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[Equipment] Newbie - which machine to buy??
Hi Guys,

Another CPAP newbie here! Sorry in advance about the length of this post!

I've recently been diagnosed with idiopathic hypersomnia (somewhat similar to narcolepsy), along with sleep apnoea (hypoapnoea). It's been a long time getting to this point (as I'm sure it is for most of you!). I've always needed more sleep than most people, can easily sleep 12-14 hours per night etc, but was getting by. Then I had to give up caffeine (only drank like 2 cups a day) as I developed an intolerance to it (thought my life was over!!), and noticed my sleep got so much worse, felt like I was living in a daze the whole time. I could sleep for 18 hours and still wake up not feeling at all rested, and still needed to nap for around 4 hours every day. My psychiatrist (I suffer from depression), suggested I get a sleep study done as over 50% of people with depression have an undiagnosed sleep disorder.

So last December I went and saw a repository specialist (my husband has sleep apnoea and is on CPAP, so I saw his specialist), who sent me off for an overnight study. Showed I was having quite a few hypoapnoeas. I was getting my tonsils out anyway 2 months after that (chronic tonsillitis), so the specialist told me to wait to see if that helps. It got worse after that, so I did a CPAP trial for 2 months (even though the sleep apnoea is technically mild so most people wouldn't bother with CPAP, my sleep problems are really interfering with my quality of life. I can't splint as I grind my teeth at night and have bad TMJ pain)
Anyway, I used it for 2 months, building up to a pretty good compliance rate, but felt no difference. My husband has extremely severe sleep apnoea due to a small set back lower jaw, and the first night after using CPAP he felt like a new person. I had none of this, which was really disappointing.

I was going to give up and just accept this, but did some research on the internet and decided to try another specialist who is supposed to be the guru of sleep problems. Apparently a lot of people are undiagnosed as just having sleep apnoea when there are other problems going on also.
Anyway, did another overnight study, and a daytime study (multiple sleep latency test). It showed I was having hypoapnoeas (waking up 45 times an hour), and that I also have idiopathic hypersomnia (that was from the daytime sleep test). I'm about to start modafanil for the hypersomnia, and I also need to go on CPAP for the sleep apnoea.

I went and had another sleep study done for a titration study. It was really good, they tried 3 or 4 masks on me (and I had also tried some during my 2 month hire), and they woke me up a few times in the night to try different masks when there were leaks or I started to mouth breathe (and the chin strap didn't fix it). It was great they could do it in real time and watch what effect the masks etc were having on the pressure levels etc. They could also see what pressure I could go to before I started to hyperventilate and woke up ripping the mask off as I couldn't breathe (scary way to wake up!)

I saw the specialist last week, and got the prescription. Which is:
CPAP pressure: 11 cm h20
C-flex/Epr: optional (any setting)
Heated humidification: yes
Auto-titrating CPAP: no
bi-level pap: no
chin strap :optional
recommended mask: Redmed quattro air (small)

Anyway, I had some questions for you guys out there.

1) If you are prescribed and planning on using CPAP, do most of you buy the CPAP only machines (which between the Resmed s9 autoset and elite mean you save some $$), or did you buy the one with APAP function and use it on CPAP just in case?

2) I'm looking between the Resmed s9 (elite or autoset) and the Phillips-Respironics Remstar auto system one 60 series.

a) Can somebody please explain to me the difference between the different PR Remstar models – I honestly can’t work out what the difference is (other than some are CPAP and some are APAP). Some have c-flex, some have c+-flex, some have a-flex. I’m so confused!!!

b) Also, can anyone tell me what the difference is in features between the Resmed and the PR Remstar.

3) Does the Resmed have auto on/off (so that the machine sits in hibernate mode and when you put the mask on and start breathing, it starts pumping air)? Some websites say it does, and some they it doesn't.

4) My specialist said in terms of data recording the Resmed is the best, followed by the Respironics. Is that everybody's general consensus?

5) Can anyone share what else compelled them to go with 1 particular brand of machine? Which machine do people think is better between the Resmed and the PR Remstar?

Thanks in advance for your help!
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Hi Yael, I had to look again to be sure I had not written your post. Idiopathic hypersomnia, dead to the world naps, sleeping 12-13 hours a night, medicine resistant depression, but AHI of only five on my first sleep test. I barely qualified for cpap, but jumped at the chance to try the machine my symptoms were so bad.

About getting a machine. I believe ResMed is a fine machine. I have a Respironics because that is what my insurance would pay for. It's a great machine.
If you are not paying out of pocket get the most advanced, and versatile machine you can- an AUTO with data capabilities so you can monitor your treatments. If money is no object get an ASV machine which is a fancy BiLevel AUTO. If insurance is paying get with the doc to write a script for a data capable AUTO. If you go with ResMed don't get anything with "Escape" in the name. I can't steer you to specific machines as I no longer know what is the newest and most versatile. Look at peoples information to see what others are using. If insurance gets funny there are many other good machines out there.
Good luck, please keep us posted on your progress. You don't have to apologize for long posts, we love them.
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Hi Yael,
WELCOME! to the forum.!
I would buy an auto-CPAP machine because you get the best of both worlds. You can use it in either straight CPAP mode or Auto-PAP mode.
Resmed and Respironics are both good brands.
Hang in there for more suggestions and best of luck on your decision and with your CPAP therapy.
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(10-06-2013, 08:19 AM)Yael Wrote: a) Can somebody please explain to me the difference between the different PR Remstar models – I honestly can’t work out what the difference is (other than some are CPAP and some are APAP). Some have c-flex, some have c+-flex, some have a-flex. I’m so confused!!!

The different flex options are really just marketing schemes. Flex lowers the pressure when you exhale.

Here's a good place to start your research.


Apnea Board Moderator

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I got my Resmed S9 Autoset 3 years ago. At that time the Resmed was the quietest, it was the easiest to get software and I wanted an auto pap.
I read reviews here and at supplier web sites, settled on what I wanted and had my friend (MD with apnea) write a prescription for exactly what I wanted. I went to a small local DME that he also used to get the machine. I was out of area and out of network for my insurance but they paid with no debate for over a year, sort of rent to own. Then they informed me they would only pay in network. Things have gone downhill from there.

Bottom line read as much as you can, decide what YOU want and do what you must to get it, even if you have to pay for a portion out of pocket.
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Hi Yael
Both ResMed S9 AutoSet (not Escape Auto) and Phillips Respironcis Auto are equally good machines. S9 offer better display data on LCD including unintentional leak but using the software, PRS1 might have slight edge as report periodic breathing (not available on S9)

You can get the clinical manuals for either machines from this board also you can download ResScan (for the S9) and SleepyHead (for both machines). You can ask for the manual via Email here http://www.apneaboard.com/adjust-cpap-pr...tup-manual

ResScan and SleepyHead download link http://www.apneaboard.com/forums/Forum-P...-and-Links

If you happen to be in US and insured, your insurance pay the same amount for whatever machine you get. But if not insured or happen to be in Australia and wanted to avoid the local rip-off merchants than check out our supplier list (Supplier #2 and supplier # 10 ... ship to Australia)
Suppliers List http://www.apneaboard.com/forums/Thread-...plier-List

ResMed EPR http://www.resmed.com/us/assets/html/dev...c=patients
Philips Respironics Flex http://www.healthcare.philips.com/au_en/...efault.wpd
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PRS1 Models. Look on the bottom of the blower unit for a number like "460 REF".

150/160 - AVOID - very little data.
250/260 REMstar PLUS - AVOID - very little data.
450/460 REMstar PRO - Good data. Manual CPAP
550/560 REMstar Auto - Good data. Auto CPAP. Auto is always the right choice, since it can be set to manual pressure if needed.

ResMed S9 models
Escape - AVOID - very little data
Escape Auto - AVOID - very little data
Elite - Good data manual CPAP
AutoSet - Good data Auto. (Don't let the DME trick you with an ESCAPE Auto. Also, note it is AutoSET, not just S9 Auto.)

Re: Data

The ResMed S9 machine throws away the most detailed data after 7 days. It throws away the slightly less detailed data after 30 days. PRS1 keeps it "forever".

ResMed has a little better data during the 7 days, but it's not a big difference.

The official ResMed data program (Resscan) is light years ahead of the official PRS1 program (Encore). The free, open source SleepyHead program is as good or better than Resscan in many ways, but it has some glitches. SleepyHead works with PRS1 or S9.

Re: Quietness

This seems to be very variable. A number of people have found S9 machines have a "honking" sound at the end of the exhale cycle. Some people seem to get a noisy machine occasionally with either type or just seem to be bothered by the noise from one or the other machine. Some people are bothered by the changing volume between inhale and exhale.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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