Reasons Needed for S9 VPAP?

[ShelaghDB]

I didnt want into ump into SUPERSLEEPERS thread on this subject, albeit a bit different as i could have hijacked it so, thought best to ask here.


I am just reading up on the S9 VPAPs for the first time. For no other reason than I stumbled upon them.

But i am noticing their descriptions...

Ideal for noncompliant CPAP patients, the VPAP S features Enhanced Easy-Breathe technology for quiet and comfortable therapy.

or for the auto version:

the VPAP Auto is an auto-adjusting bilevel device designed to address the unique needs of noncompliant OSA patients while providing quiet and comfortable therapy.

What I am getting from looking at these descriptions is that they are great for people who for whatever reason cannot cope with the regular S9 machines and can't comply.

Id be curious to understand what it is about these machines that can cause those who cannot comply to suddenly do so?

What are the most common reasons for non-compliance?



If from what i read, half of the people diagnosed with SA do not comply.
I am just looking at the number of machines for sale on my Kijiji forum for Toronto alone and I am astounded as I see at least 10 pages worth of them for sale and that is ONLY with ONE search term, "CPAP"
[link removed]


So IF indeed this is the case WHY are doctors not prescribing VPAPs before CPAPs?

Sorry if this is not a great question but i don't understand why there are so many machines for sale, or rather, what i should say is why doctors are continuing to give them IF so many cannot handle it..........and IF VPAP will reduce the low compliancy rate then why aren't they the first machines given?


TIA

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[Peter_C]

Many/most newbies can't tolerate the changing pressures of a VPAP. Just like many can't deal with the changing pressures of an autoset. I suppose that is the #1 reason they don't start everyone on a VPAP (plus the higher cost, etc...)

[archangle]

It's all about how the medical mafia (insurance, manufacturers, doctors, sleep labs) maximize their profits. For most of the manufacturers, the data capable CPAPs and bilevels are the same hardware, but different software. One machine with proper programming could easily provide manual CPAP through ASV.

VPAP and BiPAP are trademarks for bilevel.

The "proper" use of bilevel machines is mostly for patients who have trouble exhaling against the pressure. At one time, this took a more sophisticated machine, and the manufacturers justifiably charged more money for it. Insurance and regulators set their policies and prices based on that, with categories of machine based on pressure relief greater than 3, and max pressure greater than 20.

Today, the same hardware can do all the jobs, but the medical mafia wants to keep the extra revenue that the artificial distinctions generate in higher prices, extra office visits, extra charges, multiple sleep tests, and multiple machine sales.

It would be better and cheaper medicine to have one machine that does fully data capable manual CPAP through ASV, and give that to all patients, reconfiguring it as necessary.

It won't happen because the current artificial distinctions are too profitable for the medical mafia, and the medical mafia pays the appropriate bribes (campaign contributions, lobbying, etc.) to the government.

However, the machines labeled as "bilevel, VPAP, or BiPAP" are not necessarily better than an APAP machine. As I understand it, the current "good" APAP machines can all be configured to work exactly the same as the current manual CPAP machines. i.e. the APAP has a manual CPAP inside.

The current bilevel machines, even the good auto ones, apparently can't be configured to work exactly the same as the current APAP machines.

With the current machines, I think everyone should be given at least a good auto CPAP machine. I don't think everyone should necessarily be given a bilevel with the current designs.

[archangle]

Many/most newbies can't tolerate the changing pressures of a VPAP. Just like many can't deal with the changing pressures of an autoset. I suppose that is the #1 reason they don't start everyone on a VPAP (plus the higher cost, etc...)

All good APAP's can have the pressure range turned down to a level that the patient can tolerate, including a zero range, which amounts to manual CPAP. All you have to do is have someone who cares enough to set the machine to what the patient needs.

I know you can adjust the pressure difference on a bilevel. I don't know if there's a minimum level the machines can be set to, but you can largely tame the overly aggressive bilevel. I think most bilevels can be set at least as low as 2 cmH2O pressure difference, which shouldn't be too hard for most patients.

[jaycee]

"If from what i read, half of the people diagnosed with SA do not comply."

My company runs around 70%. I run around 90% (when we used elites I was closer to 95%). I tried to explain to the "big shots" that even a 5% drop in compliance rates means a huge loss in cash down the road in resupply orders.

As to your original question, many people tolerate BIPAP better than CPAP because you can usually get better results using lower expiratory pressures.

BIPAP's cost more money so insurance doesn't want to pay for them unless they have documentation from the provider that CPAP has been tried and failed or you have a sleep study that documents the better results.

[diamaunt]

So IF indeed this is the case WHY are doctors not prescribing VPAPs before CPAPs?

Sorry if this is not a great question but i don't understand why there are so many machines for sale, or rather, what i should say is why doctors are continuing to give them IF so many cannot handle it..........and IF VPAP will reduce the low compliancy rate then why aren't they the first machines given?

have you compared the price of a vpap auto vs an elite?

[diamaunt]

It's all about how the medical mafia (insurance, manufacturers, doctors, sleep labs) maximize their profits. For most of the manufacturers, the data capable CPAPs and bilevels are the same hardware, but different software. One machine with proper programming could easily provide manual CPAP through ASV.

that would be the VPAP Tx

[diamaunt]

The current bilevel machines, even the good auto ones, apparently can't be configured to work exactly the same as the current APAP machines.

I can't speak for other machines, but, the VPAP Auto can be configured *directly* as

an elite
as a VPAP S
and a VPAP Auto

if you set the pressure support to between 0-3, you then have an AutoSet.

so, it's 4 machines in one.

[Sleepster]

I know you can adjust the pressure difference on a bilevel. I don't know if there's a minimum level the machines can be set to, but you can largely tame the overly aggressive bilevel. I think most bilevels can be set at least as low as 2 cmH2O pressure difference, which shouldn't be too hard for most patients.

My PRS1 BiPAP Model 650P can be set with a pressure difference of zero by simply setting the IPAP equal to the EPAP. It can also be set to CPAP mode. Not sure what the difference is other than the fact that in BiPAP mode you have Bi-Flex as the exhalation pressure relief wheras in CPAP mode you have C-Flex. Or C-Flex plus. Or whatever. I understand the manufacturer's claims about the differences, I'm just not convinced they're significant.

I haven't bothered to look at the equivalent settings for the ResMed VPAP Auto that I recently bought on craigslist, but I would think it's similar apart from that fact that there is no exhalation pressure relief on the VPAP.

[Sleepster]

What I am getting from looking at these descriptions is that they are great for people who for whatever reason cannot cope with the regular S9 machines and can't comply.

Yes, the manufacturers would have you believe that they are "great".

The fact is that compliance is the number one issue when it comes to treating OSA with CPAP. If during your sleep study you are having trouble exhaling against the pressure, they will switch you to a bilevel machine (ResMed VPAP, Respironics BiPAP, etc.)

The idea is that increasing comfort increases compliance.

What are the most common reasons for non-compliance?

The mask and the air pressure are uncomfortable and interfere with your ability to sleep. They are strange things and people have trouble falling asleep with them or tolerating them. People who do fall asleep wake up and take the mask off during the night because of the discomfort.

Other issues are an accumulation of a liquid (saliva in the mouth, mucous in the nose, condensation in the hose).

There is also the stigma of needing a medical device. Some people feel it means there is "something wrong' with them. As in the logical fallacy: "Only sick people take pills, if I don't take pills I won't be sick".

Associated with this stigma is the way you look to your bed partner. That's a self image that many people can't tolerate.