[Equipment] Machine Comparison

[Sleepster]

My son's doctor wants him to get an auto bilevel machine, but his insurance won't cover it. Supplier #2 has these three machine that I think fit the bill:

Respironics M Series DS700 BIPAP Auto BIFLEX $579
Respironics System One DS750 BIPAP Auto BIFLEX with Heated Humidifier $719
ResMed S9 VPAP Auto 25 with Accessories $629

I'm thinking the ResMed is the best bang for the buck. The M Series machines are older and software is an issue. The System One is a bit more expensive and also software is somewhat of an issue. I think the M Series is not supported by SleepyHead, and even though the System One is, he may not be happy putting up with the bugs. And since it's more expensive why not go with the less expensive S9 where he'll have a choice of ResScan or SleepyHead.

Is there anything else to consider that I'm missing?

[Tez62]

Sleepster, is this his first machine? If so, at least he will have some there with a heap of knowledge to pass on to him.

[zonk]

ResMed S9 VPAP Auto 25 with Accessories $629

According to "CPAP Setup Manuals" VPAP Auto is not S9 ... S8
http://www.apneaboard.com/adjust-cpap-pr...tup-manual

ResMed VPAP Auto 25 & VPAP ST & VPAP S (combined manual, not the S9 series)
Note: the ResMed "VPAP Auto 25" is also known as the "S8 Auto 25" outside the U.S.

S9 VPAP Auto: http://www.resmed.com/us/products/s9_vpa...c=patients

[Sleepster]

I thought that price looked too good to be true, zonk.

I guess I'll recommend the PRS1 DS750 BIPAP Auto for $719.

Anyone know if this machine is supported by SleepyHead?

Yes, Tez, this is his first machine. He has a AHI of 107, I think he said, with desats down to 70%. He slept completely through his titration (five hours) so I'm hopeful he'll adapt fast. His pressure is 17/11. Not sure why they're prescribing an auto BiPAP instead of an APAP.

[zonk]

Anyone know if this machine is supported by SleepyHead?

I believe it does and Encore Basic does too

[Tez62]

sleepster, you know how bad those figures are, I hope he adapts to it quickly and he gets some good results. At least he has been diagnosed and can start treatment ASAP.

[SuperSleeper]

His pressure is 17/11. Not sure why they're prescribing an auto BiPAP instead of an APAP.

Because of the differential in IPAP vs. EPAP (pressure support). With a normal APAP, (with A-Flex or EPR) the pressure relief setting can only lower the exhalation pressure by 3 cmH2O, max. At a high pressure of 17, he could only get an exhalation pressure of 14 using Flex or EPR technology. With a bi-level, the inhalation pressure can be adjusted to a much lower level (in this case 11 cmH20), making the higher pressure much more tolerable.

If (and I stress if) he can tolerate breathing out against a pressure of 14, then the APAP might work with the A-Flex/EPR set at the 3 cmH2O high setting. However, if his pressure needs increase during the night (say up to 20, then he'd be breathing out against a pressure of 17 (pretty darn high). In that case, it would be better to go with an Auto-BiPAP (to adjust pressure automatically) or a less expensive straight BiPAP (bi-level). Also, if you go with a standard APAP, realize that the pressure will only go up to 20 cmH20, and he may need more than this to punch through stubborn obstructive events. That's a real possibility, considering his prescribed pressure is already at 17.

If it were me and I could afford it, at that pressure level need, I'd go with an Auto-BiPAP if possible. That way you automatically adjust to the changing needs, extend the upper pressure limit (I think most Auto-BiPAPs go up to 25 cmH2o).. plus you've got a much higher IPAP/EPAP range when needed (much greater than the simple 3 cmH20 range offered by Flex or EPR technology on a standard APAP or CPAP).

The DS750 looks like the best option to me. And Zonk is right, the ResMed VPAP Auto 25 unit they are offering is likely not the newer S9 VPAP Auto, although it might be worth getting some clarification on that, because if it is an S9 VPAP Auto, that's a pretty good price.

Here's pics of the ResMed VPAP Auto 25 vs. ResMed S9 VPAP Auto, for comparison purposes:

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[Sleepster]

If (and I stress if) he can tolerate breathing out against a pressure of 14, then the APAP might work with the A-Flex/EPR set at the 3 cmH2O high setting. However, if his pressure needs increase during the night (say up to 20, then he'd be breathing out against a pressure of 17 (pretty darn high).

That makes sense. Plus, like you said, he may need a pressure higher than 20 at times. He said the doctor told him the goal was to get his AHI down to 10. It sounds to me like he ended up just biting the bullet and either rented or bought the machine provided by his doctor. Based on what he told me, it's a data-capable auto bilevel machine. Not sure which brand or model he got.

I know if I had that diagnosis I'd be scared into getting a machine right away.

[SuperSleeper]

Well, it's good he's started his therapy sooner rather than later.

[Sleepster]

Yup. You can probably imagine how difficult life would be with those numbers. Not to mention the risk of death or serious damage to the cardiovascular system. His doctor mentioned brain damage.