I want to wake up rested!

July 8, 2008 4:05 PM

Help me buy a CPAP machine.

I have insurance, but I don't want them to get involved since they will want me to do a sleep study, which I did a couple of years ago with negative results. I think that was mostly because I barely slept. (Hospital bed with railings, wires all over my body, noisy nurses trundling past in the hall all night --- I don't know how they expect to get a good sample under those conditions...) For a few hundred bucks, I'll just spring for my own, thanks.

So, who out there has one? I am looking for very specific advice, down to specific models and websites where I can purchase one. Would this be something I could return if I didn't like?

Also, can someone explain what the nasal pillows are? Is there a general consensus on what percentage of people find relief using CPAPs? Any info at all would be appreciated.

posted by Camofrog to health & fitness (18 answers total)

I think you need a prescription for one. (Hubby has one. But he uses it.)
posted by konolia at 4:19 PM on July 8, 2008

Invacare makes a couple of great models check out their website: invacare.com
posted by cmherskovic at 4:24 PM on July 8, 2008

Camofrog -

You don't need a prescription for a CPAP/VPAP, but I would suggest that you try another sleep study. I work for a large hospital system, and would be happy to make a recommendation in your neck of the woods. Email is in the profile.

I have both central and obstructive sleep apnea, so I need to use my machine every night in order to sleep. My doctor mentioned that I am one of the worst 5 cases of apnea that he has ever come across in his professional career. I went from somewhere around 190 apnea events every hour down to 20 with my VPAP.

I have only used a VPAP from Resmed, called the CPAP Adapt SV: http://www.resmed.com/en-us/products/flow_generators/vpap_adapt_sv/vpap-adapt-sv.html?menu=products

It works for me, but the key was finding the right mask. I went through about 20 masks before I found one that would fit me without leaking and would allow me to sleep comfortably through the night.

In regards to the nasal pillow, I've read that they're marketed towards people who would have problems with a nose or nose/mouth mask, or for people who like to sleep on their side as opposed to on their back. They creep me out a little bit, frankly.
posted by Jim T at 4:28 PM on July 8, 2008

This place sells them online, I don't any requirements for prescription.
posted by doctor_negative at 4:30 PM on July 8, 2008

I also think you need a prescription. I did for mine. They have to do the sleep study to determine the correct pressure for the machine. You need enough pressure to keep your tongue in place but not so much it blows out your lungs. I don't think the pressure is adjustable by the user.
posted by rheumy_the_dwarf at 4:31 PM on July 8, 2008

To the best of my knowledge you need a prescription for a CPAP. You'll also need a prescription for your pressure settings. A respiratory therapist or other professional needs to educate you on the device. You may need your settings adjusted and should be monitored by a doctor. A CPAP isn't something you can buy willy-nilly and strap on.

I feel your pain about the sleep studies. I have had numerous patients complain of the same thing you have. I think it's a shame that lights, noise, and other distractions are happening during the study. I would look for other hospitals or settings to do another study. My hospital just got into the business and they offer a hotel-like setting that is supposed to be homey and quiet.

Good luck.
posted by LoriFLA at 4:31 PM on July 8, 2008

You may be surprised how many more options you have, in terms of location and ambiance, for sleep studies these days, even compared to a few years ago.

With America's aging (and widening) population, sleep medicine is now big business. Just in the last three years, there are 3-4 new sleep centers in my state alone; my first study was much like yours, but by the second one, just two years later, the same hospital had upgraded to hotel-like accommodations (and a nice hotel at that).

If you've never been on CPAP before, it's really not a D.I.Y. kinda thing, all the way up to and including basic safety issues. What's the problem with, at the very least, getting your primary care doc involved so you have someone to go to for followup?

And yeah, no one will sell to you without a script--not even the secondhand places like secondwindcpap.com or cpapauction.com--unless you find someone who's got a listing on craigslist (they're illegal to sell on eBay). He who buys major medical equipment off of craigslist has a fool for a patient, however.
posted by availablelight at 4:51 PM on July 8, 2008

Just adding to the voices indicating you'll likely need a prescription. No respiratory vendors in our region would give one out without one. They require a fax from our office for the slightest of pressure changes.

In regards to being able to return it, our vendors often supply a loaner unit for the patient to try for a few weeks before they return to the lab for a titration study. This also allows them to get used to it a bit and helps make the titration more accurate.

Nasal pillows refers to a type of CPAP mask that has two cushiony protuberances that sit against the nostrils as opposed to a larger mask that completely envelopes the nose (or nose and mouth in the case of a full face mask). Some patients prefer this especially if they have claustrophobic tendencies.

As far as a CPAP mask model recommendation (I do not use CPAP but have slept with a few different masks for research purposes) My favorite was made by ResMED, though the model name escapes me at the moment. Email is in profile if you would like more details.

Also, you didn't indicate why you think you need CPAP. Sometimes a little sleep in the lab can speak volumes. Also, in many cases patients are quite mistaken in their estimations of sleep time.
posted by skinnydipp at 5:14 PM on July 8, 2008

Thanks for the great answers! I didn't know the pressure setting was that sensitive/crucial -- I figured, it's a machine that blows air down your face, how sophisticated can it be? I guess pretty sophisticated. I'll check back with my hospital to see if they've made a proper sleep room yet, and if not find another one to go to. I'm in western Mass. (Deerfield, to be precise, and a slice of heaven it is), so there aren't tons of choices.

skinnydip, the reason I think I need one is because nobody wants to sleep in the same room with me. Also, I've heard my brother sleeping and it ain't pretty ... it sounds a lot like apnea to me.

I'm sure I slept at least a couple of hours in the lab that night, but the techs said they didn't see a thing which, from the empirical evidence I have of people who'd rather sleep in a doghouse on broken glass than in my room, really surprised me. I mean, they saw NOTHING? Srsly?!

Being self-employed, I have the fancy new state-mandated Mass insurance plan. Time to take it for a test run, I suppose.
posted by Camofrog at 5:57 PM on July 8, 2008

I've been on CPAP therapy for almost 10 years, I recently bought two gently used CPAP units from SecondwindCPAP.com. The owner, Mark Seager, is a resp tech, and he spend a good 45 minutes on the phone with me before I even ordered. I ended up buying two Respironics Remstar DS200s from him. I highly recommend both this CPAP unit and Mark. Give him a call, he'll be glad to talk to you about CPAP therapy and CPAP units.

The great thing was that I was able to buy CPAP units with a prescription from my present Primary Care Physician. I was able to live the dream of exchanging money for a medical device I know I need without having to pay my doctor to write a note.
posted by Fat Guy at 6:59 PM on July 8, 2008

CPAP.com does require a prescription. I had to fax mine in to them before I was able to order my CPAP. I'd highly recommend them, however. I wish that their sister site - billmyinsurance.com would take my insurance, because that would make my life a whole lot easier.

I'd definitely recommend staying away from local DME (durable medical provider) services. Had a very bad experience with a dishonest one in my area. Stick to ordering online and definitely do your homework as to which machine and features are important to you.
posted by linuxgrl at 7:04 PM on July 8, 2008

Also, maybe you've seen this on previous AskMe threads, but if you want to learn more about masks and machines (after you hopefully have been convinced to get a doc in the loop as well!), you'll want to check out the following forums:

www.cpaptalk.com
www.apneasupport.org
www.talkaboutsleep.com
posted by availablelight at 7:07 PM on July 8, 2008

Getting the pressure right is indeed important. However, APAP machines have been shown to be just as accurate as sleep studies for titrating pressure, and have the added bonus of automatically adjusting -- so if you you happen to need a higher pressure when you go to bed drunk, the APAP will take care of you. ;)

If you're not the type to need handholding and know how to do your own research, you can absolutely get by with an APAP machine and no medical assistance; this is what I'm doing even though I have diagnosed sleep apnea. You can even adjust the pressure range yourself if you get the right machine and are resourceful -- I have a REMstar Auto and the software that writes prescriptions to the smartcard. :)

Also, you can buy as many machines as you like on one prescription, and the prescription never expires. (What if you break the machine/it's stolen/you want a spare for travel/want to try a different brand/etc.) So if you find someone who has a 3-20cm APAP prescription, they might be willing to get an extra machine for you.
posted by trevyn at 7:10 PM on July 8, 2008

I'd mark all the answers "best" but that would defeat the purpose. Every one of them had good info. AskMeFi is seriously the greatest thing online. (Along with Wikipedia and Google Earth.) Just like that, I not only have the answer to my very specific personal question, but we've also generated a great place for anybody else with the same question to look. Until the links go bad, etc.
posted by Camofrog at 9:13 PM on July 8, 2008

and trevyn: thanks for cluing me in to APAPs. That makes a lot of sense. It's definitely worse if I'm drunk, but even if I go to bed just super-exhausted from physical exertion I tend to over-relax the airways.

So great -- I was all set to go the insurance/sleep study/scrip route and you spring automatics on me. Is there any reason why I shouldn't just buy my own APAP, start it off easy, and dial it up until it seems to be working?

I mean, can this be DIY?

More important, can you hurt yourself with these? Can you breathe too easily?
posted by Camofrog at 9:33 PM on July 8, 2008

Using CPAP or BiPAP isn't brain surgery, but there are details. The pressure setting differs from patient to patient and even differs in the same patient throughout his life, depending on things like pulmonary system compliance (i.e. lung elasticity, thorax shape/expandability, etc), body habitus, slackness of the soft palate, A-a gradient, etc.

Too low pressure won't work. Too high pressure can cause barotrauma, which can permanently damage the lung, leading to worse respiratory problems; too high pressure can also be extremely uncomfortable, leading to treatment failure through noncompliance (i.e. if you can't tolerate the treatment and therefore don't use it, it can't work.)

One of the annoying things about CPAP and BiPAP is that the sleep study is not only diagnostic of the condition that requires it, but is also the main modality we use to figure out what the pressure settings should be. Sleep studies are a pain for all concerned but that's how it is. These new automatic machines seem "too good to be true" to me, I'm very skeptical. I'm quite certain, though, that they work for everyone except those for whom they don't work; read that again if you don't see what I'm getting at.

Obviously a sleep study shouldn't be conducted in a busy inpatient hospital as it sounds like yours was. You should definitely look around for someone who can administer this test in a proper setting: one that's quiet and conducive to a restful night.
posted by ikkyu2 at 10:41 PM on July 8, 2008

So great -- I was all set to go the insurance/sleep study/scrip route and you spring automatics on me. Is there any reason why I shouldn't just buy my own APAP, start it off easy, and dial it up until it seems to be working?

Yup: if you have UARS (Upper Airway Resistance Syndrome). Common especially in the young and thin with long limbs, slight hereditary element, snoring not really part of the symptom list. Google it.

You end up with RERAs (Respiratory Event Related Arousals) and hypopneas (flow limitations) more than full-on apneas (complete cessation of breathing). I was waking up 42 times *an hour* just due to flow limitations...something even the most sophisticated aPAPs have trouble detecting. Because of that, of course, I could/can only be titrated with a full PSG in a lab (electrodes on my brain bucket, the whole nine yards).

The doc tells me that if I can just pack on 40-50 pound to push my BMI into the "overweight" zone, I'd have the fatty tissues necessary to transition to Obstructive Sleep Apnea (traditional diagnosis, where full apneas create the arousals)--which would also mean better insurance coverage and easier treatment options. (But that's a story for another time.)

Also, if you've got anything else going on (PLMS or skipping certain restorative stages of sleep), the only way for your doc to know is a lab sleep study.

MeMail me if you want.
posted by availablelight at 6:20 AM on July 9, 2008

I did a sleep study (testing for sleep apnoea, narcolepsy etc) a couple of weeks ago, and I slept at home. They wired me up in the clinic and I had to go back early the next morning, but in between I was free to go home and have my housemates laugh at all the electrodes and the boxes strapped to my chest. Slept as well as could be expected, considering the wires and tubes.

Apparently this is a new type of equipment, so it might not have been available when you did your study. There were also weight and height limits. But maybe you could call a few sleep study places and find out if they have it.
posted by A Thousand Baited Hooks at 6:32 AM on July 9, 2008