rimp wrote:I am newly diagnosed with osa. My doctor wants me on a bi pap......which should I consider and which should I stay away from? Need to get this nailed down asap.
To the best of my knowledge, all the current
bi-level machines do record full efficacy data. But some of the older Respironics BiPAPs do not. Basically if you go with a Respironics BiPAP, make sure you get the System One version and not one of the older versions. So you don't need to worry too much about that.
You also need to know if the doc is prescribing a simple bi-level machine or a much more sophisticated machine called a bi-level S/T or a bi-level ASV machine. The simple bi-level machines and the auto bi-level machines are designed to primarily to treat obstructive
sleep apnea. Often they are prescribed right from the start for patients who are at high pressure settings (as in over 15cm), but they are also sometimes used if folks cannot fully adjust to plain CPAP/APAP due to issues like aerophagia. (That's why I use a BiPAP.)
These more sophisticated S/T and ASV bilevel machines have modes where they can act as non-invasive ventilators. They are most often prescribed for patients who have been diagnosed with central
sleep apnea or complex
sleep apnea rather than folks with the more common obstructive sleep apnea
. The S/T and ASV machines are also sometimes prescribed for folks with serious problems with something called Cheyne-Stokes breathing. But note that some insurance companies will require a patient to start out on the simpler and cheaper plain bilevel or auto bilevel machines; the patient has to "fail" at that machine before the insurance company will authorize a switch to the more sophisticated machine.
The rest of this post assumes that you will be prescribed a plain bi-level machine or an auto bi-level machine. Both the plain bi-level machines and the auto bi-level machines are billed under the same insurance code. So you will want to know exactly how your insurance company pays for your equipment before you contact the DME. If it pays for bi-levels by billing code, then you need to be aware that the DME will receive the exact same amount of money regardless of whether they sell you a straight bi-level machine or an auto bi-level machine. In my humble opinion, it is worth trying to get an auto machine even if you are using it in fixed pressure mode. In the long run, that auto mode can be used by your doctor to fine tune your prescribed pressures if you run into adjustment problems. And that can help you avoid future in-lab sleep tests.
The word "BiPAP" is actually the trademarked name for the Respironics bi-level machines. It has, however, become the common way to refer to all bi-levels just like "Xerox" has become a way to refer to all copy machines. But other companies do make bi-level machines as well.
The current generation of Resprionics bi-levels include both the PR System One BiPAP Pro
and the PR System One BiPAP Auto
. Both record full efficacy data. The BiPAP Pro is a fixed pressure bi-level. There is a fixed IPAP (for inhalation) and a fixed EPAP (for exhalation). Neither pressure adjusts automatically through the night. The Pro does have a ramp feature available---as long as your set EPAP is greater than the minimum of 4cm. The Auto has both a fixed bi-level mode (where is works just like the Pro) and an auto mode. In auto mode, the Auto will adjust the IPAP and EPAP independently of each other in response to what's going on in your breathing. Basically, the IPAP will increase when the machine detects hypopneas, RERAs, and flow limitations. The EPAP will increase when the machine detects obstructive apneas and snoring. There are a few constraints on how the adjustments are done, however, but I don't really want to get into those details here.
On both the PR System One BiPAPs, there is a form of additional
exhalation relief beyond that provided by the difference between the IPAP and EPAP pressures. It is called Bi-Flex. Some folks like it and some don't. Bi-Flex is a patient comfort feature and can be turned off if you don't like it. Bi-Flex temporarily drops the the pressure below the EPAP pressure right at the beginning of the exhale and raises it back up to the full EPAP setting around halfway through the exhalation. In addition, Bi-Flex "rounds" the change from EPAP to IPAP and makes it feel less "sudden." I personally can't stand Bi-Flex. But others love it.
The most commonly available competitor to the Respironics System One BiPAPs is the Resmed VPAP Auto. The V in VPAP stands for "variable", but "variable" does NOT mean "automatically adjusts through the night." The "variable" pressure is that there is one pressure for inhales (IPAP) and one pressure for exhales (EPAP). The Resmed VPAP Auto is an auto adjusting bi-level machine that can be run in both fixed bi-level mode and auto bi-level mode. To the best of my knowledge there is no fixed pressure Resmed VPAP in the current S9 series, but there was one in the older S8 series. The Resmed VPAPs have a ramp feature, but they do not have any exhalation relief beyond that provided by the drop from IPAP to EPAP at the beginning of each exhalation. The Resmed VPAP Auto algorithm is quite different from the PR System One BiPAP Auto algorithm. In auto mode, the Resmed VPAPs increase/decrease the IPAP and EPAP together and by the exact same amount. So both the IPAP and EPAP will be increased when the machine detects hypopneas, obstructive apneas, flow limitations, and snoring.
Both of the PR System One BiPAPs and the Resmed S9 VPAP are compatible with the SleepyHead software, which is free. Users of the Resmed VPAP can also use ResScan for examining the detailed data. Users of the PR BiPAPs can use EncoreViewer ($) or Encore Pro or Encore Basic to examine the detailed data. The Resmed S9 VPAP has a lot more data presented on the machine's onboard LCD. There's enough data on the S9's LCD to monitor your daily therapy for many folks. But the data on the PR BiPAP's LCD is very limited and is not enough for monitoring daily therapy when you are having real problems. (The "large leak" data on the PR BiPAPs is particularly useless.)
And which machine is better? That's like asking: Which is better? Coke or Pepsi?
To the vast majority of users, the differences between the System One BiPAP and the Resmed VPAP are so subtle that there's no real difference in terms of comfort or quality of therapy. But for a small handful of users, the differences between the machines may matter a lot. But which one is best depends on the particular sensitive user. And the subtle differences may matter more when the machines are run in auto mode instead of fixed pressure mode. Both machines use well tested auto algorithms that can handle the need for modest increases in pressure during the night. Both machines are not at their best when run "wide open" in auto mode.
For me---I've never used a Resmed S9 VPAP Auto since they did not yet exist when I was switched from APAP to bi-level. I had been using a S9 Autoset in auto mode and had many problems adjusting to it. (It's a FINE machine; but it just didn't suit me all that well.) I've come to appreciate the fact that my BiPAP auto can increase only the IPAP in response to flow limitations and hypopneas rather than increasing both the IPAP and EPAP. That's because my stomach is much more sensitive to increases in the EPAP than IPAP. And because of that, my worst aerophagia is now limited to the nights where the machine is detecting some significant snoring going on. And since that does not happen every single night, most of the time my stomach is feeling much much better and my AHI numbers are consistently below about 2.5. And for me, the machine's ability to independently increase the IPAP and EPAP far outweighs the limited amount of data on the machine's LCD.