Guide to choosing APAP machine

[slarai]

Hi, thanks for your replies - they've been very helpful. Couple more quick questions - still trying to determine which machine/model of auto-BiPAPs would be best for my form of apnea (I guess it's best classified as UARS, but my doctor hasn't really put a label on it - AHI is 41 but mostly hypopneas, no central/mixed events).

(1)  What are the pros and cons of the ResMed and Philips auto-BiPAP machines (I guess between the ResMed AirCurve™ 10 VAuto BiLevel Machine (37211) (E0601, E0562) and the Philips Respironics DreamStation BiPAP Auto Machine (DSX700x11)?

(2) Of the ResMed machines - are there significant differences in the different models available - (37211, E0601, E0562 - assuming these are model numbers)? Are any of these more data-capable than others?

(3) Can either of these machines actually detect RERAs? I thought someone had said the Philips machine can and not Resmed, but just wondering how, since my doctor said they can only really be detected using an esophageal pressure catheter...

Just wondering if one brand/model tends to work better for people more on the UARS side of the apnea spectrum.

Thanks!

[Gideon]

Hi, thanks for your replies - they've been very helpful. Couple more quick questions - still trying to determine which machine/model of auto-BiPAPs would be best for my form of apnea (I guess it's best classified as UARS, but my doctor hasn't really put a label on it - AHI is 41 but mostly hypopneas, no central/mixed events).

(1)  What are the pros and cons of the ResMed and Philips auto-BiPAP machines (I guess between the ResMed AirCurve™ 10 VAuto BiLevel Machine (37211) (E0601, E0562) and the Philips Respironics DreamStation BiPAP Auto Machine (DSX700x11)?

(2) Of the ResMed machines - are there significant differences in the different models available - (37211, E0601, E0562 - assuming these are model numbers)(billing Numbers)? Are any of these more data-capable than others?  (No)

(3) Can either of these machines actually detect RERAs? I thought someone had said the Philips machine can and not Resmed, but just wondering how, since my doctor said they can only really be detected using an esophageal pressure catheter...

Just wondering if one brand/model tends to work better for people more on the UARS side of the apnea spectrum.

Thanks!

CPAP machines cannot even detect AHI.  They detect time, pressure and flow only.  It is via various algorithms used to evaluate these measurements that they conclude that various apnea events occurred and then the auto CPAPs and BiLevel/BiPap machines alter these values to alter these values to respond to the events that they detect.  This includes Central Apnea and RERA.  We do not know what algorithm is used by these machines to "determine" RERA.  




ResMed BiPAP/BiLevel

• The AirCurve 10 line includes:
  
  • AirCurve 10 S: A bilevel device ideal for patients who need extra pressure support or find it difficult to adjust to therapy on a fixed pressure continuous positive airway pressure device. It features two different adjustable pressures that can help make therapy feel more comfortable.
    
  • AirCurve 10 VAuto: An auto-adjusting bilevel device for patients who need greater pressure support to treat their obstructive sleep apnea. It uses the comfort of both the proven AutoSet algorithm and Easy-Breathe waveform in its VAuto algorithm.
    
  • AirCurve 10 ST: A bilevel device with backup rate that provides exceptional patient-ventilator synchrony, reducing the work of breathing so patients remain comfortable and well ventilated.
    
  • AirCurve 10 ASV: A bilevel device for central breathing disorders such as Cheyne-Stokes respiration, central sleep apnea, or obstructive events. The AirCurve 10 ASV targets the patient’s own recent minute ventilation. By treating central breathing disorders with auto-adjusting pressure support, and upper airway obstruction with auto-adjusting expiratory positive airway pressure, the device works to rapidly stabilize breathing.
    

• Features include:
  
  • TiControl: Found in AirCurve 10 S, AirCurve 10 VAuto, and AirCurve 10 ST, TiControl lets providers set minimum and maximum time limits on either side of the patient’s ideal spontaneous flow cycling, creating a window of opportunity for the patient to spontaneously cycle the breath and timely intervention during challenging conditions.
    
  • Trigger Sensitivity: Adjustable trigger and cycle sensitivity settings TiControl, found in AirCurve 10 S, AirCurve 10 VAuto, and AirCurve 10 ST, can be used to optimize synchrony between the device and the patient’s own respiratory efforts.
    
  • Vsync: Advanced leak management technology, Vsync helps provide patient-ventilator synchrony. Vsync is available in all AirCurve 10 devices.
    
  • HumidAir: Integrated heated humidification that affords simpler therapy, with fewer parts to set up and manage.
    

[archangle]

I had a follow-up with my doctor and tried to get a prescription for an APAP machine (currently just have basic Resmed Airsense CPAP machine), but he said he doesn't use those for any of his patients anymore because he claims the algorithms are not sensitive enough to be beneficial, particularly for my form of apnea which is primarily hypopneas without oxygen desaturations. I just wanted to see what members of this board think about that, as the APAPs just make more sense to me (to account for changes in sleep positions and different oxygen needs due to colds/allergies, medications, etc.) - In particular, I'm having a lot of issues with air swallowing, and it seems an APAP would help so that it's not set to the highest pressure all night if I only need that pressure for a small fraction of the night). 

Any thoughts regarding this question of what type of apnea the APAP machines work best/worst for would be appreciated. Thanks!

The medical mafia (MM) hates APAP machines.   MM is afraid they'll take away business for doctor visits and reduce the number of in-lab $leep $tudie$ that they can charge you for.  MM hates self-empowered patients.

Your doctor may be playing that game himself, or he may simply be ignorant and has been convinced by the self-serving bias of the medical community as a whole.  A lot of doctors, including sleep specialists, are staggeringly ignorant about the capabilities of modern CPAP machines. 

Many of them also shirk much of their duty and rely on the DME's (CPAP sellers) to do the work for them and report on the patient's "progress."  Many DME's and some doctors don't care about anything other than if you use the machine the minimum 4 hours per night that insurance requires before they'll pay for the machine.

Many doctors seem to think that APAP machines are simply "plug it in and forget it" type machines that always start at a pressure of 4 and will always go to 20 if needed. Modern APAP machines can be set to work in a narrower range of pressures.  In the rare cases where APAP doesn't work right, it can be set to work in manual CPAP mode.