This is my big chance. Which machine?

PolyMar wrote:I am an experienced sleep professional (RPSGT) who is on PAP.

And therefore you of course set yourself up with a minimal pressure of 4 and a maximum of 20.

While the idea of APAP is great I myself do not believe it is worth the risk of not getting to sleep at your "perfect pressure". Once I realized my APAP was not working like I thought I decided to test all major APAP devices available on the market, since I am a DME Coordinator [I have the benefit of being able to call my manufacurers reps and request to demo there APAP devices at no charge.

And you set them all up at 4 - 20

I received the same result with all APAP devices, none blew at my optimal pressure for my TST (Total Sleep Time).

A very good reason to use and APAP for therapy is when your pressure needs vary during the night - for instance you need much less on your side than on your back. A device the blows at your optimal pressure for you Total Sleep Time is, by definition, a fixed pressure device. Not an automatic one.

Some people doubtlessly feel much better at fixed pressure. If they have an automatic machine, they can set it up to work at fixed pressure.
Some people do much better when their pressure varies. If they have a fixed pressure machine they cannot set it up to vary the pressure.

If you are interested in a device that adds additional comfort I recommend you try ResMed's S8 CPAP model which offers EPR(Expiratory Pressure Relief) or Respironics CPAP with C-Flex. What C-Flex and ERP do is minutely drop pressure during exhalation to make breathing more comfortable.

Great advice.

You are prescribed a pressure for a reason, and hopefully you were able to work with an RPSGT, not just a sleep tech, which better assures you proper treatment, this is because RPSGT's have sat for their sleep medicine boards/registry and passed. PAP therapy is a process in the beginning, it takes time to acclimate however it is worth it in the end. Keep in mind that just like any other industry PAP manufacturers have a tendency to push the most expensive product and while this product might look attractive many times you end up losing some theraputic benefit thus doing yourself an injustice.

One of the problems with automatic machines, is that most companies don't distinguish the hoopla of "hey, this will titrate automatically" to "here's how this will work when doing therapy". The companies would have us believe the devices are great at preempting respiratory events -- they rarely are.
For good therapy, you can't afford to set the minimum too low, too far from the pressure you need to keep you airway patent.

O.

hose head wrote:Autos are not loved by everyone, but to say that because of your experience with all of the brands of autos, they didn't work for you, so they don't work well for any one is a bit of a stretch.

Excellent point, hose head! A stretch by PolyMar, indeed.

That said... Polymar, I like to see others' opinions, so no problem to me that you are posting what you think. Glad you're here.

One of the points in favor of getting an autopap is that it also has "cpap" mode built in, and can be used as a straight cpap machine if "autotitrating" doesn't suit a person.

SharkBait wrote:And by the way, whoever got on here saying "Why should the DME give them a better machine? They both blow the same pressure" falls under the category of "Who gives a rat's ass if this person gets relief and extends their life with treatment. I want to make a little extra scratch so I can buy that new boat". No two ways about it.

The unfortunate thing for the DME companies, is just that they are a company. When using insurance to pay for PAP, the insurance company is contracted with the supplier and will only pay what they consider to be "reasonable and necessary" that being said they will not pay more if you give the pt a more expensive machine and therefor the DME company can end up "losing their shirt". Business is business everyone is just trying to eat. Seems like the larger problem to me is the insurance companies. I know my company accepts taking a loss on most machines and hopes to pick up revenue on replacement parts, but everyone in our company is either on PAP or their loved one is. Hopefully with the new president "change is coming for healthcare".

PolyMar wrote: ... Hopefully with the new president "change is coming for healthcare".

MAYBE. Personally, I am scared witless about those bought and paid for idiots in our government toying w/my healthcare options!!!! I do NOT expect that they are going to improve health care in this country at all - but rather they'll most likely drag it down to the level of the rest of the world, including 3rd world countries, just as they have our economy, our standard of living, the transfer of jobs from manufacturing to services, the transfer of decent paying jobs to foreign countries, etc., etc.and my hard earned money to their fat a$$ pockets and those of their Wall Street buddies.

PolyMar wrote:Funny, I do love your name though DreamStalker! How do you eat an elephant? One bite at a time, and trust me I am trying to take huge bites of that elephant.

Well thanks ... just don't try and steal it like you did poor Bluebonnet_Gal's.

PolyMar wrote:

SharkBait wrote:And by the way, whoever got on here saying "Why should the DME give them a better machine? They both blow the same pressure" falls under the category of "Who gives a rat's ass if this person gets relief and extends their life with treatment. I want to make a little extra scratch so I can buy that new boat". No two ways about it.

The unfortunate thing for the DME companies, is just that they are a company. When using insurance to pay for PAP, the insurance company is contracted with the supplier and will only pay what they consider to be "reasonable and necessary" that being said they will not pay more if you give the pt a more expensive machine and therefor the DME company can end up "losing their shirt". Business is business everyone is just trying to eat. Seems like the larger problem to me is the insurance companies. I know my company accepts taking a loss on most machines and hopes to pick up revenue on replacement parts, but everyone in our company is either on PAP or their loved one is. Hopefully with the new president "change is coming for healthcare".

All your saying here is what SharkBait just stated ... that you consider it "reasonable and necessary" to screw the patient so that DME's can wear nicer shirts and why should DMEs fight with big insurance elephants when they can eat a buffet of sleepy little mice patients.

PolyMar wrote:Business is business everyone is just trying to eat.

Yes, some more than others apparently.

Seems like the larger problem to me is the insurance companies.

And you just go along with that... and attempt to maximize your profits by giving patients the cheapest equipment possible.

Wow ...... why don't we just throw up a rope and the lynch the guy, after all he's an RT and we all know that RT's are no-good, good for nothings that only want to sleep with our daughters and steal our fortunes after we die prematurely from improperly treated sleep apnea.

The tone around here seems a bit harsh.

I for one welcome an alternative view from the "dark side" as long as it isn't couched in absolutes and professional arrogance. If someone strays too far from our accepted beliefs there are civilized ways of challenging, correcting or ignoring them.

Each of us are experts on our own personal experiences and benefit from the collective wisdom of the group; let's embrace an opportunity to learn from and educate a professional in the field who can provide valuable insights from exposure, diagnosis, and treatment of a huge number of patients and a glimpse of the internal machinations occurring in our niche of the healthcare industry.

We're wearing masks, not hoods.

Paul

rested gal wrote:One of the points in favor of getting an autopap is that it also has "cpap" mode built in, and can be used as a straight cpap machine if "autotitrating" doesn't suit a person.

Yesm indeed, RestedGal. When I started using my Respironics M-Series Auto with A-Flex, I didn't like the feel of A-Flex - the drop in pressure between expiration and inhalation was disturbing to me. So, I went to APAP therapy but using C-Flex as the pressure relief mode. For some reason, though, the APAP mode on this machine didn't suit me, and eventually I went back to just using it as a CPAP machine. When I got my ResMed Autoset II, I started in APAP mode (7-20), with EPR set at 3, and it suits me much better than the APAP mode on the Respironics. The ability to play around is vey useful.

Anyways, here I am with a surplus Respironics M-Series Auto with A-Flex and humidifier I'd like to sell. Does anyone know of a suitable place to try and sell an APAP machine? eBay would seem to be contraindicated...

Ebay won't let you sell a CPAP machine, but cpapauction.com will. There you might see prices for other used M Series Autos with A-FLEX too.

RipVW wrote:Ebay won't let you sell a CPAP machine, but cpapauction.com will. There you might see prices for other used M Series Autos with A-FLEX too.

Thanks: I had just spotted that, and will list it there...

Paul56 wrote:

PolyMar wrote:Business is business everyone is just trying to eat.

Yes, some more than others apparently.

Seems like the larger problem to me is the insurance companies.

And you just go along with that... and attempt to maximize your profits by giving patients the cheapest equipment possible.

In my previous blog I was trying to communicate the fact that I try and provide exactly the blower my pt wants and needs. We often take hits in this department financially and in fact the standard blower we supply goes well beyond reasonable and necessary(We use ResMed Escape II's w/ EPR: Respironics M-Series with C-Flex, Bi-Flex Auto's; VPAP Auto 25's and Auto SV's), but like I also previously stated all individuals involved in my organization are on PAP or one if not several of their loved ones are. I am not the one purchasing your health insurance, you the people are and so I think you as well have some level of responsibility to fight the well oiled, money grubbing machine we call insurance. When all is said and done it is very apparant that many patients on this forum do not feel they received a fair deal when working with their DME company, and again that is why you must do research. I promise that not everyone is out to take advantage of the pt, I know I certainly am not. But if insurance is only willing to pay a supplier $300 for a $1000 piece of equipment DME wholesale price then is it fair to ask the DME company to eat the $700, no it's not, thats a sure fire way to bankrupt your business. Suppliers and the sleep industry do try to fight insurance protocols on a regular basis yet the problem continues. Why should they agree to pay a supplier more when so many people are buying and utilizing insurance everyday with out complaints. The way to fight the problems if through professional petitions as well as pt petitions, oh and make sure you elect the proper people into office-maybe eventually we will get a elected PAP official who understands.

My DME would only supply me with the resmed auto advatage and charged me 200.00 for a up grade, Even though i had a script for the auto with epr. Sent the advatage back and payed for it myself. Asked the dme why they wouldn't purchase the auto II with epr, No answer

Still waiting for my 200.00 from FRAMSC

RipVW wrote:

PolyMar wrote:

In my personal experience the APAP sounds great but rarely delivers the optimal pressure that was found during a pt's titration.

You're "experience" is inconsistent with the plethora of scholarly literature regarding APAP, certainly inconsistent with my (and many others!) experience with sleep study versus APAP titration. Where did you go to school?!

Rip,

Now I have to agree with PolyMar about, "the APAP sounds great but rarely delivers the optimal pressure that was found during a pt's titration".

The sleep lab rarely finds the optimal pressure.

Rooster

what in the world is going on in that avatar?

elg5cats wrote:When I was making my decision about the machine I wanted...I went to cpap.com and the sleep apnea forum and read the specs on all the machines. I thought about which of the features I thought would most likely result in a good experience for me. I liked the idea of a APAP to have flexible response to apnea, I wanted a quiet machine, I wanted humidifiaction, I wanted light weight.I wanted date capability, etc.....then I asked a few people for their opinions on the machines I narrowed my options to. Then I called the local DME's asked what they machines they carried and if they were in network with my insurance...I found a DME that carried my preferred machine which is not the popular brand in my area......I then went to my post cpap titration MD appointment, dressed professionally, with a written request and list of specifications I thought would result in my success and pretty much presented my case like a well dressed lawyer!!!! The jury found me guilty and sentenced me to the machine of my choice!!!!!