Which CPAP machine to select with AHI >53

Hello everyone,

I'm new to this forum and this is my first post and hope to get some help. I recently took the polysomnogram (sleep study) test and the results are startling! I'm diagnosed with very severe obstructive sleep apnea. The AHI recorded was >53. I had 291 events of sleep apnea. I'm very worried and the doctor has advised 2 options:
1. Use CPAP machine or
2. Surgery to remove excess tissue blocking the airway passage.

Doctor has advised initially to try the CPAP as it known to be very effective. I looked up on https://www.cpap.com for different types of machines. Based on different models I was thinking of buying either of the following machines:
1. ResMed - AirSense™ 10 AutoSet CPAP Machine with HumidAir™ Heated Humidifier
2. Philips Respironics - PR System One REMstar Auto CPAP Machine with A-Flex + Humidifier
3. S9 AutoSet™ CPAP Machine + H5i heated humidifier

Mask types
1. Philips Respironics - ComfortGel Blue Nasal CPAP Mask with Headgear
2. ResMed - Swift™ FX Nasal Pillow CPAP Mask with Headgear

I'm 35 years old from Hong Kong and have a BMI of 25.5 just incase the info is required.

Also may be its a silly question, if I'm using the humidifier in the room which already humidifies the air, do we still need the humidifier for the CPAP? Its kind of curious question..

Need your expert advice please on which machine to select considering I will be using for the first time.

Many thanks

Welcome. Are you currently living in the U.S.?

First consideration about machines is what machine (or insurance code) is written on your prescription?
Second: What pressure or pressure range is on the prescription?

Severity (AHI) is not what determines the machine or the pressure you need. It's about how much pressure is required to hold your airway open. You can have severe apnea but need fairly low pressure to keep your airway from collapsing, and likewise you could have a mild case of apnea (low AHI) but need pretty high pressure to keep your airway open. Did your overnight sleep study include a portion of the night spent sleeping with a machine?

Definitely, definitely go with CPAP before ever entertaining the idea of surgery. For a lot of reasons, which a lot of people will have a lot to say about.

Nidravastha wrote:Hello everyone,

I'm new to this forum and this is my first post and hope to get some help. I recently took the polysomnogram (sleep study) test and the results are startling! I'm diagnosed with very severe obstructive sleep apnea. The AHI recorded was >53. I had 291 events of sleep apnea. I'm very worried and the doctor has advised 2 options:
1. Use CPAP machine or
2. Surgery to remove excess tissue blocking the airway passage.

Doctor has advised initially to try the CPAP as it known to be very effective. I looked up on https://www.cpap.com for different types of machines. Based on different models I was thinking of buying either of the following machines:
1. ResMed - AirSense™ 10 AutoSet CPAP Machine with HumidAir™ Heated Humidifier
2. Philips Respironics - PR System One REMstar Auto CPAP Machine with A-Flex + Humidifier
3. S9 AutoSet™ CPAP Machine + H5i heated humidifier

Mask types
1. Philips Respironics - ComfortGel Blue Nasal CPAP Mask with Headgear
2. ResMed - Swift™ FX Nasal Pillow CPAP Mask with Headgear

I'm 35 years old from Hong Kong and have a BMI of 25.5 just incase the info is required.

Also may be its a silly question, if I'm using the humidifier in the room which already humidifies the air, do we still need the humidifier for the CPAP? Its kind of curious question..

Need your expert advice please on which machine to select considering I will be using for the first time.

Many thanks

Welcome to the board.

Unless you have some special problem DO NOT GET THE SURGERY!!! Try the CPAP first. Surgery can have life long side effects and has a poor success rate. Google the UPPP procedure to to get horror stories.

If you can't make CPAP work, you can always do the surgery later.

The A10 AutoSet, S9 AutoSet, or PRS1 Auto are all excellent machines.

Mask choice is somewhat trial and error. I have used both of those masks, and they were both fine. I LOVE my Swift FX, but it irritated my nose for a while until the tissue toughened up on my nose. I could wear it 24 hours a day now, and it feels like part of me.

Don't worry too much. Your apnea is bad, but you've probably had it for years, so taking a little while to get the right machine probably won't hurt. Some people have problems with CPAP, but with some help and effort, you can probably make it work for you.

Check the links in my signature line for some more general advice for CPAP newbies.

Get the humidifier unless you are really short on cash. Many people need it at least part of the year, even with a room humidifier. You can always turn it down, turn it off, or remove it if you don't need it.

Hi Thanks archangle and kaiasgram for the prompt response.

I'm based out of Hong Kong. Actually, its kind of strange my doctor hasn't advised the pressure setting because the way it works probably in Hong Kong is..I was referred to the CPAP machine agent and in this Philips Respironics who will lend me the PR System One Remstar Auto CPAP machine with A-flex trial for 2-3 weeks for US$ 250!!! They will set up a telemonitoring device at home which will monitor my sleep record. After 2 weeks the report will be given to the doctor for analysis. So the doctor advised me to meet the agent first and take the trial. He never mentioned the pressure setting and all. Anyways I just called the nurse and asked her to arrange for a prescription letter.

Will post again when I receive more details from the prescription letter.

Yes even I agree not to go for invasive methods at this stage.

Many thanks again....

What you're describing is actually not strange at all. Your doctor can't tell you your needed pressure settings yet because he or she does not know yet -- you haven't done the titration part. Titration is the process of determining what pressure or pressures you need to keep your airway open. Sometimes titration is done in the lab or hospital during the sleep study. Another way, and the way they're having you do titration, is to send you home with an auto-adjusting CPAP or APAP machine. The machine is initially set to allow the pressure to go as low and as high as it needs to go while you sleep, and this information is transmitted by that wireless device to your doctor. After the 2-3 week period they have collected enough data from the machine (hopefully!) to determine the correct pressure setting(s) and write the prescription for your machine and your pressure setting(s).

At-home titration is becoming more common in the U.S. too.

Oh I see!

In this case then I might have to take the titration study which costs US$ 250 for 2-3 weeks. The cost of buying the machine with the humidifier in hong kong is approx US$ 2700 for APAP excluding the mask and headgear!!!!! The cost of buying the machine in US is 1/5th the cost here in hong kong. Unfortunately insurance does not cover the cost of the machine here so everything is from my pocket.

From what you suggest i cannot skip the titration and have to do it before I buy the machine! So maybe I will do the titration but decide to buy the machine later from U.S.

Many thanks again kaiasgram.

Nidravastha wrote:Oh I see!

In this case then I might have to take the titration study which costs US$ 250 for 2-3 weeks. The cost of buying the machine with the humidifier in hong kong is approx US$ 2700 for APAP excluding the mask and headgear!!!!! The cost of buying the machine in US is 1/5th the cost here in hong kong. Unfortunately insurance does not cover the cost of the machine here so everything is from my pocket.

From what you suggest i cannot skip the titration and have to do it before I buy the machine! So maybe I will do the titration but decide to buy the machine later from U.S.

Many thanks again kaiasgram.

Not sure how it works there, but can you buy a machine before the titration? In other words, can you just buy an auto machine and then have the doctor review your data? It seems odd to rent an auto machine for 3 weeks if you have to buy your own machine out of pocket anyway. You might as well buy an auto machine and simply own it. Then do the titration and tighten the pressure range from there.

Some doctors here will simply prescribe the machine, and then adjust the pressure after they see data. Maybe you can talk to your doctor about doing that. I don't know if that would be allowed there.

About those prices -- YIKES!

zoocrew's idea is a good one.

Also, some people buy the APAP machine and basically do self-titration by using free software like SleepyHead to see what the pressure is doing and gradually narrow the pressure range to what works best to control their apnea events.

In either case you'd need a prescription from your doctor to make the purchase. The doc would simply write the prescription for an APAP machine with minimum pressure 4 and maximum pressure 20 (these would be the same settings as if you were using their rental machine for titration).

Do you have a copy of your sleep study report? It's important to have a copy.

Thank you Zoocrew and Kaiasgram for the very helpful advice. I'm really impressed with the promptness of the replies from members. Great job.

Yes Zoocrew's advice is good. I have emailed a copy of the prescription letter to the hospital to get it signed by the doc. Awaiting reply. I might go with outright purchase and do self-titration as advised by Kaiasgram.

Kaiasgram - Yes i have a copy of the sleep study report with me.

I liked the ResMed - AirSense™ 10 AutoSet CPAP Machine with HumidAir™ Heated Humidifier. Looks like the latest machine from ResMed.

Cheers

Online cpap sellers in the United States (like cpap.com) are going to be banned from shipping Resmed or Respironics products outside the United States.
So if you are wanting the AirSense A10 AutoSet from cpap.com (the host of this forum) you are going to run into a bit of a road block.
It's not that cpap.com doesn't want to ship it to you but ResMed and Respironics enforces a shipping ban.
There are ways around it though.. Either ship to someone you know in the US and have them forward it to you or use one of those places where mail gets forwarded and that includes packages. For a fee these places will receive and forward to you. I don't know the names of these places but other forum members will.

Now secondwindcpap.com is a secondary market source and doesn't have special contracts with ResMed or Respironics and they can ship outside the US and do it all the time. The only drawback with them is they won't have any of the new AirSense machines just yet...they are too new and just been released Aug 18 of this year. So they haven't had a chance to get any of those machines just yet...though you might email them and see what the status for obtaining the new AirSense machines might be.

Stick with the APAP models because they will offer 2 modes of operation....both cpap mode and apap (auto adjusting pressure) mode.

In the Respironics line...target this model...PR System One 60 series Auto CPAP with AFlex (actually all the apaps have AFlex) mode number 560. It has the heated hose option with the humidifier. While you might not need it now...you might need it later so better to have it available and not need it than to need it and not have it.
And yes...get the humidifier...while there are a few people who don't need it most people will need at least a little extra moisture in the air because it can really dry out the nasal mucosa.

In the ResMed line...The ClimateLine hose is their heated hose and all the S9 and AirSense models are able to use the Climateline hose and a regular hose.
The S9 Autoset or it's newer AirSense A10 AutoSet is what I would suggest.
If the new Airsense is what you want...then get it. It's going to be a great machine but you can find some deals on the S9 version of it if you look around.

It's not hard to come up with optimal pressures by self titrating with an APAP machine as long as you have plain jane vanilla ordinary OSA. Should you happen to be one of the small percent of people who develop problems with cpap therapy and need a different machine then things become a bit more difficult but not impossible to do on your own.

Hi Nidravastha,

I'm not necessarily advising you to do the titration part yourself, just saying that some people do it that way. If your sleep study showed plain old obstructive sleep apnea (with no other oddities or complications) it could work fine. That's why I asked if you have a copy of your sleep study report. (It's great that you do!) If you'll post a copy of the report (white out your personal i.d. info first) the good folks here can take a look at it for you and give you feedback that might help you decide what to do next. If you are considering doing the titration yourself I do advise that you post a copy of that report first.

All of the machines you listed are fine.
I would probably choose the AirSense 10 Autoset for Her, which has one additional mode, which may or may not be useful to you. But it is the same price so why not get all the options, in case you need them.
I am currently using the Wisp nasal mask. I have a collection of about a dozen different masks. I like the Wisp best this week. I find things change from time to time. Colds and allergies that cause nasal congestion can require a full face mask, when you cannot breathe through your nose.

Unless cash is in abundance I would apply the $250 rental fee towards the purchase, and self titrate. You can get great guidance here. I did when I first started and continue to when I have new concerns.

You will have to use a shipping company address in order to get your machines, like this one (there are others). Many of my friends in Europe do that and it works fine.

The Sleepyhead software doesn't have the code yet to handle the A10.

If you decide to order a Philips-machine 60-series, do not forget to order the larger power adapter with 80 W! You will need this if you ever want to use the heated hose. It seems to be difficult to get this outside the USA.

Fat Rat

fat rat wrote:If you decide to order a Philips-machine 60-series, do not forget to order the larger power adapter with 80 W! You will need this if you ever want to use the heated hose. It seems to be difficult to get this outside the USA.

Fat Rat

What you need to do is order the correct humidifier with your CPAP machine. There are two models of PRS1 60 series humidifiers. One will support the heated hose, one won't. Cpap.com sells an upgrade kit that includes all the parts to change a 60 series humidifier from unheated hose to heated hose capable. It costs $75 and includes a new lid, water tank, heated hose, and power supply. If you order the optional heated tube version of the humidifier when you buy the CPAP machine, it comes with the correct power supply. If you order the heated tube humidifier by itself, it comes with the correct power supply.

Given the fairly modest cost of the upgrade, it's not too big of a deal, in my opinion. Especially since the hose costs $50 or so by itself.