Help getting a new machine

[DleepyGuy]

Hi, I probably will start a new thread once I buy a machine with data recording capability, so I will try to keep this first post as concise as possible. I am a 42 y/o, 185 lbs male (5’ 8”). I was diagnosed with moderate sleep apnea (AHI 16) in June 2019 and suckered into an Airsense 10 CPAP machine by my DME company. Back then I did not know I could have gotten a better machine (APAP) from them. The first couple of months with CPAP were truly horrendous, I was waking up a minimum of 20 times a night with a full-face mask (I am a mouth breather) with AHI 7-10. The DME company was useless and did not seem to care much after the first month and tried to dissuade me from trying out a nasal pillow. However, I went on-line and bought a nasal pillow and a chin strap, and for the first time my AHI’s dropped below 5. After 1-2 weeks of use, I started seen AHI’s < 1! All was good for a while, but I kept breathing through my mouth so at times my leak statistics were unacceptably high. So, I started using Somnifix Mouth Strips and that seemed to fix the issue once and for all, or so I thought…
 
Essentially, I go through periods of particularly good sleep quality lasting many weeks, and then suffer through periods of poor sleep quality characterized by frequent awakenings throughout the night (10 or more awakenings). During the latter, I tend to have 4-5 dreams per night, which I recall well because I usually wake up right after dreaming. As first there was a clear correlation between stress and poor sleep, so that as my stress levels once again decreased, I usually enjoyed good sleep, but lately I have been at a loss as to why I continue to wake up throughout the night. Just some background information:
- I am a very anxious person.
- I work overnights, 10-hour shifts, and I work seven consecutive days on and 7 consecutive days off, and the job is stressful.
- On my 7 days of I stay in overnight mode, but I tend to keep an irregular schedule (I wake up later and stay up later). This has never been an issue when I am not stressed.
- I drink lots (I mean lots) of caffeine. On my good sleep periods, I can drink caffeine a couple of hours before bed and still sleep soundly. Again, if I am not stressed.
- I have chronic gastric reflux. I take omeprazole 20 mg daily. It is usually under control (asymptomatic) unless I am stressed.
- I was 198 lbs when diagnosed. I am now 185 lbs and exercise 5 times a week. I consider myself to be in good shape now.
 
I know some of the above points sounds like glaring issues, but I can guarantee you that caffeine and irregular sleep hours never were an issue for me in the past, and that stress has been the sole driver of sleep quality. The problem is that my current frequent awakenings, which started 1.5 months ago, do not seem to correlate with stress (I do not feel stressed out now). As an experiment, I have been going to sleep at more regular hours and having less caffeine (at least 10 hours from bedtime). Yet, I am sstill having 10 plus awakenings a night.
 
So, I have no choice but to obtain a new machine capable of recording data. I want to have a detail report of what is going on, because up to this point everything I have done is guesswork. I have had my CPAP machine for less than 2 years so there goes any possibility of having the insurance company pay for a new one. Additionally, I have a high deductible plan ($1000), the DME company are thieves, and the doctor I went to for my diagnosis is not easily accessible now to obtain my original Rx (long story). So, my plan was the following:
-          Go to CpapRx  Commercial link removed and pay $99 for a new prescription (available for people on CPAP already).
-          Use this prescription to buy a new machine online for CpapRx or TheCpapshop Supplier #14 Commercial link removed
 
I am not rich, but I do have the means to buy a new machine, so money is not a big concern. My concern is quality and safety.
-          Does anyone have experience obtaining a new prescription online?
-          Does anyone have experience purchasing PAP machines online from these retailers?
-          What is the likelihood they would lie to me and send me a used machine instead of a new one as advertised?
-          I was thinking of getting the Airsense 10 Autoset. Can anyone think off a reason why I should not or a reason to buy something else (I am not too familiar with other modes, ie. Bipap)?
 
Thanks again for sticking through this long read!

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[staceyburke]

I would check Supplier #2 of the supplier at the top of this site.  They sell machines both New and Used for a far lower price that almost anyone else.  I have purchased 2 of the ResMed VAUTO (bpap), one for me and one for my son.  My machine had about 1 month use and my son's had 2 days on it.  (15 hours).   Great company and they did not ask for a prescription for either of us.  Great Company and a great machine.

[Sleeprider]

You are entitled to copies of your medical records, including your current CPAP prescription and any sleep study tests that have been performed. These records are important to retain in your personal possession, and will prevent you from needing to pay $99 for the Rx from CPAPRx. I assume you want a Resmed Airsense 10 Autoset. Supplier #14 is selling that as a bundle for $690 which is a good deal, and many members have had a good experience and recommended this supplier. Supplier #2 is selling the Airsense 10 Autoset used for $389 with warranty and $539 new with climateline tube, so you might save some money there. The fact you already have a CPAP prescribed is sufficient for Supplier #2 and they will dispense. They may contact your doctor or existing DME, but you will not need to get a new prescription. So, I think I have saved you at least a couple hundred dollars.

Good luck and hope to see you back here as you start to optimize your new machine.

[DleepyGuy]

@Sleeprider and @Staceyburke:

Thanks for the info. I wanted to get online Rx (1-s day turn around supposedly) because I fear my physician's office may take forever to release my Rx info (or require a second visit?), and I want it ASAP. Now, I do have a copy of both my diagnostic sleep study as well as the CPAP trial sleep study with a statement from the Pulmonologist recommending pressure of 11 mm Hg and so forth. Do you think that would be enough? I also have essentially 100% compliance with my cpap machine (I have used it everyday for usually 7.5-8 hours) and Resmed's remote usage info supports that.

It seems Supplier #2 is used a lot (I also got 1 recommendation from another forum). I am very paranoid and was trying to stay away from used machines (especially in the age of covid-19). I know the machines are supposed to be sterilized before re-sale but still... am I being paranoid?

Also, someone recommended getting an "AirSense 10 AutoSet for Her" instead because it has 3 operation modes instead of just 2 with the regular Autoset. Do you think this would be beneficial?

Thanks Again!

[Sleeprider]

The documentation should be more than adequate. These stores will both call your physician's office to confirm a prescription exists if necessary. You don't actually have to be any more involved than if a pharmacy were to do the same for a prescribed drug. I have used copies of prescriptions and have seen equipment dispensed with fairly minimal documentation. It's strictly a CYA in the event the vendor has an audit that they called or retained a copy of the Rx.

Used machines are pretty safe. COVID is not documented to be transmitted in that manner, and even in hospitals, the sanitation measures are external for the machine. The CPAP itself does not come in contact with the patient. The intake filter, tube, mask and frame can be changed to new, and the humidifier chamber sterilized or replaced. It's a safe option, but if it makes you uncomfortable, the new machines can be reasonably priced.

The Autoset for Her has the same MSRP as the standard Autoset, but includes a For Her algorithm. It's a nice feature that relatively few people find useful or necessary, however if it is available at the same price from the vendor you are looking at, then no harm in getting it, but I wouldn't consider it a deal breaker.

[becker44a]

. . .
Also, someone recommended getting an "AirSense 10 AutoSet for Her" instead because it has 3 operation modes instead of just 2 with the regular Autoset. Do you think this would be beneficial?

Hi DleepyGuy,
A few months ago, I replaced my aging Resmed S9 Autoset with an Airsense 10 Autoset For Her.  I wanted to be able to try the different modes it has.  After getting a baseline, I tested the other Auto modes, and it turned out that the Autoset/Soft Response mode was best mode for me.  See the report of the tests at this thread:
http://www.apneaboard.com/forums/Thread-...rapy-Modes

I have a tendency to Aerophagia (air-swallowing), and the best approach for controlling this is to minimize pressure.  With the change, my 95% pressure dropped from about 14.6 down to just over 11.  For someone with Aerophagia, this is huge.  Of course, my results don't apply to anyone else, but it shows that the machine algorithms have improved, and the experiments are simple.

Hope this helps.

[SarcasticDave94]

FWIW if you're attempting to get the documents from Dr. Duck's office, tell them you want it ASAP. If they state it'll take longer than 1 business day to mail it or otherwise make these available immediately mention your dissatisfaction and that you'll be going elsewhere. AND remind them that they are still required to produce your documents.

[DleepyGuy]

So I contacted supplier#2 and it looks like my sleep study documents will indeed suffice in order to obtain a new machine. I plan on getting the Resmed Airsense 10 Autoset For Her (I should have it by next week after I submit my documents Thursday) . My current setting are 11 mm Hg with EPR on on my Airsense 10 CPAP. Do you guys have any initial recommenddations for setting on the Resmed Airsense 10 Autoset For Her. I want to allow the machine to titrate my pressures. Thanks!

[Sleeprider]

DleepyGuy, glad the documentation will work out for you to save some money...I knew it would. Self titration with the Autoset or Autoset for her is pretty easy. Most doctors or DMEs will simply set the minimum pressure at 4.0 and the maximum pressure at 20.0 and tell you "try this". That can work, but we can, and will do better, but understand this is a process, and the first objective is to identify an effective range of pressure to manage events, and the second phase is to fine-tune settings for comfort. A good start for you in beginning your self-titration journey is to request a copy of the Resmed Airsense 10 Autoset provider manual from the forum. https://www.apneaboard.com/adjust-cpap-p...tup-manual I think the manual is the same for the 'for her' variation. This will educate you on the features and their uses, as well as how to make setting changes.

For initial settings, let's start with the following:
Mode: Autoset or Autoset For Her (makes little difference in most cases and you will eventually try both)
Minimum Pressure: 6.0 (The minimum pressure of 4 is too low for comfort for most people, and this allows use of exhale pressure relief (EPR)
Maximum Pressure: 14.0 (We could set at 20, but if for some reason you end up needing higher pressure we can set it later.)
Comfort:
EPR on Full Time
EPR setting 2

Be sure to have a clean SD card 4-32 GB ready to put in the machine, and install OSCAR on a computer, laptop or Mac. Read the tutorials on Organizing Charts and Posting Attachments (links in my signature).

[DleepyGuy]

@Sleeprider:

Thank you Sir, you are a gentleman and a scholar. I will read the necessary documents and make a new post with the relevant data once I obtain the machine.