen meter etc to make sure I got the absolute best solution and gave them the best tools to help treat me- If fact even if I built a private sleep clinic in my bedroom - it would still be less than the cost of having a cigarette habit (which many people pay for quite happily) over a few years. Extending that comparison somewhat - apnea is perhaps analogous in effect and some consequences to a cigarette habit. Therefore to me, buying all the right gear even if it costs more makes a lot of sense. So why the hangup on cost with them when I have stated that it is not an issue? I'm tempted to just buy a bipap and an apap plus a few masks and bits and just get on with it. The clinic seems intent on taking me down what feels like a "one size fits all" treatment path. Am I just overanxious perhaps? I am also tempted to try a different clinic.

Please do not take my comments as disrespect towards these professionals by the way, though it admittedly sounds like that. I know they have a tough job with probably thousands of needy and probably tired patients. I guess I just don't know whether the requests and assumptions I am making are reasonable. I wonder also if they are used to patients with negative attitudes to cost and treatment and are not keen on changing their standard treatment advice even when I insist that cost is not a factor for me.

So, this is where you guys can give me some alternative perspectives if you will. Imagine that every xpap on the market including bipap cost 50 cents and came out of a gumball machine (weight and size not an issue for me either). Which one would everyone have? Which one would the sleep clinic send me home with if they trusted me to use it properly, follow their advice on usage etc?

Further - imagine that oxygen sensors etc and the cost of setting up a "home sleep clinic" was trivial - would it be a good idea? I asked what the oxygen sensors that they sent home with me in the first week cost and they said a lot. I asked how much, and they said 4 thousand or so. I commented that this was cheap enough considering, could I buy them? and they looked at me..well in the same way I imagine a vet would look at a dog making strange noises on the examining table.

Anyhow, sorry for the long post, hope I am making some sense.

I think an APAP with respiratory relief has some of the attributes of a Bilevel machine. Even with C/flex on my machine, I don't have it set for the maximum pressure change from inhalation to exhalation. I have found that a greater variation in pressure seems to promote higher AHI, at least in my case. Its also distracting for breating. A number of forum members run APAPs in stratight CPAP mode without using any Cflex or Aflex for that same reason. Others, find exhalation relief is more comfortable.

I would not suggest buying a BiLevel machine unless there is a medical indication you need it. That said, I think you're on the right track to take control of your therapy by getting an APAP machine with data capability and probably some form of adjustable exhalation relief.

Put up a profile...somehow "Guest" seems a bit impersonal.

For most of us money is an issue. But since the machines seem to last at least 5 years and divide the cost by 60, is probably costs about $20/month, which is quite reasonable. Also most recommendations will be from people that have also analyzed the available equipment, but have only used one type. For machines go to cpap.com and take a look at the compare apap's. All of the more expensive machines that are bi-pap are pretty specialized. I wondered the same about a bi-pap and THINK it would be a little better (also in an auto). Respironics is the only one that makes an auto bi-pap, so there is not a lot of choice there. I believe you would be happy starting out with a Respironics APAP with aflex and built in humidifier ($595). Also buy the software/card reader package ($149). You can no longer depend on the price on the websites and have to call or e-mail them to get their best price due to manufacturers requiring Minimum Advertised Price on many items.
Masks are another thing. I have a UltraMirage Full Face (6 sizes available), Hybrid full face, Swift II, and Respironics Gel and still looking for a better one, but this gives me quite a few choices to see what works best.
Oximeters do not seem to be necessary, but I bought one on clearance that records in 2 second intervals up to 16 hours sleep time and came with a program to download it and analyze it on your computer. They cost about $500. This does not make a sleep lab, but it does about everything except for a video recording camera and most people are not going to invest in ekg and brain wave monitoring for home use. It would be fun if it were not for the problem of washing all that goo out of your hair each morning. LOL.

I am certain you can get as many different answers on this one as you get responses.

If you have the more common plain old "obstruct" sleep apnea, the BiPAP Auto with Bi-Flex will be the one with the most options to tweak the perfect optimized treatment. However, you will need to find a doctor to Rx a BiPAP since you cannot purchase on in the US without the specifed script.

The next best thing avaialble with a simple CPAP script is to get an APAP with A-FLEX. You don't need an APAP script if you are buying online (at least from CPAP.COM) ... if you go through a typical DME, they will likely want the Rx to specifically state "APAP" and list both a min and max pressure setting ... that is one good reason to just buy online out-of-pocket. Insurance 80/20 coverage will not save you more than about $100 than buying out-of-pocket.

If money is not such an issue, buy all three brands of auto and try them out. They have different algorithms - which sometime makes one of them much better for one person - and another for the other.

You have to find the one that is best for you - and theoretically, that might be the machine that is best for only 4% of the poplation.

O.

Edit: on second thought, it's four brands, but the DeVilbiss is not necessarily data capable and does not have software yet.

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CPAPopedia Keywords Contained In This Post (Click For Definition): auto

Welcome!

Just to correct something that you said in your initial post.....there are data capable CPAP machines as well. YOu do not need to step up to Apap to get data.

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, CPAP, APAP

Also, since it appears that you went to one of those one-stop shop clinics, they will indeed look at you like a dog asking them intelligent questions on the vet table. They don't like good paying dogs bucking their system and taking control of their own treatment ... not good for making timely payments on their jag in the parking lot.

Your attitude is good and you will do jsut fine.

Respironics Auto BiPap SV. More flexibility than just about any machine this side of the Moon Rover. If it can handle MY problems, it should handle yours.
$3,499. Buy it with a VISA or American Express and your warranty is extended.

Very interesting post - I look forward to your reviews of whatever products you end up with! I hope you register so we can get to know you better.

I found your analogy about cigarette costs relative to xPAP to be right on the money. The one question I have for you is why fix something that's not broken? In other words, I suggest you do like most of us on the forum do - research and buy the one machine that you think will address all of your issues, and use it until you know that it's either working or not. Then try another one. Same with the masks. Like you said, you have a lifetime to get it just right - why rush it. Plus, they may invent the perfect machine in the near future...you will want to have room for it on your nightstand.

Good luck,
Cathy

I have the Respironics M Series APAP with A-Flex, along with the software and card reader. I bought it, online, with my own funds. It's a lot cheaper that way! I bought this one because I had an old Respironics before and it worked well for me. I bought this particular machine, this time, because it has so many options! I may be wrong but I think, of all the machines currently on the market, it has the most options. Having said that, I have to agree with Oiji. A brand of machine that works well for one may not work as well for another, given the different algorithms. A backup machine is always good. That could be a different brand but then there is the software, which differs from brand to brand. I think the software, card reader and a data capable machine with cpap and apap options, are the minimums, as funds permit. You could have different machines with diffferent software if it's financially feasible for you.I do not have, but do intend to get, an Oximeter. I want one with software, to read nightly results on my computer. I am researching on that one.
Only one reply has said anything about the humdifier so I will. I think it is a very useful addition to the "home sleep lab". For me, it is a must. I first bought the integrated one with my auto A-Flex. There were so many horror stories about it leaking into the machine, that I bought, on the advice members of this forum, a Fisher and Paykel stand alone humidifier which works with virtually any machine available. It is, by far, the best humdifier I have ever had. I've only had 2 others so that may not be much of a recommendation!
Masks are the real issue. Everyone is so different it is hard to make any real recommentations in that regard. I have 6 that I use interchangeably right now. One is my current favourite and I wear it most of the time, but always want to try new ones. The quest for the perfect mask is never ending! One of my 6 masks is a Hybrid (full face mask) for times when I have a respiratory condition (severe cold for example)that makes nasal breathing difficult.
Well, that's my 2 bits!

This question unfortunately is like asking a group of mums whoose baby is the prettiest. (It will be hard to get an objective answer).

So here is my 'opinion'

If choosing a CPAP I would go for (1) the S8 II series (Elite), (2) a PB420S

If choosing an Auto I would go for (1) a Resmed S8 II series (Vantage), (2) A Remstar Auto (older model)

If choosing a bilevel I'd go for (1) a PB425, (2) A PB330 (older model)

If choosing an Auto Bilevel I'd go (1) for a Bipap Auto , (2) for a Vpap Auto

If choosing an SV machine I'd go for (1) a Bipap Auto SV, (2) a Vpap Adapt SV


Good luck with your choice

DSM

ozij wrote:If money is not such an issue, buy all three brands of auto and try them out. They have different algorithms - which sometime makes one of them much better for one person - and another for the other.

You have to find the one that is best for you - and theoretically, that might be the machine that is best for only 4% of the poplation.

O.

Edit: on second thought, it's four brands, but the DeVilbiss is not necessarily data capable and does not have software yet.

There is definitely no one best machine, as ozij points out so nicely. I think that this question is similar to "what is the best mask" when there is really no way to answer that, either. It is individual.

Another factor is that some machines are out there that are fairly new. They come from companies that were looking for the niches in the market, I think. At any rate, there is not such a wealth of user information built up about these machines yet. Many of them have lower prices and they have a variety of features that seem attractive. I wonder if that is why your DME provider is giving you cheaper machines to try? They may be excited about the new, enthralling possibilities.

There are also some really outstanding DME providers AND some really lousy ones. Stories on this forum abound with the lousy ones; there are also a few about the good ones, which should give you a clue about how many there are of each.

Keep reading the forum and you will find some indications, but I would say that if your DME is having you try trial machines of different types, GO WITH THE FORCE, LUKE! I do not recall EVER reading that before.

Please do register. We need such people as you to help us with your experience and answering questions. (I feel that it is important to pay back the help that I received.) There are an awful lot of people who have given me not only information, but also support and friendship. Plus, where can one find such a wealth of expertise? I learn something almost every visit to the message board.

Best wishes, and you definitely seem to have an advantage in your attitude. That truly is everything, IMHO, and with a positive attitude nearly any problem can be surmounted.

Best,

Karen

ww wrote: ... Respironics is the only one that makes an auto bi-pap, so there is not a lot of choice there. ...

Just to clarify: VPAP is Resmed's proprietary name for their bi-levels, just as Bi-PAP is Respironics' proprietary name for their bi-levels. AND Resmed has just come out w/a GREAT bi-level w/the new Resmed VPAP Auto w/EasyBreathe technology.

That being said, even if money is no object, and even tho I was just switched to the new Resmed VPAP Auto from a straight CPAP, then an autoPAP (I have COPD) and I do love my new VPAP Auto, given the high price of a bi-level (2-4 x the cost of a good autoPAP), I wouldn't buy one unless needed. Instead, since money is no object, I'd buy two good fully data capable autoPAPs of two different brands (manufacturers) AND their software and cable readers.

The reason being that CPAP technology is moving forward so fast, my S8 that had just come out in '96 is already being replaced w/the S8 IIs w/the new EasyBreathe technology. AND it is sooooo convenient to have 2 xPAPs for traveling. Have one packed and ready to go and the other on the nightstand ready to provide therapy. Even tho easy enough to dismantle and pack, why bother? Just walk out the door ready to go w/the backup xPAP and when you get home just fall into bed w/the regular xPAP. Its great! And if one or the other gets "sick", you've got the travel/backup. In addition to which it gives you a chance to see if one provides more comfortable therapy for you than the other. And which software I liked better if the comfort was equal.

I fail to see the need for a recording oximeter BUT if you really wanna blow some money, I'd look to see what the professionals use as a hand-held as being the most versatile (about the size of a paperback, easy to take to bed w/you) and doesn't take up room on the nightstand. Software, of course, for my 'puter.

If you REALLY wanna be professional I'd give serious consideration to an autoPAP that can utlize the addition of an oximeter and include that oximeter data w/the autoPAP software. Which means being sure of compatability! I know Resmed has such a setup but you'd have to check their website and products for coordinating what w/what. They prefer the Nonin oximeters which is one of the best brands of oximeters available. And priced accordingly.

If everything were just 50 cents each - I'd go w/the Resmed VPAP Auto and Nonin oximeter setup up, the Resmed software - unless they have something even more fascinating in their product line since last I checked. And I'd also go w/the Respironics Auto w/A-Flex and software and whatever type of oximetry setup they might have.

PLUS since it was only 50 cents I'd try out the Puritan Bennett auto and software and see if they have some setup for oximetery as well. Too bad the new Sandman Auto isn't available (to my knowledge) in the USA yet.

Heck, for 50 cents I'd buy one of those DeVilBiss IntelliPAP AutoPAPs and gamble that the software, when it comes out (supposedly this summer), provides worthwhile info.

Shucks, going all out, for 50 cents why not try that Everest 2?

If you like to go camping don't forget to check all these autoPAPs for battery setups.

As has been suggested earlier in addition to the integrated humidifier I'd get the Fisher & Paykel HC 150 stand alone heated humidifier.

My favorite mask is one of Respironics' oldest and not all that popular w/others so I'm not even going to discuss masks.

Sleeprider wrote: I would not suggest buying a BiLevel machine unless there is a medical indication you need it. That said, I think you're on the right track to take control of your therapy by getting an APAP machine with data capability and probably some form of adjustable exhalation relief.

Put up a profile...somehow "Guest" seems a bit impersonal.

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Thanks Sleeprider -good advice - I'm trying to edit my profile, I thought I selected a username already so perhaps it's an administrative thing to do with number of posts or such.

I guess I should have added that if I were to choose a preferred machine over all others it would be ...

A Bipap Auto (Biflex model) or Vpap Auto (the 1 slinky has). I'd want 1 of each .

I won't mention the SV models because there are too many complexities associated in choosing them & not worth going into here. SV technology may well find its way into the mainstream in time but a lot of evaluation & assessing of peoples actual situations and matching of requirements needs to be done before we will see this happen.

DSM