Another new member from Australia

[midvalleyguy]

For over a year I have been feeling tired every afternoon and sleeping poorly every night. Using an Android sleep app, I discovered I was getting only about 22% deep sleep with 10% snoring. On referral to a sleep doctor, I spent overnight at his clinic on 17th September last. At my subsequent appointment on 12th December, after a short discussion about my results, he supplied me with a CPAP Prescription Form. On it are listed: pump pressure 6cms, humidification, nasal mask Dreamwear, and "Other: EPR/C-Flex: 3cm.Sensawake alternatively" (this was not explained to me). 

The written plan the doctor also supplied advised to contact a supplier to check out machines and trials. At the bottom of the plan in fine print appears the following :"Doctor X holds shares in several CPAP/Dental manufacturer/supply companies". He did not recommend any brand.

After shopping around in person and online, and after phoning several suppliers, I soon discovered most CPAP machines and masks in Australia are horrendously prices, with substantial variations even for the same brand and model. 

After making comparisons I have decided the most suitable and flexible CPAP machine for me is the DeVilbiss Auto with Humidifier costing AUD$895 (USD$637), Dreamwear nasal mask AUD$189, 12V DC power cord AUD$19 (USD$13). This machine is the only one that meets all my requirements: flexible (has a humidifier), price, easy data access at home, 12V cable at reasonable cost. I go on quite a few trips around Australia in my campervan and must have 12V operation. I am not prepared to import at any cost because of warranties and after sales service..

I am paying for all this out of my own pocket. I've just discovered that the supplier with the DeVilbiss priced as above is on your Supplier List and is located about 2 hours drive away from me. They are the only supplier so far who hasn't at all been pushy, and has been the most helpful out of aIl I have contacted, so I would purchase from them. 

My first available appointment with the sleep doctor is 7th March. I have requested a written copy of my sleep study data from last September (full version and/or summaries) but have had no response. My thinking at present is that it's a waste of $$$ to have a trial (not inexpensive locally with a DeVilbiss), so I'm thinking I should stop stalling and just go ahead and buy the DeVilbiss. This Board has been extremely informative so far. Any advice appreciated.  

P.S. My desktop Intel MacPro running Leopard 10.5.8 is not compatible with SleepyHead.

[Gideon]

Despite your research, I would recommend first the ResMed Autoset It does require a cable for DC Operation but it works solidly in that mode. The machine I had before my ResMed was an Auto DeVilbiss. It was pushing my numbers up to 18-20, I currently have a range but is steady at 10-11. More importantly The ResMed can be used with Sleepyhead which will give you detail down to a breath by breath basis if necessary. This makes it extremely easy to modify your settings based on data. I did have teh data module for the DeVilbiss, no comparison IMHO.


Fred

[Fats Drywaller]

I strongly recommend not getting the De Vilbiss. It can't compare to the Resmed Airsense 10 Autoset, in all kinds of ways. The A10 is the gold standard. If you want a list of things wrong with the DV5x series, then say so and I'll post a rant on that subject. If a DV6x (63 or 64), also known as "IntelliPAP 2" (second generation), was recommended instead, that's somewhat better but still IMO a big waste of money. There's no reason to settle for an inferior machine. Much better to do it right, from the start. Using the initial cost as the main criterion is false economy, sorry to say. I know it's easy for me to say, but it's true in this case.

A 3rd-party DC cable for the Resmed is US$70 and worth it. (Actually, that's about the same price as the official Resmed DC cable, maybe slightly less.)

For Sleepyhead, just upgrade your Mac to Snow Leopard (10.6.x) and you should be fine. Everything else in 10.6 is the same as Leopard, but it's Intel-only and it's the earliest Mac OS version that Sleepyhead will run on: http://OSCAR Official Download Page ----> CLICK HERE ./wiki/Main_Page#System_Requirements

[Sleeprider]

Midvalleyguy, get a quote for a Resmed Airsense 10 Autoset from Supplier #33. The machine cost is $599 to $638 USD depending on heated hose option, but he is good a delivering new machines anywhere in the world. Your cost will be a bit higher to cover shipping. Supplier #2 is also very good at selling new and used machines overseas. The big advantage with the Resmed is the best software support to help you optimize your treatment and really succeed. It's worth the difference if any.

[Fats Drywaller]

I enjoy ranting because I have all this existential disgruntlement, a.k.a. free-floating angst ("Bit crook, Bruce"), and my head-shrinker is on vacation (and he's sick & tired of listening to me anyway ... a 35-minute hour lately, WTH?), so I decided to write up my DV5x punch list even though it hasn't been requested yet.  This is not an impartial review suitable for the Reviews forum.

I will preface the list by saying: Yes, absolutely web-order an Airsense 10 Autoset machine (optionally the "for Her" model if you can get it, which includes the third algorithm for free) from Supplier #2 (or anywhere else) instead of buying an inferior machine locally.  Apologies to local retailers!  But why are Resmed machines not available at reasonable prices in their country of origin?

• I've found the DV5x to be subtly uncomfortable compared to Resmed's algorithms ... relatively primitive firmware (sorry, DV developers) results in bad sleep for me.  One of the biggest problems with this is that if you never try an Air10 machine, you'll never know what great stuff you're missing or that you should immediately switch!  If all you have is a DV, you could spend months investigating a dozen possible subtle causes of the discomfort, and never realize (but now that I've mentioned it, you will know) that it's the DV firmware that's at fault.
  
• In particular, the APAP algorithm in the DV54 (don't know about the 64) is somewhat nasty in ways I can't quite describe because I've never bothered to figure out the details.  It was so annoying, so sleep-disruptive (even using a relatively narrow range around the Rx pressure), that I gave up on APAP with the DV (only) and I keep my DV54 set to constant pressure, which is OK for me because that's what my prescription is for and it works in my case.
  
• Wrong AHI values, very much overestimated, are reported.  Useless.  At first it seemed like this could have been caused by wrong values for the OA and H thresholds in the clinical settings, but nope; they're set to the defaults, which I assume are an industry standard: 10% for 10 sec and 50% for 10 sec.
  
• No flow-waveform data are made available to Sleepyhead, as mentioned [url=http://OSCAR Official Download Page ----> CLICK HERE ./wiki/Main_Page#CPAP_Machines]here[/url].
  
• The SD-card slot is in an optional plug-in module (Smartlink) costing extra.  If you don't want it, then that's a feature, not a bug.
  
• The humidifier base unit is clumsy to deal with day to day, compared to the Air10's.  Filling it pretty much has to be done with the removed reservoir (which is very shallow) sitting on a level surface and you have to pay careful attention to the water level as you fill it, then carefully clip the separate top cover on before replacing the reservoir in the machine.  When you want to clean it other than by simply draining it and letting it dry out, that's tricky also because of the labyrinthine design with the plastic baffles (increasing the distance the air travels over the water, which of course is otherwise a good thing).
  
• Auto-start is defective, starting every time you move the hose around with the mask off, so that you have to press the button to stop the machine.  Move the hose again, it happens again.
  
• Auto-stop has a silly timeout value of 25 seconds (should be 10), not changeable.
  
• De Vilbiss was bought by Drive Medical some number of years ago (the last time I looked, it was called "Drive De Vilbiss"), and I have no idea how viable it still is as a company ... have never bothered to do a web search to find out.  It doesn't matter to me because I'll never buy another DV product, even though in some ways I would like to root for the underdog.  ISTR that the DV Aloha nas-pil mask was bought by another company and is still being sold, and it's recommended by a few AB members.
  

I'm not completely disgusted with my DV5x or else I would have sold it on ebay or at a flea market long ago, but I am somewhat disgusted.  For my purposes it's usable, but just barely.  I don't recommend it to anyone else.  Some good points are the absence of a built-in cellular modem, the absence of a separate cumbersome AC power brick, easy 12VDC operation with a standard power connector instead of a US$70 converter box with a secret Masonic handshake, and the built-in UPS circuitry ... none of which has anything to do with CPAP therapy!  What is wrong with this picture?

About the two DV6x models, I don't know and don't care.  :-P

Edited to add: Oops, just realized ... if that "10% for 10 sec and 50% for 10 sec" is not the industry standard, someone please say so and I'll change those in my machine's settings, thanks. That is DV's default setting, though.

[Big Guy]

Another big   for the ResMed AirSense 10 AutoSet. 

I was diagnosed last August. I didn't know squat about CPAP machines. My sleep doc ordered the ResMed outfit for me. To include the built-in humidifier and the heated hose. 

It's been a pleasant walk in the park for me since the very 1st night of use.

[midvalleyguy]

Much appreciate the replies so far. All good info!

First - I am not prepared to purchase any non-Australian imported model. I want local after sales and Consumer Affairs support if anything goes wrong. 

Second - A new ResMed package here in Oz will set me back around AUD$2000 - simply not a consideration. More than double the DeVilbiss DV54. Yes, you get what you pay for.

BUT - I notice there are several used ResMed 10 Autoset CPAP machines advertised on my local eBay and Gumtree quite cheaply - around AUD$500. Obviously out of warranty. 

***So,is it unhealthy and/or unsafe germ-wise to buy a used ResMed 10 Autoset machine?***

Don't mind your rant Fats Drywaller  . Every bit of info helps in my final decision. Luckily I'm in no hurry to purchase.

[Fats Drywaller]

So, is it unhealthy and/or unsafe germ-wise to buy a used ResMed 10 Autoset machine?

Nope, not very risky, germ-wise. Buying used is a thing to do, and many here have done that. Just be prepared to buy mask, hose, and humidifier tank (water chamber) new. For a mask, that always goes without saying anyway. For the other things, it's just the usual matter of "You don't know where they've been" that applies with any personal/medical item. The hose, tank, and filters are standard replaceable parts, are not expensive, and can be bought without a prescription. However, a heated hose, which Resmed calls Climateline, is more expensive. Guesstimates are US$10 for generic unheated hose, US$40 for Resmed heated hose, and US$20 for Resmed water chamber.

The important things about a used machine are: (1) must be from a non-smoking household and (2) should have low run hours, or total blower hours (that's a number that is not resettable by the user). You check the second item by putting the machine into its "clinician's mode" and scrolling down to the "About" item in the menu. An online seller who knows CPAP machines will include a photo of that "About" screen showing the run hours. If no photo, ask, and of course when you examine a machine in person, look in that menu for the hours.

[DeepBreathing]

G'day midvalleyguy. I know where you're coming from in regards service and warranty, but really these machines are very very reliable. I can't comment on the DeVilbiss but it's possibly a bit of a dead-end development-wise.

Getting a used machine should be OK provided it has been well cared for. You want one from a non-smoking house, and preferably with no pets in the bedroom. I'd be inclined to replace the hose, mask, filter etc. I've looked briefly at Gumtree and the prices are in general very high for a used machine, in same cases very old twice-superseded models. I did notice somebody in Melbourne CBD has a demo Philips Dreamstation for a not unreasonable price. The other issue with buying from Gumtree is that warranty protection is going to be minimal at best, and you may need to fall back on ACL. Not really worth the hassle.

[Gideon]

The general recommendations for a used machine are to replace the tube, mask, filter with new, and many say the humidifier too.  The tube and mask will be in contact with exhaled air so rather than take chances just replace them.  The internals, meaning the blower itself is well removed from the user and is generally considered to not need cleaning or sanitation.

Other factors to be considered are did the machine come from a smoke free environment, especially from a non-smoker.  And the Total Run Hours for the machine.  The user hours can be reset but the total run hours cannot be changed.  

Fred