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AutoPAP vs. Auto-VPAP
#1
Hello,

After many years of snoring and daytime spontaneous narcoleptic episodes, my father has finally been diagnosed with apnea with a AHI of 60. He is about to go see his doctor to hopefully get his prescription for a PAP machine.

I have been reading up on apnea and the types of PAP machines available (CPAP, APAP, VPAP/BPAP). From my readings, I've summarized that a APAP supersedes a CPAP in that if you set Low and High pressures to be the same, you can convert a APAP into a CPAP. That is, besides cost, there is no real reason to get a CPAP.

My question is - can the same be said for a Auto-Bilevel-PAP? Does it supersede the APAP and the CPAP in that if you set IPAP and EPAP the same while maintaining a Low/High Pressure setting, you have a APAP, and if you set Low/High to be the same, then your Auto-BPAP will perform like a CPAP?

My hope is that my father can purchase one machine that will:
A) Provide him the best therapy
B) Most comfort (increase compliance)

If he can get one prescribed, is the Auto-BPAP the machine of choice given that it can be converted into either of the other machines if the features are not currently needed?

Thanks
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#2
Some of this info is US specific.

Bilevel machines are a different machine in terms of insurance coding. They may be a lot harder to get prescribed and approved by insurance. In particular, you may have to "fail" CPAP to get a bilevel.

CPAP and APAP use the same billing code, so for many people, the out of pocket cost is the same with insurance. The "prescription code" (?) is the same, so an APAP can be dispensed if you have a CPAP prescription. A bilevel requires a bilevel prescription.

They also tend to cost quite a bit more in terms of out of pocket cost.

My impression is that the auto bilevel doesn't work quite the same as APAP no matter how you set them. I can't remember the exact difference at the moment. I'm not saying either one is better, just that you can't set the bilevel to to exactly the same thing the APAP does.

Don't assume bilevel is more comfortable than CPAP. Many people have no discomfort with the pressure after they get used to it.
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#3
(07-30-2012, 11:26 AM)tempus Wrote: Hello,

After many years of snoring and daytime spontaneous narcoleptic episodes, my father has finally been diagnosed with apnea with a AHI of 60. He is about to go see his doctor to hopefully get his prescription for a PAP machine.
Hello and welcome - Does your dad had his titration study yet? During the titration can be determined his pressure and the type of machine is best to treat his apnea.

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#4
Hi tempus, I don't know the answer to your question but I would like to take this opportunity to WELCOME! you to the forum.! Just hang tight and someone that knows more about this than I do, will be along to answer your questions shortly. Best of luck to you.
trish6hundred
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#5
Thanks for the prompt replies.

Archangle - My father is located in Hong Kong. I'm not sure if he has insurance coverage (been trying to get him to find out) but my main hope is just that he gets one machine as oppose to getting one, finding it's not good, buying another one etc. I was thinking that if the AutoBPAP covers all the other functions, then just get it (despite the added costs) and it can be used as any of the types of PAP. However, if as you say AutoBPAPs are different regardless of settings, and might not be appropriate for his problem, then I guess it will probably be a APAP...

Zonk - My father did do his titration study, I've been trying to get him to scan and send me the info so I can look at it in greater detail. I've only obtained the AHI=60 so far. Will try to get him to scan and send again...
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#6
Tempus,

Welcome! Please refer to the Wiki associated with this forum, but short answer below. Some of these terms are proprietary to specific machine vendors, don't let that confuse you.

CPAP - Continuous Positive Airway Pressure. The machine provides a fixed pressure, usually 4 - 20 cmH2O. It may have a means of decreasing the pressure on exhalation, called different things by different manufacturers (EPR Exhalation Pressure Relief, A-Flex, B-Flex, C-Flex, etc.). In general, this feature only decreases pressure by 3 cmH2O maximum. Many people find it doesn't synchronize with their breathing cycle and can be detrimental, many people think it works great.

APAP, Auto - APAP is a CPAP (or some BPAP's) machine that senses your breathing status and can either increase or decrease the treatment pressure, and the exhalation pressure on some machines, based on how you are doing that hour or that night. While it is the topic of much discussion, many people have had very positive results using this type of treatment. It is a different mode of treatment. These machines are usually only about $100 or less than straight CPAP, and can be set in CPAP mode.

BPAP, BiLevel, VPAP - Bilevel is the same as CPAP but a more complicated machine that can change the pressure during inhalation and exhalation even more than the 3 cmH2O. It really is a different mode of treatment, often applied to people who have other respiratory issues requiring more than a standard CPAP can provide. These machines are, generally, much more expensive (about twice CPAP).

You'll have many more questions. You've found an excellent place for information, tips, and just plain support. One thing I can recommend, check here before you accept any machine. The people here can make sure you get a machine that has the capabilities your father needs.

Please keep us up to date and post any question you have!
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#7
If buying out of pocket, then go with an APAP. Better flexibility. Both major brands, Resmed and Respironics, have great exhale/inhale relief.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#8
I know that a BiPAP can be set to CPAP mode.
I know that a APAP can be set to CPAP mode.

I don't know if you can set a auto-BiPAP to APAP mode.

If your father can tolerate a CPAP at his titration sleep study, I doubt you'll be able to get him a prescription for a BiPAP. The problem with your plan is that even an auto-BiPAP won't cover all the bases. It may be that he'll be diagnosed with a form of sleep disordered breathing (SDB) more compicated than simple obstructive sleep apnea (OSA). For example, central apnea or mixed apnea. In these cases he may be prescribed an even more sophisticated machine called a auto servo ventillator (ASV).

Also, he'll likely need to exchange masks as they are difficult to fit properly. We usually go through a number of different brands and styles before finding one that's comfortable and effective. Since he'll be swapping out masks, there's no harm in him swapping out machines, too.

The really important thing you want to do is make sure he gets a fully data-capable machine, not a brick. You'll want to be able to monitor the effectiveness of his therapy.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
(07-30-2012, 09:48 PM)Sleepster Wrote: I know that a BiPAP can be set to CPAP mode.
I know that a APAP can be set to CPAP mode.

I don't know if you can set a auto-BiPAP to APAP mode.

Hi. I was just looking into this on the ResMed website over the weekend. Yes, you can set a ResMed auto-BiPAP to APAP mode. But in general you can't set a ResMed standard BiPAP to APAP mode.

ResMed has about half a dozen types of BiPAP machines with various combinations of features/modes. In general, the only Bilevel machines which can act like a regular APAP are the bilevel machines which have Auto in the name. And an Auto BiPAP will probably be missing some or most of the features/modes of other BiPAP varieties.

ResMed has started naming their bilevels "VPAP" machines. You can make a ResMed "VPAP Auto" act like a regular APAP simply by reducing the EPR (renamed "Pressure Relief") to 3 cm H2O or less.

This is because the main difference between a regular APAP and a ResMed VPAP Auto is the VPAP Auto allows up to 10 cm H2O of Pressure Relief between inhale versus exhale. If you wouldn't like that, I think there is not much reason to get the VPAP Auto instead of a regular APAP. But maybe many people, if they tried it, would end up just loving having more Pressure Relief between inhale versus exhale.

For the most part, a VPAP Auto is like a regular APAP with more adjustability in the EPR. For example, if I remember correctly, the VPAP Auto has 5 sensitivity levels relating to how quickly or slowly after you start to inhale the machine will "trigger" a transition to the higher pressure for inhalation. And 5 adjustable levels for how quickly the machine will end the inhalation phase.

Although more adjustability may sound great, I suppose more adjustability is not always a good thing - things which are more adjustable can get farther out of adjustment relative to what feels right for our individual breathing style, and may be more complex to get adjusted just right. Plain vanilla, so to speak, may work better for some people. But, on the other hand, I suppose most doctors (or most patients) could simply opt to leave most adjustable parameters at their default or mid-range values.

Just like with EPR on a regular APAP, on a VPAP Auto the amount of Pressure Relief stays fixed throughout the night. The inhale pressure and exhale presure adjust higher or lower, together, with a fixed difference (from 0 to 10 of "Pressure Relief") between the inhale and exhale pressures.

Take care, all.
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#10
I would suggest starting with a regular CPAP. It may meet his needs easily. The alternative, of course is an auto which can switch to CPAP mode. Used to be that most doctors started with basic CPAP ( an excellent, easy to use therapy, and with EPR, or flex has some variability in exhalation pressure- this would be my choice), then if that failed to try Bilevel or AUTO. Neither is superior in function, it's what would work best for your Dad. Bells and whistles do not make for a superior machine. The best of luck to you and your Dad. He's lucky to have you looking our for him. The one thing I would ask for is a data capable machine.
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