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New toys

How to tell you're no longer in a "young" demographic.  With the added bonus of an observation about health care costs.

That "young" thing -

1. You have to scroll when entering your birthyear online.

2. You have as much fun getting a new CPAP as you used to when you got a new gun, or a stereo component.  Or car.

No, really.

Last Wednesday evening I got a new CPAP. Wazzat, you ask? Heh. That's how you tell which of your friends aren't young anymore. They don't ask what a CPAP is. They probably have one, or their spouse does. Only the youngsters ask.

It's a breathing machine. A Continuous Positive Airway Pressure machine, to be more precise. Helps keep you from choking to death, stroking, or having a heart attack. As a side benny, you don't snore much anymore, either.

It's for people with sleep apnea. In my case, Obstructive Sleep Apnea, caused by soft-tissue collapse in my throat when I fully relax when sleeping. The CPAP keeps the tunnel inflated, so to speak.

This would be different from Central Sleep Apnea, which is a brain malfunction where the command "inhale" doesn't get sent.  SWWBO has a former workmate who's husband died from sleep apnea - it's not something to dismiss lightly.

But it *is* hilarious to be sitting at the kitchen table with a guy who is an Ibo tribesman who immigrated here from Nigeria - and who started a home health company when he was fired by Merck.  And who was wondering if he could bring his family by to see the guinea fowl (they're orginally from Africa, and with the snow and single digit temps, wish they were back there) and wondering if we'd start raising goats for meat - as his current supplier of same is a robber baron. 

He didn't get any goats, but we did send him home with some guinea eggs for his wife, and told him he could bring his family to visit the Castle.

Okay, that was the fun part - the hilarious part was sitting around oooohing and aaaaahing over the new ResMed S8 Elite and humidifier that now sits on the nightstand by the bed.  And the newest Mirage Micro mask.

Mind you, I've been a cheap date for TRICARE and the VA.  Being diagnosed with obstructive sleep apnea is one of the reasons I retired when I did, it was go then with a regular retirement or get medically retired.  I'll save the discussion of why going out with the regular retirement was the better choice.  Oddly enough, apparently now it's no longer an automatic medical board, but this is now, that was then.

So, I get my original Sullivan V back in 1999.  That machine has given good service and traveled hard, to Europe, Asia, and all over the US, never once failing to work.  But the power cord was wearing out, and it's kinda clunky - put that in the carry-on suitcase, and you're limited in what else you can pack.

I mentioned to my Doc that the CPAP was getting kind of worn, and they weren't repairable, so what do I do to get a new one?  He said, flipping through my records, "CPAP?  You have a CPAP?"

"Um, yeah.  Had it since '99."

He consults the computer - "I don't see anything in here about a CPAP, or hoses, or masks."

"Um, no.  I buy a new mask every couple of years or so, and replace the hose when the cats have put more holes in it than I can repair and still have it hold the correct pressure."

"But, I don't see where you've brought it in to be tested and calibrated, either."

"Er, no.  I take it to the place downtown once a year and have them pressure test it."

"But how do they know what pressure to test for?"

"I tell 'em.  11cm of H20, which is what the sleep study found was the best pressure."

flip, flip, flip.

flip, flip, flip.

"Here it is - wow, that's a long time ago.  Yep, 11cm.  Huh. You know, Major Donovan, you're supposed to get a new mask and hose every six months or so?  And a new machine every 4-5 years?"

"Um, no, I didn't.  I just wash the mask, replace the replaceable bits, and buy new hoses when I need 'em.  They aren't cheap, but I figured that was just on me.  But the machines can only be had by prescription, which is why I'm bringing it up. My current one is going to fail at some point in the near future, and is arguably electrically unsafe now."

"Heh.  John, you should have been just getting this stuff delivered.  TRICARE covers it, and whatever they didn't cover, VA would have."

Heh. 

Well, like I said, I'm a cheap date.  And now I have my kewl new toys.  And I have to recognize there's no deluding myself about my age anymore, either, when home medical equipment seems cool.

And I'm still thinking I'll just clean the mask and only get a new hose or mask when they need replacing, not just auto-order them every six months.  Stuff ain't cheap. A mask costs $150.  A hose costs $40.  I know.  I've been paying for 'em for years, but now I can get 'em for free (like hell, they come out of the Federal budget) every six months.  Which - doesn't seem right to me, when I can keep 'em serviceable.  For years.  And if the hose needs replacing, well, that's usually because of my cats.  Seems like that ought to be on me, too.

Hmmmmmm.  I sense a disturbance in the force.  And a lesson about single-payer health care, too.

SWWBO doesn't like the new machine, btw.  It's too quiet.  The old one (still being kept on as a reserve - and now that I have a replacement, I'll see if I can't fix that power cord, too) made a sussuration that sounded a lot like waves hitting the beach.

And she could tell I was still breathing. 

The new one is so quiet she's been waking up at night to make sure I'm not rapidly assuming room temperature.

After all, if I were to do that, she'd have to get an electric blanket.  And TRICARE doesn't cover that.

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I’ve grumbled before about how the nation’s demographers have decided that I am old (which I already knew), and now there are two new ways to verify the fact: 1. You have to scroll when entering your birthyear online. 2. You have as much f... Read More

28 Comments

It's true, we were all excited about the new CPAP!  Wow!  It's so small!  And John seems to be sleeping better!

But I wish it made that noise the old one made.
 
heh.  Didja know you can get animal masks from a pediatric supply?  That'd give your better half something to look at when you're sleeping.  I understand they come in bear faces and elephants.
 
oh baby, i'm gonna have to take one of those quiet ones out for a test snooze!
 
Your new CPAP mask is cute. So, how did they get you to model for the patient brochure listed at the Mirage Micro web page? And, how did they arrange to get SWWBO to allow your picture to be taken in bed with some other woman?

It is amazing what we can get used to. I got my first bite splint back in the 70's to limit the damage caused by my teeth grinding (bruxism), now I can't sleep without it. By the way, I'm only on my second or third splint in all those years.

Although they typically show bulky people with CPAP equipment, that isn't always the case. I have a friend who is our height, but half our weight, that recently went through the soft palate surgery to help reduce the potential for the airway collapsing. The jury is still out on whether the surgery was effective.
 
Thomas - that looks a lot more like Jay Leno's cousin than it does me.

I have shorter hair, and more of it on my chin.
 
Sounds like Beth might need one of those white noise generators they sell to make some gentle staticky noise at night.
 
John, I just went through the exact same process. I had not been to the VA since I retired in '98. My old Sully V was just as you describe, never been recalibrated, my nasal pillows were falling apart and duct taped was holding the harness together. Now I've been issued a REMstar Pro. The thing is tiny compared to the Sullivan. The new CPAP is sure quiet. Debi has the same problem with it, it is too quiet. No more white noise. I even find myself waking to noises around the house that never bothered me before. My biggest problem with the whole VA process in Alaska...for one round trip to the VA clinic in Anchorage the cost is about 650-700 dollars to the American taxpayer. Air fare and hotel prices, don't ya know. Because of time constraints on one trip, I flew First Class on Alaska Air. If there is one trip to fly first on, flight 65 is the one. Three stops to get to Anchorage, ugh. Hunter Ketchikan
 
Sarah, look closely at any pic of me.  SWWBO already has a bear mask to look at...
 
But I wish it made that noise the old one made.

That was *John*.

Give him some time to get comfy with the new one and the noise will be back. Right now, he just doesn't want to spook it...
 

LOL!  One of my girls does nothing but call recalcitrant patients like you!

Medicare will cover a new mask every three months, new headgear, tubing, and filters every six months.  Blue Cross is similar.  The technology is constantly changing and once people get used to the idea of being compliant, they like trying new masks.

Resmed is a great company and they really stand behind their products, we use them a lot.

I could have told you that you didn't have central sleep apnea.....those people are always a little "off", lol.

Proper use of a CPAP will add years to your life and improve the quality of those years. 

LOL, this is not a discussion I expected to have here.

 
Oddly enough, despite being young and in (more or less) perfect health, I actually do know what a CPAP is...because our local Fox News Radio station (AM610 WIOD) is CONSTANTLY running ads for CPAP PRO.  I sure as hell wouldn't want to have to sleep with one of those things, but they do LOOK cool.  Any sort of complicated mechanical equipment gets me excited...especially if it makes you look like some kind of cyborg.  Yes, I am a nerd at heart.

Now that you guys are both replacing your masks on a regular basis, maybe you should look into that CPAP PRO thing?  I know the website by heart (nomask.com) seeing as I've heard that damn ad about 40,000 times...they're always claiming it's the greatest thing ever for sleep apnea patients...
 
I had to migrate to XPAP. I have neurological oriented apnea more so that airway issues. So, at most times, the air flow required is quit low, but when the brain just forgets to breath for awhile, the pressure needs to be highest possible.

With straight CPAP, the pressure setting has to be so high that I wake up with stabbing pains in my inner ear from pressure inflation, and so bloated with swallowed air that sitting up in bed can risk gut damage.

Cant use BiPAP because I can't never get the dang machine to match my breathing rhythm so I'd wake up all the time feeling like I was suffocating.

Another something something to look into is self monitoring. Some CPAP, BiPAP and XPAP machines come with a smart card that records breathing, pressure, apnea events and so on. There's computer software that will take that data and chart it. Helps the doc fine tune your treatment needs.

Been off treatment for a year now. My old ResMed machine quit and I haven't gotten round to getting re set up. It's nice not having to wrestle with the hose and such while sleeping, but I do wake up grumpy and often as tired as when I went to sleep.
 

Grimmy - your last statement answers your question.

Me, I don't mind the mask and hose.  I haven't from day one.  Sleeping was so much better than what I was doing before I got the machine that the mask and hose simply aren't an issue.  I've never used the "ramp-up" feature for pressure either.  Full pressure from go.  The new machine does have the smart card, but the Doc didn't prescribe using it.  For some reason, he takes me at my word that I've been using the machine like I'm supposed to for 10 years, and that since I've no complaints about sleeping or breathing, another sleep study isn't needed, nor is a compliance check.

Maggie - I'm still not going to swap masks just to swap masks, or hoses, etc simply because there's a schedule.  I'm getting the therapeutic benefit intended, I'll get a new mask when I need one, not just because I can.  Same thing is true for the hose.  If it's not holed, and still seals at both ends, why get a new one?

Filters?  I'll change those according to the recommended specs unless experience or periodic checks indicate it needs to be done sooner - with the cats, well, they're hairy critters, sooner is always a possibility.  Or if it's been windy, which around here, especially with winds from the west, also tends to mean dusty.

But the way I'll handle that is to order 'em in a bunch of 5 or so, on my own dime, the paperwork is a PITA, and toss 'em in the drawer so they're there when I need 'em.

And I'll get *crabby* if someone keeps calling me to tell me that I due a new mask.  Well, that's not entirely fair - call once, take no for an answer.  Call again the next cycle.

But don't be like the fundraising arm of the political parties and call and call and call and call and call and call and call and call and call.  Because eventually I won't be nice at my end.

 
Josh - looked up the CPAP Pro.  No thanks.  I'll stick to the mask.  Sticking that thing into my mouth in order to hold those nozziles in my nostrils does *not* look like an improvment on my mask, no matter that it would reduce the "Alfalfa-look" my hair has in the morning.
 

<looking at fingers that betrayed him>

Gad, I actually typed "nozziles" and didn't notice it.  Shoulda waited until after that first cuppa joe.

 
Nozzle + narghile = nozzile.

See? Easy fix.
 
Heh.  Congrats, Bill.  I don't often have to look words up.

It fits, in a perverse way, too.
 
If you have any tips on cleaning the water reservoir please let me know.  That is the only thing I don't like about my ResMed CPAP. 
 
It fits, in a perverse way, too.

Well, geez, what else'd you expect from *me*?
 
The frequency of replacement is recommended for several reasons.  One of the biggest is hygeine.  What's the point of helping you with your pressures if something funky is building up in your mask?  Also, most people are not careful enough with their stuff.  Even when you are careful the components wear down.  If you don't get a good seal, you don't get optimum results. 

A replacement accessory schedule aims for the most people to have efficient use of their PAP.  It also helps people try new equipment.  There are so many different styles out there that it can take several trials to find the right one.  Plus peoples needs can change. 

You were obviously more careful than most, but even so, you should be replacing masks twice a year like your doctor told you.  My point was that even insurance companies recogognize the need for frequent change. 

I also said Nic made lots of calls, I didn't say that they were to the same people over and over.  My point was that lots of people need reminding.  Most people are grateful for the call.

You are crabby.
 
 One of my daughters uses a CPAP. Huge difference for her; sleeps well, and the night terrors have completely gone away.

Our son-in-law occasionally was startled to see a small elephant sleeping next to him in the early morning.

The cats and dogs took a while to adjust, too, but they're OK now.
 
I think you should listen to Maggie, the doctor and the callers.  You're acting in blind knowledge too much here.  Is it fair to assume you're stuborn enough to make the mule back off?
 
It looks like John doesn't want to waste stuff, even if he isn't paying for it. That olden view of conservation and what not.
 
Hmmm.  

I keep my mask clean.  My hose, too.

If I notice a seal problem, I replace the rubber portion that provides the seal.  Same thing is true of the hose.  I replace the straps if needed, too.

If my mask seals, and I'm comfortable, good golly, why do I have to keep trying new $150 masks twice a year just because?

It strikes me, a solution resides in the data card.  Make changes when the data indicates a change might be needed.

But yes, I get a little perturbed when we just assume what amounts to a $400 a year, per person swap of kit is needed because people don't clean their masks.   Or there *might* be a more comfortable option. 

If the thing is working, and I'm getting what I need out of it - why should everybody in the insurance pool just automatically pony up $400 a year, just because?

Especially with data cards, it doesn't make sense to me.  Heck, put a USB port in the CPAP and I'll save on the postage, too.

I guess I just object to what I see as a huge cost just because some people are too lazy or stupid to do a little maintenance.

When they do that with their car, they pay the price.  Here, we're all paying the price.
   

Woot!  I win! I won!  I'll pay, horribly, sometime down the pike...

 
"Grimmy - your last statement answers your question."

It only took two trips to the emergency room with blood coming out my ears from over pressure to sour me on the PAP thing.

The doc wanted to do a throat hole thing so I could hook up and bypass the ear issue, but I'm just not needing the therapy of the PAP that bad, yet.
 
John, you are one of a rare breed.  If only we could have an entire country full of people like you, we could probably get something USEFUL accomplished once in a while...

Grimmy, what exactly is XPAP anyway?  I looked up BiPAP but I didn't see anything about XPAP.