Hypoventilation vs. CPAP choice

[SleeplessInVirginia]

A number of conditions, such as obesity or allergies, can cause very shallow breathing during sleep (hypoventilation).  Many decades ago, when I first started with CPAPs, I had trouble with the basic Respironics CPAP (fixed pressure) offered by the DME supplier.  I was advised that (at least at that time), some brands of machines were better than others at detecting and handling hypoventilation (differences in sensors, algorithms, etc.).  They switched me to a ResMed machine (confounded with that also being an AutoPAP), which did a much better job.

I've stayed with ResMed AutoPAPs since then because I've been happy with how they work, but I'm now in the market for a new machine and don't want to unnecessarily restrict my choices.  There have been many studies of using CPAP with hypoventilation, or that combined with OSA, but at least the readily available summaries don't disclose what machines were used in the studies.  So I'm wondering if today, are all brands of AutoPAPs equal (or at least adequate) at handling hypoventilation? 

I'd be interested to get feedback from any hypoventilation sufferers who have either had problems with how a specific machine handled the condition, or have used a brand other than ResMed with good results.

[SarcasticDave94]

Of the several respiratory issues I've got, hypoventilation probably isn't on that list. Regardless, ResMed will be the best. Philips Respironics is in melt down due to a foam scandal and recall, so you're not wanting one of these. Here in the US, these 2 are the biggest brands. IMO just stay with ResMed.

[Gideon]

The key to hypoventilation is pressure support, the difference between exhale and inhale support. Any doctor should prescribe a BiLevel for this reason. With the self adjusting or auto machines I, and many others here have a preference for ResMed because their algorithms are more aggressive than others.

It turns out that ResMed's implementation of EPR in it's CPAPs behaves like a BiLevel with PS settings of 1, 2, or 3. The preference would still be for a BiLevel such as the VAuto but that depend on what other cardio pulmonary issues you have going on, think Asthma or COPD and others and how severe they are.

[SleeplessInVirginia]

SarcasticDave94, I wouldn't have thought of switching away from ResMed except my last two machines both required replacement because the humidifier heater failed, and repair of this minor item isn't cost-effective.  I was exploring machines with a replaceable humidifier.  The ResMed S9 would fit the bill, but it is no longer in production and who knows how long parts and support will be available.

I had identified the Dreamstation Auto, which Respironics still shows as a current machine, and which people generally seem happy with (well except for the killer foam).  If that was a viable option, I could just wait until the company weathers the crisis and potential bankruptcy from the lawsuits.  Sometimes the best time to buy a product is after something like this--the problem gets fixed, the company bends over backwards to regain public trust, and good products are sometimes available at fire sale prices.

The other candidate I identified is the DeVilbiss IntelliPAP 2 Auto with the PulseDose humidifier.  DeVilbiss has been around forever, and their machines generally get good grades.  I have no idea how their support is in the US, and have questions about PulseDose (does it hold up long-term, is it noisy, is it effective at timing vs. irregular breathing).  They sell only a small fraction of the machines in the US compared to ResMed and Respironics, but it isn't clear why (e.g., could be just that ResMed and Respironics are already too entrenched with DME suppliers and another brand would cut into quantity pricing).

If these other machines are generally inferior to ResMed, or aren't effective for hypoventilation, I'd just stick with ResMed and eat the cost of the limited lifespan.

[SleeplessInVirginia]

Gideon, interesting.  Apparently, my hypoventilation isn't severe enough that it was noticed in the sleep study for OSA, so the doctor never thought to prescribe a BiPAP (and I don't have other conditions like asthma or COPD).  But that would explain why the ResMed machines have been effective for me.  If ResMed is unique in this way, I guess that would limit my options, other than pursuing a BiPAP (seriously more expensive, and not justifiable if ResMed AutoPAP is effective).

[cathyf]

It turns out that ResMed's implementation of EPR in it's CPAPs behaves like a BiLevel with PS settings of 1, 2, or 3. The preference would still be for a BiLevel such as the VAuto but that depend on what other cardio pulmonary issues you have going on, think Asthma or COPD and others and how severe they are.

Well kinda sorta... My experience is that the vauto with "identical" settings to autoset is that the vauto is night and day better. (By "identical" I mean autoset pressure 7/20 with EPR=3, vs vauto 4/17 with PS=3)

This is a top-over-bottom comparison of mask pressure (vauto on top, autoset on bottom):
   
https://www.dropbox.com/s/ovdn2mexnbu9mw...M.png?dl=0

I sure as heck can't see any difference, but the vauto behaves much better.

[SarcasticDave94]

Looks at Supplier #2 on our list, go to the website, look up the inventory, and then call them. I'm conveying the experience of others, call and get a non advertised price. They'll tell you exactly how many hours are on gently used machine xyz that you're about to buy. Several have used them with great results. They have used ResMed S9's.

PS I've not used them because I'm on fixed income Disability and must make the doc, insurance, DME's do their job to issue me my machines. Just so you know why I've not used them myself.

[SleeplessInVirginia]

cathyf, the scale isn't visible, but if the two are at the same scale, I can eyeball a difference.  The waveforms are similar, but VAuto averages about 5/8 of a division higher pressure (whatever a division represents), and has about 1/4 division bigger difference between high and low.  Since that's automatically set, it looks like VAuto does a better job of figuring out what you need.

[SleeplessInVirginia]

SarcasticDave94, thanks for the link.  That source is good to know.  I now suspect that my issue with the humidifier heaters was my own doing.  If that turns out to be the case, the desire for a separate humidifier may be moot and I can just go with a current model.