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[split] Request for Machine Recommendation
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DeepBreathing Offline
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Posts: 2,297
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Perth, Western Australia

Post: #31
RE: [split] Request for Machine Recommendation
Do you know why you were prescribed a bilevel machine? They are not all the same, and are used to treat various different conditions. Both Resmed and Respironics have more than one bilevel in their range (as do some other manufacturers). By the way, the term Bipap is a Respironics trademark. Resmed use VPAP for the superseded S9 range and Aircurve for the new A10 range. It's not a case of which brand is better, it's more a case of which type of machine is required, then which model best suits you. From my own experience there is a world of difference in the feel of a Resmed ASV machine against the equivalent Respironics, and what suits one person will definitely not suit another.

As Vaughan said, an auto is always preferable to non-auto. But there are other variables at play such as ASV for example (for treatment of central apnea and Cheyne-Stokes respiration). It's important to understand why bilevel was prescribed in order to understand which type of machine will be most suitable. Then you need to work out which make and model feels right for you.

DeepBreathing
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.
06-22-2015 03:58 AM
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vsheline Online

Advisory Members

Posts: 1,915
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #32
RE: [split] Request for Machine Recommendation
(06-22-2015 02:06 AM)Shvitzer Wrote:  Talked to my DME lady re getting a ResMed Bi-PAP. She claims that there are a number of docs she deals with who normally insist on ResMed equipment for all of their patients, but make an exception for Bi-PAP, and prescribe Respironics. I'm wondering if anyone has any info on this issue. She says she can easily order a ResMed Bi-PAP for me, but would need a prescription specifying ResMed. I can easily get one, but I'm puzzled by the objection these docs have to the ResMed Bi-level machines. Will check further with DME on specifics.

If the group thinks I'm better off with a Respironics, that's OK with me.Thanks.

I have only used ResMed devices and am used to the shape of the air pressure curve produced by ResMed devices and didn't like the feel of the Respironics device I used during a titration once. But the tech doing the titration was a student and was not familiar with the machine's adjustments for the shape of the air pressure curve (abruptness versus gradualness, early versus late transitions) and perhaps a more knowledgable tech would have known how to adjust Respironics Bi-Flex to feel a little more like the shape of a ResMed machine. Or maybe with time I could have become accustomed to the Respironics feel and preferred it - I don't know.

I assume you have only obstructive sleep apnea and therefore will *not* need an ASV bi-level with a "backup rate" for treating combined central sleep apnea and obstructive sleep apnea, but regarding ASV machines Respironics machines are more adjustable and customizable and provide more data (central versus obstructive apnea detection and RERA detection) than RedMed ASV machines do.

Regarding standard bi-level machines (without a backup rate), the Philips Respironics System One BiPAP Auto with Heated Tube has a very nice feature which the ResMed AirCurve 10 VAuto machine lacks, which is that in bi-level auto therapy mode the PRS1 BiPAP Auto can automatically adjust not just EPAP (keeping Pressure Support fixed) like the AirCurve 10 VAuto can, but can slowly automatically adjust Pressure Support also, in order to optimize the amount of Pressure Support used. I think this is a valuable feature which the ResMed machine lacks.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 06-22-2015 03:51 PM by vsheline.)
06-22-2015 09:45 AM
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Shvitzer Offline

Members

Posts: 13
Joined: Mar 2012

Machine: ResMed S8 and Sullivan V
Mask Type: Nasal mask
Mask Make & Model: ResMed
Humidifier: ResMed 3i
CPAP Pressure: 11.0
CPAP Software: Not using software

Other Comments:

Sex: Male
Location: Kensington MD

Post: #33
RE: [split] Request for Machine Recommendation
(06-22-2015 03:58 AM)DeepBreathing Wrote:  Do you know why you were prescribed a bilevel machine? They are not all the same, and are used to treat various different conditions. Both Resmed and Respironics have more than one bilevel in their range (as do some other manufacturers). By the way, the term Bipap is a Respironics trademark. Resmed use VPAP for the superseded S9 range and Aircurve for the new A10 range. It's not a case of which brand is better, it's more a case of which type of machine is required, then which model best suits you. From my own experience there is a world of difference in the feel of a Resmed ASV machine against the equivalent Respironics, and what suits one person will definitely not suit another.

As Vaughan said, an auto is always preferable to non-auto. But there are other variables at play such as ASV for example (for treatment of central apnea and Cheyne-Stokes respiration). It's important to understand why bilevel was prescribed in order to understand which type of machine will be most suitable. Then you need to work out which make and model feels right for you.


Here's what I can say, based on the sleep lab report--
I have a combination of obstructive apnea and central apnea.

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.

Re a bilevel machine, my DME lady says this:
She claims that she deals with a number of docs who always insist on ResMed equipment for their patients, but when it comes to a bilevel, they order Respironics (660 Pro). (She says) their patients complain that the "pressure feels too abrasive", and that, when given a Respironics machine set to the same pressures, the complaints disappear.

Since she normally stocks only Respironics, she'd have to special order a ResMed, and that means that, if the machine presented a problem, the mchine is "yours to keep", and an exchange wouldn't work. However, if you get a Respironics, and the device presents a problem, your doc can prescribe another machine.


I'm guessing she stocks Respironics because she makes a higher profit on th....and who knows how true the story is re ResMed docs insisting on Respironics for bilevel only...dare I give her the benefit of the doubt? Smile One of the things I've learned from being in this group is that you need to take DME comments with a grain of salt.

That's about what I've got at the moment.
Thanks.
"
06-23-2015 11:14 AM
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tedburnsIII Offline

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Posts: 196
Joined: Mar 2015

Machine: 3B RESmart APAP
Mask Type: Nasal mask
Mask Make & Model: Wisp nasal; ResMed FX nasal
Humidifier: came with unit-I vary it, currently set at '3', '5' is max
CPAP Pressure: 10 cm CPAP
CPAP Software: Other Software

Other Comments: Dx moderately severe OSA. Overnight pulse oximeter-CMS50D Plus

Sex: Male
Location: San Diego

Post: #34
RE: [split] Request for Machine Recommendation
(02-28-2015 05:29 PM)Shvitzer Wrote:  Apologies---couldn't find how to start new thread, so here 'tis, and if you can direct me to new thread procedure, I'd be happy to post there.

...

2 - Have also been given the option of going with the Wisp Nasal Mask, instead of the traditional ResMed nasal mask.

Would appreciate input from the group on both of these questions. Thanks.

2- I have both, and I'd recommend either, with a preference for the Wisp. Overall, the Wisp has controlled leaks better as I have long periods of time with zero or near-zero leaks, it is easier to read with if you do so with glasses, etc. it seems less confining. My AHI's with Wisp are consistently 0.2-0.9.

High leak is >90LPM on my machine. Average leak speaks for itself night of 6/21/2015.

You should try on both masks before you decide.

[Image: 6-21-2015%20CPAP%2011pt5%20EXP_zpsr1tnavhi.png]
(This post was last modified: 06-23-2015 11:59 AM by tedburnsIII.)
06-23-2015 11:50 AM
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vsheline Online

Advisory Members

Posts: 1,915
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #35
RE: [split] Request for Machine Recommendation
(06-23-2015 11:14 AM)Shvitzer Wrote:  Re a bilevel machine, my DME lady says this:
She claims that she deals with a number of docs who always insist on ResMed equipment for their patients, but when it comes to a bilevel, they order Respironics (660 Pro). (She says) their patients complain that the "pressure feels too abrasive", and that, when given a Respironics machine set to the same pressures, the complaints disappear.

Since she normally stocks only Respironics, she'd have to special order a ResMed, and that means that, if the machine presented a problem, the mchine is "yours to keep", and an exchange wouldn't work. However, if you get a Respironics, and the device presents a problem, your doc can prescribe another machine.


I'm guessing she stocks Respironics because she makes a higher profit on th....and who knows how true the story is re ResMed docs insisting on Respironics for bilevel only...dare I give her the benefit of the doubt? Smile One of the things I've learned from being in this group is that you need to take DME comments with a grain of salt.

The DME sounds to me to be selfserving in her claims, recommendations and threat that a ResMed machine would not be returnable if it presented a problem. Respironics is an excellent brand but the "Pro" model is the most basic Respironics bilevel machine.

Can you call your insurance company to find what alternative DMEs are in the insurance network?

Respironics makes an excellent ASV machine (DS960TS) for treating combined obstructive plus central sleep apnea.

If you decide to get a Respironics standard (non-ASV) bilevel machine, ask your doctor to prescribe the excellent Philips Respironics System One DS760TS BiPAP Auto with heated Tube.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 06-28-2015 08:41 AM by vsheline.)
06-26-2015 09:12 AM
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Adoniscmj Offline

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Posts: 168
Joined: May 2015

Machine: Resmed AirSense10 Autoset for her
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Integrated
CPAP Pressure: 6 to 9
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Everett, Washington

Post: #36
RE: [split] Request for Machine Recommendation
I don't know about bi level machines, but I do know that DME's will often try to give you the machine they make the most money on. I had to insist on a ResMed machine. I also noticed my Doctor wrote my script. with Respironics wording such as A-flex. I wonder if my doctor get's a kick back from Philips. Not sure but I wanted the ResMed Air Sense 10 Auto Set and I finally went online and purchased the A10 for her as this is the most feature rich version of the A10 line up. I use the female setting because I found it to be less harsh than the standard setting. I don't think you can go wrong with the Resmed machine in a Bi-level. I think it just comes down to personal preference as the Philips machines are good as well. I just liked the smaller size and how super quiet the ResMed machine's are.
06-26-2015 11:53 AM
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Sleepster Offline
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Posts: 4,995
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #37
RE: [split] Request for Machine Recommendation
Medical professionals regularly use the Respironics BiPAP machine. It has been around for a long time. It sounds like it's the go-to bi-level machine preferred by your DME and the doctors they deal with, so it's the one they pedal. As already mentioned in this thread the Respironics auto-adjusting BiPAP has an extra degree of freedom over the comparable ResMed machine in that it can auto-adjust the pressure support. In other words, both brands of auto-adjusting machines vary both the IPAP and EPAP, but the Respironics machines can also auto-adjust the difference between them. Respironics also has the Bi-Flex feature which lowers the pressure further on exhale and modifies the shape of the expiratory part of the pressure graph in an attempt to increase comfort.

Personally, I think either machine would meet your needs, but in my experience the ResMed machines last longer and seem better built. I also find the ResMed water chamber sturdier and easier to clean, but I do prefer the way the hose exits the top of the Respironics machine as opposed to the back of the ResMed machine.

I think that more important than the brand is getting an auto-adjusting machine. I like them a lot more than the fixed pressure bi-level machines.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
06-26-2015 03:45 PM
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Shvitzer Offline

Members

Posts: 13
Joined: Mar 2012

Machine: ResMed S8 and Sullivan V
Mask Type: Nasal mask
Mask Make & Model: ResMed
Humidifier: ResMed 3i
CPAP Pressure: 11.0
CPAP Software: Not using software

Other Comments:

Sex: Male
Location: Kensington MD

Post: #38
RE: [split] Request for Machine Recommendation
(06-26-2015 03:45 PM)Sleepster Wrote:  Medical professionals regularly use the Respironics BiPAP machine. It has been around for a long time. It sounds like it's the go-to bi-level machine preferred by your DME and the doctors they deal with, so it's the one they pedal. As already mentioned in this thread the Respironics auto-adjusting BiPAP has an extra degree of freedom over the comparable ResMed machine in that it can auto-adjust the pressure support. In other words, both brands of auto-adjusting machines vary both the IPAP and EPAP, but the Respironics machines can also auto-adjust the difference between them. Respironics also has the Bi-Flex feature which lowers the pressure further on exhale and modifies the shape of the expiratory part of the pressure graph in an attempt to increase comfort.

Personally, I think either machine would meet your needs, but in my experience the ResMed machines last longer and seem better built. I also find the ResMed water chamber sturdier and easier to clean, but I do prefer the way the hose exits the top of the Respironics machine as opposed to the back of the ResMed machine.

I think that more important than the brand is getting an auto-adjusting machine. I like them a lot more than the fixed pressure bi-level machines.

Thanks again for all the info. Fact is, I got tired of all the hassle, and ordered a Respironics bilevel, fixed at 15 inhale and 11 exhale. It's the model 660. Took delivery Thursday, and have already slept 2 nights....feels OK. For the last few months, I had been sleeping with my Sullivan V (issued to me in 1998)...fixed at 11. Was using the Sullivan because my ResMed S8 Compact was cutting on and off by itself during the night.

Once again - thanks all.
06-27-2015 08:41 PM
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