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Machine recommendation
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Amybirds Offline

Members

Posts: 12
Joined: Apr 2015

Machine: PRS1 DS760 BIPAP Auto
Mask Type: Full face mask
Mask Make & Model: ResMed AirFit F10
Humidifier: Heated tube humidifier
CPAP Pressure: 8-25
CPAP Software: Not using software

Other Comments:

Sex: Undisclosed
Location: California

Post: #1
Machine recommendation
Hi, new to the boards but hoping for some advice/opinions.
My husband was recently diagnosed with apnea after a sleep study and although initially reluctant to even be tested, he felt amazing after the sleep study and has been anxious ever since to gets mask and feel that energized again.
Unfortunately, the local suppliers have been flakey but after many phone calls they say our insurance requires a one month rental at roughly $1000 out of pocket (to verify compliance) and then the machine itself will be another $5000+ out of pocket (we have a $5000 ded, they're non-preferred provider, etc).
For obvious reasons that's just not feasible financially right now. Our budget keeps us around $2000 max for this.

We are looking instead to order online and I'd love some recommendations for machines and masks for a newbie.
From what I've pieced together on these boards we're thinking of a ResMed S9 Auto but then I get confused by the ST, etc.
Additionally, we have no idea what mask to start with.

The sleep study report says,
"Therapeutic summary: CPAP east it rated up to 13cm. CPAP was later changed it BIPAP because patient was waking up due to high pressure. Final BIPAP pressure was 25/10cm. REM latency was 46 minutes. Sleep efficiency was 95%. Patient maintained a saturation above 87%. Patient apnea hypopnea index was 6/hr. During REM sleep apnea hypopnea index was 8/hr.
Impression: Successful Titration study with significant improvement I sleep apes with a BIPAP of 25/10. The AHI though did not resolve completely.
Recommendations:
1. Auto BIPAP of 8-25 cm of H2O"
We have a prescription for "sleep apnea CPAP and supplies".
Any help would be welcome. Thanks in advance!
04-12-2015 03:51 PM
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iSnore Offline

Preferred Members-2

Posts: 148
Joined: Apr 2015

Machine: Phillips-Respironics DS560TS REMstar Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: Phillips-Respironics DS6T Heated Tube
CPAP Pressure: 9-13 A-Flex 2
CPAP Software: SleepyHead EncoreBasic

Other Comments: SYSTEM ONE resistance set to X1 for P10

Sex: Male
Location:

Post: #2
RE: Machine recommendation
I am also shopping for my first CPAP. First, Phillips Respironics calls bi-level "BiPAP" and ResMed calls it VPAP. These two are the latest model auto bi-level, and these prices from vendor #1 on the forum list are within your budget.

The ResMed AirCurve 10 VAuto BiLevel Machine with HumidAir Heated Humidifier costs about $1,729 online and a heated tube adds $40.

The Phillips Resperonics System One REMStar 60 Series BiPAP Auto with Bi-Flex costs about $1,639 without the humidifier ($229 heated tube included) which brings it up to $1,868.

You don't mention anything about mask, but the cost with one of the above machines should come in right about your budget. I'd recommend getting the insurance that lets you return the mask if it doesn't work out. In some cases, it's free.

The experienced users here on the forum can give you much more advice than I.
(This post was last modified: 04-12-2015 04:21 PM by iSnore.)
04-12-2015 04:18 PM
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Amybirds Offline

Members

Posts: 12
Joined: Apr 2015

Machine: PRS1 DS760 BIPAP Auto
Mask Type: Full face mask
Mask Make & Model: ResMed AirFit F10
Humidifier: Heated tube humidifier
CPAP Pressure: 8-25
CPAP Software: Not using software

Other Comments:

Sex: Undisclosed
Location: California

Post: #3
RE: Machine recommendation
Thanks iSnore!
04-12-2015 04:52 PM
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SaldusMiegas Offline

Advisory Members

Posts: 228
Joined: Apr 2015

Machine: ResMed AirSense 10 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: P-10, F&P Simplus
Humidifier: integrated
CPAP Pressure: Rx:14, Set:Auto 8.0-15.0
CPAP Software: ResScan SleepyHead

Other Comments: Woot! P-10 pillows plus Ruby chinstrap for side-sleeping mouth breathers

Sex: Male
Location: Virginia

Post: #4
RE: Machine recommendation
Amybirds

Does your insurance have an 800 number or website where you can search for preferred providers? It would be good for you to compare preferred rates versus "street prices" to see if a contracted supplier would provide a lower cost even if you are paying it out of your deductible.

Also, don't trust the DME on requirements ... call your insurance company and find out. Like iSnore, I am a newbie but I did a lot of research before buying my machine. There is a lot of variation in what insurance companies will cover, and in some cases you will have options the DME provider won't tell you about.

Medicare guidelines require a patient to demonstrate "compliance" before Medicare will make an outright purchase. Compliance means that in a three month period you are able to demonstrate that you have used the machine for at least 4 hours per night, 70% of the time, during any consecutive 30 day period within the three months. All machines collect compliance data because of the Medicare requirement. So it would be a matter of either bringing in the SD memory card with the data to your DME or some newer models report compliance wirelessly over the cell phone network.

From what I was able to learn, you could expect that your insurance will cover one or more of the following scenarios, and DME providers have come up with various plans around each scenario:

* if you are under Medicare then compliance is the Government requirement.

* Some insurance policies will simply adopt the Medicare requirement. In that case the insurance would cover a rental for the initial period to demonstrate compliance, and then purchase the machine if the patient is compliant in using it.

* Some insurance policies will allow the patient to choose whether you want to rent or purchase a machine from the get-go. In that case the "compliance" is not a requirement to buy the machine, but they might want to see compliance to cover the recurring supplies.

Always look at in-network / preferred providers even if you go another way because these providers will have negotiated rates with your insurance company that are better than what the same provider would offer you as a non-preferred / out of network patient.

Most insurance also treats your share of the cost differently if you go out of network. Out of network providers can make you pay the difference up to any arbitrary amount they want to charge you, whereas in-network they are constrained to the contracts they signed with your insurance company.

You might decide to go another way but with these big numbers do your due diligence and find out your options and costs of each option.

DMEs have different plans to fit the different options:

.. outright purchase - if your insurance allows you to purchase on day 1, and if that's what you want to do, I would say make sure you at least get a quote from an in-network / preferred DME provider or else you may end up overpaying by a lot (it sounds like the local DME you mentioned might be taking you to the cleaners based on iSnore's information).

.. rent for compliance period, then purchase - so this might be a 3 month rental or 6 month rental, followed by separate purchase. Probably means you get a "rental unit" for the initial term, then buy a new machine from scratch. No slam on the quality of the rental unit, but there is no credit towards the purchase built up from the rental period.

.. rent to own over a 13-month or 15-month rental period - in this case you get a new machine and after the rental period you own that machine with no separate purchase. It will be a more expensive way of buying than an outright purchase (like any rent to own) but it does spread out the costs.

I feel very fortunate that my insurance covered immediate purchase but we could have chosen any plan our in-network DME offered (rent/buy, rent-to-own, or simply buy now). I also found out that at least for supplies our DME charges more to out-of-pocket patients than in-network insured patients. So ask questions of your DME to make sure you understand what plans they offer and not just what they suggest.

BTW, your insurance might require you to acquire your machine through a DME because the acquisition (rent or buy) includes training on how to use the machine and fitting the part that goes on your face. I found this forum and you tube to be much more informative than our DME was, but YMMV.

I understand from poking around that you could also buy from online sources, and this forum has a page of commercial vendors. As I understand it, these suppliers still require your doctor prescription for you to buy from them. I don't know if there are different rental options nor what they do about fitting and training (other members will chime in with better advice than I can give you about listed suppliers).

I am too new to have permission to post clickable links, so...
See: Supplier-List at top of the forum web page

I can tell you that like your husband I actually felt a difference just from the night of titration study, and I was eagerly counting the days to get on the machine. I learned a LOT in this forum (for solid advice) and on youtube (for demos and reviews) before I met with our DME and I know I made much better informed decisions for doing it. So I commend you for coming here.

Like iSnore, I am a newbie in this world with the born-again zeal and desire to share what I have learned so far.

here is a good starting point I found to be a gold mine... Archangle's Links and Stuff

again I cannot post a clickable link, hope you can figure this out...

http: (slash) (slash) www(dot)apneaboard(dot)com (slash) wiki (slash) index.php?title=Archangle:Links

best wishes to you.

.. Learn what you need to know and go make an informed decision.
.. Find out directly from your insurance company what your real options are and identify some preferred DMEs.
.. Run the numbers and ask lots of questions of your prospective DMEs.
.. Remember your plan year and when deductibles/out-of-pockets/copays reset to avoid surprises if you rent-then-buy.

Saldus Miegas
04-12-2015 06:02 PM
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iSnore Offline

Preferred Members-2

Posts: 148
Joined: Apr 2015

Machine: Phillips-Respironics DS560TS REMstar Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: Phillips-Respironics DS6T Heated Tube
CPAP Pressure: 9-13 A-Flex 2
CPAP Software: SleepyHead EncoreBasic

Other Comments: SYSTEM ONE resistance set to X1 for P10

Sex: Male
Location:

Post: #5
RE: Machine recommendation
Great post, Saldus! Very thorough. Thanks
04-12-2015 06:21 PM
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vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #6
RE: Machine recommendation
Here is a link to Archangle's wiki page (with machine recommendations and lots of other advice):

http://www.apneaboard.com/wiki/index.php?title=Archangle:Links


(04-12-2015 04:18 PM)iSnore Wrote:  The Phillips Resperonics System One REMStar 60 Series BiPAP Auto with Bi-Flex costs about $1,639 without the humidifier ($229 heated tube included) which brings it up to $1,868.

The cost of masks can add up fast. Most new CPAPers try several (half a dozen?) masks before they find a couple which work well for them.

So, because a particular mask may not work out for you, if ordering on line would usually be best to order mask with return insurance (so you could call vendor and return mask within a certain time limit, to receive a refund).

An example of fair price for a premium but slightly used bi-level Auto machine (professionally cleaned, with 6 month warrantee) would be the premium model below, from Supplier #2 (a link to the Supplier List is located at top of each forum page):

[start ad]

Gently Used Respironics System One DS760 BIPAP Auto Machine
Optional heated humidifier available for $70.00 at the bottom of this page.
Low hour, gently used, 6 month warranty.
$649.00

[end ad]

Would need to add at least the $70 (heated humidifier) and would need to call before ordering to find out how much more (if any) would would be needed for the heated tube and the larger power supply (80 Watts instead of 60 Watts, I think) needed for the heated tube (which I strongly recommend).

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 04-12-2015 09:11 PM by vsheline.)
04-12-2015 06:37 PM
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Sleeprider Online
Wiki Editor
Advisory Members

Posts: 3,369
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #7
RE: Machine recommendation
I bought a DS760 Auto BiPAP on Craisgslist locally for $350 and the machine had less than 160 hours. Those deals don't come up all the time, but they do happen. Even if you buy at full retail price, that machine would cost under $1900 with humidifier. You can submit a form for the purchase out of network and have some of the cost applied towards your deductible. The lightly used unit from Supplier #2 mentioned above is a very good deal, and that company backs up their equipment with service and warranty.

Based on the prescription of 25/10 your husband has severe apnea and the cost of this device should not delay you from getting him treated. I think your insurance is essentially missing in action, and you'll have to find the best deal you can outside of the normal provider network, which is much more expensive.

We will be glad to provide support here, and you can buy masks from online providers with 30 day exchange guarantee if the fit or feel does not work out.

______________________________________________
Organize your SleepyHead Data
Post your SleepyHead Data from Imgur
Robysue's Beginner's Guide to Sleepyhead
04-12-2015 06:52 PM
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Amybirds Offline

Members

Posts: 12
Joined: Apr 2015

Machine: PRS1 DS760 BIPAP Auto
Mask Type: Full face mask
Mask Make & Model: ResMed AirFit F10
Humidifier: Heated tube humidifier
CPAP Pressure: 8-25
CPAP Software: Not using software

Other Comments:

Sex: Undisclosed
Location: California

Post: #8
RE: Machine recommendation
SaldusMiegas, vsheline, sleeprider--
Thank you for the informative and thoughtful posts. That is a lot of good information and I will read up on more of the Archangle links.
At this point I think we might just pay out of pocket and get a machine from Supplier #2 on the list, and find a place to get a mask with return insurance (which I didn't know was an option till you guys mentioned it -- thanks!)
My concern with even dealing with insurance and/or the local DMEs: the first DME didn't return our phone calls and lost our paperwork twice, so we sort of told them to buzz off (little did we know the only other option here was this out of network place, who I am quite certain is trying to rip us off) So much as we'd prefer a local place, and to go through insurance, I am uneasy with the whole experience.
About the ins stuff vs paying out of pocket, I haven't called our insurance directly but researched our plan. We do have a $5000 deductible for this equipment. It seems like best case with a place that bills insurance is price point of over $5000. So even though we've accrued about $3000 in a deductible fund (HCA), we'd still pay $2000+ out of pocket *and* wipe out our HCA.
I appreciate the information you have all provided and will keep you updated. Unless I hear something drastically different from you guys, I'll contact Supplier #2 tomorrow and get the ball rolling.
Thanks!!
04-12-2015 09:58 PM
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trish6hundred Offline

Advisory Members

Posts: 6,449
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #9
RE: Machine recommendation
Hi Amybirds,
WELCOME! to the forum.!
I wish your husband much success as he starts his CPAP therapy and he is very fortunate to have you looking out for him, good luck to you both.
Hang in there for more responses to your post.

trish6hundred
04-12-2015 10:54 PM
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vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #10
RE: Machine recommendation
Hi Amybirds,

From your initial post:
Quote:The sleep study report says,
"Therapeutic summary: CPAP east it rated up to 13cm."

CPAP "was titrated" up to 13cm, right?


Quote:CPAP was later changed it BIPAP because patient was waking up due to high pressure. Final BIPAP pressure was 25/10cm.

Probably, right now you do not yet need to be concerned with the things I will briefly discuss or suggest below, but in future you may find it helpful to refer to this post.

Does the data portion of the report indicate what was meant by "25/10cm"? (Please note: For your husband's own personal medical records, he has a right to receive copies of the complete reports, including the data, of both the diagnostic sleep study report and the titration report.)

Does the titration record show that IPAP (or Max IPAP) was set to 25 cmH2O, and Pressure Support (or Max Pressure Support) was set to 10 cmH2O?

(IPAP is the positive airway pressure during inhalation, EPAP is the positive airway pressure during exhalation, and Pressure Support is the difference between IPAP and EPAP.)

Quote:REM latency was 46 minutes. Sleep efficiency was 95%. Patient maintained a saturation above 87%. Patient apnea hypopnea index was 6/hr. During REM sleep apnea hypopnea index was 8/hr.

What was the breakdown of central apnea versus obstructive apnea, at the final titrated pressures?

If the pressure is too high, or if the Pressure Support is too high, these can cause central apneas to increase. But on the other hand, the pressures were presumably needed to control the obstructive apneas and hypopneas, and, usually, central apneas which are created by CPAP therapy gradually settle down and go away during the first few weeks of therapy, as the nervous system gradually becomes accustomed to CPAP therapy.

Quote:Impression: Successful Titration study with significant improvement I sleep apes with a BIPAP of 25/10. The AHI though did not resolve completely.
Recommendations: Auto BIPAP of 8-25 cm of H2O"

1. I suggest confirming with your doctor (or whoever provided your husband's prescription) that appropriate ranges for EPAP and IPAP would be:

Max IPAP: 25 cm H2O. (This seems to be what the sleep report is recommending, but actually this is very high, the highest possible value supported by the PRS1 BiPAP Auto. Although it is not unusual to set the Max IPAP this high, if your husband experiences a painful amount of air swallowing "aerophagia" you may need to lower the Max IPAP, at least temporarily.)

Min EPAP: 8 cm H2O. (This seems to be what the sleep report is recommending.)

Max EPAP: 15 cm H2O. The sleep report does not seem to be recommending a value for this. Some machines do not have this setting and the EPAP simply ranges as high as it needs to go, as long as EPAP + PS does not exceed Max IPAP. For machines which have a Max EPAP setting, Max EPAP is set somewhere between (Max IPAP minus Max PS) = (25-10) = 15 as an example lowest possible value, to (Max IPAP minus Min PS) = (25-4) = 21 as an example highest possible value.

2. The ResMed bi-level Auto machine can only use a fixed (manually-adjusted) value for Pressure Support, but a very nice feature of the PRS1 BiPAP Auto is that we can give PS a range, and the machine will automatically adjust itself to use only as much PS as your husband needs to avoid Flow Limitation.

I suggest confirming with your doctor (or whoever provided your husband's prescription) that an appropriate range for Pressure Support would be:

Min PS: 4
Max PS: 10

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 04-13-2015 01:02 AM by vsheline.)
04-12-2015 11:27 PM
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