Introduction - Newbie here...

If he has a prescription for auto bi-level then I'm not sure which sticker shock you're referring to? Even just a bi-level machine without the auto is a lot more than a CPAP or APAP. If you're buying them out of pocket, there should be a lot at places like second wind - current model auto bipaps aren't cheap!

The reason I'm suggesting those two models is they are the current major models from resmed and respironics. The M-series (which I have exactly the machine he's talking about) are like 5 years old. The DME is probably not going to have an M series, but if you're getting a new machine, you might as well get the right current one. Both the S9 and the 60 series respironics have all the data and features you'd want from an auto bipap.

The slightly older respironics auto bipap would be fine - I think that one uses SD cards - but the M series has proprietary data cards and software. The S8 is similarly NOT a good option.

Xney wrote:If he has a prescription for auto bi-level then I'm not sure which sticker shock you're referring to? Even just a bi-level machine without the auto is a lot more than a CPAP or APAP. If you're buying them out of pocket, there should be a lot at places like second wind - current model auto bipaps aren't cheap!

I have not seen the prescription, but I had the sleep lab technician tell me the details she was allowed to give over the phone. BiPAP, full face mask, heated humidifier were all definites. She was not 100% sure of the data capable part, but says the doc normally adds that when going to BiPAP/VPAP, instead of a regular CPAP. I assume the purpose is for data collection, so the bi-level pressures can be quickly adjusted for the perfect balance. I'm such a novice, so correct me if I'm wrong in this assumption.

Greg6657 wrote:Charleyj and all other newbys Welcome.
Im new to the site but have been on Bipap for almost 4 years, Here are some of the main things I have learned from here:
1. Once you get your equipment please fill out your profile, it helps all the pro's on here to help you.
2. Ask all the questions you have and remember the only dumb question is the one you don't ask. I can pretty much guarantee its been asked here before so don't be embarrassed.

THANKS much for this encouragement! Here's how I look at the whole kit-n-kaboodle right now -- having not even received the machine. I have fibromyaglia, a high level stress job and haven't slept a full night in years (LITERALLY). I also had a pretty major heart attack on July 31, 2012. Soooo, whatever it takes for me to get better, I'm willing to do. I have a loving wife and three awesome kids. I want to be around to enjoy all of them for many years to come. As such, IF the VPAP machine will help me sleep, stop my snoring and give me energy I have not seen in almost 10 years, it's worth every moment of research, every ounce of newbie frustration and every single thing it takes to get there. In other words, I see this - at the outset - as a totally positive experience. And I plan to make it positive by arming myself with knowledge, making friends who will help me through the process, working closely with my physicians, and holding the DME accountable for making things right.

In four years, I hope to be the one offering learned advice, assisting newbies and giving back to those who will be where I am right now.

The $1,000 difference between ResMed VPAP and similar Respironics machine is due to the fact that ResMed does not allow and reduction or discounts off of MSRP. There isn't a $1,000 worth of difference between those machines.
I know because I have one of each and they are the latest models. Minor pros and cons with each.

There are some differences in how each one works though.
Robysue took the time to put the differences into words here viewtopic.php?f=1&t=71017&p=655822&#p655822

I wouldn't advise the M Series BiPap because it doesn't collect the extra data points that the System One machines collect...specifically Clear Airway (centrals) and RERAs and wave form graph....
The equivalent oldie in the ResMed line also doesn't collect central or wave form data and requires a very difficult to find and pricey special card reader.

I would zero in on the PR System One and ResMed S9 VPAP line. These are the latest technology models. They use SD card and nothing special is needed beyond a generic card reader/adapter if your computer doesn't have a SD slot.
Software is easily obtain. SleepyHead works with both brands and there is also ENcore or ResScan.

CharlieJ,

Welcome to the forum. I've been in HoseHead Land for right at 2 years now, and I've been using a PR System One BiPAP Auto for the last 18 months.

To answer some of your questions:

Char1ieJ wrote:WOW, thanks for the warm welcome everyone! I'm blessed. I can pick my own DME -- and there are at least 3 close by.

Interview each of the DMEs and make them earn your business. You'll be sleeping with your machine for the next 5 years or so and you'll be buying masks and supplies from this same DME if everything works as it is supposed to. So make sure you are happy (not merely "content") to do business with your chosen DME. Since the script is for a BiPAP, you won't need to worry about being sold a "brick"---all the modern bi-level machines record full efficacy data. But because you breathe through your mouth, the script specifies a full face mask, and the fact that FFMs tend to be more difficult to adjust to, you need to be comfortable with the DMEs mask replacement policy. In the early going, many DMEs tend to encourage newbies to continue to try to make a troublesome mask work for a longer time than necessary. The reason why is simple: Many DMEs will only replace masks free of charge during the first 30 days. If they can stretch out how long you keep using a mask that is obviously not working well for you, they minimize the that they will need to make (multiple) exchanges. Give a mask 7-10 days (tops) at most: If it is still leaking profusely and causing you much mask discomfort after 10 days of use, chances are it's simply not the right mask. And there are dozens of FFMs to choose from.

So, does anyone have recommendations on which brand to favor? I realize that's a subjective question, but at least pointers would be very much appreciated.

Specifics of the prescription are:
Bi-PAP machine
Heated humidifier
Data capable
I would think these parameters would narrow the options greatly, but I'm not sure.

and

Java wrote:

Xney wrote: These are the two you would probably want to choose between:

https://www.cpap.com/productpage/S9-VPA ... chine.html

S9 vpap auto, the vpap is the resmed "bipap". "bipap" is a respironics trademark - other xPAP manufacturers tend to use "VPAP".

https://www.cpap.com/productpage/pr-sys ... chine.html

Whoa.. little sticker shock here..
Seriously, what is so great about these to make them $1000+ more than other "good" machines?

BiPAPs are about twice as expensive as APAPs because they are a somewhat more sophisticated machine and they are much less frequently prescribed than CPAPs/APAPs. A BiPAP must be capable of changing the pressure by as much as 10 cm with each and every inhale/exhale cycle. And it must do this while still remaining about as quiet as the APAPs/CPAPs in the same model line. (And the S9 VPAP Auto and the PR System One BiPAP Pro and PR System One BiPAP Auto are all virtually silent.) And BiPAPs typically have a max (IPAP) pressure setting of 25cm H2O instead of 20cm.

Now a good question for your sleep doc is this: Why did you prescribe a BiPAP for me right after my titration study?

It is a bit unusual (but not unheard of) for newly diagnosed folks to be started off on a BiPAP rather than a CPAP/APAP. Many (but not all) insurance companies are reluctant to pay that extra $1000+ to provide a BiPAP unless it's been proven that the patient cannot or does not benefit from using a CPAP/APAP machine. But the there are some sleep docs who feel strongly that bilevels are good machines to start with for some (or in a few cases, all) patients. Usually patients given bi-levels right from the start are also being prescribed pressures that are considered "high"---i.e. near the upper end of the regular CPAP/BIPAP range. The titration guidelines allow bi-level trials whenever a patient is titrated to 15cm or more during the titration study. And obviously, for the few folks who need more than 20cm of pressure, a bi-level is required for effective therapy. So it could be that your initial prescription is on the high side. And one advantage of bilevels for folks with pressure needs of 15cm+ is that the IPAP (inhale pressure) and EPAP (exhale pressure) can be set much farther apart than the 3cm provided by the S9 Elite and S9 AutoSet. (The drop in pressure provided by Flex on the PR System One Pro and Auto is less than 3cm even when Flex is set to 3.) The larger drop in pressure on exhale provided by a bilevel usually is more comfortable for newbies---i.e. you don't have to fight as hard to exhale against what seems like a gale force wind right at the beginning. Aerophagia problems are usually less on bilevels. And that also can make them easier to adjust to.

1) Could someone point me to relevant BiPAP machine reviews / recommendations? CPAP.com shows the M Series BIPAP Auto with Bi-Flex and the M Series Heated Humidifier, manufactured by Philips Respironics, as the top rated BiPAP and heated humidifiers on their site.

As others have pointed out, the M-series was discontinued several years ago. The current models are the PR System One Series 60 Remstar BiPAP Pro and the PR System One Series 60 Remstar BiPAP Auto. Some DMEs may still have the (slightly) older PR System One Series 50 Remstar BiPAPs around. The primary differences between the Series 60 and Series 50 machines are these: The Series 60s have an optional integrated heated hose and the Series 60 machines are not yet compatible with the Sleepy Head software that you may have read about here. But note: JediMark knows of the SleepyHead problem and there are folks working on it, so it's only a matter of time before Sleepy Head will work with these Series 60 machines. And if you wind up with a Series 50 machine, but want to try a heated hose, there are heated hoses, such as the Aussie hose that can be used with any machine.

The competing Resmed machine is the S9 VPAP Auto. Any of these machines can provide top notch therapy and they all record full efficacy data. Both the Series 50 and Series 60 System One Pros are fixed bilevel---they cannot be set to Auto mode where the machine can automatically adjust the pressures through the night. Both of the System One Autos (Series 50 and Series 60) and the S9 VPAP can be set in either straight bilevel mode (fixed pressures) or in auto mode; hence they are a bit more flexible in the long run.

In fixed bilevel mode, there's not going to much difference between a System One BiPAP and an S9 VPAP as far as therapy goes. The System One will have Bi-Flex, which provides an additional bit of exhale relief above and beyond that provided by the drop from IPAP to EPAP at the start of the exhale. Some folks really like this feature, others don't. The S9 VPAP does not have any form of additional exhale relief beyond the drop from IPAP to EPAP.

The S9's LCD will provide a lot of useful data for those mornings when you don't want to download the data to a computer. The System One's LCD data is pathetic. But both machines use SD cards and there is free software that can be used to look at and analyze the data on your own PC. (The Series 60 BiPAPs require Encore Basic right now, but if you PM Pugsy, she can set you up with it.)

If you wind up running the bilevel machine in Auto mode, there are some real differences in how the PR and Resmed Auto algorithms are implemented. I give a pretty throrough review of those Auto algorithms in this post to another newbie thread about bi-levels.

2) What feature(s) should be a must?
3) What is "fluff" that I don't need?

I run through a lot of this information in this post to another newbie thread about bi-levels.

The only thing that's new since I wrote that post are:

• the fact that integrated heated hoses are now available for both the S9 and the Series 60 System One;
• the current problem Sleepy Head has with data from the Series 60 machines; but Encore Basic can be downloaded for free and so software exists for both the S9 VPAP and the Series 60 System One BiPAPs.

In my humble opinion, neither the heated hose nor Bi-Flex is a feature that is really needed. But for many people these can be make or break features that are not "fluff".

4) Tech told me to get long hose - implying that is needed if I sleep on my side. Is that true?

I sleep on my side with a standard 6-foot hose. Of course, I'm a small person (5'1" and 110 lbs). If hubby is not in the bed, I can pretty much get anywhere in the bed---but then we share a plain old double bed---as in "full size" not Queen or King size. I can see where a large person sleeping solo in a large bed might want a longer hose to get to the far side of the bed. But under normal circumstances? It seems to me like a longer hose is just going to give you more stuff to get tangled up in and weigh more to boot. On the other hand, a longer hose will allow you to place the machine farther away from the bed or much lower than the level of your mattress top. And many people do like that.

5) What question does a newbie not ask, but need to know before deciding on a machine?

You've already asked a bunch of these.

Additional questions to ask before you decide on the machine include:

• Asking your insurance company exactly what your benefits are. Benefits for durable medical equipment are often quite different from prescription drug benefits. In particular, you want to know what your copays are going to look like. For example, my insurance company covers all my prescription drugs with $5, $10, or $30 copays depending on which tier the drug is in, and even with the $30 drugs, my copay represents no more than 10-20% of the cost of the drug. But my copay on all durable medical equipment is 50%---as in I pay half of all my CPAP supplies that are "covered" by my insurance company.
• Ask both the DME and the insurance company about the replacement schedule for "disposables"---i.e. how often will the insurance pay for new filters, new mask cushions, new masks, new hoses, new humidifier tanks, and a whole new machine. It may be difficult to get the insurance company to give you this information, but between the DME and the insurance company you should be able to get a working idea of how often you are entitled to replacement parts. You may find that some parts will need more frequent replacement (at 100% OOP) and other parts won't need to be replaced as frequently as the insurance will pay for them.
• Ask for a written estimate of what your start up costs will be. You want this estimate to look exactly like the paperwork you will be expected to sign when you take delivery of the machine. Ask that the written estimate include what the DME expects the insurance to pay and what you will be paying OOP.
• Determine whether the blower unit will be a "rent to own" contract (for how long? for how much each month?) and whether the humidifier will be a "purchase" contract (you own it from the start.)
• Ask if the DME will provide you with free copies of your downloaded data or if you will have to purchase them. While this seems stupid---particularly if you intend to download the software for yourself, the answer to this question is one of many that can be used to assess whether the DME is really concerned about helping their patients get to 100% compliance or whether the DME is just interested in selling the equipment and then tends to let their patients flounder around without much help.

robysue & Pugsy, THANK YOU for the excellent advice. I am taking copious notes and learning from everyone, especially your posts.
This post helped me understand the differences between the two machines that seem to be the most "popular":
ResMed S9 VPAP Auto
Respironics REMstar System One 60 Series BiPAP Auto
viewtopic.php?f=1&t=71017&p=655822&#p655822

IF given a choice, at this point, I'm not really sure which one I would choose. I did receive a fax of my diagnostic report this afternoon -- with lots of numbers, etc. If ANY of that data would help members with advice, I'll gladly post it. From what I have learned thus far, the basics advisors would need to help me make an informed decision are:

First study = apnea/hypopnea index = 11.8

Titration study started w/ 4cm... increased to 15cm, at which time "patient could not tolerate". So, "bi-pap was initiated". From what I am reading, it looks like I settled down and really slept (without snoring, etc) at VPAP levels of 17/14.

BiPAP/VPAP settings prescribed:
IPAP = 17
EPAP = 14
Final pressure AHI was 0.9

Does this help anyone with offering specific advice on which one to choose -- OR, a totally different machine?
THANKS again!
Char1ieJ

Char1ieJ wrote: First study = apnea/hypopnea index = 11.8

Titration study started w/ 4cm... increased to 15cm, at which time "patient could not tolerate". So, "bi-pap was initiated". From what I am reading, it looks like I settled down and really slept (without snoring, etc) at VPAP levels of 17/14.

BiPAP/VPAP settings prescribed:
IPAP = 17
EPAP = 14
Final pressure AHI was 0.9

By numbers, your OSA is in the middle to top end of "mild OSA". Your pressure levels are on the high side. You are a classic example that the pressure setting needed to splint the airway open has nothing to do with the severity of the the untreated OSA.

And this also clarifies exactly why you're starting off with a bilevel: You're dealing with high pressures, had trouble tolerating straight CPAP at 15cm, and stuff settled down when they switched you to bilevel.

Does this help anyone with offering specific advice on which one to choose -- OR, a totally different machine?
THANKS again!

As to which bilevel to get: If insurance is paying a substantial amount of the cost of the machine, your OOP may be exactly the same regardless of which machine you choose. If cost of the machine is an issue, then go with the PR System One BiPAP Pro or BiPAP Auto. They cost less. If you have a huge deductible or are buying completely out of pocket, you might want to consider getting Series 50 PR System One BiPAP Auto or Series 50 PR System One BiPAP Pro which are currently heavily discounted at CPAP.com because they are discontinued machines.

I think that most people would probably do well with either brand bilevel machine. There might be a few people who would do better with one over the other but for the most part either brand would likely work for the majority of the users.
Your doctor may have a preference because he may have the software for one brand and not the other.
Same thing with a DME. Most DMEs will stock one brand...they buy in bulk and get a better price.
If you stick with either the S9 or the PR S1 machines you won't go wrong. There are some other bilevel brands but Respironics and ResMed have long been the industry leaders in bilevel machines.
If your chosen DME happens to have both brands...ask to briefly try each brand at your prescribed setting to see if initially one feels better to you.

THANKS much for this encouragement! Here's how I look at the whole kit-n-kaboodle right now -- having not even received the machine. I have fibromyaglia, a high level stress job and haven't slept a full night in years (LITERALLY). I also had a pretty major heart attack on July 31, 2012. Soooo, whatever it takes for me to get better, I'm willing to do. I have a loving wife and three awesome kids. I want to be around to enjoy all of them for many years to come. As such, IF the VPAP machine will help me sleep, stop my snoring and give me energy I have not seen in almost 10 years, it's worth every moment of research, every ounce of newbie frustration and every single thing it takes to get there. In other words, I see this - at the outset - as a totally positive experience. And I plan to make it positive by arming myself with knowledge, making friends who will help me through the process, working closely with my physicians, and holding the DME accountable for making things right.

In four years, I hope to be the one offering learned advice, assisting newbies and giving back to those who will be where I am right now.[/quote]

I have a feeling your going to do just fine in this transition.
I also had a heart attack 3/28/2010, and I have a great wife and one of the cutiest grandsons alive and I had the exact same attitude and almost felt like a duck taking to water (I do believe attitude is alot of it) good luck and remember were here for those few monents when you just arent sure.

Greg6657,

You've got a great attitude towards this new adventure in Hosehead Land. And attitude goes a long, long way in sticking with therapy and making the tweaks needed to make it work.

robysue wrote:Greg6657,

You've got a great attitude towards this new adventure in Hosehead Land. And attitude goes a long, long way in sticking with therapy and making the tweaks needed to make it work.

Thanks Robysue, I really do feel that Charleyj is also going to do very very well
PS, I also want to say that I really enjoy reading your posts, You and JohnBFisher and a few others always seem to speak laymans english. Plus I am just about due for a new machine and your guide answered a lot of questions. Keep up the good work everyone.

Great attitude for somebody adjusting to the changes it requires! But do try to get your machine ASAP - especially with your conditions. They need to get you something ASAP.

Xney wrote:Great attitude for somebody adjusting to the changes it requires! But do try to get your machine ASAP - especially with your conditions. They need to get you something ASAP.

THANKS again everyone!

I am supposed to hear from the cardiologist's preferred DME today; tomorrow latest. I told the sleep lab tech, who sent the script to the DME, to make sure the right person calls me up front because I am learning what I need to know -- and don't want to have to bypass a "salesman" in order to get a technical professional to help me make the right decision. One thing the great folks here have taught me already -- this is about my health. Thankfully, I work for the hospital system that is associated with my cardiologist and the sleep lab. While I don't have any "pull" to get things done, the mentality of most folks within the system is - we take care of our own.

[tear jerker mode = on] Dealing with fibromyalgia since 2003 has been hell. Add to that, three severely blocked heart vessels AND not having a full night's sleep in (literally) several years -- and you can easily understand my frustration, depression and exhaustion. Therefore, I'm actually excited about the prospects this new venture holds for me. My heart vessels are open now (thanks to two stents & some heart meds). And, I truly believe that with restorative sleep/rest, my FMS symptoms will greatly decrease, removing the worst effects of depression, exhaustion -- and the frustration caused by these issues. [tear jerker mode = off]

After doing a lot of reading, and being a techie kinda guy, I am slightly leaning towards the ResMed S9 VPAP Auto. Since there are several DME's around -- including one across the street that sells ResMed machines -- I have a call in asking exactly how insurance reimburses. If I can go "out of network" without a major monetary penalty, I'll probably go with the local DME. Truthfully, it's probably going to come down to which brand the "preferred" DME sells, though.

The model? I'm going for a S9 VPAP Auto or the System One 60 Series BiPAP Auto. While finances are very tight right now, I'll gladly scrape together money to handle co-pays on these models, because I see the benefits of having the data and flexibility they provide. After all, the plan is for me to loose 30 more pounds -- and that might change my pressures.

Crossing my fingers that BCBS of SC is going to take care of the majority of the costs. As for meeting my deductible, let's just say when they life flighted me from the local ER to the cardiac care center in Florence, my health coverage deductible was met - with a vengeance. (I can smile about that now.) No idea if there is a DME deductible, yet. Waiting on a phone call...

Charlie, have you seen this example of delta sleep in a fibromyalgia patient (down near the bottom of the page on that site)? The sleep tech who runs this website wonders if fibromyalgia is primarily a sleep disorder that causes physical pain rather than a physical disorder that causes sleep disruption. Kind of a chicken-and-egg question. But when I read about your fibromyalgia I remembered this website info and thought you might find it interesting.

His style is informal but he's a good guy and knows his stuff. He also has a brief Youtube video about fibromyalgia:

http://www.freecpapadvice.com/Fibromyalgia_Sleep.html

kaiasgram wrote:Charlie, have you seen this example of delta sleep in a fibromyalgia patient (down near the bottom of the page on that site)? The sleep tech who runs this website wonders if fibromyalgia is primarily a sleep disorder that causes physical pain rather than a physical disorder that causes sleep disruption. Kind of a chicken-and-egg question. But when I read about your fibromyalgia I remembered this website info and thought you might find it interesting.
His style is informal but he's a good guy and knows his stuff. He also has a brief Youtube video about fibromyalgia:
http://www.freecpapadvice.com/Fibromyalgia_Sleep.html

kaiasgram,
I have not seen that, nor been exposed to that theory. However, as someone who has dealt with FMS since 2003 (and before I was diagnosed), it would not surprise me to learn that fibro is more of a sleep disorder that causes physical pain than a physical disorder that causes sleep disruption. In fact, in my case, my doctor believes an acute physical injury, and the ensuing 16mths of untreated pain & lack of restorative rest, were the primary factors for the onset of my FMS.
I'll read the blog and watch the video. THANK YOU for pointing this information out to me.

robysue wrote:By numbers, your OSA is in the middle to top end of "mild OSA". Your pressure levels are on the high side. You are a classic example that the pressure setting needed to splint the airway open has nothing to do with the severity of the the untreated OSA.

And this also clarifies exactly why you're starting off with a bilevel: You're dealing with high pressures, had trouble tolerating straight CPAP at 15cm, and stuff settled down when they switched you to bilevel.

robysue,
Even though I'm in the "mild OSA" range, should it worry me that my "pressure levels are on the high side"? I have always blamed my restless/sleepless nights on fibromyalgia. I never really had a clue about OSA until I was talking with my brother-in-law about his CPAP machine. He described his sleep, habits, feelings -- and I kinda thought, "Hey, that sounds like me - every night."

As for "trouble tolerating straight CPAP at 15cm" -- If I remember correctly (it was the middle of the night), I had trouble exhaling and felt like I couldn't breathe at that level. But, when the sleep lab tech made a change (the change I now know was moving from CPAP to BiPAP), I fell asleep comfortably and didn't snore or remember waking the remainder of the night.

On a side note: I added an avatar. Don't let that face scare you away!! Haha

First off, a collective, "pleased ta meetcha!"