Difference between revisions of "Machine choices"

Revision as of 05:32, 19 March 2019

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 you take during the night and attempt to detect apneas and tell you how your treatment is working. Unfortunately, the manufacturers still make "brick" CPAP machines that only record the hours you use the machine, but don't record data on how your therapy is working.

Many DME's (Durable Medical Equipment provider / CPAP salesmen) will try to sell you a brick CPAP because they make a higher profit with a brick machine. Do NOT trust your 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 trust your doctor to make sure you get the right machine, either. Many doctors have a spectacular ignorance about CPAP machines. Often wrong, but never uncertain. They also tend to put WAY too much faith in the DME.

This page is a consensus of Wiki Editor opinions on what machine to get.

Remember that even a dataless CPAP machine is a marvellous, life saving device. It's just that a fully data capable CPAP machine is a much more wonderful device that will save many more lives if used properly.

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, hypnopeas 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 are used to treat apnea that requires high pressures or other respiratory conditions.
• Adaptive servo ventilators (ASV) are an even more sophisticated and are used to treat central apnea, Cheyne-Stokes respiration and other conditions. ASV machine are typically much more expensive than CPAP or APAP and are only recommended for special cases.

Makes and Models

The 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 Oscar software.

There are a number of second string manufacturers including Fisher & Paykel, Devilbis and Weinemann. 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.

Newly arriving on the market is a range of Chinese machines such as BMC, Luna and others. While they may be excellent machines, apnea community support is lacking and software support may not exist.

Recommended Models

The following is a list of machines supported by Oscar. In general all machines supported by Oscar are recommended, while those not supported are likewise not recommended. Note that many machines are sold world-wide and may be called different names in different markets.

Philips Respironics System One 50 and 60 Series

• Supported
  • CPAP Pro
  • Auto
  • BiPAP Pro
  • BiPAP Auto
  • BiPAP Auto SV
  • BiPAP ST
• Not recommended
  • CPAP Plus

Philips Respironics Dreamstation Series

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

• Supported
  • CPAP Pro
  • Auto
  • BiPAP Pro
  • BiPAP Auto
  • BiPAP Auto SV
  • BiPAP ST
• Not recommended
  • CPAP Plus

Resmed S8 and earlier series

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

Resmed S9 Series

• Supported
  • Elite CPAP
  • Autoset and Autoset for Her
  • VPAP S
  • VPAP Auto
  • VPAP ST
  • VPAP Adapt (AutoSet CS)
• Not recommended
  • CPAP SE
  • Escape CPAP
  • Escape Auto

Resmed Airsense 10 and Aircurve 10

• Supported
  • Airsense 10 Elite
  • 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)
• Not recommended
  • AirStart (all models)
  • Airsense 10 CPAP
  • AirMini

Devilbiss

• Supported
  • DV64 CPAP
  • DV64 Auto

Note: Devilbis DV64 machines are supported by OSCAR v1.0.0, however the support for this model is incomplete, and needs further development and quality assurance.

Fisher & Paykel

• Icon ??

Weinmann

• Prisma ??

The following manual or automatic CPAP machines are recommended:

• Auto Adjusting Pressure CPAP (APAP)
  • ResMed S9 AutoSet
  • ResMed S9 AutoSet for Her
  • ResMed AirSense 10 (A10) AutoSet
  • ResMed A10 AutoSet for Her
  • Philips Respironics System One (PRS1) Auto
  • Philips Respironics DreamStation Auto
• Fixed Pressure CPAPs
  • ResMed S9 Elite
  • ResMed A10 Elite
  • Philips Respironics PRS1 Pro
  • Philips Respironics Dreamstation Pro

All the ResMed S9/A10 or Philips REspironics PRS1/Dreamstation bilevel/BiPAP/VPAP/ASV/AVAPS machines provide efficacy data that can be displayed by Resmed's ResScan, Philip's Encore and #Sleepyhead.

Philips Respironics DreamStation

The current line of Respironics machines are called the DreamStation, including all CPAP, APAP and BiPAP models. The latest version of SleepyHead does work with these machines.

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

The DreamStation "CPAP" base model does not collect efficacy or breath by breath flow rate data, and for this reason is called a "brick". The Pro and Auto models have good data collection.

There is a working version of Encore Pro available now. It's not nearly as good as SleepyHead, but does work. It also is a problem install for many people. It's recommended that you log in as an administrator for the install, not just do the "run as administrator" process.

These machines have an optional wireless modem that allows you to view basic hours of use, AHI and leak data online, but the data is limited compared to Encore Basic or SleepyHead. The online program also requires someone to pay money every month to use the web site and the cell phone network.

Notes on confusing model names

Do not mistake the Resmed S9 Escape Auto for the S9 AutoSet. The AutoSet is much better. If someone refers to the name "S9 Auto", be sure you know which one is being discussed. Similarly, the Resmed Airsense 10 CPAP also has not data, while the Elite and Autoset do. Finally, do not confuse the Resmed AirStart 10 series with the Airsense 10 Series. All AirStart machines are basic featured auto or fixed CPAPs with no efficacy data. They are sold to meet a low price-point to increase profit margins, not to provide better treatment and help to patients.

The current ResMed CPAP series is the AirSense 10 and the Resmed bilevel or VPAP series is the AirCurve 10. More recently, Resmed also introduced the AirStart series. Avoid the base "AirSense 10 CPAP" model, because its data collection is limited. The A10 Elite, AutoSet and AutoSet for Her are good, along with all the AirCurve 10 machines. All Airstart machines are bricks.

The AirCurve and AirSense 10 models are often called "A10." ResMed sometimes uses the term "Air10." Some people call them "S10." the use of abbreviated names can lead to confusion and it is preferable to use the full name of the series and model, as it can make a big difference.

More recent versions of the PRS1 Pro may say "AutoIQ" on the label. Do not mistake the "PRS1 Pro with AutoIQ" for the "Auto." It's still a Pro model, which is a fine manual CPAP, but it has a 30 day trial Auto function and some other improvements over the original PRO. It's believed that all new PRS1 and Dreamstation Pro machines have the AutoIQ feature. If it says "AutoIQ," it's not the equivalent of the PRS1 Auto

Models and brands to avoid

It's recommend to avoid the following machines

• Resmed S9 Escape
• ResMed S9 Escape Auto
• ResMed AirSense 10 "CPAP" Note that AirSense 10 Elite and AutoSet are good.
• Philips Respironics PRS1 Plus
• Philips Respironics PRS1 DS150
• Philips Respironics PRS1 DS160
• Philips Respironics PRS1 SE
• Philips Respironics DreamStation "CPAP" model. (Elite and Auto are good.)
• Older ResMed (S8 or earlier) models
• Any Respironics machine that doesn't say Philips.
• Any Philips Respironics Dorma model

Note that older models may have the same model name as current models. For instance, theResMed S8 AutoSet is not recommended, only the ResMed S9 Autoset.

The most important distinction between the recommended machines and the ones to avoid is the recommended machines machines are fully data capable and display airflow waveforms. This data gives you or a good doctor a very powerful additional tool to tell if your therapy is working.

There is no "S9 Auto" model. Be very careful when discussing this with your CPAP salesman, that you specify "AutoSet," not "Auto," or you may be dispensed the less capable Escape Auto. Do not confuse S9 Escape Auto with S9 AutoSet.

The Philips Respironics Dorma models are fairly new, and there isn't a lot of information on them, but it's likely they have very limited data collection.

Other brands of CPAP/APAP machines aren't recommended because either they do not record as much data or it's not as easy to access it.

Philips Respironics PRS1 models

Many PRS1 machines have a newer "60 series" model. The main difference is that the 60 series has an optional heated hose. The original or 60 series models are both good.

60 series models have a 6 instead of 5 as the second digit. For instance, model 560 is the 60 series model equivalent of the PRS1 Auto model 550.

Misinformation

Many doctors, technicians, and DMEs give out misinformation about CPAP machines and choices. Many are honestly misinformed. Some of them may be "willfully ignorant" or outright dishonest.

In particular, it's hard to get clear information about which model a particular CPAP machine is. The labeling on the machines is confusing. It's almost like birdwatching. You almost need a "spotters guide" to figure out which machine you have.

Wireless Modems

Most CPAP's now have a wireless modem option or built-in. It connects to a server via the cellphone network.

The wireless modem is mainly used to transmit compliance data, but may also be used for the DME to change prescriptions and for the manufacturer (Resmed) to upload firmware updates. If your machine is a brick, it still can transmit compliance (hours and days of use) data.

Even when the machine has a wireless modem, it usually reports a LOT less data than the machine records on the SD card. If there is a problem, you need to look at the SD card data.

Reading Your Own Data

If you have a good CPAP machine, especially the Philips Respironics or ResMed machines, you can get free software to see your own data.

SleepyHead is a free, open source program to read your data from many CPAP machines.

Philips and ResMed have online programs to access your CPAP data, but the data is limited compared to SleepyHead or other programs that access the data from the SD card. The online programs also require someone to pay someone every month for the service. You may not get a bill, but you or your insurance is paying somehow.

The online system also requires you to have cell phone coverage for whatever system of towers the system is using. Even if it's "free" now, it might not be free or even available in the future, or if you change equipment suppliers, doctors, insurance, etc. Having your own software and using the SD card for the data makes you independent of others for access to your data.

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