The Respironics Synchrony is the machine my sleep lab uses when titrating patients. At least it is the unit they used for my titration.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed's new VPAP Auto. Humidaire 3i, Simplicity & Micro mask, ResScan 3.4 software, SPO 7500 oximeter.

Unfortunately, the American medical profession more and more seems to be driven by money and greed rather than patient need.   One reason I can think of as to why a DME would withdraw the wonderful feature allowing a patient to monitor his/her own progress is that they were pressured to do so by the medical establishment so the patient would have to invest more time and money in doctor appointments and further possible sleep studies with his/her sleep doctor to find out what was going wrong when his/her treatment needed adjusting rather than just see the data on his computer.

CrohnieToo wrote:

EXCELLENT post, advice and information, SleepySandy.

I will go one step further tho. I maintain that any sleep specialist who allows his sleep apnea patients to be provided w/anything other than a fully data capable xPAP machine should be drummed out of the profession (aside from extreme monetary problems for the uninsured).

Dear SleepySandy,

THANK YOU so much for that wonderful informative post!!!  I was just diagnosed and will be going in for "titration" next week for my CPAP.  Your information will be very useful to me!!  It is invaluable!!

I was disappointed, from other posts, to learn that some companies have been discontinuing the wonderful benefit of allowing patients to monitor their own progress.  I feel that move was probably prompted by pressure they received from the medical profession so patients would then have to turn to their MDs for periodic readings of their data (translation:  more money for the MDs).

I have a suggestion to make for all CPAP users:   As customers, we can make an important statement to the CPAP companies.  Since money is so important in our culture, we can make the statement that we CHOOSE NOT TO BUY from companies that have discontinued the software allowing patients to monitor their own progress.  We can notify those CPAP companies who have discontinued this wonderful feature that we have purchased our CPAP from a company that DOES allow patients to monitor their progress.  Then we need to spread the word about this and get everyone we know with sleep apnea to write to the CPAP companies whenever they buy a CPAP that allows patient monitoring:  They should inform, in writing, the CPAP company that they purchased their machine from why they chose to purchase from that company (because that company allows patients to monitor their own progress) and then they should write all the CPAP companies that no longer allow patients to monitor their progress and tell them that they have just purchased a machine from a company that allows patient-progress-monitoring and that those companies missed the sale because they no longer allow patient monitoring.  

I think this could work.  Could be, CPAP companies were coerced into discontinuing the patient-progress-monitoring feature by money (such as MDs possibly threatening them with refusal to consider their machines for patients) and now we could get them to bring it back by the real perception of lost sales (lost money).  As consumers, we have power.  Money seems to be the way to get people's attention in this culture.  Lets do it!!

My own impression is that a large number of "sleep doctors" don't have the foggiest ideas of the features offered by xPAP machines other than straight CPAP therapy, autoPAP therapy and bi-level therapy. They are quite content to let the DME suppliers be the "experts" in determining which xPAP machine the patient receives as long as it delivers the pressure(s) the sleep tech had success with during the titration study. Even when the sleep doctor scripts a particular mask, he is just relying on the one the sleep tech determined worked best for the patient the night of the titration study.

The night of my titration study I wrote right on the paperwork I had to fill out and sign that I would NOT accept ANY CPAP script or equipment UNTIL I had the opportunity to discuss my titration results and had some say in what equipment would be ordered.

Of course, that delays the start of therapy and requires the expense and time required to have an appointment w/the sleep doctor scheduled but at least it gets the patient some say in what equipment they will receive and also gives the patient a good idea of just how interested and cooperative this sleep doctor is going to be in that patient's therapy.

Some sleep labs and sleep doctors you can rely on for help when you have difficulties w/your therapy or DME supplier. Others you learn right away from this appointment that you might as well just write them off and not bother w/them in the future.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed's new VPAP Auto. Humidaire 3i, Simplicity & Micro mask, ResScan 3.4 software, SPO 7500 oximeter.

CrohnieToo wrote:

EXCELLENT post, advice and information, SleepySandy.

I will go one step further tho. I maintain that any sleep specialist who allows his sleep apnea patients to be provided w/anything other than a fully data capable xPAP machine should be drummed out of the profession (aside from extreme monetary problems for the uninsured).

I got my machine on January 2nd.  M-series PLUS (basic complience only), not Pro.  After you told me about this I spoke to my DME and he said that the sleep center specified the "Plus".

Today, I have called the sleep center/doctor's office to see if they will switch me to the PRO version. They said that they'd call the DME and see if they can get me switched.

I'm waiting for a return phone call.


_________________
M Series Auto CPAP with A-Flex with integrated heated humidifier and Smart Card
Using strait CPAP/C-Flex 12cm H20/2
IQ Nasal Mask with Holey Strap Headgear

I'm new on this forum, and I thank God I found it.

I've been diagnosed with sleep apnea, and get my "fitting" next week in a sleep lab.  I've heard a lot about the CPAP from friends at work who have one.  The information I've found here is great.  I think that being more informed before going to the sleep study will definately help.  I have some more research to do, but I know here to look now.  I'm looking forward to gettng my CPAP, and some better rest.  The lack of snoring will help my wife sleep better too.

I have health coverage through Kaiser Permanente. My identical twin was recently diagnosed with OSA and just got her CPAP machine. I'm getting tested next week, and I should hopefully get my CPAP machine soon. My sister said the respiratory therapist was very abrupt and highly dismissive of her request for a fully data-capable machine. The therapist said that "only pilots need something like that" since they "have to show compliance for their jobs". I think that if someone has sleep apnea, they should have some sort of tracking to see if the device is even treating the condition!

Does anyone have advice for dealing with this situation when I go in to get my CPAP machine? I have heard that the data-capable machines cost twice as much as a regular CPAP machine. Is there a way to reason with the insurance company, or do y'all think I'm just going to have to pay out-of-pocket if I want the data capability?

Hi, thanks for the info. I am a new user, just two weeks and I am trying a REMstarPro M series with a smart card. I would like to be able to read the card myself.
My health care provider showed me the results of the first week and it seemed that I had many OSA episodes during the night, but she said that the C-Flex detects them but corrects them. Is this true? I felt very tired anyways.
How do I contact the people who could sell me the program? Also, apart from the program, do we need a special key to operate the software?
I have also found out that there is now an A-Flex machince that adjusts automatically to the pressure setting needed. Would this mean that we would not have any or at least fewer apnea episodes with this machine?

japhy wrote:

I have health coverage through Kaiser Permanente. ... My sister said the respiratory therapist was very abrupt and highly dismissive of her request for a fully data-capable machine. The therapist said that "only pilots need something like that" since they "have to show compliance for their jobs". I think that if someone has sleep apnea, they should have some sort of tracking to see if the device is even treating the condition!

Does anyone have advice for dealing with this situation when I go in to get my CPAP machine? I have heard that the data-capable machines cost twice as much as a regular CPAP machine. Is there a way to reason with the insurance company, or do y'all think I'm just going to have to pay out-of-pocket if I want the data capability?

You've been fed horsepuckies. There is very little difference in cost between a Resmed S8 Compact which is a bare-bones straight CPAP and the Resmed S8 Escape which is a straight CPAP capable of only compliance data and reminders for filter, mask, etc. replacement and the fully data capable Resmed S8 Elite w/EPR to the local DME suppliers. About a $45 spread in cost between the three for the DME suppliers. Considering most insurances are paying about $900 or more and that a Resmed S8 Escape was selling for about $365 thru an online DME supplier ... draw your own conclusions.

Be aware too that insurances pay, not by brand and model, but by HCPCS (insurance code) and that all CPAPs from the bare bones Resmed S8 Compact straight CPAP thru the top of the line Resmed S8 AutoSet Vantage fully data capable AUTO PAP all fall under the exact same HCPCS code, E0601. (The bi-levels, etc. are much more expensive and fall under an entirely difference HCPCS code). So the local DME suppliers get paid the same amount whether they provide a Resmed S8 Compact or a Resmed S8 AutoSet Vantage, the only difference is to their profit margin. This holds true for all other brands and models of CPAP as well. I mention the Resmeds only because the Resmeds were my choice.

I don't know that there is much hope of your getting more than a bare bones CPAP out of Kaiser. They don't have the best reputation. With most insurances you can call and ask the benefits rep what local DME suppliers they are contracted with and most offer the option of more than one which leaves you bargaining room. You can refuse to accept anything less than a fully data capable CPAP, you can shop your options and pit one against the other if necessary to get a fully data capable CPAP. You can TRY asking your sleep doctor to please specifically script you a Resmed S8 Elite w/EPR or a Respironics M Series Pro w/C-Flex but assuming he/she is a Kaiser doctor ... rots o ruck.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed's new VPAP Auto. Humidaire 3i, Simplicity & Micro mask, ResScan 3.4 software, SPO 7500 oximeter.

susy wrote:

... I am trying a REMstarPro M series with a smart card. I would like to be able to read the card myself.
My health care provider showed me the results of the first week and it seemed that I had many OSA episodes during the night, but she said that the C-Flex detects them but corrects them. Is this true? I felt very tired anyways.
How do I contact the people who could sell me the program? Also, apart from the program, do we need a special key to operate the software?
I have also found out that there is now an A-Flex machince that adjusts automatically to the pressure setting needed. Would this mean that we would not have any or at least fewer apnea episodes with this machine?

You are fortunate, the Respironics M Series Pro w/C-Flex is a fully data capable CPAP. Respironics does offer the EncoreViewer software specifically for patients. You also need a cable reader to download the data from the data card to your computer. Insurances do NOT pay for the software and cable reader. Your local DME supplier should be able to obtain a copy for you IF your sleep doctor will write a prescription for it. You can buy the software and cable reader w/o a script and considerably cheaper thru various online DME suppliers. Just keep in mind that Respironics recently placed a MAP (minimum advertised pricing) policy in effect for ALL ONLINE DME suppliers. So it behooves you to call the various online DME suppliers via their toll-free number to ask if they have an "unadvertised special or sale price" for EncoreViewer and the cable reader. Two factors in HongKong is usually the cheapest place to get the Mako Infineer DT 3500 cable reader. It takes about 10 days to 2 weeks for it to arrive from HongKong and it runs about $32 with shipping.

C-Flex does NOT detect and correct apneas or hypopneas. C-Flex is Respironics form of expiration pressure relief. It can drop your pressure upon expiration by 1, 2 or 3 levels from your set pressure. It can make breathing w/CPAP easier for some and usually at least makes the adjustment to CPAP therapy period easier for first time users.

The only thing that is going to reduce the number of "events" you experience is the proper pressure and no mask, mouth or lip leaks. Mask leaks, mouth breathing and air escaping gently thru your lips all reduce the amount of therapeutic pressure you receive from your CPAP. A comfortable, properly fitting mask is THE KEY to successful CPAP therapy once your needed pressure setting has been determined.

The Respironics M Series Auto w/A-Flex is the newest and top of the line Respironics CPAP. It can be used as a straight CPAP w/or w/the A-Flex (a form of pressure relief on expiration) or in auto mode. In auto mode it can be used to auto titrate your pressure needs, acting as an informal at-home titration study.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed's new VPAP Auto. Humidaire 3i, Simplicity & Micro mask, ResScan 3.4 software, SPO 7500 oximeter.

SleepySandyG wrote:

I've done a lot of research about the various machines available to CPAP users.  The manufacturers provide a lot of information on their websites and are a very good place to start machine research.  It's very important to know the options you have.


Manufacturers

Resmed is a big manufacturer - http://www.resmed.com/en-us/

Respironics is the other big manufacturer - http://www.respironics.com/

Puritan Bennett is a smaller manufacturer - http://www.puritanbennett.com/

Fisher and Paykel is a smaller manufacturer - http://www.fphealthcare.com/

Sunrise Medical makes the Devilbiss brand - http://www.sunrisemedical.com/index.jsp

Aeiomed is a smaller manufacturer - http://www.aeiomed.com/

Respironics and Resmed seem to be the most popular manufacturers.  Most of the people you encounter on the forums will have one of these 2 brands.  Puritan Bennett is less popular but I do come across a few people with Puritan Bennett machines.  I don't think I've encountered anyone with a Fisher and Paykel, Devilbiss, or Aeiomed machine, but that does not necessarily mean there's anything wrong with them.  It just means they're less popular.



Machine Types
There are different types of machines.  I'll categorize them into the basic functions:

CPAP Machines (CPAP) - provides a straight continuous pressure.  This link has good information about what CPAP does:  http://www.resmed.com/en-us/patients/treatment.html?menu=patients

Autotitration Machines (Auto) - provides a flexible pressure based on a set pressure range.  As the machine recognizes a change in breathing that could lead to an apnea, the pressure is increased in an attempt to prevent the apnea.  The advantage of an Auto is you can spend parts of the night at a lower pressure and the machine raises the pressure only when the machine determines it's necessary.  This link has good information about an Auto:  http://www.resmed.com/en-us/patients/treatment/autotitration.html?menu=patients

Bilevel Machines (Bilevel) - provides different inspiratory (inhalation) and expiratory (exhalation) pressures.  Bilevel machines are typically used for people who have difficulty exhaling against their CPAP pressure.  Usually these are people with very high pressures, but not always.  The inspiratory pressure is set at that high pressure and the expiratory pressure is set at a lower pressure.  This allows for easier exhalation.  This link has information about Bilevels:  http://www.resmed.com/en-us/patients/treatment/bilevel.html?menu=patients

Autotitration Bilevel Machines (Auto Bilevel) - provides a combination of Auto and Bilevel features.  The inspiratory pressure is set to vary as needed based on the breathing pattern and the expiratory pressure is also set to vary as needed.  The expiratory pressure is lower than the inspiratory pressure.  This link shows the Respironics' Auto with BiPAP information:  http://bipapautomseries.respironics.com/

Additional Machine Features
There are other features that can be helpful in treatment and should be researched and considered.

Ramp
Ramp allows you to start your machine at a lower pressure each night and it slowly works up to the set pressure.  For example, if your titrated pressure is 10cm, ramp can be set to 6cm over 20 minutes.  The machine will start at 6cm and slowly raise the pressure to 10cm over 20 minutes.  The ramp starting pressure as well as the ramp time can be changed by the DME.  Ramp is considered a comfort feature and can help when trying to acclimate to CPAP.  I believe all manufacturers have ramp.


Exhalation Relief
Some manufacturers offer a feature which is designed to make exhalation against the CPAP pressure easier.


Resmed


EPR (Expiratory Pressure Relief) allows the exhalation relief to be set to reduce the exhalation pressure by 1cm / 2cm / 3cm.  When using a Resmed machine in Auto mode, EPR cannot be used.  http://www.resmed.com/en-us/products/flow_generators/s8_subpages/epr.html?menu=products1

Respironics


C-Flex allows the exhalation relief to be set to a low / medium / high relief.  The relief does not directly correspond to a cm of pressure number like EPR does.  C-Flex is available on Respironics' CPAPs, and Autos.  When using a Respironics machine in Auto mode, C-Flex can also be used.http://cflex.respironics.com/

A-Flex is intended to make both inhalation and exhalation more comfortable.  A-Flex is only available on some Respironics Auto machines and is used when the machine is in auto mode.  Given the newness of this technology, I highly recommend reading the information on the Respironics website about A-Flex.  Initially it appeared a machine with A-Flex would also have C-Flex, but that's not how it's explained.  A-Flex is considered a technology on its own and (quote from Respironics website) "During exhalation, A-Flex provides variable expiratory pressure relief that is the same as our clinically proven C-Flexâ„¢ technology. During inhalation, A-Flex also provides inspiratory comfort that varies with the patient's pressure level." There are two links that seem relevant:  http://remstarautomseries.respironics.com/ and http://systemone.respironics.com/aflex.asp

Bi-Flex allows exhalation relief on certain Respironics Bi-level machines.  http://mseries.respironics.com/Technology.asp

As far as I know no other manufacturer offers exhalation relief


Data Capability
Data capability varies among manufacturers and models.  Definitely research what's available in terms of data capability.


Compliance-Only  Compliance-only machines only gather machine usage data - the dates / times the machine was actually used.

Fully Data Capable  Fully data-capable machine collect a lot of data regarding therapy.  In addition to compliance information, AHI data, leak information, pressure information is included.  A Fully data-capable machine will give a lot of information about how the therapy is progressing.

My personal opinion is every CPAP user should have a fully data capable machine.  Compliance-only machines offer very little information and do not allow you or your doctor to see what types of events (apneas / hypopneas) may be happening when you use the machine.


Software
Certain manufacturers have software available that allows the data on the CPAP to be downloaded.  The software is technically intended for physicians and DMEs.  Many CPAP patients feel the software is essential to monitor our therapy.  If you work with a local DME it is highly unlikely you can obtain the software from them and the majority of DMEs and sleep docs frown upon patients having the software.  However, many of us have purchased our software from online DMEs.  We continue to push for the availability of software to patients because we feel strongly it's important to monitor our own therapy.  The software can only be used with machines made by the same manufacturer.


Resmed:  AutoScan  Resmed has officially prohibited the sale of the AutoScan software to patients.

Respironics:  EncorePro  Until very recently Respironics allowed online DMEs to sell EncorePro to patients.  They seem to be reconsidering this policy and the software is now difficult to find.

Puritan Bennett:  Silverlining  Silverlining is still available for purchase from online DMEs.

Machine Details
I'm going to list links to the various machines that are available, but I'm not going to list the specific features such as fully data-compliant or exhalation relief because I don't want you to make a mistake on your machine choice if there is any mistake in this post.  Please completely research each machine to see if it has the features you need for your therapy.  You can find opinions on specific machine models that interest you by doing a search on the forum.

Resmed
Resmed has makes CPAPs, Autos, and BiLevels.  They can be accessed from this page:  http://www.resmed.com/en-us/products/product-catalog.html?menu=products


Respironics
Respironics makes CPAPs, Autos, BiLevels, and Auto BiLevels.  They are divided into two different categories which are "families" of machines.


M Series Sleep Systems:  These are the newer models of the Respironics machines.  The main M Series page is here:  http://mseries.respironics.com/Home.asp

REMstar Family (pre-M Series):  These are the older models of the Respironics machines but are still well-liked by many patients.  They are also referred to as the "tank" or the "classic".  They can be accessed here:  http://remstar.respironics.com/

BiPAP Family (pre-M Series):  These are the older versions of the bilevels.  They can be accessed here:  http://bipap.respironics.com/


Puritan Bennett
Puritan Bennett makes straight CPAPs, Autos, and Bilevels.  The machines can be accessed here:  http://www.puritanbennett.com/prod/List.aspx?S1=SPT


Fisher and Paykel
The Fisher and Paykel machines are in two groups.


SleepStyle 200 CPAP Series:  these are straight CPAPs and can be accessed here:  http://www.fphealthcare.com/osa/cpapi.asp

SleepStyle 600 CPAP Series:  these are straight CPAPs with the addition of a heated CPAP hose.  They can be accessed here:  http://www.fphealthcare.com/osa/cpaps.asp


DeVilbiss
DeVilBiss makes straight CPAPs, Autos, and BiLevels and can be accessed here:  Sunrise Medical


Aeiomed
I'm pretty sure Aeiomed only makes one machine - the Everest.  The link is here:  http://www.aeiomed.com/everest.asp

Bottom line.  My recommendation to every new CPAP patient would be:

1.  Research.  Research.  Research.  Find out all you can about the machines that are available BEFORE you go to the DME to get your machine.  You want to try to determine what model will allow you to maximize your therapy.  If you have trouble getting what you need from the DME you may need to work with your sleep doc.  While the mask is the most important component for comfort and to keep us compliant, the machine is extraordinarily important so that you actually get the therapy you need.  Do you need a straight CPAP; an Auto; a BiLevel?

2.  Regardless of the model you choose, it should have:


a.  Fully Data-Capable machine - you need the ability to see what's going on with your therapy as does your doctor.  If your apnea is not under control there is no way for the doctor to know if your machine does not collect that data.

b.  Heated Humidifier - CPAP therapy can be very difficult without a humidifier because having the air blow into your nasal cavity can be very drying even if you live in a humid climate

I have a REMstar M Series Auto with C-Flex with an integrated heated humidifier.  I like it very much.  Prior to this machine I had the REMstar M Series Pro with C-Flex.  I also liked that machine very much.  They look identical.  The Pro is a straight CPAP while the Auto is, well, an Auto.  My new sleep doc wanted me to switch to an Auto because I'm going to be losing weight and that may result in pressure changes for me.  I have the EncorePro software so I can monitor my therapy daily.  My AHI is conistently below 2 and my leaks are well-within tolerance so I'm getting the therapy I should be.

If you are looking for information on a new machine, check out the links here and also research on the forums.  I didn't post opinions of the machines because the opinions vary greatly and what is right for you might not be what is right for someone else.


The information in this post is consolidated from information found on the webisites of the various CPAP manufacturers.  I have inserted some of my own opinions regarding what I feel is necessary in order to get the best CPAP therapy.  I am not in the medical field and none of this information is intended to be medical advice.

Thanks Sandy to you and others here. I was able to make a very infromed decision on my equipment, and mask. I just got my cpap, and my first night was a wonderful first nights sleep in a very long time. Thank you again, and god bless all of you, and I'm very happy I found this place.