CPAP Machine Choices - read this before you accept a new machine

[SuperSleeper]

The Wiki article on "Machine Choices" should be read by everyone here.  Don't let a Durable Medical Equipment $upplier (DME) bamboozle you.  Never accept or settle for what we nickname a dumb "brick" CPAP machine (one that is not fully data-capable).

Be an informed patient and read this excellent article, here:

http://www.apneaboard.com/wiki/index.php...ne_choices

If you get a good, data-capable CPAP machine - you and your doctor will be greatly empowered to monitor the effectiveness of your treatment on an ongoing basis.  You can also use free software (like OSCAR) for your personal computer to monitor and chart your progress - as long as you have a data-capable machine.

To see a list of machines supported by the OSCAR software, go here:
http://www.apneaboard.com/wiki/index.php...d_machines

OSCAR is available for free, at this link:

https://www.SleepFiles.com/OSCAR

OSCAR is the best PC software (assuming you have a supported CPAP machine), but if not, there are other proprietary software packages you can use as well.  Here's our Private Files & Links area, where you can learn how to obtain some of these free PC software packages:

http://www.apneaboard.com/forums/Forum-P...-and-Links

(you'll need to be logged into your Apnea Board Forum account to access the above link.  Register HERE for a free forum account if you haven't already).

[Adoniscmj]

I agree totally, as when I went to the DME they had a machine waiting for me. They didn't ask me what I wanted at all. I told them that I wanted a ResMed Air Sense 10 Auto set with data. She was surprised and said oh you did some research. I said yes and that is the unit I decided on. I had to make another appointment as they had the brick set up for me not the Air Sense. Don't let them pick it for you. They will choose the unit that they make the most profit on. Get what you want. There are some really good machines out there from ResMed and Phillips. Plus some other brands as well. It is your money, get a useful machine that will keep track of your therapy.

[DariaVader]

This should be a sticky!!!

[DariaVader]

Did you read the article? It offers advice for each *class* of machine - certainly whether therapy should be achieved with cpap/bilevel/ or a more advanced asv type machine is part of the prescription, but there is a lot of difference within those classes that are not therapy related, such as the ability to gather data and how it is shared. We recommend patients to educate themselves, it results in better therapy. demonstrably.

[kwhenrykerr]

"should choose the best machine for you"

That would be nice. Education before and after getting your "best machine for you".

Heck in a perfect world their would be no need for cpap.

But I wish well with your ideas. I have not found my DME much help and less than informed. My primary doctor helps but is limited in sleep problems. My Sleep doctor just says "you are doing well making your own adjustments, keep doing it"

It is this forum and the people on it that have done the most.

[SleepyBee]

can I just add that the latest APAP devilbis machines (DV6x) do have breath by breath flow data recording (@25hz) as well as event, leak and various other parameters (@1hz)

sleepyhead is not yet compatible (afaik) so I had to write my own homebrew data visualizer, but the data is there on the card.

[Sleeprider]

i do not agree with you 100%. In my research, different machines have different algorithms and I feel that although all machines will treat your OSA all machines are not created equal. if you buy into all the propaganda out there you can buy the machine that is not necessarily the best for you or was not prescribed for you. All this to say that your home care provider has a trained health care specialist who should choose the best machine for you regardless of its styling or looks or potential revenue production. Remember anybody can buy a cpap, however what you are really buying is long term after care. Follow up visits and regular contact with your provider. DO NOT buy on the net, you will be sorry.

Kraz, let me put this delicately... Most DMEs, or their employees, do not have the patient's best interest at heart since they have a financial interest in the transaction, which pays the same whether a basic "brick" or a premium full-efficacy data machine is dispensed.  Meeting the minimum requirement of the prescription is the only mandate for a DME, and the uninformed patient who goes in to receive a machine will receive the machine that best serves the DME financially, while meeting the minimum requirements of a prescription. Data is important. Patients should control their own therapy, and most suppliers fail to help them to do this. The "trained health care specialists" are constrained by the prescription from a short and typically inaccurate sleep study, titration study, or the default settings of an auto machine. I am telling you here and now that in 5 minutes, that patient will get better advice on this forum than struggling for weeks with most providers, and I can offer you the threads to prove it.

Significant numbers of patients are prescribed the WRONG machine until they "prove" they are intolerant of the CPAP therapy, in spite of the fact their sleep study demonstrated a central or mixed apnea problem; and they are not given any guidance whatsoever from the RT or prescribing physician when their machines indicate extraordinary AHI problems. I am aware of several congestive heart failure patients prescribed CPAP, and failing with events over 30 AHI, that received no assistance or incorrect advice from their RT, and even prescribing physicians.

Many people have very high deductibles and copays, or no insurance at all.  DMEs routinely sell at highly inflated prices compared to the "net".  Even with insurance, it is possible to be charged multiples of the fair price the same equipment is available for on the Net.  The "trained health care specialists" are constrained by the prescription from a short and typically inaccurate sleep study, titration study, or the default settings of an auto machine.  I am telling you here and now that in 5 minutes, that patient will get better advice on this forum than struggling for weeks with most providers, and I can offer you the threads to prove it. As far as recognizing different machines use different algorithms, it's my opinion that maybe 1% of health care providers are even remotely aware of the faster/slower auto CPAP algorithms, and especially the influence of EPR/Flex on them. When we get to more sophisticated bilevel ST and ASV machines, we're dealing with such esoteric knowledge that you'd think it was a State secret. There are huge differences, and very few of the DMEs have a clue.

Nice try.

FWIW, my last contact with a DME 3-weeks ago, my wife was offered a discontinued PRS1 60 Series Auto, and I requested a Resmed Airsense 10 Autoset for her and got it. She was prescribed at 8-cmH2O CPAP mode at CFlex 3, and she is now in Autoset standard mode at 7.5-12 cm with EPR at 2, and getting less than 1 AHI after her prescription resulted in greater than 3 AHI. Please tell me again why the pros should have done this.

[lab rat]

I agree totally, as when I went to the DME they had a machine waiting for me. They didn't ask me what I wanted at all. I told them that I wanted a ResMed Air Sense 10 Auto set with data. She was surprised and said oh you did some research. I said yes and that is the unit I decided on. I had to make another appointment as they had the brick set up for me not the Air Sense. Don't let them pick it for you. They will choose the unit that they make the most profit on. Get what you want. There are some really good machines out there from ResMed and Phillips. Plus some other brands as well. It is your money, get a useful machine that will keep track of your therapy

A newly diagnosed work colleague had an appointment to be supplied with machine and mask. I'd mentioned that the Dreamstation and Airsense 10 were the top models, and he should get either one.

Next minute he walks into the office carrying a Fisher and Piklet for God's sake. Clearly a larger kickback for them.

He told me he's renting for 90 days (after which he decides which machine he wants) but goes back in 2 weeks. Needless to say I told him how can he use a 3rd rate machine then "decide" what he wants?

I gave him large pictures of both machines and said to thank them for the 'trial' of the F&P for the 2 weeks, but now he wants to try the others. 

[Sleepster]

i do not agree with you 100%. In my research, different machines have different algorithms and I feel that although all machines will treat your OSA all machines are not created equal. 

What part are you disagreeing with? There's no claim that all machines are created equal. Quite the opposite.

if you buy into all the propaganda out there you can buy the machine that is not necessarily the best for you or was not prescribed for you. 

That's true. But there was no advice to "buy into all the propaganda". Again, quite the opposite.

All this to say that your home care provider has a trained health care specialist who should choose the best machine for you regardless of its styling or looks or potential revenue production.

It's exactly the point that most of them don't do what they "should" do. Instead many will use a far different criterion or set of criteria to decide which machine they'll sell you. 

Remember anybody can buy a cpap, however what you are really buying is long term after care. Follow up visits and regular contact with your provider.

Again, that's exactly the point. Many providers do not schedule any follow up visits. Consumers are often not aware they're entitled to follow up visits for mask fittings. We see them coming here for advice. Sometimes providers only concede to a mask fitting and replacement after the consumer tells them that they're required by a contract to do so!

DO NOT buy on the net, you will be sorry.

 
I would say that it's a risk to buy your first machine on the net. The reason is because you may find that you need a more complex machine due to problems such as aerophagia or CPAP-induced central apnea. Many people may choose to take that risk and end up not being sorry. It's not a risk I would take or recommend.

[Mosquitobait]

i do not agree with you 100%. In my research, different machines have different algorithms and I feel that although all machines will treat your OSA all machines are not created equal. if you buy into all the propaganda out there you can buy the machine that is not necessarily the best for you or was not prescribed for you. All this to say that your home care provider has a trained health care specialist who should choose the best machine for you regardless of its styling or looks or potential revenue production. Remember anybody can buy a cpap, however what you are really buying is long term after care. Follow up visits and regular contact with your provider. DO NOT buy on the net, you will be sorry.

I find it interesting that, as a brand new member, your very first post indicates that you have neither read the article referred to by the OP nor any of the threads here in the forum.   What research have you done?  What propaganda? The only propaganda I see comes from DMEs who are trying to sell patients supplies that they don't need. Trained?  Many PTs at DMEs don't even know what a manometer IS much less how and why to use one.  They think that a data-capable machine is one that provides compliance info.   :

Let's address your specific issues.  What experience do YOU have buying on the net? Please detail this personal experience.  How will someone be sorry?  The only long term after care that most people are getting is harping to buy more supplies THAT THE PATIENT DOESN'T NEED often by people who are trained in warehousing, not medical supplies.  They don't even know the mask parts (frame vs. head gear).  I get that you are in Canada, but Canadians often complain of the very same issues. That's why they come here instead of continuing to bang their head against the wall dealing with their DME supplier.