Replacing 420E - What is as good?

[emery]

I am coming up on my 10 year anniversary on a machine. My first night was 9/11 (yep, that one) and it was a Goodnight 418P (I first did my homework in the forums). It died due to lightning, about 4 years later and was replaced by a 420E (again, thanks to the forums). Although the replacement was having problems from the get-go (blame the DME for a used machine), that was eventually replaced with a new 420E and it has been gold ever since.

Time now for another replacement but PB no longer makes any APAP machines so....... What is the next best thing?

Some Constraints that limit my choices:
Yes, I have tried CFlex type alternates but I switch hoses (6' to 10' - depending on where I am sleeping) and C-Flex can't adjust correctly.

I also seem to need more than the available differences in pressures that a flex machine offers on the lower end of the range.

We are Full-Time RVers so we may be at the beach or high in the Rocky Mountains and accurate altitude compensation is really important. Also, with a number of "environmental" sensitivities, like to pollen, pollution, foods, meds,etc. my pressure needs can vary from hour to hour during some nights.

The machine needs to be able to run directly off of 12 volts DC when we are off the grid.

Although my "native" pressure is defined as 14, the variances of true need range from around 7 or 8 up to 16 on rare occasions. Too much pressure when my needs are low, just fill my stomach with air (not pleasant for anyone).

I depend on being able to pull my sleep history, track the changes and adjust to my quirks at the present time to get the therapy that works best so I need access to the software to collect the data, analyze it and modify the settings as needed.

Finally, I have switched masks from time to time and the external sensor line of the Goodnight machines has kept me at the right mask pressures no matter what interface I have been using or the altitude. I know that differences in tubing length and routing (looped, kinked,etc.), inline humidifier ... or not and even room temperature can cause inaccurate mask pressures with many machines. I don't mind dealing with the funky little tube if it is delivering dependable rest to me night to night. But, it does not seem that any of the currently available machines sample pressures at the mask, anymore, so what does work as well these days?

A final constraint is that my machine has to sit in a narrow area below mattress level as the head of the RV bed is built into the wall. This makes filling the humidifier impossible on some machines where it has to be removed from the rear or the machine sits on top of the humidifier and has to be moved to refill it. The 420E humidifier is removable from the front without disturbing the APAP, cords or location. Something as easily refillable would certainly be nice but the real need is to meet the other criteria.

Suggestions, comments (besides about my personality disorders) questions? The DMEs are usually stumped when I even use the word "constraints".
Thanks
Emery

[ozij]

Hi Emery,
I swtiched from a 420E to a Resmed S9 Autoset, aftere trying both DeVilbiss and Respironics.
The S9 humidifier can be pulled out from the side. Unlike the 420E, there's a lid you have to raise to take out the tank -- and I take it out daily. Keep in mind also that all new machine have the hose coming out of the back -- same side as the cable.

I don't know of new machines with a sensor tube. The machines I tried before buying the S9 did not respond well to my breathing pattern. Software for the ResMed machines is free -- downloadable from Resmed's site. It gives you great wave form data. Two drawbacks compared to Silverlining: 1) No statistics per session. 2) No export of csv files. I believe Silverlining was one of a kind in having those options.

The S9 is incredibly quiet.

[GumbyCT]

Two drawbacks compared to Silverlining: 1) No statistics per session. 2) No export of csv files. I believe Silverlining was one of a kind in having those options.

While I am not familiar with either the 420 or S9 and you seem pretty satisfied with the 420 maybe someone here has one they are not using or you can find a gently used one at secondwind or cpapauction? Even Craigslist may have something?

[Slinky]

The Resmed S8s and S8 IIs have the humidifier coming off the front of the CPAP.

The PR (Respironics) SystemOnes have the humidifier off the right side (facing you) but lengthwise would open from the side. The one nice thing tho is that the hose attaches to a swivel on the top of the humidifier. The PR S1s would need at least a 7" wide opening and would then be 11 inches long w/the humidifier attached.

The Resmed S9s still are the forerunner in easy access to the most data via the LCD screen and the software as stated is available at no charge. Like the PR S1s when positioned lengthwise which would be the narrowest way for them to sit, the humidifier is on the side and opens from the front which would be the side as you would need to position them. The hose attaches to the back which most likely wouldn't work for you in the narrow confines you describe.

I can't speak for the DeVilbiss IntelliPAP AutoAdjust or the Fisher & Paykel ICON Primo. The F&P software is not available to the best of my knowledge nor is the DeVilbiss software - BUT - the DeVilbiss allows downloading to an online site that you can printout or save in a pdf file as I understand it.

[emery]

This is all good information. I have considered getting a gently used 420E so thanks for the suggestion. I have also found a few DME that still have them in stock. I was hoping that the technology had moved forward, though, not backwards but I am an optimist.

I have yet to find anything particularly useful about the on machine displays, mostly because I am really interested in trends and not averages and it is rare that I can actually see the display screen without compound glasses.

Next to the actual effectiveness for me, the reports are the most important. Making fixed decisions based on one night's results is as unhelpful as getting a glucose reading at the doctor's office and then getting an Rx for a med based on it. The results from many nights of monitoring are what is necessary to make any sort of specific treatment directive. Anything else could be as much underdosing as overdosing or misdosing the condition altogether with the wrong med.

So far, it is looking like my only hope is going to be to find another GN 420E for the next 5 years and treat it gently.

One issue that I figured out on mine was with moisture getting into the sensor tube from the mask when it got a lot of rain out in it. That would really hose the sensing and subsequent adjustments the machine would try to make. I inserted a small (about 4 cup) canister in line with the sensor tube and just before it goes into the 420E. The gave the droplets of water somewhere to accumulate and not be passed back into the 420E. Simple fix and no more of those odd changes it would make when it got wet or burbled in the tubing.

Thanks for all your input so far. This is really helpful.

[moresleep]

If it's reports that interest you, you should consider a machine that gives breath-by-breath flow waveform data, like the Remstar System One Auto. Nice as the 420e is with Silverlining 3, it doesn't give that.

[emery]

Update time: 2/2013

I was never able to find a solution to my quest. Back in 2011 finding a replacement was elective for me. I had a few problems with the 420E but I was able to work around most of them and no other machines at the time seemed to be a complete solution. The whole shtick of the red tape and hateful medicare/insurance/state regulations/arrogant sleep doctors/DME suppliers was more than I could work through to get anything but their default machines.

But now, after my Goodnight 420E drowned last fall from an upside down fall to the floor while running I can no longer avoid this looming nightmare. I have been surviving with my original 2001 Goodnight 418P machine since the accident and while it is better than nothing, it was retired to backup status 7 years ago due to its age.

At present, It appears that the only APAP machine that will meet my needs is the DeVilbiss IntelliPAP Autoadjust SmartFlex machine with SmartLink. It is the only one that appears to give me the main thing I need to theoretically get the right rest. Second to that, its software support seems to be adequate for what I need to track and the adjustments I may need to make.

I have been perusing these forums and it appears that most of the folks that have this setup prefer it over whatever they previously had been using. The difficulty is acquiring one through the necessary channels when it is not the standard machine that the DMEs want to provide. When I got my 418P in 2001 I just got my doctor to write a script for exactly what equipment I needed and sent it to a mail order CPAP supplier. This was premedicare days for me so they just sent me the machine and software and I was off and running.

Now, the equipment MUST come through the hands of a local DME and RT (in NC, at least). However I am now in St Augustine, FL and will be for a long time. I don't know if Florida has the same requirement of involving a local hands-on DME rep.

Does anyone know if I can just get one shipped directly to me in Florida (via a mailorder DME) with a properly worded script?

Any comments, suggestions or insights would be really helpful at this point.
Thanks

[Therapist]

Sorry, I don't understand why you don't just order a ResMed AutoSet S9. You can download the software free.

My doctor prescribes this for all patients unless you need something special like BiPAP or ASV.

[Pugsy]

I assume you are wanting an online DME so you can use Medicare? So you would need an online source that is a participating provider and will bill Medicare and let you pay your 20% (or your supplement pays). Is this what you are asking?
If so there are some who will file Medicare...now whether they have the machine you are wanting is a different story.
Liberty Medical comes to mind but there are others.

If you don't have a supplement to pick up the 20% copay for Medicare you might want to do the math.
It might be almost a wash to just buy it from cpap.com. Medicare won't care...they just won't pay you back.

Medicare typically pays for the blower over 13 months...a rent to own thing.
The humidifier is typically an outright purchase the first month.
I have a link somewhere that shows what Medicare allowed for last year. Don't have a new fee schedule yet for cpap stuff. It likely won't change all that much. By the time all the months are added up for the rent to own thing the total amount isn't all that much less than what cpap.com charges for the Devilbiss machine you are leaning towards. If you want that link let me know and I will try to find it

[RandyJ]

I agree with Pugsy that you might be better off out of pocket. Also consider that you might not be able to get the machine you want through Medicare.

This member is trying to sell his Intelllipap with 663 hours on it: viewtopic/t86236/For-Sale-IntelliPAP-Au ... lbiss.html

Or new from cpap.com is a good deal.

[hyperlexis]

Well everyone seems to be pushing a particular model just cause it has free software. Well whoopeedeedo. If you dont obsess over daily numbers or waveforms, that may not mean so much to you.

You said you use an RV and said your must-have need is actually DC power. I think that the DeVilbiss line of machines can do DC without adapters. They are great machines, US-made, and have therapy data aside from waveforms. They do lack heated tubes, however your old machine doesn't either. They may not fit well in your RV's cubby hole area, however.

I don't think you should go nuts over 'remote sensing tubes'. No modern machines as far as I know do that. It's most likely been completely obsoleted by new technology. And current models can cope with different hose lengths automatically so don't sweat that issue either.

It's a shame Puritan Bennett ditched the CPAP market like it did (stupid) but what are you going to do? Live in the past, recycling old, used machines, forever or enter the modern era of xPAP machines. Try a shiny, clean, new one -- you will probably be pleasantly surprised with it's performance and noise levels. Even without sensing tubes and whatnot.

And FYI the current 'cadillac' machines for APAP are the Respironics PR 560 and the Resmed S9 autoset (neither directly accept DC). Followed close behind by the DeVilbiss (that does take DC).

Good luck!

[Therapist]

Well everyone seems to be pushing a particular model just cause it has free software. Well whoopeedeedo. If you dont obsess over daily numbers or waveforms, that may not mean so much to you.

Read ------>

We are Full-Time RVers so we may be at the beach or high in the Rocky Mountains. I depend on being able to pull my sleep history, track the changes and adjust to my quirks at the present time to get the therapy that works best so I need access to the software to collect the data, analyze it and modify the settings as needed.

[hyperlexis]

Well everyone seems to be pushing a particular model just cause it has free software. Well whoopeedeedo. If you dont obsess over daily numbers or waveforms, that may not mean so much to you.

Read ------>

We are Full-Time RVers so we may be at the beach or high in the Rocky Mountains. I depend on being able to pull my sleep history, track the changes and adjust to my quirks at the present time to get the therapy that works best so I need access to the software to collect the data, analyze it and modify the settings as needed.

OMG yes sorry about that omission. Well then any of the top machines should be able to do it.

Regardless, if you want data certain models of the new ones allow for patient viewing of the info -- on the screen or via download from a SIM chip. But if you want data + direct DC power, then your choices are more limited.