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BiPAP vs. VAuto
#1
First, I am new and I have read the forum rules and hopefully I won't violate any rules with this first post.

I have been on CPAP for 22 years. The one thing I have learned is that 10 years between sleep studies is a bit too long once you are over 50. I am a bit disappointed that none of my medical support team ever asked me when my last CPAP study was done. I was the one that had to suggest it. Don't think your Doctors always know what is best.

I had a Sleep Study done in December 2014 revealed that my CPAP pressure went from 12cm to 20cm to get the event level down AHI < 10. Based on these results it was recommended I do a second BiPAP study which I did in mid-January. Results from this study indicated that at 17cm/12cm my AHI @ 1.6.

So, I know you are not Respiratory Therapist, but I was wondering if I am going to end up getting an expensive BiPAP machine (versus cost of CPAP), should I be pushing for a VAuto device? I would be interested in any feedback.

Thanks,
Lux

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#2
(02-07-2015, 11:44 AM)Luxsit5280 Wrote: First, I am new and I have read the forum rules and hopefully I won't violate any rules with this first post.

I have been on CPAP for 22 years. The one thing I have learned is that 10 years between sleep studies is a bit too long once you are over 50. I am a bit disappointed that none of my medical support team ever asked me when my last CPAP study was done. I was the one that had to suggest it. Don't think your Doctors always know what is best.

I had a Sleep Study done in December 2014 revealed that my CPAP pressure went from 12cm to 20cm to get the event level down AHI < 10. Based on these results it was recommended I do a second BiPAP study which I did in mid-January. Results from this study indicated that at 17cm/12cm my AHI @ 1.6.

So, I know you are not Respiratory Therapist, but I was wondering if I am going to end up getting an expensive BiPAP machine (versus cost of CPAP), should I be pushing for a VAuto device? I would be interested in any feedback.

Thanks,
Lux

if it were me, I would not accept anything but an auto set BECAUSE as you have seen, pressure can change over time and it just makes sense to have the option of a machine that can provide a range of pressure so you are not at a high pressure all night long. If you choose you can still use a fixed pressure but also have the option to use it in auto mode. When I got switched to vpap, I would not take anything less than the auto machine. Just my opinion
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#3
Hi Luxsit5280,
WELCOME! to the forum.!
I would get an auto bipap machine so you can set your pressures in a range.
Check out this link, it will give you an idea of the different machines out there. http://www.apneaboard.com/wiki/index.php...ne_Choices
Hang in there for more suggestions and much success to you as you continue your CPAP therapy.
trish6hundred
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#4
Lux: You are mixing terms a bit.
A BiPAP (generically called a Bilevel) is a machine that can run a split between IPAP and EPAP pressures.
There are fixed Bilevel machines and there are Auto Bilevel machines.
You used the term VAuto. It's not defined.

There are auto machines that are not Bilevel; and there are Bilevel auto machines.
Resmed's name for a Bilevel is VPAP. Their name for a Bilevel Auto is VPAP Auto. Their word for an auto CPAP is an Autoset.

The VPAP Auto can be set as high as 25 cm-H2O IPAP pressure. The others max out at 20.

I would push for the VPAP Auto. It can run in 3 modes: straight CPAP, fixed "S" mode bilevel, or bilevel auto. Has a variable split. And can run up to 25 since you seem to need higher pressure. Even if initially you run only up to 17, your pressure requirements may, in the future, exceed 20.

If you are using insurance, you get one chance to get it right -- if paying out of pocket, Supplier #2 on the list has the S9 VPAP Auto as a zero hour open box special.


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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#5
(02-07-2015, 11:44 AM)Luxsit5280 Wrote: First, I am new and I have read the forum rules and hopefully I won't violate any rules with this first post.

I have been on CPAP for 22 years. The one thing I have learned is that 10 years between sleep studies is a bit too long once you are over 50. I am a bit disappointed that none of my medical support team ever asked me when my last CPAP study was done. I was the one that had to suggest it. Don't think your Doctors always know what is best.

I had a Sleep Study done in December 2014 revealed that my CPAP pressure went from 12cm to 20cm to get the event level down AHI < 10. Based on these results it was recommended I do a second BiPAP study which I did in mid-January. Results from this study indicated that at 17cm/12cm my AHI @ 1.6.

So, I know you are not Respiratory Therapist, but I was wondering if I am going to end up getting an expensive BiPAP machine (versus cost of CPAP), should I be pushing for a VAuto device? I would be interested in any feedback.

Thanks,
Lux

Lux, welcome! I have both an APAP and BiPAP, so I think I can help you with this question. Your study shows that you need a relatively high pressure in order to control apnea events. An APAP is capable of providing pressure up to 20 cmH20, but a BiPAP is capable of higher inhalation pressure support up to 25 cm. As pressures are increased, it can become increasingly difficult to exhale against the pressure support, which can actually trigger central apnea (CA) in obstructive apnea (OA) patients. So the answer to that problem is BiPAP/bilevel therapy.

In bilevel therapy, the machine provides separate inhalation IPAP and exhalation EPAP pressures. The difference between IPAP-EPAP is the pressure support (PS). A titration with BiPAP will look at using this pressure differential for both your comfort and a better efficacy of treatment, reducing both OA and CA. Another version of fixed bilevel is the Auto BiPAP. This unit provides a minimum EPAP and and maximum IPAP and a specified pressure support, and is allowed to self adjust to remove obstructive apneas. Pressure needs can change with body position and sleep stage. Also Respironics and Resmed approach this very differently. So your bilevel study will look at whether bilevel is beneficial, and to attempt to identify EPAP / IPAP parameters for you.
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#6
The terminology keeps changing. Bipap is Philips Respironics terms for bilevel machines, while Aircurve is Resmed's new term for bilevel. The Aircurves come in several versions, of which the VAuto is the auto adjusting bilevel machine. The non-auto version is the Aircurve 10s, and the ASV version is the Aircurve ASV. These replace the various S9 VPAP models.

If you have central or mixed apneas then the ASV machine will be required - these are expensive. If it's only obstructive apnea, then try for the VAuto.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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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#7
Just a quick addition on the different machines. Respironics bilevel machines use the trademark term BiPAP. The 560 is an Auto CPAP, the 660 is a fixed BiPAP that uses a fixed IPAP and EPAP through the night with no variation. The 760 is an Auto BiPAP that can be set to CPAP, fixed BiPAP or Auto BiPAP where the EPAP and IPAP can independently vary through the night depending on needs. In this auto BiPAP, the IPAP and EPAP can move independently and move farther away from each other, or move as close together as the PS setting will allow.

In Resmeds VPAP auto, the PS between IPAP and EPAP is fixed and the two move in the same direction and always the same distance (PS) apart. I'll have to find some graphs to explain that better.
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#8
There are folks on the forum who can parse your data, but it makes sense to see what the sleep doc recommends. With the large split, it seems that a BiPAP is in order, but depending on the other sorts of events, a different machine might even be better.

I think auto adjusting is not only good because things change over time, but things change due to conditions on the ground; your sleep position, whether you are congested or not, etc. So an auto that titrates through the night seems to be an improvement over non-auto machines.

Normally, I think it is backwards for the patient to push for a particular therapy. But TV commercials do that all the time. Still, probably not right.

That said, I think the best course is to inform yourself before you talk to the sleep doc so you can ask intelligent questions about his recommendations. That seems like the only positive use of the patient pushing the therapy recommendations one direction or the other. IOW, see what he recommends, but if it does not support your research, then ask why, and suggest what you think would be better and ask him about that. You have to do that in a way where he views you as an informed patient, and not someone without respect for his recommendations.
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#9
I would push for the Auto Bilevel machine. The cost is not that much more than a straight bilevel machine. See if your doc will write the prescription for a min EPAP and a max IPAP with pressure support of 5. That will force the DME into providing you with an Auto Bilevel machine. If not, you can still try to push the DME into providing an auto bilevel. Good luck.

Best Regards,

PaytonA
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#10
Seems like I've been banned from the Forum. Not sure what I did. I can't make reply to posts or create new threads. I guess I am not wanted Sad
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