What Machine to Choose ?

[oldteddybear]

Each of the companies could make a single machine that handles all of the modes making them a true xPAP but then the insurance companies would not be happy. The only real difference is the software in the machine that handles the breathing algorithyms (patterns of airflow).

The way that you breath will make the difference in which of the brands that you will be most happy with. This is why you should try out a couple of models before purchasing one. If your body and lungs are not compatible with the algorithym of your machine you will not be happy with the treatment and most likely will abandon it.

I am a large guy with very large lungs (~ 6L capacity) the respironics algoithyms do not work for me at all and I get out of sync with the machine fairly often and the S9 with an EPR of 2 works fantastic, I have friend that likes both machines but cannot use the expiration pressure reduction programs on either.

The clinical tech who sets up your machine is very important in the initial setup and having a good tech will assist in getting good results. If you do not have a good tech do a lot of reading and have the software available to monitor your progress, if you are not comfortable doing this, find another tech

[PaulaO2]

I've read about and asked about the x-Flex of the Respironics machines. They just don't seem comfortable.

I tried my S9 with the EPR off. For several days, I had plugged up ears then it settled down. I then turned it back on but less than what it was originally. I slept better with it on that low but only a little better than with it off.

[archangle]

I suspect SleepyHead will not work yet with the Philips Respironics BiPAP A30 yet. Mark may get around to updating it sometime, but he hasn't been able to work on SleepyHead for some time.

There are still several models that fit the description of "ResMed S9 VPAP." They're probably all pretty good, but try to find out the particular model.

[cardinalgirl]

I just completed my third sleep study. First one 5+ years ago as part of a general workup- because of lifelong insomnia and known restless legs. Wasn't felt to have OSA then, but few weeks ago, had another study because RLS symptoms were much worse. I didn't qualify to start CPAP on the night of that study, although it was recommended as an option. Then they called and said they wanted me to come in for another study, for " CPAP titrations". They used the nasal mask; said the pressure setting was 14. Made no difference in the RLS sypmtoms- have to start meds for that. SO finally- my questions-
What does that pressure setting mean? When I go in for my followup- what should I ask for the prescription to say so that I can have the widest choices? They said my copay for the machine would be $269.00 ( if I purchase my setup from them. ) Is it better to purchase from the sleep clinic or from an online company? Thank you for this forum- I can already tell how helpful it will be.

[zonk]

What does that pressure setting mean? When I go in for my followup- what should I ask for the prescription to say so that I can have the widest choices?

Welcome to Apnea Board
Its the pressure needed to keep your airways open so it wont collapse during sleep. Probably they started the titration on lower pressure and kept increasing gradually during the night to prevents most obstructive apnea without inducing central apnea. ResMed S9 AutoSet is the best choice as it can be used whatever your doctor prescribe straight pressure (S9 Elite: full data capable machine) or auto adjusting (two machines in one). Its better investment only about $40 more on-line so you get more for your $$$.
Also its the only machine supported by two free readily available software (ResScan and SleepyHead).
The prescription should specify the type of the machine for example:
ResMed S9 AutoSet (Full Data Capable Machine) - pressure range 10-15 (just an example) - H5 humidifier - ClimateLine - Washable water tub (sometimes its optional) - mask of choice and "DISPENSE AS WRITTEN".
You don,t want any Escape or Escape Auto. It should say AutoSet next to stop/start button as shown here:

[mjbearit]

I've read about and asked about the x-Flex of the Respironics machines. They just don't seem comfortable.

I tried my S9 with the EPR off. For several days, I had plugged up ears then it settled down. I then turned it back on but less than what it was originally. I slept better with it on that low but only a little better than with it off.

I personally love my A-Flex! My old machine had one constant pressure and a ramp button. I got this new machine an Auto with A/C-Flex and WOW! What a difference! There are times, even after having this machine for a couple months, that I still put my hand in front of the exhaust port to prove to myself it is on! It is really comfortable. Maybe that's because I have used to old technology and appreciate the improvements more. Maybe because of that I had lower expectations going in, but whatever the reason, you'd be hard pressed to take it away from me now! JMHO To be fair, I have never used an S9 so I cannot compare maybe it is better, but at what point does it matter? I'm happy so that's it for me!

[PaulaO2]

First, call the sleep clinic back and ask for your sleep study report. They may tell you it is a bunch of data you'd not understand. That's fine. You want it anyway. And if they were the same ones to do the other studies, you want those results, too. These are YOUR medical records and it never hurts to have that information on file.

Then they called and said they wanted me to come in for another study, for " CPAP titrations". They used the nasal mask; said the pressure setting was 14. Made no difference in the RLS sypmtoms- have to start meds for that. SO finally- my questions-
What does that pressure setting mean?

The pressure number does not reflect the severity of the condition. What it means is that's the amount of air pressure needed to either maintain your throat opening or to re-open it once it closes. the 14 is actually 14cmH2O. This means if you take a clear water hose, put it in a U shape, put water in it, and apply enough air pressure that the water moves up 14 centimeters, that's the air pressure they say you need.

When I go in for my followup- what should I ask for the prescription to say so that I can have the widest choices? They said my copay for the machine would be $269.00 ( if I purchase my setup from them. )

You want a fully data capable machine that records more than just compliance data. This means a Respironics that does not have the word Plus in the name and a Resmed S9 that does not have Escape in the name. It would be even better if you got a auto-PAP (aka APAP) that adjusts the pressure to what you need.

Is it better to purchase from the sleep clinic or from an online company?

Personally, I am very much against a sleep doctor or sleep clinic that also sells machines. To me, that is a huge conflict of interest. If it were my situation, I would ask them for the prescription then go shopping elsewhere. Call other suppliers (referred to as DME) and ask them about their mask policy. The mask is by far the hardest yet most important piece of equipment. You want a supplier that will allow you to try different masks at home. Typically, they let you take a mask home to try for anywhere from 2 weeks to 30 days. Sometimes it takes that long to decide if you really like it. Other times, you know the first night. Just take it back at any point and ask for another. If you find one that has such a policy, tell them the insurance you have and ask what your co-pay would be. Or, better yet, call your insurance company and ask if they follow Medicare guidelines concerning CPAPs. This means they pay the same amount no matter what the machine is (excluding the higher costs of variable PAPs and some bilevel PAPs). This is why DMEs like to push the 'brick' machines because they have a bigger profit margin.

Thank you for this forum- I can already tell how helpful it will be.

You are welcome! We're crazy, of course, but we're sincere about wanting to help each other.

As to the RLS, there is a condition at night called Periodic Leg Movement Disorder (PLMD) and that is probably what they were looking for. Sometimes, but not always, a person can have both. Sometimes, but not always, treating the cause of one helps the other. PLMD is a condition many persons with sleep apnea have. It is because our bodies and brains are screaming for oxygen and are struggling to wake us up. The legs are typically the ones most involved. There may be another underlying condition that causes PLMD.

I am one of the lucky ones to have both. In my sleep, I have kicked my 85 lb Rottweiler up and over the 6" foot board of my bed. She was NOT amused. Using a CPAP has cut that down a lot but not completely. My RLS has been found to be connected to my potassium levels which has a tendency to go a little wonky. When it goes low, I cannot keep my legs still for nothing. It is like a trillion ants are under my skin, demanding that I either move my legs or they will explode outwards. We keep potassium high fruits on hand (bananananas, usually) for when that happens. I take a multi-vitamin but not specifically potassium. I have in the past, however. Some medications cause the body to dump out potassium (such as HCTZ, a blood pressure medication).

[Sleepster]

I've read about and asked about the x-Flex of the Respironics machines. They just don't seem comfortable.

I find mine comfortable. There's not a lot of sophistication here. It just lowers the pressure a bit when you exhale.

It's the more expensive APAP's or the really more expensive auto ASV machines that make use of algorithms, and if you don't like the way they behave you can always shut them off and put the machine in dumb CPAP mode.

[cardinalgirl]

Thank you very much for your thoughtful and helpful responses to my questions- there is so much info to sort thru it is intimidating (obviously in the medical scheme of things not as big a deal as many other things, but still ) You were right also about the PLMD- they were hoping it was related to the apneic periods but no such luck. My labs were fine. I have now read that it can be worsened by some antidepressants- so that is an avenue to explore. Funny you should mention your Rotty- my Dorkie won't sleep with me for long now- pretty bad when your source of unconditional love turns his nose up SO thanks again= I'm sure I'll have lots more questions but you gave me a fabulous start

[zonk]

We keep potassium high fruits on hand (bananananas, usually) for when that happens.

Do you mean hand of bananas ..... bananananas