[Equipment] Need help finding machines to try

[RonWessels]

Information on Respironics BiPAP machines (BiPAP Pro and BiPAP Auto) can be found at http://bipaps.respironics.com/. The same information for Respironics REMstar machines (REMstar Plus, REMstar Pro and REMstar Auto) is at http://respironicsremstars.respironics.com/.

To answer your questions based on the above information, there is also a Respironics BiPAP Auto. The autoSV Advanced you specified also has auto-servo, which is a mechanism by which breaths are delivered on a timed basis rather than solely on-demand. I would strongly recommend consultation with your doctor before getting an auto-servo machine.

I can't find any reference to setting the ramp time duration on any of the machine manuals listed on those pages, although I know for a fact that the REMstar Pro has that feature, since I have that machine. On my machine, I can set the ramp start pressure in 1 cmH2O increments from 4 to my CPAP pressure setting, and the ramp duration in 5 minute increments anywhere from 5 to 45 minutes.

[Zorki1c]

I have the F&P Icon Auto and like it a lot. It takes up less space than most of the others (the machine and humidifier are combined) and it is very quiet. It doesn't have a large a following as the ResMed but it does the job for me. My doctor specified the machine--maybe he gets a kickback--but I have no complaints--especially now that the latest version of Sleepyhead reads data from it.

[markrb]

I adjusted my request list to the doctor to be.

1. Philips BiPAP Auto
1a, ResMed VPAP Auto

If insurance won't cover the BiPAPs then will try.

2. ResMed S9 auto
2a F&P Icon Auto

All of these have the ramp feature, which I think will be the most important to me. Once asleep I think I will be OK.

Thanks for all the help,
Mark

[archangle]

Don't worry about ramp. If necessary, start at a lower pressure and increase it slowly over a few days. Wear the machine during the day while you're reading or watching TV to get used to the pressure. If necessary, start at a pressure that doesn't adequately treat your apnea, but you can stand wearing the machine. Then increase the pressure until your apnea is adequately treated.

After a few weeks, even at full pressure, you'll probably find you can't even feel the pressure and have to put your hand in the airstream or lift up the edge of the mask to tell it's on.

If you get an Auto machine, if the pressure bothers you, temporarily reduce the maximum pressure to a level you can live with and increase it bit by bit.

Doctors and DMEs are sometimes pigheaded about setting pressure. It's possible to change the pressure yourself if necessary.

By the way, sometimes ramp or a low pressure can make things worse because you get a feeling of not getting enough air.

Don't get the F&P Icon. The superior data collection offered by the PRS1 or S9 machines is important. With the PRS1 or S9 you can see every single breath and every single breathing problem for the whole night.

Here are some examples of the data you yourself can get from an S9 or PRS1 machine of the correct models. http://sourceforge.net/apps/mediawiki/sl...sers_Guide

The BiPAP/VPAP (generic term "bilevel") machines are not strictly "better" than the CPAP/APAP machines. They do allow more "exhale relief" where they reduce pressure on exhale. They generally go to a pressure of 25 vs. 20 for the CPAP.

A bilevel machine can help with difficulty exhaling, but I think most people will readily adapt to the pressure when exhaling

In particular, the ASV machine (ResMed VPAP Adapt or PRS1 AutoSV Advanced) is not necessarily an improvement unless you have some form of Central Sleep Apnea (CSA.) When used on a "normal" apneac, it may be "rough" on you because it decides when it wants you to inhale and you may feel it's forcing you to breathe on its schedule, not your own. If you have CSA, you need an ASV. Others should avoid it.

[SuperSleeper]

Yep, most patients can get used to the pressure over time and end up turning the ramp feature off completely. It's only a comfort feature, really. Not a necessity.

[vsheline]

1. Is the BiPAP autoSV Advanced — System One the only auto BiPAP they currently sell?
2. What is the maximum time the ramp can be set to come to full pressure? All the manual says is 1,2,3. There is no explanation of what these relate to.

Hi Mark,

Below is attached the current Philips Respironics System One comparison guide.

From the comparison guide, it looks like the ramp time can be set as long as 45 minutes on all PRS1 models except maybe the BiPAP AVAPS and BiPAP S/T models.

By the way, the "1, 2, 3" in the BiPAP manual would be referring to Bi-Flex, which adjusts how abruptly or gradually the pressure transitions between the lower EPAP exhale pressure versus the higher IPAP inhale pressure. A Bi-Flex setting of 3 is the most gradual/smooth.

ResMed EPR and Philips Respironics A-Flex and C-Flex are used with APAP and CPAP machines, where the 1, 2 or 3 refer to approximately 1, 2 or 3 cmH2O drop in pressure during exhale.

ResMed EPR differs from Respironics C-Flex, which raises the pressure back to the high inhale pressure WELL BEFORE you have finished exhaling. This is not a bug, this is an (uncomfortable) feature: this is done to ensure that low pressure will not allow the throat to collapse during the beginning of inhalation, which is the time when it is easiest for the throat to collapse. ResMed EPR does not include that feature and is therefore more comfortable than C-Flex, but (at least for some people) EPR makes obstructive events more likely unless the normal CPAP set pressure is raised a little, to compensate. In fact, using EPR can actually decrease the number of obstructive events as long as the CPAP set pressure is not too low. If someone is using ResMed EPR on a CPAP machine (meaning a constant pressure rather than an Auto-adjusting APAP machine), unless the titration was done using the same or larger EPR setting, I would suggest it would be best to have the CPAP pressure raised by an equal amount as the EPR being used.

Take care,
--- Vaughn


  Respironics_ SystemOne_Comparision_Guide.pdf (Size: 59.32 KB / Downloads: 157)

[markrb]

My Doctor has put in the request to insurance for the Philips BiPAP Auto, but does not think insurance will cover it.
She is really pushing the F&P Icon Auto as she says she has had success with that machine when people were not able to use other machines.
She insists it is the Sense Awake technology.

I have tried CPAP in the past and was not able to use it.

My thinking, right or wrong, is the BIPAP with a ramp would give me the best chance to get used to something and who knows maybe she is right about the F&P for me.
Data collection for me is a secondary concern. I need to be able to use a machine first and that will be a huge challenge given what my reaction to it was before.

At least the ball is rolling now. They say a decision takes about a week.

Thanks for all the help,
Mark