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:
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.