Stumbled in... [general questions]

[anonEmouse2004]

I was searching to information on CPAP repairs yesterday and "stumbled" onto this site. Today I installed the SleepyHead software and imported the information from my RemStar Pro with C-Flex+ (450P). I knew I've had it a while, but I didn't realize I first used it on 6/3/2011. I still have my first machine which dates back to 2008, but it has no SD card to read.

Here's the over-all stats:

   

This is from the first night:

   

This is from the last night I used it August 30:

   

The pressure seemed to slowly be decreasing over the last few months, and at times there was an odd odor to the air but it would go away. I never smelled anything except through the mask so I figured it might just need cleaning. I'm usually pretty good about that stuff, but I cleaned everything anyway. It got bad enough that I switched to my older (Respironics REMstar Plus #200M) machine thinking I'd take my "new" one apart and clean inside it. My old worked fine the first night, but by the third night my nasal passages were irritated and runny and my chest was starting to feel like an infection was setting in and I stopped using that one too.

I now have two machines down, but not because they quit working. Both exhibit signs of bacterial buildup internally. I've taken them both down to just plastic parts and a pile of screws. I've soaked all filters and part in straight vinegar, rinsed thoroughly, and air dried.

So, I thought maybe it's just time to replace them. I'm disabled and on a Medicare Advantage plan so I called the insurance company. They sent me to Apria where I got them both. They said I need a prescription. I asked if they were kidding. They assured me they weren't, but if I could find the order from the original sleep technician they could work with that. Since I think I got my first machine in 2008 that will be quite a find indeed. I've since changed Doctors at least 6 or 8-years ago. The once who ordered the study has moved his office and those records are in a box in a locked storage someplace. The hospital where the study was done at was purchased by a larger one a few years ago. Now I have to submit a form and wait. Apria says it will take another 7 to 10-days to process the order. I'm sleeping (poorly) in the recliner as I wait for my current Doctor (who's great) to get back from taking a week off to see if he can help. Looks like I may have to start the whole process over again, which means co-pays I don't have. I guess you could say I'm tired and not very happy right now. Ugh.

[PaulaO2]

Prescription: Yes, any doctor can write the script. And if you can go to any supplier than Apria, that would be great. Apparently they have a lousy reputation.

Machines: yep, sounds like it is dead. Crap can build up inside them in certain environments but it does take a while. While you wait for the doc, get a new hose and put in new filters.

[Sleepster]

I now have two machines down, but not because they quit working. Both exhibit signs of bacterial buildup internally. I've taken them both down to just plastic parts and a pile of screws. I've soaked all filters and part in straight vinegar, rinsed thoroughly, and air dried.

On your newer machine there's an impeller attached to the blower motor. I soaked the impeller blades in a small bowl, being careful not to put too much liquid in the bowl. You want the impeller blades fully immersed, but the motor needs to stay dry.

There's a thread somewhere with posts from me about this. It took the nasty odor completely away. But the machine started to fail shortly after that. That's a pretty old machine, they've improved them quite a bit since then. Plus, you could probably benefit from a machine that auto-adjusts the pressure.

[Melman]

Sleepster,

Did you see a buildup of material on the impeller blades? Although I would expect some of the dust that gets through the filter to accumulate on the blades I wouldn't expect a buildup that would promote enough microbial growth to cause an odor. If there was a buildup of material was it moist? Bacteria don't grow well on dry surfaces. I'm not questioning that the washing eliminated an odor but I'm just trying to get a better understanding. I wouldn't expect to see significant microbial growth inside the machine unless it were wet. But then, I've never seen the inside of any of these machines.

[anonEmouse2004]

Prescription: Yes, any doctor can write the script. And if you can go to any supplier than Apria, that would be great. Apparently they have a lousy reputation.

Machines: yep, sounds like it is dead. Crap can build up inside them in certain environments but it does take a while. While you wait for the doc, get a new hose and put in new filters.

Ooh, so my GP can write the script and I don't have to go through the study again???

Yeah, I figured stuff would build up over time. What's the expected lifespan of these things?

Edit: Yeah, not impressed with Apria. Didn't know any better when I started in '08. I did get a chance to see a bill they submitted to the insurance. Their prices were utterly outrageous, and they even tried to bull the insurance for in-home care! I guess my insurance will also work with Lincare, but I know nothing about them. Do you?

[GWild]

Check the filters.  I don't think most people ever bother to replace them, and they are a great place to grow stuff you don't want to breathe.  And, there are filters you can attach at the hose/machine connection that filter everything down to viruses - and they are cheap.

As for a machine failure - they contain a fan and electronics. Being mechanical, the fan motor bearings wear out. I think somewhere around 10,000 hours of use is a good lifespan. My first machine has thousands of hours, but can't read data from it (pre-SD card).  My second machine had 8,000+ hours on it when I retired it.  It was working then and I use it for short camping trips.  My third machine is getting long in the tooth, but is still quiet. When it starts getting noisy I'll retire it.  I keep the filters clean: I clean the primary foam filter and replace the secondary fine filter every few months.  These filters are also cheap.

Anyway -  a blower motor with bad bearings can cause all sorts of problems, including odd smells.  Replacements might be available, but I doubt you'll find anything close enough off the shelf.

[Sleeprider]

Prescription: Yes, any doctor can write the script. And if you can go to any supplier than Apria, that would be great. Apparently they have a lousy reputation.

Machines: yep, sounds like it is dead. Crap can build up inside them in certain environments but it does take a while. While you wait for the doc, get a new hose and put in new filters.

Ooh, so my GP can write the script and I don't have to go through the study again???

Yeah, I figured stuff would build up over time. What's the expected lifespan of these things?

Edit: Yeah, not impressed with Apria. Didn't know any better when I started in '08. I did get a chance to see a bill they submitted to the insurance. Their prices were utterly outrageous, and they even tried to bull the insurance for in-home care! I guess my insurance will also work with Lincare, but I know nothing about them. Do you?

Any physician and even dentists can write the CPAP script. It's also possible to get prescriptions from online DMEs which provide everything from prescription services based on a questionaire to home apnea tests with physician analysis, recommendation and prescription for under $200.  Whether your insurance company will cover a machine is the main question. Most will allow coverage with your doctor's recommendation/ prescription, but Medicare requires that at least one sleep study be on file that shows a diagnostic of sleep apnea meeting the insurance criteria.  You should continue to work to get your records out of archive, and in your possession.  If necessary, you can threaten the practice in charge of those records with HIPAA violation of patient access to records.  Most will provide the records if you are persistent or direct your request through your GP.  If you get your doctor to prescribe CPAP, also be sure to review your use of the machine annually with him. That will create a medical record that will help you to get future machines and any masks, tubing, filters etc that you need. 

Other alternatives exist.  There are very good machines in most market areas on Craigslist. I have seen many new model auto CPAPs for under $300 and would try to keep that under $200.  Good "gently used" low-hour machines are available from Supplier #2. For example they currently have a Resmed S9 Autoset for $349. That is a unit with warranty and seller support you can rely on.  There are a number of discounted opportunities for CPAP available, and I would recommend you consider mainly the Resmed Airsense 10 or S9 Autoset and the Philips Dreamstation or System One Auto.  An auto CPAP will help to keep your titration needs current and is responsive to your changing needs. In addition they provide full data which is important to someone managing their own care.

[anonEmouse2004]

I get it. Didn't realize Medicare required a copy of the original diagnosis. You're right about my keeping those records handy. I have copies of all my imaging studies and results. Don't know why I thought I could relax on my CPAP/Apnea documentation. Won't make this mistake again, though. Thanks for the information.

[Sleepster]

Did you see a buildup of material on the impeller blades? Although I would expect some of the dust that gets through the filter to accumulate on the blades I wouldn't expect a buildup that would promote enough microbial growth to cause an odor. If there was a buildup of material was it moist? Bacteria don't grow well on dry surfaces. I'm not questioning that the washing eliminated an odor but I'm just trying to get a better understanding. I wouldn't expect to see significant microbial growth inside the machine unless it were wet. But then, I've never seen the inside of any of these machines.

It was the strangest thing. A thin buildup of dusty grease on every surface of the air pathway. So thin that it was barely visible, but you could feel it and see a trail left by your finger. You could wipe a surface and see it on the wipe. The impeller blades were much worse, and had to be scrubbed with a brush. I figure there was some kind of grease left from the manufacturing process. It trapped dust and turned rancid. I say this because the odor started a few months after the machine was first used, and got worse as the months of daily use went by.

[anonEmouse2004]

I thought I saw a comment in this thread regarding mask leakage and how mine looked high. I can't find it now, though.