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CPAP user for 5 years, switched to BIPAP
#1
This week I went to a sleep doc to discuss my frustrations. I have been tracking sleep notes as well as sleepyhead data. He was very impressed with all the data I had and very quickly said I should be on a BIPAP vs the CPAP I have been struggling with. From the data alone, he set up a demo machine for me. Here are his notes:
 
Titration 101:
Initial Settings: IPAP: 12cm H2O and EPAP: 8cm H2O
If OA > 5/hr: Increase EPAP and IPAP by 1cm H2O pressure
If OA is < 5/hr and Hypopneas >5/hr, increase IPAP (only) by 1cm H2O pressure to a max of 8cm H2O pressure difference when compared to EPAP. Increase EPAP instead.
If CA > 5/hr, consider increasing ST from 10 to 11 or 12.
 
I'm now three nights in and I love it. Sleeping much better. I'm also using a heated tube which has helped tremendously, especially since my wife likes the bedroom at sub 60 degrees. One of my worst nights for rainout was during the winter in Colorado she had the window open and it was 48 degrees in our room. I noticed without the heated tube, when the temp is below 60, I have rainout issues. Not so with the heated tube.
 
My plan is to keep the settings as is for a couple weeks and see if the results are consistent.
 
I have the option of purchasing the Dreamstation Pro BIPAP that I am currently demoing, for a discount of 20%, around $1400, and they will also give me a credit of $280 for the Dreamstation Pro CPAP, which I purchased earlier this year. All in, I would give them my CPAP machine in exchange for the BIPAP for a cost to me of $1188.
 

  1. Does this sound reasonable?

  2. Would you suggest a different BIPAP machine, if so why?
  3. The dreammapper app is nice for the data, even though it is finicky. Are there better apps for different machines?

  4. Do you have any other suggestions?
 
Thank you all. Thanks

C
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#2
I don't know much about the bipap machines, but the Dreamstation Auto Bipap is $1639 plus tax at Supplier #1. The PRO is $1339. Not saying you need an auto for a bipap, but without some Sleepyhead charts, it's hard to comment.
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#3
What are there advantages of having an auto bipap vs the pro? 

The cost difference is at as much of a concern as the quality. 

If charts would help, I can add those when I get back to my computer. 

Thank you.
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#4
If your doctor is mentioning ST mode, you will need a machine that is backup rate capable. Tell your doctor to write a prescription for a specific machine, at specific pressures, for specific reasons documented. That way you will surely get the machine you need, or at least have recourse if you don't.
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#5
From our Wiki
While this is for a CPAP, in general, the same principles hold for BiPAP / BiLevel.

Many of the contributors on this forum, myself included,  have a decided preference for ResMed because of a faster response and the way Pressure Support (EPR on CPAPs) is implemented.  

Quote:I'm often asked the question, "What's the difference between an automatic CPAP machine and a regular CPAP machine?", so in this article I'll set out to explain the primary differences.

First I'll say that I've always wondered why many people in the industry tend to call an automatic CPAP machine something other than what it is - an automatic CPAP machine. You'll often hear people call these types of machines APAP machines or Auto-PAP machines. I believe this is a result of a misunderstanding of the acronym CPAP. CPAP stands for Continuous Positive Airway Pressure, indicating that air pressure will be delivered continuously throughout the sleeping cycle. The term CPAP, however, doesn't imply that the continuously delivered air will be at a constant pressure. Therefore, the proper term to use for a CPAP machine which automatically adjusts the pressure setting according to your needs is automatic CPAP machine.

A CPAP machine is designed to blow air through your partially obstructed airway in order to eliminate the obstruction and to allow you to breathe normally. What many people call "regular" CPAP machines do this by blowing air at a constant pressure throughout the night, regardless of whether you're experiencing an apnea - or cessation of breathing - or not.

An automatic CPAP machine does not use a constant pressure. Rather, the machine is designed to sense your breathing through the use of a pressure feedback device. When the machine senses you are breathing well, the delivered pressure will be lower. On the other hand, when the machine senses you're not breathing well - that is, when it senses an apnea, hypopnea or snoring - the delivered pressure will be higher. Since most people with sleep apnea breathe normally for at least some portion of the night, it stands to reason that a constant pressure is generally unnecessary for effective CPAP therapy. Automatic CPAP machines deliver approximately 40% less pressure throughout the course of a night compared with a CPAP machine which delivers a constant pressure. This reduced pressure helps to increase patient comfort and compliance and makes CPAP therapy more tolerable for new CPAP users.

If your prescribed pressure setting is relatively low - under 10 cm H2O - the primary benefit of an automatic CPAP machine may not be the reduced average pressure, but it may simply be that you don't have to worry about adjusting your pressure setting in the future. An automatic CPAP machine virtually guarantees you'll be getting optimal CPAP therapy regardless of changes in your condition.

As with most CPAP machines, automatic CPAP machines are designed to deliver air pressure between 4 cm H2O and 20 cm H2O. During the intial setup of the machine the minimum and maximum pressures will be set. Usually the default setting of 4 cm H2O as the minimum pressure and 20 cm H2O as the maximum pressure is used. However, if your prescribed pressure setting is well above 10 cm H2O then increasing the minimum pressure might make sense. I would almost always recommend using the default minimum and maximum pressure settings since these settings will allow for the maximum average pressure reduction and the highest level of patient comfort.

Another great advantage of automatic CPAP machines is that they're really two machines in one. You get a CPAP machine which adjusts pressure automatically, and you also get a machine which can be set to deliver a constant pressure just like a regular CPAP machine. This flexibility in functionality is attractive to many CPAP users, especially to those who are using CPAP equipment for the first time.

There are two types of sleep apnea - central and obstructive. Central sleep apnea occurs as a result of a dysfunction in the thalamus area of the brain, while obstructive sleep apnea occurs as a result of an obstructed airway. CPAP machines are designed to open the airway for patients who suffer from obstructive sleep apnea, but CPAP machines will have no effect on central sleep apnea. Some automatic CPAP machines such as the Puritan Bennett 420E can detect apneas which occur with and without cardiac osciallations to avoid increasing the pressure during central apnea events in which the airway is already open. Similarly, advanced automatic CPAP machines can also differentiate between central and obstructive hypopnea (which is defined as shallow breathing).

Below is a summary of the benefits of using an automatic CPAP machine:

* Approximately 40% overall reduction in delivered pressure
* No need to worry about adjusting a constant pressure as your condition changes
* Flexibility - the machine can be set to automatic mode or constant mode
* Some automatic machines detect the difference between obstructive apneas/hypopneas and central apneas/hypopneas 

Your Dr mentioned in his "notes" a fairly standard and simple Titration protocol.  It mentioned ST mode.  This is a different class of BiPAP / Bilevel.

CPAP choice to treat OSA, CA, obstructive or pulmonary restriction
The Auto CPAP such as the AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea
Just to clarify The VAUTO, ASV and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between the three to treat a single condition.
They should be chosen to treat the specific condition that the user has,
  • To treat obstructive apnea and minor hypopnea and for most initial treatments a standard Auto CPAP such as AirSense AutoSet (or for her) is appropriate.

  • To treat obstructive apnea and hypopnea, and a standard Auto CPAP is insufficient the treatment of choice is the Aircurve 10 Vauto (has higher pressure and greater Pressure Support (PS) (similar to EPR) available

  • To treat central apnea, the only appropriate therapy would be the Aircurve 10 ASV

  • To treat obstructive or pulmonary restriction including hypoventilation, would be the Aircurve 10 ST
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