Difference between revisions of "Machine choices"

Latest revision as of 21:54, 20 March 2024

This article is incomplete and may be under construction or include dated information. You can help update it by becoming an Apnea Board Wiki Editor.

One of the most important factors in successful treatment of sleep apnea is getting the correct CPAP machine.

Good vs. Bad Machines - Don't Get Taken

Good CPAP machines will record every breath taken during the night and attempt to detect apneas and tell the patient treatment is working. Unfortunately, many manufacturers still make "brick" CPAP machines that only record the total hours of use on the machine, but don't record data on how therapy is working. Having data can allow the patient and doctor understand problems and target those problems with changes in therapy pressure or even show the need for a different type of machine. Data avoids the need for repeat sleep studies to diagnose and treat problems, and to fine-tune CPAP or bilevel (BPAP) therapy. To see the complete list of machines supported by the OSCAR (Open Source CPAP Analysis Reporter) software, read the OSCAR supported machines page.

Many DME's (Durable Medical Equipment supplier / CPAP salesmen) will try to sell patients a "brick" CPAP because they make a higher profit with that type of machine. Patients should not unconditionally trust a DME. Many will claim a brick does record data when in fact it only records "compliance" data, i.e. the time you use it.

Don't blindly trust a doctor to make sure the right machine is prescribed, either. Many doctors are simply uninformed about modern CPAP machines and some put too much faith in the DME.

Although not comprehensive, this page contains a general consensus of Wiki Editor opinions which machines to favor and which machines to avoid.

Remember that even a "dataless" CPAP machine is a marvelous, life saving device. However, a fully data capable CPAP machine is a much more useful device that will provide far better therapy for most patients.

With the Philips recall, top-tier CPAP machines are in short supply, and retail prices have nearly doubled. In response to that, suppliers are pushing much less expensive Chinese manufactured CPAP machines by Resvent (iBreeze) and BMC (Luna) out the door and into the hands of unwitting consumers. We advise our members to decline these machines which are not supported by Oscar and to follow the guidance of this article.

My DME Dispensed a Used CPAP

Unfortunately, there are many examples of used CPAP machines dispensed to patients initially or as replacement devices. This has been the case with both private insurance and Medicare. In most cases where the recipient identifies the machine as used before accepting delivery, and refuses delivery, the machine is replaced with a new one. In most situations, someone who complains about a used machine prior to delivery will be given a new machine. Relatively few patients are either aware or knowledgeable about this issue and how to deal with it, and it is very difficult to leverage a return once the machine is accepted and used.

Patients can protect themselves by knowing what machine make and model they want in advance, and making it clear that is what you want dispensed. Before picking up a CPAP machine, it's important to become informed on how to access and use the settings. Members of Apnea Board can request a free copy of the [Clinician Setup Manual], and learn how to access the "Run-Hours" of the machine to verify it is new. If patients are offered a machine that is not the make and model they expected, or that has significant prior usage, it is important to complain, explain the basis of the complaint, and not accept the machine until the problem is satisfactorily resolved. Once you agree to pay for a machine and take possession, you will have much less leverage to obtain an exchange. Some insurance policies and Medicare do not stipulate a machine must be new, and DMEs will not hesitate to box up a returned rental. It is entirely on the patient to verify a machine is what they expected and is not a used machine, before accepting delivery and signing for the machine.

Buying a used or reconditioned machine is a smart way to save money, especially for under-insured patients or to have a second, stand-by machine. Patients who are paying full-price or being dispensed initial machines through insurance should not have to worry whether the machine they are receiving has prior use. It's important for the patient to protect themselves from this common practice that is generally considered legal by insurance and DMEs filling prescriptions under insurance.

CPAP Machines

Auto vs Manual CPAP vs Bilevel vs ASV machines

CPAP machines typically come as one of four basic types:

• Manual or fixed pressure machines. The are the most basic form of CPAP. You (or your medical adviser) will set a single pressure and the machine will maintain it all night long. Some doctors and respiratory technicians prefer this type of machine, but in general we don't recommend it - an automatic machine is better for a number of reasons.
• Automatic machines, also known as auto-setting, auto-titrating or APAP. With these machines, you can set an upper and lower limit for the pressure, and the machine will automatically adjust the pressure between these extremes. The machine can sense apneas, hypopneas and "precursors" such as snoring and increase the pressure as necessary to head off any further apneas. APAP machines generally run close to the lower limit, raising the pressure when necessary then lowering it again later. APAP machines can accommodate changes in your breathing, position in bed (eg supine or not) and general health changes as you age. APAP machines can also be set to run in fixed-pressure CPAP mode if desired.
• Bilevel machines are identified by names such as Bipap, VPAP, AirCurve etc. These are typically more sophisticated and provide different pressure for inhale (IPAP) and exhale (EPAP). The difference between IPAP and EPAP is called Pressure Support (PS) Bilevel pressure is more comfortable to users, and can specifically target flow limitation, hypopnea and respiratory effort related arousal (RERA). Bilevel pressure is used to treat apnea that requires higher pressures or other respiratory conditions. Bilevel machines are also sold in fixed pressure or auto-adjusting models. Fixed pressure machines deliver a fixed IPAP and EPAP, while auto bilevel can increase EPAP pressure in response to obstruction, while maintaining pressure support so IPAP pressure also increases.
• BiLevel machines may trigger IPAP based on the patient's spontaneous respiratory effort, or may include a backup rate that triggers IPAP based on a timed trigger, or more sophisticated algorithm that maintains the respiration rate in breaths per minute. These machines with backup rates are non-invasive ventilators for insurance purposes and are in three classes; Spontaneous-Timed (ST), Adaptive servo ventilators (ASV), and Volume-Assured Pressure Support (AVAPS or iVAPS). ASV, AVAPS and iVAPS much more sophisticated and are used to treat central apnea, Cheyne-Stokes respiration,and hypoventilation related to thoracic impairment or obesity. The more sophisticated machines other than ST, help maintain both respiratory volume and rate and target minute vent, tidal volume and even alveolar minute vent. and other conditions. Non-invasive ventilation is the highest level of positive air pressure machine, and is usually prescribed only when less sophisticated machines have failed, and bilevel with a backup rate is determined to be medically necessary and effective for the conditions being treated.

In addition to these standard types, many manufacturers have "travel" machines. These include Transcend, DreamStation Go, and Resmed Airmini. While offering some convenience, most of these machines do not provide the full range of features as found in the bedside models. This wiki article does not go into depth on travel machines, but there are many discussions in the Apnea Board Main Forum

Makes and Models

Although there are many CPAP manufacturers, the U.S. CPAP market is dominated by two players: ResMed and Philips Respironics. These companies make some excellent machines as well as a few to be avoided. Their research and development seems to be well in advance of other makers. The majority of members on apnea forums such as Apnea Board are familiar with one or other of these brands, making it easy to get support and advice from fellow users. Most (but not all) of these machines are supported by the OSCAR software.

There are a number of second string manufacturers including Fisher & Paykel, DeVilbiss (no longer in CPAP business), Puritan Bennett and Weinmann Lowenstein. While these companies make good machines they are not as widely known and in some cases support software is either not available or not very useful. Oscar (Open source CPAP Analysis Reporter) is currently functional with many of these devices. OSCAR supported machines

Newly arriving on the market is a range of Chinese machines such as Resvent, Apex, BMC, Luna and others. While they may be excellent machines, apnea community support is lacking and software support may not exist. The Chinese machines are being sold in the U.S. under COVID era Emergency Use Authorizations. These devices have not been subjected to the same testing and rigorous review as more established brands.

Patients should be careful - it's easy to be confused by the names of the machines. For example a ResMed S9 Escape Auto is a totally different machine from an S9 AutoSet. A BMC RESmart is not the same as a ResMed. Note also that many machines have different names and model numbers in different countries. Patients should be absolutely certain about the exact model they want, and it's wise to double-check the Apnea Board forum if there are any questions.

Software

To get the best possible results from a CPAP machine it's necessary to see in detail what's happening during sleep. Most major manufacturers have a simple web-based software which provides some basic data, such as the hours used and AHI. Examples are ResMed MyAir and Philips Respironics DreamMapper. Much more detailed data can be viewed using the manufacturer's professional software (eg ResMed's ResScan and Philips' Encore). Generally speaking these professional software packages are complex and difficult to use.

The preferred software is OSCAR (Open Source CPAP Analysis Reporter). OSCAR supports a wide range of machines, is relatively easy to use, and generates charts and tables to allow you to see exactly what happened on a breath-by-breath basis. Apnea Board generally recommends machines that are supported by OSCAR, as they will have the most complete support for this user-friendly analytical software. Link to OSCAR Software

Recommended Models

The following is a list of recommended and non-recommended machines created by Apnea Board Wiki Editors. In general, autosetting machines with full data capability are recommended, while fixed pressure CPAPs with full data are considered acceptable and machines with limited or no data capability are not recommended.

Note that many machines are sold world-wide and may be called by different names in different markets. The model numbers will likely also be different for the same machine sold in different countries.

Philips Respironics DreamStation Series

The DreamStation was introduced in 2015 and replaced the System One series.

Notice: All Philips-Respironics DreamStation machines are under a safety-related recall notice (not the DreamStation 2 models).
Please see this Apnea Board forum thread or the Philips Respironics Recall 2021 wiki article concerning this issue.

• Recommended (Full data capability and automatic pressure)
  • DreamStation Auto (DSx500)
  • DreamStation BiPAP Pro (DSx600)
  • DreamStation BiPAP Auto (DSx700)
  • DreamStation BiPAP AutoSV (DSx900)
  • DreamStation BiPAP S/T (DSx1030)
• Acceptable (Full data capability and fixed pressure)
  • DreamStation CPAP Pro (DSx400)
• Not recommended (Compliance-only data capability)
  • DreamStation CPAP (DSx200)
  • DreamStation 2 (All Models) (Encrypted Detailed Data not accessible to user)

Philips Respironics System One (PRS1) 50 and 60 Series

Notice: All Philips-Respironics System One machines are under a safety-related recall notice.
Please see this Apnea Board forum thread or the Philips Respironics Recall 2021 wiki article concerning this issue.

• Recommended (Full data capability and automatic pressure)
  • Auto CPAP (DS550 DS560)
  • BiPAP Pro (DS650, DS660)
  • BiPAP Auto (DS750, DS760)
  • BiPAP Auto SV (DS950, DS960)
  • BiPAP ST (DS1050, DS1060)
• Acceptable (Full data capability and fixed pressure)
  • CPAP Pro (DS450, DS460) (Fixed pressure)
• Not recommended (Limited or no data capability)
  • CPAP Plus (DS250, DS260) (Fixed pressure "brick")

Note: All of the above machines also use the trade name REMstar, including legacy machines such as the M-Series and earlier models. None of the machines prior to the System One series are supported by OSCAR, because they are not equipped with SD card slots.

Resmed Airsense 11

• Airsense 11 Autoset - Early support: Time zones and C/F conversion not yet implemented
• (Elite model has not yet been tested)

ResMed Airsense 10 and Aircurve 10

• Recommended (Full data capability and automatic pressure)
  • Airsense 10 Autoset and AutoSet for Her
  • Aircurve 10 S (Lumis 100 VPAP S)
  • Aircurve 10 ST (Lumis 150 VPAP ST)
  • Aircurve 10 ST-A (Lumis 150 VPAP ST-A)
  • Aircurve 10 VAuto
  • Aircurve 10 ASV (PaceWave CS)
• Acceptable (Full data capability and fixed pressure)
  • Airsense 10 Elite
• Not recommended (Limited or no data capability)
  • AirStart (all models)
  • Airsense 10 CPAP
  • AirMini

ResMed S9 Series

• Recommended (Full data capability and automatic pressure)
  • Autoset and Autoset for Her
  • VPAP S
  • VPAP Auto
  • VPAP ST
  • VPAP Adapt (AutoSet CS)
  • VPAP ST-A iVAPS
• Acceptable (Full data capability and fixed pressure)
  • Elite
• Not recommended (Limited or no data capability)
  • CPAP SE (Limited or no detailed data)
  • Escape CPAP (Limited or no detailed data)
  • Escape Auto (Limited or no detailed data)

ResMed S8 and earlier series

• These machines are obsolete; not supported by OSCAR and are not recommended.

DeVilbiss

• Acceptable
  • DV54 Auto Note: does not provide the very important Flow Rate chart
  • DV64 CPAP
  • DV64 Auto

Note: DeVilbiss DV64 machines are supported by OSCAR v1.2.0, however the support for this model is incomplete, and needs further development and quality assurance.

Fisher & Paykel

• Icon
• Icon+

Some of these machines are supported by OSCAR.

Lowenstein / Weinmann

• Prisma series including CPAP, APAP, bilevel and ASV.

Some of these machines are supported by OSCAR, see OSCAR supported machines. Users of the Lowenstein Prisma devices should read the Apnea Board wiki Lowenstein PrismaLine optimization The manufacturer's software prismaTS provides a reasonably good alternative.

ResMed vs Phillips Respironics

In the opinion of several Wiki Editors, both brands are solidly built and durable. Most models of both are OSCAR compatible.
Wiki Editors, having observed user outcomes on forums for several years, have formed a consensus opinion that ResMed machines result in better outcomes for more users. PR machines definitely have a following and do work for many people.

In the opinion of some Wiki Editors, the AutoSet is a much more capable machine. The following outlines their comparison of ResMed vs. Philips-Respironics auto-CPAP machines:

Why ResMed?

1. Faster algorithmic response to events than PR.
2. ResMed Responds to Flow Limits and PR responds to Snores
3. Lower average pressure (PR require a higher pressure to ward off obstructive events)
4. Better to avoid Aerophagia.
5. Flex is not the same as EPR
6. EPR provides for better treatment of hypopneas, RERAs, Flow Limits, UARS, and snores
7. EPR acts like a BiLevel up to a limit of 3cmw (1,2, or 3cmw) and a max pressure of 20 cmw. Phillips Respironics does not do this.
8. EPR follows your breathing whereas Flex predicts it with a feeling of fighting to get a breath when it predicts incorrectly
9. More flexibility in treating a greater variety of Apneas and respiratory events.
10. In general ResMed provides better therapy.

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