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AutoPAP vs. Auto-VPAP
#21
Hi Tempus, you've had so many good answers I have stayed out of this one, but I did want to address one of your apparent concerns, that being exhalation issues. I use the machine (or one close to it) that your Dad had for his Titration. I have heard from many other people as well that run the S9 series from ResMed. Both machines offer various levels of exhalation relief. Until recently I had an old machine that had no data, no exhalation relief, not even an Auto. It was just a dumb blower motor. Well I got my new machine and the first thing I wanted to do was to play with the exhalation settings! I started out on 2 (it goes one through three) and I just could not believe the difference! I felt like it wasn't even blowing, but it really was and if I held my hand in front of the port I could feel the difference on inhale and exhale. Kinda freaky! That the machine knows when I am breathing and cuts the pressure? Wow! Anyway, after a few weeks I cut it down to 1 to see. I did notice more leaks when I would hit at or over 15 mm H2O, so after about a week I went back to a two. I have yet to try the setting of 3 to see what happens, but I am still trying to let my body become accustomed to the machine so I don't want to play too much. But, my whole point is that these machines are so darned adaptable now a days it is just amazing! Whichever machine your dad ends up with, he may wish to play around with the exhalation relief to find what he likes best, but I believe that there will be a setting that he will like. Your Bi-PAP, VPAP, all of those are for very specific uses. I'm sure your dad will probably do just fine by following whatever the doctor says (as long as the doc says fully data capable, and auto is so much sweeter than just a straight CPAP! Remember an auto can also be set to straight pressure).
As always, YMMV! You do not have to agree or disagree, I am not a professional so my mental meanderings are simply recollections of things from my own life.

PRS1 - Auto - A-Flex x2 - 12.50 - 20 - Humid x2 - Swift FX
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#22
I agree with mjbearit about the exhalation relief, as this is the number one problem that I have heard from others, particularly with higher pressures. They have trouble exhaling against the machine. When searching for a new machine recently the clinic suggestion an F P Icon auto set, but I refused this machine as it did not have EPR / Flex or any kind of exhalation relief.

As far as mask leakage is concerned, the better the mask fit the more effective the treatment, the lower the AHI. All masks leak, and are designed to exhaust stale air. I just checked my leakage, and it was 9ml/hr which is a good fit. A happy face appears in the Information window on the ResMed S9 Autoset to tell you this. The 14 that your dad had would be acceptable, but 45 is too high, and you might consider another mask. Don't however be too quick to change as some nights, the mask just gets moved and stays that way until you roll over or some such. Mask comfort is essential for good compliance, and he should try several if possible. I have tried several, and I have settled for the ResMed Swift FX. However, some people have reported trouble using this mask at pressures greater than 10. I have gone to 12 without trouble. That's the beauty of Autoset CPAP; you only go to high pressures, when the low ones don't work. I was 10.8 pressure last night with a .2 AHI......outstanding performance!

Good luck!
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#23
Actually it depends on how the machine measures leak. ResMed and Respironics measure differently. On a ResMed machine a good leak might be 9 but on a respironics a good leak could be in the 30s. From what I understand ResMed measures and displays unintentional leak and Respironics measures and displays total leak. All machines have intentional leak, that is the stream of air you feel coming out of your mask flushing the "stale" air out. Unintentional leak is where you lose the seal on your mask. To properly measure intentional leak you have to look at the chart for your mask. It will show the amount of intentional leak by mm H2O.
As always, YMMV! You do not have to agree or disagree, I am not a professional so my mental meanderings are simply recollections of things from my own life.

PRS1 - Auto - A-Flex x2 - 12.50 - 20 - Humid x2 - Swift FX
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#24
PRS1 machines just report the percent time in what they call "large leak". The PRS1 official software Encore reports unintentional leaks. Lots of PRS1 patients use SleepyHead, which can be set to detect both unintentional and total leak. I don't trust SleepyHead to report unintentional leak rates for my PRS1 BiPAP accurately, so I have it set to report total leak.

The other thing that SleepyHead does is display the leak graph without showing zero on the leak rate axis. This makes the leak rate graph look a lot more bumpy. Encore displays the zero leak rate on its leak rate graphs, so the graph looks smoother.
Sleepster
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