The topic of CPAP machines has come up a number of times with friends and family, and recently I have had cause to look into these once again.
It seems there is a lot of information available, but you could question its quality and the likelihood of being able to make a truly informed decision based thereon.
A multitude of CPAP machine brands exist, to name some:
Fisher and Paykel
the list goes on …
These break down into manual and automatic pressure, home, portable/travel, humidifying or not … and probably other categories/variations I’ve not stumbled across to date …
Then there is buy or rent …
Price range is enormous, with units ranging from many hundreds of dollars to many thousands of dollars - a variance factor of ten or more!
Private Health is another consideration - ‘devices’ as they are affectionately known by some can have a fixed total amount per person regardless of device, multi-year timeouts for purchasing, with the amount claimable varying quite significantly and notably in all cases I’ve looked at, only a fraction of the higher end devices cost.
Fitting services are also a factor - online vs pharmacy outlet vs ‘professional fitting’ - then other factors such as facial hair …
There is a CHOICE article on Sleep Apnoea but it is about the condition, not a machine review …
It would be very interesting and helpful to hear from others with more experience in this area
what kind of machine you chose and why
whether you rented before you bought
was price a relevant indicator of performance/quality/efficacy/etc?
I have used three different CPAP machines. One was trialled as it was the recommendation from a supplier associated with the sleep clinic- good machine but very expensive and decided to look for other options. I used one which had been reconditioned for a couple of years (acquired from a friend) and last year purchased a new one through a pharmacy. They had several brands and had considerable expertise. (I am a health professional with training in sleep disorders). Clinics offering sleep studies often seem to be linked with machine providers (sometimes pushing a single brand) and some of these are very commercially oriented if I might put it that way. One provider I approached about servicing/repairing my machine said it was unable to be done but went on to recommend I purchase two new machines (one for travel) at a total cost of over $5000! I went elsewhere and I was able to have it fixed and a loan machine provided for the interim- repairs cost $250.
My private health cover gave a rebate towards the purchase of my most recently purchased “device”- I had to obtain and provide a recent (less than 6 months old) doctor’s letter stating I needed it which meant the fund did not accept any of the original specialist reports from the first sleep study which seemed unnecessarily picky.
My current machine is a Resmed S10- I am very happy with it. Finding a good mask can be difficult for some- I am a side sleeper and many masks dig into the face.
I have used the Resmed, Fisher & Pykel and the Phillips Respronics machines. All have been good and in the Resmed I have also used an auto pressure one. My current one is a F&P set pressure one and I prefer the Phillips Masks to the Resmed ones but everyone has differing likes. I don’t like the “pillows” style nasal fittings and so either go for a “full face” (it covers both the mouth and nose) or just the nasal covering masks. If you are likely to be a mouth breather or possibly need a chin strap then just go full face and avoid the strap. Price is generally no reflection of quality beyond perhaps features that the machine comes with (and will you need or use them is a decision you need to weigh up). I have purchased a $600 dollar machine that lasted 6 years before I went for the next one which was a Resmed and cost a packet more. The F&P was around $1,400 but as a pensioner I get mine free now through the Hospital and I have had it for 3 years now with no issues (and I prefer the fixed pressure model but you may like the auto sensing ones).
If you get dry nose symptoms or dry throat then you may need a humidifier which for most machines is an additional purchase. You however may wish to try nasal oil before getting one (it is refined sesame oil), which can come as drops or spray and it has almost no smell so don’t worry you won’t smell sesame all night long.
Most masks come in three sizes small, medium and large and it definitely pays to make sure you get the right size for your face/nose and you don’t really need to pay out for a custom fit unless you have some extra ordinary facial features/disfigurement. You can easily try them in a store and many will put them on a machine and let you try so you can see if the fit is right for you. However the best test is when lying down so try to find a place where they will let you lie on the floor or bed to see how the mask feels. Heavy beards are not conductive to a good fit but moes that fit within the confines of the mask are fine or even several days growth can be handled. If you really want a heavier beard then the pillows are probably the only way to go but in all honesty they are a difficult item to get sealed well and fitted to you.
Many machines now come with heated tubes and each brand has their own way of fitting these so if buying one tube then buy two instead. They are more costly than a non heated tube but they generally last about 3 or 4 years each. I have had machines last 8 years before needing replacement. Buy as many filters as you can when purchasing a machine and replace them at least every 6 weeks but more if you live in a dusty environment, the filter will start looking very furry and gray and you should replace before it gets very gray. Some people try to economise by washing the filters once or twice before totally replacing them but I don’t recommend this at all. Replacing the filters regularly improves the lifespan of the machine as well as keeping your air supply as clean as possible.
Mask care is important and they should be washed and dried regularly and in some cases daily, but don’t wash the neoprene straps all the time as the fabric does wear out/breaks down. I just use a mild detergent or soap to wash the plastic and silicon fittings, thoroughly rinse and then let them air dry before the night/days use but you can use them wet if you need/want to. Oh don’t use brushes to clean them as the silicon is very thin and can be damaged by too harsh abrasion and will mean a costly early replacement of parts. A mask with good care can last two years easily and many have spare parts available that if the rest of the mask is good can be a cheaper way of extending their life. I find the straps are the thing I replace most often as the material over time stretches and the velcro doesn’t hold well in the end but my pressures are very high and so my straps are usually being under more pressure so that the mask remains well sealed.
My brother uses an F&P unit, and I think his main complaint is the very poor power factor, which you don’t really notice when connected to the mains, but when camping it drains the battery (via a portable inverter) far more than is reasonable.
The fix is probably just adding a suitable pf correction capacitor, but the manufacturer should be doing that- its hardly an expensive component to add.
I think the free machines are only free for fixed pressure?
I’ve been using Respironics and PhillipsRespironics for 12 years. Only recently bought a Dreamstation Auto from Secondwind Cpap in the US. That was before we got landed with the GST for stuff under $1000. It cost me about $750 AU whereas the Au price is well in excess of that, more than double.
When you are on a Mac, as I am, you also need to consider whether you want to access your machine’s data. I bought the dreamstation for only one reason, that being that my older machine didnt use a data card that I had a reader for, and even if I did, the software was PC only. It didnt bother me for a long time but eventually I decided I wanted to be able to see what was going on… and the Dreamstation talks to an app on my phone. And its information is pretty much useless. So I use a software called Sleepyhead (written by an Aussie guy) and its been illuminating. Its also been handy to be able to print out a summary for my GP ahead of the annual medical for Driving. Sleepyhead is also compatible with the REsmed S9 and S10. https://sleepyhead.jedimark.net. The beauty of this software is that once you learn what all the graphs are about, you can see what you need to do to improve your outcomes.
I like really lightweight masks, for years I used the REspironics Comfort Classic, but had to find something else when it went out of production… currently I vary between a Phillips Pico and a BMC nasal mask, the designation of which I forget. Bought both on ebay, since both came with all three sizes so one was bound to fit well, and they did, indeed. I think I saved about $200 doing it that way.
Overall my machines have assisted me a lot, my AHI is down from 44 to 2-3 per hour and sometimes I have NO obstructions at all during sleep… The reason it stays at 2-3 or whatever, is the dreaded hypopnea which I have had all my life.
I’m rambling and thats because its 3am and I didnt get to sleep til 11, and awake again at 1. There are non-OSA reasons for me to be awake, and I’ll go back to bed again shortly
Mostly they are fixed pressure but if you need the auto ones you do get them. The auto ones are generally given where the intake pressure needs to be high but the exhale pressure needs to be lower (bi-level I think the term is) which at one stage I did need but now fixed is all I require.
I sleep much better since the diagnosis and treatment of my husband’s obstructuve sleep apnea (OSA) - no more lying awake listening to the awful noises as he struggled to breath, and then the horrifying silences when he stopped breathing (cue for me to nudge him enough to get him breathing again). Also no more being terrified when he was behind the wheel and steering onto wrong side of the road etc - worst of those moments was that he wasn’t aware he was doing it (micro sleep behaviour).
After a sleep test he was diagnosed with OSA and prescribed suitable pressure for a CPAP machine. At first he rented - which is a good idea as some people do not manage to learn to tolerate the mask.
Since then he has purchased a variable pressure machine. The variation is two-part: when the machine is turned on it gradually ramps up to the pressure you have set; during the night if the machine detects a mask leak it increases the pressure to try to seal the leak (up to a value that you set on medical advice). The data from this machine reveals both breathing stoppages and leakage events.
Masks. Getting one to suit (shape, style, size) is trial and error.
My husband needs a chin strap to reduce the number of leakage events per night even though he wears a full face mask. Must be the combination of the shape of his face, amount of side sleeping, and tendency to mouth breath. The full face mask can ‘ride up’ so that it’s bottom seal is sitting in between his upper lip and lower lip - leak; the full face mask can move sideways so that the seal no longer sits in the normal facial crease between cheek and mouth - leak.
Leaks are noisy (which I don’t like) but more importantly leaks mean that the positive pressure effect is not happening for his airway.
Even though we aren’t in a “dry” area of Australia, a heated hose and humidifier are a must for comfort and health of his airways. He tried humidifier without heated hose for a while and experienced the “rain out” effect where moisture from humidified air condensed into water drops in the unheated hose - causing water to drip onto his face inside the mask.
Agree that replaceable filters are a good idea (CPAP units are often placed at or below pillow level - surfaces and air at those levels can be dusty even with weekly cleaning).
Plug the CPAP into a small UPS (power supply) is a good idea - gives the CPAP user a bit of warning when there is a power outage (he tells me it was a nasty experience to be sound asleep and unaware that the hose & mask have stopped delivering air - until wake up gasping for breath wondering what happened).
He recently took his CPAP machine on a 4WD trip - using second battery with inverter to run the CPAP at night. It was heavy on both the inverter and battery - maybe that was the heating element in the humidifier and the heating element in the heated hose rather than the air pump & electronics of the CPAP itself.
A good side effect is that with his CPAP on my husband does not hear my snores. I don’t have sleep apnea (been tested) but I have snored since childhood, so with the CPAP my husband gets much better sleep all round.
I was diagnosed with mild/moderate sleep apnoea after participating in a sleep study as part of a research program about aging being undertaken by a University. I had no indications that I had a problem with sleep. The universe clinic spent a lot of time and many visits calibrating the machine which was on loan for three months. At the end of that period, I purchased the same machine through them - a Phillips Respironics machine. It is very quiet, my partner cannot hear it at all.
As I travel a fair bit I also purchased a ResMed AirMini. It is excellent for travel, fitting into a small bag with all the bits and pieces included. It is a bit noisier than the other machine but well worth it for the convenience of an easily portable machine.
Both were expensive but when I consider how much better and more mentally alert I feel it is worth every cent.
My husband has had the same resmed auto for over 16 years. It cost an arm and a leg, thousands. It has been around the world several times and had one repair. He wears a full mask and is a mouth breather, I recently got him another new mask, of course he has had many over the years, Resmed Airfit, which is absolutely brilliant. No slipping, blurting, leaking at all. Magnetic and velcro fasteners, positive hose clips, they have the design right now. It cost $290, non refundable by our health fund, NIB. Another story, health funds.
My personal experience regarding sleep apnea and treatment.
I have sleep apnea for years, about 14 years ago I did a surgery called Uvuloppalatopharingoplasty. It basically removed your tonsil and soft tissue above inside your mouth at the top part. I did that surgery thinking that it might fix my sleep apnea and I won’t have to wear CPAP machine for the rest of my life. Unfortunately that is not the case. The surgery was completed successfully but it did not have any improvement to my sleep apnea. I still have to use CPAP machine for the last 14 years.
The surgery left me with the following 3 problems.
I used to take personal singing coaching and was able to sing well even for high notes. After the surgery I no longer able to sing notes a bit higher than normal.
When I talk sometimes I will be out of tune. It was never the case before the surgery.
When I drink water sometimes it will goes inot the wrong hole and cause me to choke.
I wish I did not do the surgery.
CPAP machine, on the other hand is very successful in helping me getting good sleeps for many years.
I strongly recommend using CPAP machine against any surgery.
I was told most sleep apnea are caused by our tongue blocking the airway. I fix this you will need to have a major surgery that cut a bit of your jaw bones on both sides of your jaw and join them back. This is a major surgery and I believe will come with more bad effects (strange looking face and jaw?). I would advise against it.
I have had several surgeries done in my life, all of which has left me with irreversible negative results and I wish I have not done them. Stick to non-invasive measure when you can. Because surgeries are irreversible.
You can’t power a clothes iron with a camping battery via inverter for very long due to the high power needs of the heating element in the iron.
It is the same with the heating element in a CPAP humidifer and the heating element in a CPAP heated hose. Therefore detach the humidifer from the CPAP machine when using CPAP while camping or on 4WD trips, also turn “heat” off for heated hose or use a nun-heated hose.
Many CPAP machines also are able to be directly powered with 12 volt adapters/cables rather than down converting from mains 240 volts. This means when camping that getting the 12 volt cable can pay for itself in longer usage times and no need for an inverter (and the converting from 12 to 240 then back to 12 this involves). Certainly a heated tube and humidifier are needed by some and these do use substantially more power and this may require more preparation to avoid issues. There are nasal drops made from refined sesame oil that can help avoid the use of a humidifier in these types of circumstances.
For some scientific references re sesame oil usage see:
A randomized, single-blinded cross-over trial of sesame oil (Nozoil) for the treatment of nasal symptoms associated with CPAP. Feenstra J et al. Sleep Disorders Centre, Dept of Respiratory and Sleep Medicine, Princess Alexandra Hospital, QLD 4102.
A randomized cross-over trial of inhaled nasal sesame oil (Nozoil) versus heated humidification versus placebo for the treatment of nasal congestion associated with CPAP. Rixon K, Tang T and Hukins C. Sleep Disorders Centre, Princess Alexandra Hospital, Woolloongabba QLD 4102.
I have complex sleep apnoea, and also had an uvulopalatopharyngoplasty done to hopefully help me breathe. As with your experience, I found absolutely no improvement but plenty of downsides - including that I was unable to yawn for several months after the surgery, and I often choke on food or drinks.
I haven’t experienced the same singing difficulties, but I actually stopped performing well before the surgery due to sleep issues.
My CPAP machine is actually VPAP (variable positive airway pressure). The model is a ResMed VPAP Adapt Pacewave, and it came with humidifier. CPAP technology was developed at the University of Sydney, and ResMed was originally formed out of that work but moved to the US in 1990.
It turns out that CPAP is really bad for me… I stop breathing, and wake up gasping for air. Unfortunately, after about three years I still can’t tolerate VPAP and so my sleep specialist said to give up on it a few months ago. I’m due to do another sleep study shortly to find out how my sleep is going - or not.
Compliance is a major issue with CPAP technology. My understanding is that about 1/3 of people who are put onto CPAP end up not using it long term. On the other hand, I have heard some good stories of people who now can’t sleep without it. I’m just one of those ‘difficult’ sleepers.
In bad news, it looks like the Australian developer of SleepyHead has had enough of the issues involved in developing software that may violate the US DMCA (and Australia’s version of it, adopted based on our ‘free trade’ agreement with the US of 2004). Hopefully others will pick up from his good work. Additionally, Apnea Boardmay be able to help you to find appropriate software for your device (the manufacturers like to control their software).
Good advice - the information out of SleepyHead is incredibly more detailed than at least the Philips that I’ve seen - actually explains a number of things that are happening that are completely obscured by the consumer side of the Philips reporting.
SleepyHead and user forums such as CPAPtalk.com and ApneaBoard.com have enabled patients to bypass medical device manufacturers who would prefer the software to be non-existent. Medical device manufacturers fought in 2015 to prevent an exemption from the Digital Millennium Copyright Act to legalize hacking by patients who wanted access to their own data, but an exemption was granted, legalizing SleepyHead and such software. Source: Vice.com, Jason Koebler
Original Vice article here:
… said exemption appears to be interpreted from the following document and not entirely clear …
… anyway, the successor/derivative of SleepyHead is here (apparently there is a lot of politics …):
MY goodness. I hadnt been to Mark’s site since I downloaded Sleepyhead and am so disappointed that he’s stopped development… But I don’t blame him one bit.
" After repeated hostile takeover attempts, undermining, betrayal, and torrents of abuse,
I have no desire to continue subjecting myself to working under those condtions.
No Free & Open Source Software developer should have to endure that. "
Well its a sad loss. I use a Mac and not one of these CPAP companies make software for my computer. I have a halfassed app on iOS called Dreammapper, but it doesnt tell me nearly enough. I’m glad I already have Sleepyhead.