Latest revision as of 08:47, 11 May 2020

How to acquire a CPAP.

UNITED STATES

With Insurance

The common path with health insurance is to

1. Make an appointment with a Sleep Doctor
2. Get an appointment for a Sleep Study to Test for the presence of a sleep disorder, commonly Sleep Apnea, and determine what type of Apnea you have and how bad it is.
3. Get an Appointment for a Titration Sleep Study to determine settings for your new CPAP machine
4. Get prescription for the CPAP machine of your choice, Preferably an Auto-CPAP (More Flexibility in use), is recommended by your Sleep Doctor.
5. Visit your DME to pick up your CPAP machine from the DME

Purchase Considerations:

• Fully Data Capable, you want data with which to soundly make changes
• Compatible with OSCAR (for other data system) to produce detailed Daily Charts
• Get the right machine for your apnea
  • To treat obstructive apnea and minor hypopnea and for most initial treatments a standard Auto CPAP such as AirSense AutoSet (or for her) is appropriate.
  • To treat obstructive apnea and hypopnea, and a standard Auto CPAP is insufficient the treatment of choice is the Aircurve 10 Vauto (has higher pressure and greater Pressure Support (PS) (similar to EPR) available
  • To treat central and/or complex apnea, the only appropriate therapy would be the Aircurve 10 ASV
  • To treat obstructive or pulmonary restriction including hypoventilation, would be the Aircurve 10 ST
• Auto mode (This provides Flexibility)
• Zero or low total run hours (not usage hours which can be reset). See the setup manuals for how to. Note: DMEs have been known to deliver used machines as new

It is strongly suggested that you post a full copy, not just the summary, of your Sleep Study(s) (with personal information redacted) to the Apnea Board Forum so that you know what kind of CPAP would be best for you. For pure Obstructive Sleep Apnea (OSA) this is typically an Auto-CPAP which is flexible and fully compatible with The best software available for you to monitor your therapy. Note that these studies often indicate or hint at more complicated apneas which may need a more advanced version of a CPAP than is initially recommended to treat.

Without Insurance

The reasons for purchasing without insurance boil down to two reasons, you do not have insurance, or you are choosing to purchase out of pocket.

Note: Legally the US Requires a Prescription to purchase any CPAP or any CPAP mask. That said it is possible to make a purchase without a prescription.

Caution: It is preferred / safer to purchase through storefronts either brick and mortar or on the internet. Many locations in the list end with a person selling a single unit which they are likely not familiar with. Note the Purchase Considerations below for product eveluation. These sources may change frequently, use this list as a guide.

Where to Purchase, not in any particular order

1. Always first choice The Apnea Board Suppliers List but they usually require a Prescription (ask) (supplier #2 and Supplier #33 have good prices and ship internationally).
2. Amazon
3. eBay
4. craigslist
5. Letgo
6. Facebook Market Place
7. Offerup
8. garage sales
9. estate sales
10. want ads
11. sleepapnea.org cpap-assistance-program Generally older machines that
12. Gumtree (Australia)
13. Sleepoz.org provide a members' buy and sell page, though it is not very active. (Australia)

Many of these sources exist because, unfortunately, many people refuse to treat their apnea and sell their machines. Usage and condition may vary from brand new, sealed units to having many thousands of hours on them (know how to check Run hours not user hours which can be reset)

Purchase Considerations:

• Fully Data Capable, you want data with which to soundly make changes
• Compatible with OSCAR (for other data system) to produce detailed Daily Charts
• Get the right machine for your apnea
• Auto mode (This provides Flexibility)
• Zero or low total run hours (not usage hours which can be reset)
• Used by a non-smoker in a non-smoker house
• Recommend replacing the filter(s), Mask, Tubes, and Humidifier chamber

Purchasing from Outside the USA

Australia

It is often cheaper (sometimes substantially so) to purchase a machine from the United States rather than Australia. See the Apnea Board Supplier List

Some clinics will try to tell you it is illegal to import a machine - it is not.

Many American suppliers require a prescription which can be provided by your GP.

When comparing prices take into account the current exchange rate and shipping charges. CPAP is GST exempt, but will likely attract a Customs fee (currently around $80.00).

Remember also that if you have any problems you may need to refer back to your overseas supplier. You will not get warranty cover here in Australia, even if your machine was manufactured here.

Machine Choice

Resmed AirSense 10 Autoset

• ResMed AirSense 10 AutoSet (best choice) (E0601) (Fixed CPAP, Auto CPAP)
• ResMed AirSense 10 AutoSet for Her (best choice) (E0601) (Fixed CPAP, Auto CPAP)

Why choose a Resmed AirSense 10 AutoSet? Because it delivers a true bilevel pressure and does not try to predict your breathing, but instead follows it. The AutoSet provides up to 3-cm of pressure increase during inhale (or 3-cm pressure relief during exhale depending on how you want to look at it). This makes the respiratory effort easier and reduces flow limitations, snores, and hypopnea. This, in turn, reduces RERA. On top of that the AutoSet provides preemptive treatment of hypopnea and apnea by increasing pressure as a result of any flow limitation and stops the event before it happens. The reason the AirSense 10 AutoSet works is that it won't get caught up with an irregular breathing rate and flow limitation and try to predict when to decrease or increase pressure, instead, it will just follow along. A graph of typical ResMed mask pressure and flow rate is in the third chart down.

The AirSense 10 can behave as an effective bilevel at the price of a CPAP, up to the limit of 3-cm Pressure Support or Expiratory Pressure Relief (PS/EPR) that a CPAP is capable of supplying. Per ResMed, EPR is a comfort setting.

Below are a couple of images that show how the Resmed AirSense 10 AutoSet applies pressure and how it responds to flow limitations to prevent apnea. These are not ideal sleep breathing but intended to show the response when needed. Notice the normal breathing coming into events shows good inspiratory strength and machine pressure follows each breath, increasing pressure as the flow rate comes up. In this case, the user has flow limitation that disrupts the breathing rate, volume, and pace. The flow limit is the flattened peak. Here we note the mask pressure follows the flow limit and some chaotic breathing exactly, it doesn't get in the way, but the machine promptly increases pressure and stops the event.

Philips Respironics DreamStation Auto CPAP

• Philips Respironics DreamStation Auto CPAP Machine (DSX500x11) (Not all DreamStation Models, Check SN on bottom, bricks look the same) (Fixed CPAP, Auto CPAP) (best choice)

The chart below shows a persistent flow limitation which is that flattened top on the close-up flow rate graph. The DreamStation doesn't know if you're coming or going (inhaling or exhaling), so the respiration is chaotic. That is why it persistently reporting your expiration time is shorter (1.5 seconds) than your inspiration (2.44 seconds) time. A typical respiration cycle for you is a good start to inspiration as flow rises from the zero-line but then flow flattens out and even acquires a downward slowing flow rate like we see at 04:35;35. This breath cycles out to exhale and quickly shows zero flow (flat across the zero line) or in some cases a brief blip above zero, but not inspiration. This is your machine quitting on exhale relief (Flex). These persistent reductions in flow represent increased respiratory effort and potential arousals. In this segment we see a near-hypopnea from flow limitation from 04:35:10 until 04:35:50. It is not flagged because the flow reduction is not more than 50% less than the preceding period, however it's disruptive, and we see a snore.

Four minutes later at 04:40:50, your next segment has chaotic breathing suggesting an arousal occurred. Breathing here is about 27 BPM and is not typical of a normal sleep cycle and is irregular. At 04:41:50 the breathing tails off close to apnea range, followed by recovery breathing with higher volumes and flow rate, before becoming much slower at 15 BPM. The Dreamstation just sits there and watches it, sometimes increasing pressure after the event.

Most doctors and equipment suppliers have no clue these two machines are fundamentally different.

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