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Recommendations for new BIPAP machine
#1
Recommendations for new BIPAP machine
Hi, all - This is my first post in about 5 years...since my last BIPAP acquisition. I've been s CPAP user since 1998.  I'm now eligible for a new machine, and have been in touch with my supplier.  They inform me that there are two autoset-type BIPAP choices available to me currently:  ResMed Air Curve 10, and the Respironics Dream Station.  I tried to get more specific info on these machines, but the folks I spoke with don't seem to know much in detail. 

My current, fixed  BIPAP works OK, but I'm interested in an auto adjusting machine.  I currently use a Phillips Respironics BIPAP PRO, Bi-Flex, System One.

I have no intentions of having another sleep study at this time, gven the current situation, and considering my age and underlying conditions.

My last sleep study  (2015) concluded that I have OSA, and CSA.  Below is a summary of the findings. 

The Tech wrote the following::
"This CPAP/BIPAP sleep study used a CPAP pressure of 11 cm and BIPAP pressures of 14/10 cm to 15/11 cm. EKG normal and no limb movements. Central events were noted throughout, and patient was switched to BIPAP. Previous study was 2007, and patient currently uses CPAP 11 cm at home."

The sleep center doctor wrote the following:
"This overnight polysomnogram was performed as a BIPAP titration study (CPAP failed to normalize disordered breathing). Over the sleep period, BIPAP was initiated, and pressures were increased to resolve the obstructive breathing (to include apneas/hypopneas as well as snoring, or evidence of a flow limited respiratory signal). At a pressure of 15/11 cm., there was complete resolution of disordered breathing, and oxygen saturations were maintained greater than 90%.The patient cycled through all stages of sleep, and tolerated the BIPAP well."

"Diagnosis - Obstructive Sleep Apnea.  
Recommendation - Treatment of OSA with BIPAP at 15/11 cm is recommended for this patient. Non-resolution of presenting symptoms should prompt further investigation."

My notes culled from the report-- there were a total of 13 apneas, and 14 Central events...all in non-REM...zero apneas in REM. The machine used was a ResMed S 9. Not sure why the sleep lab doc wrote OSA for diagnosis, but the lab report, as well as my primary doc, verified the combination of OSA and CSA.

Would like to hear ideas on which of these two machines is the best choice for me.  Many thanks. 
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#2
RE: Recommendations for new BIPAP machine
I would 100% recommend the ResMed aircurve! I owned the dream station and could NOT get less than 20 events (all types central, obstructive etc) every night. I got the ResMed and the highest I have had is 3. No comparison between the two.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
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#3
RE: Recommendations for new BIPAP machine
Thanks so much for the prompt reply.  I had already gotten this impression from reading a variety of posts on this forum, but am certainly eager to hear any and all replies.
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#4
RE: Recommendations for new BIPAP machine
You want a Resmed Aircurve VAuto, there are a number of models in the Aircurve range some fixed pressure and some auto pressure the VAuto is the auto machine
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#5
RE: Recommendations for new BIPAP machine
Yes, sorry the VAUTO Is the best machine, I did not name the best AirCurve.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
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#6
RE: Recommendations for new BIPAP machine
Based on what I'm hearing from your sleep study, you have complex sleep apnea with a significant portion of central events. While the Aircurve 10 Vauto is clearly a superior bilevel machine for obstructive sleep apnea, I suspect you will ultimately fail this trial and require ASV therapy. I'm not a pessimist, but trying to warn you that your purchase should consider the strong likelihood, this won't be your permanent machine. If you have good insurance and going through a DME supplier, a rental period may work to your advantage. If you are buying out-of-pocket, think about buying used from Supplier #2 or finding a good used machine on Craigslist, Offerup, Facebook Marketplace, Nextdoor etc. If this purchase is going through insurance, you have protection and the machine should be able to be upgraded.

Based on our experience on the forum, when your doctor says, "CPAP failed to normalize disordered breathing", but the report goes on to find a bilevel pressure that worked, it means you will fail. We call central apnea events "consistently inconsistent", and it is not surprising to have a period of low or no events for a period of time in any given night. That may be interpreted by a technician as a successful titration, but we rarely find those results are repeatable, or experienced by the user once they are issued a machine and get home. EVERYONE is diagnosed with obstructive sleep apnea, even if that is clearly not the case. The insurance industry controls the behavior, diagnoses and practices of sleep doctors. It is really an exception for them to make a diagnosis of complex or central apnea, even when the evidence is overwhelming.

With all that negativity said, we will help you to get the best results possible, and coach you through the "process" that most people that ultimately get the right machine experience. Keep a positive outlook and understand this is just how it works to get the advanced PAP you need. Ultimately you will need a different diagnosis, but you don't need another test. Your current test should suffice as evidence of your condition. What you may need is a new doctor. To understand all this better, please read our wiki on Justifying Advanced PAP http://www.apneaboard.com/wiki/index.php...P_Machines With a choice between Philips and Resmed, always choose the Resmed. The Resmed Aircurve 10 ASV is what you ultimately want.

My best recommendation, with your tests in hand and a copy of the ASV section of the Resmed Sleep Lab Titration Guide, ask your PRIMARY doctor to prescribe ASV. Use the titration guide to specify Resmed Aircurve 10 ASV in ASVauto mode with EPAP min 4.0, EPAP Max 15.0, PS min 3.0 and PS max 15.0, then use Supplier #2 to buy the "lightly used" ASV for $1349. That will solve your problem, and future ASV machines will be covered once you demonstrate efficacy using this self-funded solution. https://www.resmed.com/us/dam/documents/...er_eng.pdf You can ask your sleep doctor to do the right thing, but as I said, it would be the exception to the rule of incompetence and uncaring.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Recommendations for new BIPAP machine
We have seen sleep reports with as few as 1 obstructive event the entire night, with an AHI of over 30 diagnosed as OSA, so you are not alone.

First I'll say a VAuto is the best machine for OSA BUT, the big but, you have Complex or Mixed Apnea meaning a Mixture of CENTRAL and Obstructive events which neither your current machine, nor the VAuto is designed to treat.

You want the ASV. Stacey and Jason above saw BiLevel and missed the Central element of your apnea.

Because ASV model the most expensive it is shied away from by Sleep Centers, Doctors, DMEs and insurance so it is often difficult to get one thru the system. Often a sleep study is required to provide that the ASV works. It will and with very low AHI often approaching zero.

Self funding is often cheaper and quicker.

Reread Sleepriders post above, I concur with all he said
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Recommendations for new BIPAP machine
These 2 gentlemen know what they are talking about listen to them!! I gave you a recommendation for the best bipap but they know how to read the charts and if they say you need more that is what you need.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar     Dealing w DME     Chart Organizing
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#9
RE: Recommendations for new BIPAP machine
Thank you very much for the detailed responses.  That's a lot for me to chew on.  Guess my first step is to see how likely it is that insurance will allow/cover re the Air Curve 10 ASV.  If it appears feasible, then I've got to get to work on my primary doc.  Will report back whatever I find.  I'm assuming I can find the ResMed Sleep Lab Titration Guide somewhere on the Apnea Forum.  Much appreciated.
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#10
RE: Recommendations for new BIPAP machine
The Resmed titration guide is available direct from Resmed here https://www.resmed.com/us/dam/documents/...er_eng.pdf
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