[Equipment] Type and brand of pap machine to buy

[stans39]

I recently finished my sleep study and titration. In the sleep study I only slept 216 min out of 371 min. I had 2 OA, 4 MA, 25 CA, and 70 Hypoppneas with over twice as many in the Supine position as the side position. In the titration (177 min sleep) I had 0 OA, 0 MA, 1 CA, and 2 Hypopneas. However, it said I had 2.7 events per hour at 16 cmwp. I don't see how I could have only 3 events and get 2.7 per hour. I am trying to decide between a ResMed S9 AutoSet and their bilevel, and the Respionics REMStar 60 and their bilevel. The reason I am considering a bilevel is because my titration pressure level was rather high (16cmwp) so there will be a lot of pressure when exhaling. Not sure if 3 cmwp reduction will be enough. In the titration I had trouble breathing through my nose so was mainly breatinng through my mouth and was very tired so I didn't notice much back pressure. However, I borrowed my friend's Auto Cpap with a nasal pillow mask and at times did notice some back pressure.

Is the only difference between an Auto bilevel and an auto cpap (besides price) that the auto biIlevel can be set at 2 pressures and has a maximum of 25 cmwp while the auto cpap only goes to 20 cmwp? The S9 reduces the exhale pressure by 1-3 cmwp and the REMStar by 1-3 somethings. How much does the REMStar actually reduce the exhale pressure? Does this reduction in exhale pressure work in the auto mode in both machines? Which machine gives the best (most complete) data? Overall which machine do you think is the best? My doctor did not ask to see me after writing a prescription. He wrote Auto pap 5-20 cm's of pressure. I think he meant an Auto cpap. He also wrote RAMP 30- 45. Although I know what ramp means in general, not sure what he meant here. Ramp to 5 cmwp ???

Thanks,
John

[Ugly]

I recently finished my sleep study and titration.

Hi John!

In the sleep study I only slept 216 min out of 371 min. I had 2 OA, 4 MA, 25 CA, and 70 Hypoppneas with over twice as many in the Supine position as the side position.

Brutal. But it's great to see that you've been kept well informed.

I am trying to decide between a ResMed S9 AutoSet and their bilevel

In part it can depend on what the doctor recommends.

Is the only difference between an Auto bilevel and an auto cpap (besides price) that the auto biIlevel can be set at 2 pressures and has a maximum of 25 cmwp while the auto cpap only goes to 20 cmwp?

It sure sounds like it. I wondered that myself. (I don't know)
I can't answer your hard questions but I did want to offer a friendly hello and acknowledge your existence.

[trish6hundred]

Hi stans39,
WELCOME! to the forum.!
I don't know the answer to your question but hang in there for more responses to your post.
Best of luck to you on your decision on which machine to buy, I know it's a difficult one.

[Shastzi]

Hi Stans!

I cant offer any hard advise on Bipaps but I would go with the Resmed S9 Autoset since you can easily set the clock onboard. I almost bought a Respironics till I found that out.
The pressure regulation is so good on the S9 I can fall asleep with it on 15cm with no ramp up after a couple minutes of accimating.
I am not using exhalation pressure relief either.
< Easy-Breathe expiratory pressure relief (EPR™) >
<Ramp is expressed in minutes. example: 35 minutes to ramp up to therapy set pressure >
Unless the doc has some hardcore reason for you to be on BiPAP I would question that.
***
You mention that your mouth falls open as well.
That might mean you need a full face mask to cut out the mouth leakage which also dampens your therapy. Not a good thing.
***
The prescription he gave you "5cm to 20cm" is no prescription at all.
He is just giving the machine free reign to schedule pressure as it calculates it to be proper.
Note that the Auto PAP starts out at 4cm and upper limit is at 20cm (with most makes)
so with a ramp time of 35 minutes the machine would start at 4cm and spenf 35 minutes to raise the pressure up to 5cm.
This makes no sense at all, and you might even have CO2 issues with that configuration. "Get this STUFFY THING OFF MEEEE!"
(Been there and done that.)
During a long low pressure ramp-up like that you may even have so obstructive events as well.

This is not a good strategy, if you ask me.



When I see something that looks wrong, I say so.

IMO, Stans, I think you need a bit more "fine tuning"

Summing up:
Glad you made it here!

[cincysinner]

It's a tough call, especially if you have to pay out of pocket. I didn't so I wanted the best, most flexible machine I could get. I run at 13, with a exhale pressure of ~8 - so a ~4 cm "support level".

The reason I wanted a bilevel and more exhale relief is I couldn't stand the constant pressure during titration. I was titrated on a respironics machine and I didn't even like that in bilevel with a 4cm difference.The change in pressure was too abrupt, it was on then off. This probably was tweakable.

Not to sound like a commercial, but I really like my S9 bilevel with EPR on (yes EPR on in bilevel "S" mode). It is a really comfortable breath and I hardly notice I am wearing throughout the night. Sounds weird, but sometimes I stick my hand in front of the exhaust port to make sure it is working (though when you turn it off you know it was).

The heated tube/humidifier is nice and recommended.

Though kind of petty, I don't understand why phillips doesn't put a nice backlit lcd display on their machines. I mean, it probably increases the cost per machine by maybe $10? I like being able to fiddle/check on the machine without turning lights on and waking up my wife.

Between the respironics and resmed machines of the same type, the differences are subtle and mostly subjective in terms of therapy - so you can't go wrong with either of them. It all comes down to nit picky things. I like to tinker, tweak, download my data and be interactive with my therapy - this is biggest reason I like the resmed. The menu system is easy to navigate and there are all kinds of parameters you can tweak (stuff like setting the date/time :-) ). This would not be important to someone who is going to strap on the mask, push the start button and never look at the screen.

[zonk]

He wrote Auto pap 5-20 cm's of pressure. I think he meant an Auto cpap. He also wrote RAMP 30- 45. Although I know what ramp means in general, not sure what he meant here. Ramp to 5 cmwp ???

Thanks,
John

Its obvious your doctor must have a valid reason not to trust the titration test so he,s trialling this wide range (letting the machine figured it out) and to come back at some stage go through the data with you and do some adjustment to the range

Beside the machine, its essential to find the right mask
There is no efficient therapy without good mask fit

Ramp is comfort feature allows you to fall asleep with less pressure
Any time you stop/start the machine, it,ll go back into 30-45 minutes of reduced pressure. You may choose to limit or not use Ramp at all

[stans39]

Thanks Ugly, Trisg6hundred, Shastzi, cincysinner for your replies.

Cincycinner, did you ever try the auto mode with different PS setting? If so how did you like this mode? After more research I also like the S9 vpap. However, I can't find a decent price. Seems they discount the Remstar, but not the S9.

Shastizi, How do you set the clock with the Remstar? As far as the 5-20 cm setting, I think as Cincycinner stated my doc would probably later change the setting. However, he won't have to as I will change it myself.

Take care,
John

[stans39]

Sorry Zonk. I didn't include you in my last post. It just an oversight. Thank you and I agree with your analysis

[Shastzi]

stans39, I never could get a good answer on the clock setting question.
only a vague reference to "there is some top secret factory clinician software that will set the clock"

So...I chalked it up as Respironics = *UNACCEPTABLE*

If the silly thing has a shortwave WWV receiver on board and sets it's own clock, I need to know that too.
(thats ok, because I have a few alarm clocks at home that set themselves)
But nobody had a clear answer and I wasn't getting any younger so I bought ResMed. Cost a bit more but: I CAN OPERATE IT!

[archangle]

There are some subtle other differences between an auto bilevel and and auto CPAP, but the separately adjustable inhale and exhale pressure is the big one. The differences vary depending on whether you get ResMed or Philips Respironics.

You won't be able to buy a bilevel without a bilevel prescription.

ResMed S9 or PRS1 Auto are both good choices. Each has their good and bad points, but they're roughly equally good.

The PRS1 machines have an internal clock, a watch battery, and require a special cable and software not available to the public to set the clock. ResMed has their design flaws as well.

There's no clear winner in exhale relief/EPR/Flex between PRS1 and S9.

You'll probably need to adjust your pressure after you use it for a while. With the PRS1 Auto or S9 AutoSet, you'll have the info you need. You may have to adjust it yourself if your doctor doesn't do his job right, and many don't.

Wean yourself off Ramp as soon as possible.

If you get an S9, be sure it's the S9 AutoSet. There's an S9 Escape Auto that records a lot less data. There is no S9 "Auto." Some people have gotten the old switcheroo from their DME.