New to Apnea / CPAP - Avoid DME and Go Straight to Online Purchase?

[dreamstream]

Question: After extensive online research, I'm almost certain I know what machine and mask I want to get (Respironics DreamStation Auto CPAP), should I just forget about going to the appointment I have with a DME this week and buy online?

Back story: Was diagnosed with OSA 8 months ago. Opted to try (at great expense) an oral appliance vs. CPAP since the dread of wearing a machine at night was so disheartening but after 7 months of working my way up through oral appliance stages I'm just not getting good results and am experiencing too much jaw pain and teeth misalignment and still having bad apnea symptoms.

Just discovered this forum. So grateful for all the resources here. Have spent all weekend reading and researching. Have settled on getting a Respironics DreamStation Auto CPAP with humidifier and heated tube, Philips Respironics DreamWear Fit Pack with Headgear and a DreamWear Full Face Mask. All the reviews of this gear seem strong and the feedback here is consistently good. I'm in BC, Canada. Am not covered by provincial health or a health care provider and though do run my own businesses and have health coverage with a 100% business write off under a PHSP (PRIVATE HEALTH SERVICES PLANS FOR INCORPORATED BUSINESSES)

Have an appointment this week with DME but now after intensive research all weekend thinking I should just cancel my appointment the DME and order online right now. Any guidance on whether it makes sense to still go through the trial with the DME? Seems like it might just be a waste of time vs. buying Respironics DreamStation Auto CPAP now and getting going with it. When I told the DME I was interested in that machine they sounded hesitant and asked if I want to look at others as well but noted they would have one of those ready for me to look at if I wanted one. Not sure if I was reading into the conversation that they might want to steer me in a direction that benefits them or if they were wanting me to stay open to possibilities that might suit me effectively but based on everything I've read here about Respironics DreamStation Auto CPAP it's one of the top options and I can't see why I wouldn't just order it rather than dealing with trialing and returning, etc.

Thank you again for this incredible forum and all the resources here.

Noob sleep apnea guy

[jaswilliams]

I eould suggest looking at the Resmed Autoset 10 for her rather than the Dreamstation it’s more expensive but provides more effective treatment than the Dreamstation

[Fats Drywaller]

Yes to what jas said, and the actual model name is "Airsense 10 Autoset for Her". If you can't get that for any reason, the "Airsense 10 Autoset", without the "for Her", is fine. Those two should be the same price, so any price difference between them would be a ripoff by the retailer or DME. The "for Her" model isn't just for her; it's also for him. It includes an additional APAP algorithm to choose from, so it has one more feature than the regular model. It's essential to include the "Autoset" in the model name; don't get an "Airsense 10 Elite" or "Airsense 10 CPAP". See the Machine Choices article for the reasons.

Whether you buy a machine & mask on your own should, I imagine, depend on comparing two calculations: First, if you use insurance, how much will you pay out-of-pocket for the equipment over the life of the DME contract? (13 months?) I mean buying, not just trialing with an option to return and cancel. Also, will that increase your premium or deductible for future years? Second, how much will you pay if you buy the machine & mask yourself? Compare those two costs, and you should have your answer. Or is it more complicated than that for some reason?

[Fats Drywaller]

Why Air10? One good answer, in two parts, is:

http://www.apneaboard.com/forums/Thread-...#pid281361

http://www.apneaboard.com/forums/Thread-...#pid273655

[snorybob]

FD & jaswilliams are giving you good advices. If you decide to buy online, you could check Supplier #34 (top main page).

They have some all in one packages, good price, good service, free shipping.(can.$- ontario)



  Bob.

[Gideon]

The extensive research we do here is with multiple hundreds of users and while some find success with the PR DreamStation Auto, many more are more successful with the ResMed.

So you want 

1. significantly slower response to Flow Limits, 
   
2. have to maintain a higher initial pressure, possibly increasing painful aerophagia, so your machine can react to events before they are over.
   
3. not be adequately treated for Flow Limits and Hypopneas where ResMeds EPR which can function similar to a biLevel machine in the treatment of Flow Limits and Hypopneas (up to a 3cmw limit imposed by all CPAPs)
   
4. Maintain a higher AHI than you likely would with a ResMed Autoset
   

When do we recommend PR machines, when the user has a demonstrated success with a high level of comfort with PR machines (not often)


I'm sure I'm missing several more reasons.

[Melman]

I agree with Fats. Check your cost using insurance. I had to pay about $270 total for my Airsense 10 Autoset using my insurance which saved me a lot os $$. It lists for about $800 but new ones can be purchased for around $650. If you decide against the DME route, check Supplier #33 in the commercial posts section of the forum. They currently sell the Airsense 10 Autoset for Her for $648 with free shipping. A friend recently purchased one from them and was very pleased.

[dreamstream]

Thank you for the responses. I'll look at the ResMeds and though to the original question. In this case I can write off the full costs under my own business as an expense and that is the only payment option I have so it's probably best just to buy a unit and all the fixings outright. Should I just go ahead and buy a machine online or is there an an actual benefit to going through the full DME process/trial? Would seem from many posts here that the forum here offers better support that making repeat visits to DME (which for what is worth is a multi-hour round trip for me each time since we are in a remote location.)

[Fats Drywaller]

IMO there's no reason at all to use the DME, especially if it requires long travel times. You can get very good help here on AB from the chart-interpreting experts, after using your machine for a little while with an SD card in it to collect data for the ... OSCAR! software. Or the Sleepyhead software for a few more weeks, anyway.

[Fats Drywaller]

By the way, I'll answer something you haven't asked and maybe weren't concerned about: The expense of buying the supplies yourself is not huge. I don't know how that works out with your accounting and insurance, with your own business and all, but I don't think you would ever need to be concerned about not having a DME to periodically feed you the mask parts, filters, replacement masks, humidifier tanks, and hoses. It's not that those things are so inexpensive, but that the replacement schedule that's commonly used is very much overstated. For instance, you don't need a new mask every 6 months. One per year is plenty, and some people who are 100% self-paying don't even buy 'em that often. And so on down the line for all the other consumables. All of that stuff is a huge profit center for DMEs, but if you're operating without a DME you can mostly just ignore it.

FWIW, I don't use a DME or insurance for any of my CPAP-related purchases. And I'm retired/unemployed and poor. So maybe that gives you some idea.