I've done a lot of research about the various machines available to CPAP users.  The manufacturers provide a lot of information on their websites and are a very good place to start machine research.  It's very important to know the options you have.


Manufacturers

Resmed is a big manufacturer - http://www.resmed.com/en-us/

Respironics is the other big manufacturer - http://www.respironics.com/

Puritan Bennett is a smaller manufacturer - http://www.puritanbennett.com/

Fisher and Paykel is a smaller manufacturer - http://www.fphealthcare.com/

Sunrise Medical makes the Devilbiss brand - http://www.sunrisemedical.com/index.jsp

Aeiomed is a smaller manufacturer - http://www.aeiomed.com/

Respironics and Resmed seem to be the most popular manufacturers.  Most of the people you encounter on the forums will have one of these 2 brands.  Puritan Bennett is less popular but I do come across a few people with Puritan Bennett machines.  I don't think I've encountered anyone with a Fisher and Paykel, Devilbiss, or Aeiomed machine, but that does not necessarily mean there's anything wrong with them.  It just means they're less popular.



Machine Types
There are different types of machines.  I'll categorize them into the basic functions:

CPAP Machines (CPAP) - provides a straight continuous pressure.  This link has good information about what CPAP does:  http://www.resmed.com/en-us/patients/treatment.html?menu=patients

Autotitration Machines (Auto) - provides a flexible pressure based on a set pressure range.  As the machine recognizes a change in breathing that could lead to an apnea, the pressure is increased in an attempt to prevent the apnea.  The advantage of an Auto is you can spend parts of the night at a lower pressure and the machine raises the pressure only when the machine determines it's necessary.  This link has good information about an Auto:  http://www.resmed.com/en-us/patients/treatment/autotitration.html?menu=patients

Bilevel Machines (Bilevel) - provides different inspiratory (inhalation) and expiratory (exhalation) pressures.  Bilevel machines are typically used for people who have difficulty exhaling against their CPAP pressure.  Usually these are people with very high pressures, but not always.  The inspiratory pressure is set at that high pressure and the expiratory pressure is set at a lower pressure.  This allows for easier exhalation.  This link has information about Bilevels:  http://www.resmed.com/en-us/patients/treatment/bilevel.html?menu=patients

Autotitration Bilevel Machines (Auto Bilevel) - provides a combination of Auto and Bilevel features.  The inspiratory pressure is set to vary as needed based on the breathing pattern and the expiratory pressure is also set to vary as needed.  The expiratory pressure is lower than the inspiratory pressure.  This link shows the Respironics' Auto with BiPAP information:  http://bipapautomseries.respironics.com/

Additional Machine Features
There are other features that can be helpful in treatment and should be researched and considered.

Ramp
Ramp allows you to start your machine at a lower pressure each night and it slowly works up to the set pressure.  For example, if your titrated pressure is 10cm, ramp can be set to 6cm over 20 minutes.  The machine will start at 6cm and slowly raise the pressure to 10cm over 20 minutes.  The ramp starting pressure as well as the ramp time can be changed by the DME.  Ramp is considered a comfort feature and can help when trying to acclimate to CPAP.  I believe all manufacturers have ramp.


Exhalation Relief
Some manufacturers offer a feature which is designed to make exhalation against the CPAP pressure easier.


Resmed


EPR (Expiratory Pressure Relief) allows the exhalation relief to be set to reduce the exhalation pressure by 1cm / 2cm / 3cm.  When using a Resmed machine in Auto mode, EPR cannot be used.  http://www.resmed.com/en-us/products/flow_generators/s8_subpages/epr.html?menu=products1

Respironics


C-Flex allows the exhalation relief to be set to a low / medium / high relief.  The relief does not directly correspond to a cm of pressure number like EPR does.  C-Flex is available on Respironics' CPAPs, and Autos.  When using a Respironics machine in Auto mode, C-Flex can also be used.http://cflex.respironics.com/

A-Flex is intended to make both inhalation and exhalation more comfortable.  A-Flex is only available on some Respironics Auto machines and is used when the machine is in auto mode.  Given the newness of this technology, I highly recommend reading the information on the Respironics website about A-Flex.  Initially it appeared a machine with A-Flex would also have C-Flex, but that's not how it's explained.  A-Flex is considered a technology on its own and (quote from Respironics website) "During exhalation, A-Flex provides variable expiratory pressure relief that is the same as our clinically proven C-Flexâ„¢ technology. During inhalation, A-Flex also provides inspiratory comfort that varies with the patient's pressure level." There are two links that seem relevant:  http://remstarautomseries.respironics.com/ and http://systemone.respironics.com/aflex.asp

Bi-Flex allows exhalation relief on certain Respironics Bi-level machines.  http://mseries.respironics.com/Technology.asp

As far as I know no other manufacturer offers exhalation relief


Data Capability
Data capability varies among manufacturers and models.  Definitely research what's available in terms of data capability.


Compliance-Only  Compliance-only machines only gather machine usage data - the dates / times the machine was actually used.

Fully Data Capable  Fully data-capable machine collect a lot of data regarding therapy.  In addition to compliance information, AHI data, leak information, pressure information is included.  A Fully data-capable machine will give a lot of information about how the therapy is progressing.

My personal opinion is every CPAP user should have a fully data capable machine.  Compliance-only machines offer very little information and do not allow you or your doctor to see what types of events (apneas / hypopneas) may be happening when you use the machine.


Software
Certain manufacturers have software available that allows the data on the CPAP to be downloaded.  The software is technically intended for physicians and DMEs.  Many CPAP patients feel the software is essential to monitor our therapy.  If you work with a local DME it is highly unlikely you can obtain the software from them and the majority of DMEs and sleep docs frown upon patients having the software.  However, many of us have purchased our software from online DMEs.  We continue to push for the availability of software to patients because we feel strongly it's important to monitor our own therapy.  The software can only be used with machines made by the same manufacturer.


Resmed:  AutoScan  Resmed has officially prohibited the sale of the AutoScan software to patients.

Respironics:  EncorePro  Until very recently Respironics allowed online DMEs to sell EncorePro to patients.  They seem to be reconsidering this policy and the software is now difficult to find.

Puritan Bennett:  Silverlining  Silverlining is still available for purchase from online DMEs.

Machine Details
I'm going to list links to the various machines that are available, but I'm not going to list the specific features such as fully data-compliant or exhalation relief because I don't want you to make a mistake on your machine choice if there is any mistake in this post.  Please completely research each machine to see if it has the features you need for your therapy.  You can find opinions on specific machine models that interest you by doing a search on the forum.

Resmed
Resmed has makes CPAPs, Autos, and BiLevels.  They can be accessed from this page:  http://www.resmed.com/en-us/products/product-catalog.html?menu=products


Respironics
Respironics makes CPAPs, Autos, BiLevels, and Auto BiLevels.  They are divided into two different categories which are "families" of machines.


M Series Sleep Systems:  These are the newer models of the Respironics machines.  The main M Series page is here:  http://mseries.respironics.com/Home.asp

REMstar Family (pre-M Series):  These are the older models of the Respironics machines but are still well-liked by many patients.  They are also referred to as the "tank" or the "classic".  They can be accessed here:  http://remstar.respironics.com/

BiPAP Family (pre-M Series):  These are the older versions of the bilevels.  They can be accessed here:  http://bipap.respironics.com/


Puritan Bennett
Puritan Bennett makes straight CPAPs, Autos, and Bilevels.  The machines can be accessed here:  http://www.puritanbennett.com/prod/List.aspx?S1=SPT


Fisher and Paykel
The Fisher and Paykel machines are in two groups.


SleepStyle 200 CPAP Series:  these are straight CPAPs and can be accessed here:  http://www.fphealthcare.com/osa/cpapi.asp

SleepStyle 600 CPAP Series:  these are straight CPAPs with the addition of a heated CPAP hose.  They can be accessed here:  http://www.fphealthcare.com/osa/cpaps.asp


DeVilbiss
DeVilBiss makes straight CPAPs, Autos, and BiLevels and can be accessed here:  Sunrise Medical


Aeiomed
I'm pretty sure Aeiomed only makes one machine - the Everest.  The link is here:  http://www.aeiomed.com/everest.asp

Bottom line.  My recommendation to every new CPAP patient would be:

1.  Research.  Research.  Research.  Find out all you can about the machines that are available BEFORE you go to the DME to get your machine.  You want to try to determine what model will allow you to maximize your therapy.  If you have trouble getting what you need from the DME you may need to work with your sleep doc.  While the mask is the most important component for comfort and to keep us compliant, the machine is extraordinarily important so that you actually get the therapy you need.  Do you need a straight CPAP; an Auto; a BiLevel?

2.  Regardless of the model you choose, it should have:


a.  Fully Data-Capable machine - you need the ability to see what's going on with your therapy as does your doctor.  If your apnea is not under control there is no way for the doctor to know if your machine does not collect that data.

b.  Heated Humidifier - CPAP therapy can be very difficult without a humidifier because having the air blow into your nasal cavity can be very drying even if you live in a humid climate

I have a REMstar M Series Auto with C-Flex with an integrated heated humidifier.  I like it very much.  Prior to this machine I had the REMstar M Series Pro with C-Flex.  I also liked that machine very much.  They look identical.  The Pro is a straight CPAP while the Auto is, well, an Auto.  My new sleep doc wanted me to switch to an Auto because I'm going to be losing weight and that may result in pressure changes for me.  I have the EncorePro software so I can monitor my therapy daily.  My AHI is conistently below 2 and my leaks are well-within tolerance so I'm getting the therapy I should be.

If you are looking for information on a new machine, check out the links here and also research on the forums.  I didn't post opinions of the machines because the opinions vary greatly and what is right for you might not be what is right for someone else.


The information in this post is consolidated from information found on the webisites of the various CPAP manufacturers.  I have inserted some of my own opinions regarding what I feel is necessary in order to get the best CPAP therapy.  I am not in the medical field and none of this information is intended to be medical advice.



Last edited by SleepySandyG on Sat May 19, 2007 8:34 pm; edited 5 times in total

EXCELLENT post, advice and information, SleepySandy.

I will go one step further tho. I maintain that any sleep specialist who allows his sleep apnea patients to be provided w/anything other than a fully data capable xPAP machine should be drummed out of the profession (aside from extreme monetary problems for the uninsured).


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed's new VPAP Auto. Humidaire 3i, Simplicity & Micro mask, ResScan 3.4 software, SPO 7500 oximeter.

This is great Sandy!!  I made it a sticky.  Feel free to come back and update it.  I especially appreciate it since I am CPAP shopping!

Vicki


_________________
That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

SleepySandyG wrote:

My personal opinion is every CPAP user should have a fully data capable machine.  Compliance-only machines offer very little information and do not allow you or your doctor to see what is happening when you use the machine.

I agree.  I was upset when my DME took away my data-capable cpap.  I went out on a limb and purchased my own. I was fortunate BCBS reimbursed me.  My data-capable cpap has proven quite useful.  My ENT changed my cpap prescription based on my cpap data--the same ENT who wouldn't permit me to have the cpap I purchased.  EVERY DAY I look at my treatment pressure, leak, and AHI.


_________________
my cpap: resmed s8 autoset vantage
my mask: resmed mirage quattro

CrohnieToo wrote:

EXCELLENT post, advice and information, SleepySandy.

I will go one step further tho. I maintain that any sleep specialist who allows his sleep apnea patients to be provided w/anything other than a fully data capable xPAP machine should be drummed out of the profession (aside from extreme monetary problems for the uninsured).

I agree on both points.
If I were to add anything, I would say that if, like many folks here, you feel that your Doctor is less than an expert with these machines, try to get him to prescribe a Bilevel Auto.  Even if it is not what you need, it can be set to mimic any of the other types.  That way, if the machine you get is wrong, or if your needs change through weight loss or health changes, you can adjust or have adjusted your xpap to match what you really need instead of having to buy another machine.  Be aware, however, that you pay for what you get.  The Auto Bilevel is the most expensive version out there.

Thank you Sandy, your post should be printed out and given to everyone who goes through a sleep study.  It would save a lot of folks a great deal of trouble.


_________________
SidecarMike

BiPAP Auto M Series & a Respironics OptiLife mask

Excellent post!



_________________


Acronyms and Often Used Forum Phrases
Respironics? M-Series Auto w/ HH & C-Flex; Flexfit? Hybrid? Mask, Encore Pro 1.8i

Fisher and Paykel 200 series CPAP machines have a ramp feature.

I assume that the 600 series machines do too.

Thanks, Frances.

It took a while but I did finally find the information.

EXCELLENT POST SANDY.

THIS WILL BE A GREAT HELP TO MANY WHO ARE SHOPPING FOR EQUIPMENT.
THANK YOU RICH G

Great job!  BTW I modified one of your links so we don't have to scroll.  It makes it a bit easier to read that way.

SleepSandyG,

You have done an excellent job of digging out information and have done probably the most important thing anyone with a sleeping disorder can do -- EDUCATE YOURSELF!!!

You have also touched on another very important point -- The DME providers, therapists and doctors don't know everything and are sometimes very biased. You must take everyting they tell you with a LARGE grain of salt and have the knowledge to dispute or verify anything they tell you.

Runningbare



Last edited by runningbare on Tue Aug 14, 2007 12:32 pm; edited 1 time in total

I made some updates to the EPR and A-Flex info per the recommendation of runningbare.

Please feel free to PM me with any changes you think should be made.

I never expected this post to become a sticky, but since it is I will do my best to keep it current.

Nice post SleepSandyG.....however, I got a new one.  My prescription is reads as....

can be written as "Synchrony or comparable CPAP/BIPAP device with a Respironics Comfort 2 full-face mask, size large, to be used with BIPAP with an IPAP of 11 and an EPAP of 7 for sleep with heated hunidity bled in."    

Now based on this prescription....I haven't a clue to what type of equipment this is referring to???    I have only seen one unit that uses the 'term' Synchrony and that is from Respronics.....which seems to be the device with the most everything.    What would a 'comparable' unit be.  This has me confused.  I want to make sure that I get what I need....but this comparable phrase seems to confuse things.   Any insight would be helpful.

Still looking for the best TRAVEL CPAP. Lightweight. For overseas travel. Trying to compare Invacare Polaris and Puritan Bennets GoodKnight 420. Anyone with these machines who can give advice. I'll have to order over the Internet since my supplier don't think these are up to standard and don't sell these. THANKS!

I really wish I had found this forum before I got my CPAP machine.  I went in knowing nothing and now am trying to learn my way around the world of sleep apnea.  Thank you for this very valuable information...now I am getting a better idea of what I should be asking for from my DME and PCP.