Info Request: Want to find resources for a replacement CPAP

AggieMike88

AggieMike88

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The original "I don't know it all" of aviation.
(cross posted form AOPA board since I know many here don't go over there)

Now that we're approaching the end of the calendar year, and I met my deductible for my medical insurance not that long ago, I'm considering upgrading my now 3yr old CPAP machine. This was the one that "was chosen for me" by the DME provider I was told to report to (aka, I had no prior info that I actually had a choice of DME provider or machine).

While it works okay and I have no significant issues with it, I'm wanting to find something that is easier to get the data out of for FAA reporting and take advantage of any new feature ideas. What I get now is a very basic report that both my sleep doc and the FAA reviewers have been accepting, but I know there's better out there to tell me more about what's happening as I sleep.

Recommendations for models are welcome, especially if the model makes extracting of data a simple thing through cable or smart card (and the reader/software isn't as expensive as the machine).

But what would be even more helpful is recommendations for discussion sites that provide input and somewhat unbiased reviews of the makes/models available.

Currently, I get my supplies at CPAP.com, but there's nothing there to really answer questions or convince me which make/model is the right fit for me.

Thanks for the info!
 
For the consumer, and insurance, what's important is hours of use and logging that. That's how they determine compliance and participation. At its most basic level the analogy is that of a Hobbs timer with a pressure switch. The only possible monitoring would be associated with pressure readings and changes therein.

More expensive machines may track occurrences of flow-limitation events like snores, hypopneas or apneas, time at specific pressure levels (on auto CPAPs and BiPAPs), event histograms and mask leaks, but you have clearly said the device you are using is working fine, and you have not reported issues with your therapy. These more sophisticated machines are prescribed when there is trouble, usually with compliance but occasionally when there's something more than just plain old OBSTRUCTIVE sleep apnea going on.

What data do you want and what would you do with it?

Keep in mind when you go to have a sleep study the blower you are hooked to is CONTROLLED remotely but its not really a monitoring instrument.

All the data about what you are REALLY doing while asleep comes from sophisticated multi-channel monitors that are independent of the blower. EKG, EEG, resp rate and pulse ox give the true picture of what's happening, and are used to make the diagnosis and treatment. And that's 5-6 figures worth of gear.

To actually answer your question: One particular brand, Respironics, makes devices (RemStar series) that uses SD cards. Online, the card reader is $70 USD and the software is $100 USD. And the information you would glean would in most cases simply show hours and days used at the most simple level, and the very limited compliance/diagnostic info that is pressure related in the most complex consumer equipment levels.

http://www.cpap.com is a vendor website that sells the gear.
http://www.cpaptalk.com is a forum website, and be forewarned, its a layperson site - I'd verify anything before acting on it.
 
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"What data do I want to see?" is a good question for you to ask. My answer... I don't know, beyond the basic "used it every night and the time in use with the mask on my face is ___"

I really haven't delved into what other info can be recorded on a home machine or what of that additional data set is useful for a user lie me. I think I read somewhere that one machine is able to pick out certain events that the patient will experience and show that as "event per hour" or some other form of frequency and severity. IIRC, the number was one that you wanted to show decreasing or at a lower value to demonstrate the CPAP effectiveness.

There is also the concept that this data, while interesting, is like the joke we used to tell in the Industrial Engineering classrooms at Aggieland, where much of the information we'd develop was extremely accurate, but also very unrelavant and not useful for the situation. *shrug*

Dr. Bruce, if you're monitoring this thread... what info are the reviewers wanting to see in the report off of the CPAP chip?

As far as getting info about the machines, I guess I'm wanting to know more of what's out there. The Fischer&Paykel blower I got now is okay... but I was wanting to find out what is better.

And easier to get the data off of.
 
AggieMike88 said:
"What data do I want to see?" is a good question for you to ask. My answer... I don't know, beyond the basic "used it every night and the time in use with the mask on my face is ___"

I really haven't delved into what other info can be recorded on a home machine or what of that additional data set is useful for a user lie me. I think I read somewhere that one machine is able to pick out certain events that the patient will experience and show that as "event per hour" or some other form of frequency and severity. IIRC, the number was one that you wanted to show decreasing or at a lower value to demonstrate the CPAP effectiveness.

There is also the concept that this data, while interesting, is like the joke we used to tell in the Industrial Engineering classrooms at Aggieland, where much of the information we'd develop was extremely accurate, but also very unrelavant and not useful for the situation. *shrug*

Dr. Bruce, if you're monitoring this thread... what info are the reviewers wanting to see in the report off of the CPAP chip?

As far as getting info about the machines, I guess I'm wanting to know more of what's out there. The Fischer&Paykel blower I got now is okay... but I was wanting to find out what is better.

And easier to get the data off of.
Click to expand...


I'm covered under private insurance and they've always taken my word for useage.. I tell them I've missed 3 nights in 2 years and I get at least 5 usually 6 hours a night and that suffices.. If I was on medicare, I'd have to bring the chip to them or have them actually sample my data to prove compliance.

The purpose of the data is to determine if the insurer (or medicare) should continue paying for the machine (why pay for it, in rental/installments if its not being used). The Medicare threshold is at least 4 hours a night and I want to say >70% of the time in the last 30 days.

The insurance nor medicare wont pay for added functionality you dont need (and trust me, its priced higher), so even if an MD prescribed it, some reviewer somewhere is going to be looking for magic words in your sleep study and depending on those magic words they may not pay for the gee-whiz device even WITH a script.

My "plain jane" respironics Remstar plus came new in box to me, and when chatting with vendor, found out it was $800 as charged to insured. The insurance company paid it off at $50/month "rent to own"

BiPap costs more (used in more severe obstruction with higher inspiratory pressures)

Vpap costs even more (used in central sleep apneas, it breathes for you too)

http://www.ghc.org/all-sites/clinical/criteria/pdf/cpap.pdf;jsessionid=UTX3EQAREPVG1JCISQ4CHPQ

The first link has one insurer's criteria for covering CPAP therapy. The threshold is fairly simple: positive response to initial auto-titration. Quantification is left to the physician.

http://www.google.com/url?sa=t&rct=...Gr0ouWAP7f44CkY1Q&sig2=jjnmhbfYNGgp666GfCpsWQ

the second link is a copy of the Medicare rules (word doc) for sleep studies. Lots of thresholds and criteria called out. The private insurers essentially mimic key portions.
 
Doggtyred said:
I'm covered under private insurance and they've always taken my word for useage.. I tell them I've missed 3 nights in 2 years and I get at least 5 usually 6 hours a night and that suffices.. If I was on medicare, I'd have to bring the chip to them or have them actually sample my data to prove compliance.

The purpose of the data is to determine if the insurer (or medicare) should continue paying for the machine (why pay for it, in rental/installments if its not being used). The Medicare threshold is at least 4 hours a night and I want to say >70% of the time in the last 30 days.

The insurance nor medicare wont pay for added functionality you dont need (and trust me, its priced higher), so even if an MD prescribed it, some reviewer somewhere is going to be looking for magic words in your sleep study and depending on those magic words they may not pay for the gee-whiz device even WITH a script.
Click to expand...
I'm years away from having to deal with Medicare. But I get where you're coming from.

My "plain jane" respironics Remstar plus came new in box to me, and when chatting with vendor, found out it was $800 as charged to insured. The insurance company paid it off at $50/month "rent to own"
Click to expand...
Mine is fully paid for now, but I did witness the big rip the DME did to my insurance company for the machine. CPAP.com lists mine for about $700-ish. But I remember my insurer being billed for 6-8 months at around $150-165 per month. All in, I beleive they really over paid, and I also got stuck with a small deductible. No clue if anyone audits the DME's of the land, but the one I got my machine from (Monitor Medical) I'll never support with my dollars again.
 
Don't me so negative about the DME provider. I have n't done Medicare for over a year and I am still getting bills and back payments for work done in 4/2010(!!).

I am glad that SOMEBODY still provides for what Medicare pays. The usual "cash paid" discount is about 30%, so that just about fits your experience.
 
My wife deals with Medicare daily in home care. Late payments to providers for supposed "administrative errors" is the common theme in a sea of never-ending changes to payment policies.

Her company ends up spending so much money and time on training staff on how to dot the I's and cross the T's just-so, so that Medicare won't bounce the documentation, it's sick. I can only imagine a world where all that money for overhead actually went toward patient care or staff salaries.

Most of the healthcare folks who deal with Medicare are in a constant state of burn-out on the paperwork. And the wave of Boomers flooding that system hasn't even really started to peak yet. Only going to get worse.

She dreams fondly of her private-pay days working for a single Doc. Back then she thought fighting insurance companies was difficult. Now that she's seen medicare from the Assistant Director of Nursing's seat, she says insurance companies were easier by orders of magnitude.

Just passing it along for discussion fodder. I'm not in the biz. All I know is that she wants us all stocked up on long-term care insurance sometime soon... she sees the mess first-hand with retirees and elderly patients.
 
Getting back to the original question....
 
AggieMike88 said:
Getting back to the original question....
Click to expand...

Good point. Sorry.

Are you wanting more data for your health, personal curiosity, or just for more data to send to the FAA and Insurance companies?

Do you have any reason to believe your non-fancy machine isn't an effective treatment?

Ask your Doc if he or she thinks more data is needed. Ask if there's anything a fancier machine could show you that would be clinically useful to make your health better.
 
I currently use this one with a humidifier. http://www.cpap.com/cpap-machine/respironics-pr-system-one-remstar-pro-cpap-cflex-plus.html

It has been rock solid. I travel with it to include camping and moto-camping. Just this summer, it was fully submerged in tent flooding incident and after spending some time in the sun to dry out, came right back to life with no issues. It utilizes an SD memory card for the data and has provided over 2 years worth of data in one shot. The last compliance report I got from my provider showed a daily graph of time use, plus any "breaks" in treatement. The report provided along with a statement from my provider showing no problems with the treatment, has so far sufficed. If you want to monitor the reports yourself, the software is available (last a I checked anyway) for somewhere around $75-$100.
 
A basic question - I didn't know that some insurance requires a compliance report. Is that because some co's 'rent-to-own' and want to know that you are actually using it? I have a very high deductible, so I pretty much pay for everything out of pocket anyway (except that I do get the insurance co negotiated discount.)

If all the FAA and ins co's want is a compliance report that shows the number of days > 4hrs divided by the total # days available, then anything else is a bonus.

It would be nice to know that you have reached some maximum benefit level if you had a report that also showed number of events or other details. The problem then becomes the possibility of knowing too much about the effectiveness of the treatment and then having to decide whether or not you report it and ground yourself. What happens if you see a detailed report that shows a difference in the quality of treatment, even though you are compliant and have no loss of effectiveness? I don't remember the exact wording of the SI, but I think it says something like - ... you must promptly report any adverse changes...operation of aircraft is prohibited at any time adverse changes occur...

Maybe I'm just making too big a deal about this.
 
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denverpilot said:
Good point. Sorry.

Are you wanting more data for your health, personal curiosity, or just for more data to send to the FAA and Insurance companies?
Click to expand...
Yes for health and personal curiosity.

The FAA appears to be happy with single page print out that says, paraphrasing, "over past XXX-hours of being on, patient was wearing the mask (aka compliant with therapy) YY.YY% of the time".

Insurance co can talk to my sleep doc of they want more info.
 
Matthew said:
Maybe I'm just making too big a deal about this.
Click to expand...
I might be too.

As long as I'm compliant, I've been sleeping and resting well and not experiencing any pre-CPAP problems.

But with my machine only supplying the basics of usage, I'm not sure if there is any "home data" to be gathered to supply to my sleep doc to improve treatment.

I only visit with my sleep doc when it's time to handle FAA reports, so it's not like tweaking the machine settings is a regular or needed thing.

And like I said a second ago, perhaps the added data is more of a personal curiosity thing than a necessity.

Other than that, my only gripe is the cumbersome way required to pull the data. (old style serial connection on at the computer, round "power plug" style connection on the CPAP. And the software is very much Windows 98 era)
 
AggieMike88 said:
Other than that, my only gripe is the cumbersome way required to pull the data. (old style serial connection on at the computer, round "power plug" style connection on the CPAP. And the software is very much Windows 98 era)
Click to expand...

Check out DeVilbiss. They generate a code on the display that you enter into their website. Their online utility decodes the string you enter, then generates a series of reports. No removable chip, and no extra expense for s/w.
 
Matthew said:
Check out DeVilbiss. They generate a code on the display that you enter into their website. Their online utility decodes the string you enter, then generates a series of reports. No removable chip, and no extra expense for s/w.
Click to expand...
Interesting. Is this an acceptable report for SI compliance?
 
AggieMike88 said:
Interesting. Is this an acceptable report for SI compliance?
Click to expand...

I've never been required to submit a machine report - just a status report from my doc - that's all my SI says, and that's all that FAA and AME have ever asked for. If the rules change on me (and it sounds like they are in the middle of phasing in the new requirements), then I hope it's acceptable. Why wouldn't it be? It comes right out of the machine, like any other data you download.
 
My AME says he believes the data report requests are looming in the near future. He handles difficult SI cases and keeps his finger close on the pulse of what's happening at OKC, I believe.

My old Puritan Bennett tracks usage, apnea and hypopnea episodes, but I have (not yet) been required to provide a usage report. My GP generates a letter based on my info and his examination that states "fully compliant", "effective treatment", "no indications of daytime sleepyness", etc ... and that has been acceptable for years (so far) ...
 
Another route to the information???

The Up band, a stylish band that syncs with the Apple iPhone, aims to gently prod us into making better choices.
Up syncs with an app that tracks sleep patterns, food intake and general physical activity.
Its motion sensors tell you what percentage of your night was spent in deep and light sleep and chart it on a graph. In the morning, you can see a sleep quality ranking from zero to 100.
Click to expand...
http://www.freep.com/article/201111...ou-think-healthy?odyssey=tab|topnews|img|Life
 
I've been using CPAP gear for almost 10 years now & have seen major improvments in the equipment. My current machine is a ResMed Series 9/AutoSet. It has all the data collection features you're looking for...in a modern case...and most of all...it's VERY QUIET. It's the BEST.
 
gkainz said:
My AME says he believes the data report requests are looming in the near future. He handles difficult SI cases and keeps his finger close on the pulse of what's happening at OKC, I believe.
Click to expand...
They started demanding this in February 2011.
My old Puritan Bennett tracks usage, apnea and hypopnea episodes, but I have (not yet) been required to provide a usage report. My GP generates a letter based on my info and his examination that states "fully compliant", "effective treatment", "no indications of daytime sleepyness", etc ... and that has been acceptable for years (so far) ...
Click to expand...
The new SI letters now demand it; if you're on an old 6 year SI itwill be a while before you need to do this, but it's coming even for everyone else, for sure.
 
Yeah, I'm on a 6 year SI letter. I think I have 3 or 4 more years on it.
 
Necro-threading to update...

This information (and other received privately) can now be employed.

I didn't act on anything from here back in November and decided to keep my existing blower since it was working and I could get the required download without too much trouble.

Unforunenately, the CPAP machine died Friday night. It was no fun to fall asleep as normal and be at peace for a few hours, then be woken up feeling like you're being smothered and can't draw a breath. No amount of tinkering or simple reset attempts such as pulling the power cord from the wall for 60 seconds could resolve the issue.

Searching the interwebz doesn't provide any info on what the displayed error code means. I still have the ops manual so I'll see if there is a customer service phone number. Original supplier will be a no-go because I refuse to deal with them.

Last result is purchasing a new one, but I'm already leaning that way since I could have a replacement here by end of week or sooner. It is a bit of a hit on the wallet, but that's what cash emergency funds are for.

/rant complete. No we return you to your regularly scheduled forum posts.
 
If it comes down to "replace", check with www.cpapman.com and/or www.cpapsupplyusa.com - I've used both, back when I had a major medical high deductable plan and was paying out of pocket for my DME. (Durable Medical Equipment, not Distance Measuring Equipment).
 
gkainz said:
If it comes down to "replace", check with www.cpapman.com and/or www.cpapsupplyusa.com - I've used both, back when I had a major medical high deductable plan and was paying out of pocket for my DME. (Durable Medical Equipment, not Distance Measuring Equipment).
Click to expand...

Thanks. Had been using CPAP.com out of Houston, but always good to have other sources to comparison shop with.
 
For years I used Sleep Med and the therapist working for them loved a couple of miles from me. He would bring my supplies and adjust the machine every couple of months went to work for American Home Patient. So I went with them and he upd and quit them. However, they have an office in the next town. All of the companies charge about the same, but the service I receive from American Home Patient is tops. Just got a brand new machine The Resmed S9 with the heated humidifier. However, the thing I like best is the climate line tubing. This is totally temperature controlled and its the lightest tube on the market so dragging it across my body when I move does not wake me up.

All of the newer machines have a removable SD Card which gives all of the compliance information.
 
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I like catching typos

"the therapist working for them loved a couple of miles from me"

Now that's service!!
 
"All of the companies charge about the same,..."

A bit of research tonight found a blog entry from one CPAP supplier explaining that most of the manufacturers are going with the pricing model like many of the consumer electronics such as Apple. Price is fixed and if you want to sell our product on your site, you must display the price at the set MSRP. To do otherwise risks losing the ability to sell that line or model.

http://www.cpap-supply.com/Articles.asp?ID=327

So, you're correct that it's coming down to which supplier gives you the best service for the dollars you spend. Perhaps I need to find that therapist you mentioned....


My investigation has found a model that is both well within my budget and can easily get the desired compliance report without the need for additional software or card readers. Look up the DeVilbiss line and "SmartCode" if you wish to know more. One supplier appears to have a very long warranty available too.
 
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One of my big decision factors is that the machine MUST use 12VDC input. My Puritan Bennett GoodKnight (among others) does so. I use mine for camping a lot. The RV does have an inverter, so I could run off battery, but for non-RV camping (and power outages at home) I have a 12V battery pack (almost CPAP UPS). Sure, it has an inverter as well, but I'm just obstinate enough that I refuse to invert 12VDC to 110VAC and then convert it back to 12VDC for my CPAP.
 
CPAP for sleep disordered breathing aka sleep apnea is very important to prevent many heart problems including pulmonary hypertension, heart failure and atrial fibrillation. More good news on the effectiveness of CPAP.

A nightly breathing treatment may not only help people with obstructive sleep apnea sleep better, it might also lower their risk of heart failure, a new study finds. The new study does suggest that moderate-to-severe sleep apnea can reshape the heart, increasing its size, thickening its walls and reducing its ability to pump blood throughout the body.
However, the study also found that at least six months of continuous positive airway pressure (CPAP) treatment can help restore the heart's size and function to nearly normal levels. CPAP uses a mask to deliver pressurized air into the airway of sleepers.


http://consumer.healthday.com/Article.asp?AID=662687
 
AggieMike88 said:
I like catching typos

"the therapist working for them loved a couple of miles from me"

Now that's service!!
Click to expand...

I probably should not mention that the therapist in question is a man.:goofy:

I ride a motorcycle and take multi-day road trips on the bike. The Resmed S9 is quite small, not taking up much room in my bikes trunk.
 
It's been a while so I should provide a report on my solution.

A few folks recommended via PM to check out the DeVilbiss line of CPAP's and cpap-supply.com.

After doing research on both, that's what I did. A deciding factor on the brand and model chosen was how easy it is to get details on usage. The on-board display will provide quick answers like hours used, mask leaks, AHI, compliance, etc. And a free website allows you to take some codes from the display and convert them into a report that my PCP will accept to write my SI status report letter. (see https://www.intellipap.com and click the Help tab for sample codes).

I went ahead and upgraded to the Auto machine. This is the version that senses how you're breathing and will auto adjust during the night. My prescription is for 10 cmH20 and the machine is set for that. But the auto range permits the software to select between 4.0 and 15.0 as conditions require. Something about my situation must be working in my favor since the last week I've been averaging about 6 cmH20 and a very low AHI.

There was one night where I woke up to use the facilities and felt the machine really pushing some air to me. A look on the screen showed 14 cmH20. But I believe this was I had consumed a fair amount of alcohol with a late dinner, so the throat tissues involved with OSA were likely more relaxed than normal and I was experiencing a much higher apnea rate than normal..

Final things I like about the machine are: The humidifier tank is much easier to remove and clean. And the power button is small enough that my cat doesn't turn the machine off in the middle of the night.

Thanks to all for their input on this. It was a big help.

--Mike
 
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