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Machine choice for Auto-bilevel?
#1
Was just changed to an Auto-bipap, and was given the choice of machine.  My sleep doc is pretty good, he loves when folks get into the data, and prefers I pick what is most comfortable for me.  Anyways, I'm trying to decide between the Dreamstation Auto-bipap and the resmed Aircurve 10 vAuto.  I know there are a number of threads pertaining to these two machines, just curious if you had to choose from the two, what would you choose and why?   

I had this same issue with my APAP and settled on the A10 Autoset because I found EPR much more comfortable than the PR flex.
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#2
I agree you made the right choice for your auto CPAP. I have both a PRS1 Bipap Auto 760, and Aircurve 10 vauto. Both machines allow you to specify a minimum EPAP and maximum IPAP. Philips allows a range of pressure support, while Resmed uses fixed pressure support.

With the Philips, I set a range of 2-6 for pressure support, and it varied through the night. It was very comfortable although the machine sometimes did not sync perfectly, and would cut off inspiration or begin to increase pressure during exhale. I ended up increasing the setting for TiMin and that solved the issue. PS can be set to 0.5 cm increments.

With the Resmed I started with a PS of 4, and found i had some centrals. Cut that to 3 and it works much better. Settings can be refined by 0.2 cm increments, so you can set it as close as needed. If running on 12 volt power, or you will use a battery with any frequency, get the Philips. The Resmed always follows my breathing, so there is never a feeling it is encouraging me to inhale or cutting off a breath. It displays the pressure curve on the screen so you can see the real-time pressure output. Like other Resmed units, this requires a proprietary 24 volt power supply.

Which one is best? I have gotten excellent results, generally less than 1 AHI from both. Resmed does not report RERA or flow limitation in the Aircurve. If this data is important, or you think variable pressure support might be useful, get the Philips. I give the edge to Resmed for screen information and layout, and for following breathing. In other words, there is no clear winner in my opinion.
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#3
(01-25-2017, 03:25 PM)Sleeprider Wrote: I agree you made the right choice for your auto CPAP.  I have both a PRS1 Bipap Auto 760, and Aircurve 10 vauto.  Both machines allow you to specify a minimum EPAP and maximum IPAP.  Philips allows a range of pressure support, while Resmed uses fixed pressure support.  

With the Philips, I set a range of 2-6 for pressure support, and it varied through the night.  It was very comfortable although the machine sometimes did not sync perfectly, and would cut off inspiration  or begin to increase pressure during exhale.   I ended up increasing the setting for TiMin and that solved the issue. 

Thanks for the response Sleeprider.  I'm not sure if I know what TiMin is.  Is it the min time for inspiration breath?  

I must say, having you inspiration breath cut off does not sound very appealing.
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#4
C0mbe,
This is a passing thought.  If you already have supplies for your current A10, then you have a running start in the Resmed's direction. That's just the tightwad in me.
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#5
(01-25-2017, 05:11 PM)Crimson Nape Wrote: C0mbe,
This is a passing thought.  If you already have supplies for your current A10, then you have a running start in the Resmed's direction. That's just the tightwad in me.

Quite a few actually!  I hadn't considered that, but it's a great thought.  It never crossed my mind they were all interchangeable but of course they are, it's the same family of device. 

Thanks!
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#6
Mostly masks, filters, hoses and humidifier chambers, and the most expensive items, any electrical adapter supplies. It's a good consideration, and they are all interchangeable.

What is the reason you are being prescribed bilevel?
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#7
Good point Crimson Nape, well done.

Sleep-well

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#8
(01-25-2017, 07:04 PM)Sleeprider Wrote: Mostly masks, filters, hoses and humidifier chambers, and the most expensive items, any electrical adapter supplies.  It's a good consideration, and they are all interchangeable.

What is the reason you are being prescribed bilevel?

Good question.  I had thought I was adjusting ok to APAP, but one complication is I travel constantly between sea level, 6300 ft (home) and 10,000 ft. I was seeing AHI at sea level of 0-2, at 6300 it was more like 3-6, and at 10,000  >6 and occasional nights of 13+ with pretty high pressures and no substantial leaks.  I was waking up a lot during the night at 10,000 ft, and struggling with epap, and centrals at high pressures.     

If I was to stay at 6300 or below, he would have stuck with the APAP, but he said apnea had a tendency to become complex at higher altitudes and he found it to be more comfortable for patients and see better compliance and results with an Auto BiPap.  After that explanation he gave me the option to switch.  So here i am.
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#9
(01-25-2017, 08:36 PM)C0mbe Wrote:
(01-25-2017, 07:04 PM)Sleeprider Wrote: Mostly masks, filters, hoses and humidifier chambers, and the most expensive items, any electrical adapter supplies.  It's a good consideration, and they are all interchangeable.

What is the reason you are being prescribed bilevel?

Good question.  I had thought I was adjusting ok to APAP, but one complication is I travel constantly between sea level, 6300 ft (home) and 10,000 ft. I was seeing AHI at sea level of 0-2, at 6300 it was more like 3-6, and at 10,000  >6 and occasional nights of 13+ with pretty high pressures and no substantial leaks.  I was waking up a lot during the night at 10,000 ft, and struggling with epap, and centrals at high pressures.     

If I was to stay at 6300 or below, he would have stuck with the APAP, but he said apnea had a tendency to become complex at higher altitudes and he found it to be more comfortable for patients and see better compliance and results with an Auto BiPap.  After that explanation he gave me the option to switch.  So here i am.

Great to hear the back-story.  Did insurance buy off on this?  My story is similar.  I got good treatment on auto CPAP in the 2-3 range, but a fair amount of RERA.  With bilevel that goes away, and AHI is less than 1.  Insurance paid last time based on doctor's prescription and recommendations, but the DME was surprised they did without a sleep study.
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#10
(01-26-2017, 10:39 AM)Sleeprider Wrote:
(01-25-2017, 08:36 PM)C0mbe Wrote:
(01-25-2017, 07:04 PM)Sleeprider Wrote: Mostly masks, filters, hoses and humidifier chambers, and the most expensive items, any electrical adapter supplies.  It's a good consideration, and they are all interchangeable.

What is the reason you are being prescribed bilevel?

Good question.  I had thought I was adjusting ok to APAP, but one complication is I travel constantly between sea level, 6300 ft (home) and 10,000 ft. I was seeing AHI at sea level of 0-2, at 6300 it was more like 3-6, and at 10,000  >6 and occasional nights of 13+ with pretty high pressures and no substantial leaks.  I was waking up a lot during the night at 10,000 ft, and struggling with epap, and centrals at high pressures.     

If I was to stay at 6300 or below, he would have stuck with the APAP, but he said apnea had a tendency to become complex at higher altitudes and he found it to be more comfortable for patients and see better compliance and results with an Auto BiPap.  After that explanation he gave me the option to switch.  So here i am.

Great to hear the back-story.  Did insurance buy off on this?  My story is similar.  I got good treatment on auto CPAP in the 2-3 range, but a fair amount of RERA.  With bilevel that goes away, and AHI is less than 1.  Insurance paid last time based on doctor's prescription and recommendations, but the DME was surprised they did without a sleep study.

Insurance hasn't signed off on it yet - but I expect they will...  I have pretty good work insurance and they don't tend to give me much in the way of hassles.  I should probably review my policy so I know what I can and can't get away with.   Either way I need to be back in to review the auto-bipap performance in 60 days and go from there.  Doc suggested a min epap of 5, with max ipap of 20, ps of 4 as a starting place (seems a little wide), with what I took to be carte blanche to tweak and dial it in.
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