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CPAP vs BIPAP vs APAP
#1
CPAP vs BIPAP vs APAP
I'm a newbie.  Have been reading extensively on internet.  I know CPAP is the basic machine, BIPAP is a machine that lowers pressure for easier exhaling, but I'm confused as to what APAP  does.  Read abt so many people stuck w/wrong machine ($700 - $1000 down the drain).  If I can talk them into an APAP, is it a machine that can be stepped down to whatever I decide I am a few months from now?  IE, could it function as a BIPAP or a CPAP w/ some dumbing down?

But first of all, just what does an APAP do?
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#2
RE: CPAP vs BIPAP vs APAP
The Simple Version,   but first, and most importantly you want a machine that reports full detailed data, not just compliance data

CPAP --- Basic Single pressure solution - Also a generic title for all "PAP" machines.
APAP --- CPAP but has an Automode,  this is the same insurance code as the above CPAP machine.  This is the most preferred class of machines for MOST people.  This, and the above machine is what MOST people need.

More Advanced than above - 
BiPAP/BiLevel (depending of manufacture.)  There are several different models which contain different treatment algorithms depending on the cause of your Apnea.  Most models can be used as a basic CPAP.  The first level is similar to ResMed AirCurve 10 VAUTO.  Used for high pressure CPAP (GT 15-20 cmH2O) and for hypopnea treatment.

even more advanced
ASV Auto Servo Ventilator - The best at treating Central Apneas.

Read the links in my sig for more basic info.

Fred
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#3
RE: CPAP vs BIPAP vs APAP
Usually APAP machines can also be set to CPAP mnode but not to BIPAP.
If the pressure is below 10mbar, there is no need to think about BIPAP. APAP and CPAP machines also have 1-3 bar relief that can be set as desired. This is more or less BIPAP light. BIPAP machines are better at pressures >>10mbar.
If possible try APAP for flexibility. You can always use CPAP mode as well.
If you are having trouble with CAs, consider Auto Servo machines.
Usually your doctor and insurance will decide which is best for you. Auto Servo is expensive, so is BIPAP. APAP and CPAP are less expensive
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#4
RE: CPAP vs BIPAP vs APAP
To answer the OP's question "But first of all, just what does an APAP do?"

An auto-titrating positive airway pressure machine (APAP) provides inspiration pressure as needed throughout the night. It will adjust the pressure between preset limits depending on whether you are experiencing apneas and hypopneas, or "precursors" such as snoring or flow limitation. If it detects flow limitation or snoring, the APAP will bump pressure up enough to eliminate the precursor, at the same time preventing an apnea from occurring.

Most APAPs come from the factory set "wide open" with a minimum pressure of 4 and a max of 20. In theory the machine can range anywhere between these limits, but for best results it is advised to set tighter limits to give the machine the best chance of optimum performance.

Most APAP machines have some form of expiratory pressure relief (EPR), also called "flex" where they drop the pressure a few cm as you exhale. The Resmed EPR and Philips Flex aren't exactly the same, but both are designed to make it easier to exhale against pressure, by reducing the exhale pressure by up to 3 cm H2O (for Resmed machines). This is where there can be confusion with bilevel machines, which are set with a basic inhale pressure (IPAP) and exhale pressure (EPAP). The amount of additional pressure added to EPAP is called pressure support (PS). Remember the simple equation: EPAP + PS = IPAP. Depending on the machine, PS can go very high (up to 15 on my ASV) compared with a max EPR of 3. This is why bilevels are sometimes prescribed for people who need high pressures.

There are a lot of different bilevel machines ranging from very basic units through more sophisticated ones with variable EPAP and those with "backup rate" which will try to force you to take a breath if you fail to do so. Which bilevel is right for any given patient is not a straightforward question.

For plain vanilla obstructive sleep apnea the most popular machine on the market, which seems to suit most people is the Resmed Airsense 10 AutoSet (or the very similar Autoset for Her which has an additional therapy mode designed for female physiology).
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#5
RE: CPAP vs BIPAP vs APAP
(12-25-2017, 07:59 PM)Snorzz Wrote: I'm a newbie.  Have been reading extensively on internet.  I know CPAP is the basic machine, BIPAP is a machine that lowers pressure for easier exhaling, but I'm confused as to what APAP  does.  Read abt so many people stuck w/wrong machine ($700 - $1000 down the drain).  If I can talk them into an APAP, is it a machine that can be stepped down to whatever I decide I am a few months from now?  IE, could it function as a BIPAP or a CPAP w/ some dumbing down?

But first of all, just what does an APAP do?

Assuming you are going be treating obstructive sleep apnea within the normal range of pressure for most people, just ask for the Resmed Airsense 10 Autoset CPAP. It is the best performing APAP in terms of responding quickly to apnea precursors such as flow limitations, snores and other things picked up by the sensors, and provides the best expiratory pressure relief for comfort.  Don't make this harder than it needs to be, there is a "best" machine for most people.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#6
RE: CPAP vs BIPAP vs APAP
BiPAP (Phillips tradename) and bilevels are the same. They are usually for those who need the extra exhale support. Regular CPAP/APAPs can only drop in pressure on exhale by just 1 to 3 cmH2O. Bilevels can drop more than that. The other difference is Bilevels can be set for individuality to the point of being overly confusing. From Pressure Support to inhale pressures to exhale pressures to this and to that...I find those beasts more than I ever want to mess with.

Some bilevels can be auto, too.

For the basic user with obstructive sleep apnea, an APAP is the way to go.
PaulaO

Take a deep breath and count to zen.




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#7
RE: CPAP vs BIPAP vs APAP
Thanks for sharing these info.   Does anyone's BiPAP machines auto switch between APAP, Fixed Bi-Level, Auto Bi-Level (Variable PS)?
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#8
RE: CPAP vs BIPAP vs APAP
(12-26-2017, 08:33 PM)Iso0725 Wrote: Thanks for sharing these info.   Does anyone's BiPAP machines auto switch between APAP, Fixed Bi-Level, Auto Bi-Level (Variable PS)?

None that I'm aware of do. It's a manual mode setting that is under clinical set-up.

Dave
lots-o-coffee
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: CPAP vs BIPAP vs APAP
Thanks Dave.  I didn’t touch the setting but somehow in the summary acreen of SH, it showed that the BIPAP machine was switching between diff modes over the last 10 days.   Hope this is not an X file :p
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#10
RE: CPAP vs BIPAP vs APAP
Reading this thread brings to mind a machine type question I've been thinking about. It is slightly off the OP's question, but I'd like to ask anyway. 
What seems to be the best machine type for someone like me who's successfully using an APAP for OSA (centrals not an issue) but pressures often bump up against the 20 max. available on the machine?
Many (most?) Bilevels go up to 25, but their exhale relief isn't really needed, I don't think.
Is my impression correct that to switch from an APAP to something like a bilevel would require a new sleep center titration to prove the need and get the script?

David
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