Respironics Auto CPAP vs Respironics BiPap Manual

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
heartchakra
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Respironics Auto CPAP vs Respironics BiPap Manual

Post by heartchakra » Tue Jan 03, 2012 1:53 am

Hello again from India.


So we have been trying different machines for my father, aged 70 , since a week.

Have tried the Respironics Auto Cpap, Respironics Manual Bipap and the Resmed Auto Cpap.

He is comfortable with all 3.

He has tried the nasal mask and the nasal pillow mask - he is more comfortable with the nasal mask and not so with the pillow one. Are any other kinds of less cumbersome mask designs available ?

Could you experts here please give your opinions on which one would be best ?

Love to all,
Deepak

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Pugsy
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Tue Jan 03, 2012 3:49 pm

Respironics Auto CPAP and ResMed Auto CPAP are essentially the same types of machines.
Both are like 2 machines in one since they can be used in either APAP or straight CPAP mode.

The Respironic BiPap Manual is a different type of machine but would be more along the lines of one of the others used in straight cpap mode but with much greater exhale relief features than are available on the others. It can also be used in plain ordinary CPAP mode. It doesn't offer variable pressure mode.

I have used the regular APAP machines in APAP mode with variable pressures and I have also recently bought and used a the Respironics BiPap Auto but I use it in manual mode. It is hugely easier to exhale with and while all 3 give me satisfactory therapy per the reports....I find I feel more well rested on the BiPap.

So..does your father need variable pressures or does he do well with straight pressure? If he does not need a wide range in pressures to treat his apnea events then I would opt for the BiPAP.
I used variable pressures in my APAP machine for over 2 years and did well. I do well on the BiPap in the auto mode also. My only preference in using the BiPap in Manual bilevel mode is the exhale relief available at that setting over the other machines. It simply feels better while I am awake.

All 3 machines do a great job. If cost is a significant factor then you can factor that in. From my own personal experience....all will do a good job...but I do notice that I feel better on the BiPap.
It was a night and day difference. I can't explain why the difference in how I feel.
I have talked about it here if it helps you understand these machines. viewtopic/t71442/viewtopic.php?f=1&t=71 ... te#p656179

Of course your dad might be different but if he has any lung problems at all...the BiPap is hugely easier to breathe with.

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derek70
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by derek70 » Tue Jan 03, 2012 4:52 pm

What's the difference between exhale relief on APAPs (EPR and A-Flex) and BiPAPs?

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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Tue Jan 03, 2012 5:51 pm

derek70 wrote:What's the difference between exhale relief on APAPs (EPR and A-Flex) and BiPAPs?
ResMed APAP or CPAP machines use a simple per cm drop in the delivered pressure during exhale.
Setting of 1 is a 1 cm drop...setting of 2 is a 2 cm drop.

Respironics various Flex options are not the same per cm drop like with the Resmed machine. The drop is smaller and the timing of the increase back to delivered pressure is different. The drop in pressure is based on user's own breathing force or flow based. Someone with a more forceful breathing pattern will have a little more drop and different timing than the person with a less forceful respiration.
They are sort of explained here.
http://flexfamily.respironics.com/

BiPap machines deliver 2 separate pressures before any exhale relief comes into the picture and the difference can be greater than the 3 cm maximum difference offered on the ResMed machines. ResMed's EPR is similar to BiPap but the timing is not the same. I have experimented with both with a ResMed VPAP (VPAP is ResMed's name for Bilevel thereapy and BiPap is Respironics name for theirs) and in straight CPAP mode. The 3 cm difference in ResMed cpap mode machine doesn't "feel" the same as a 3 cm difference on their Bilevel mode with a 3 cm difference.
I experimented with BiLevel VPAP pressures of 13 inhale and 10 exhale. There is a difference felt between it and cpap mode with EPR of 3 and pressure set to 13. Not a huge earth shattering difference but there is a difference.

Respironics Bipap machines and the ResMed VPAP machines allow for a much greater difference pressure delivered during inhale and exhale ..Like Inhale pressure of 14 and Exhale pressure of 9 (called IPAP and EPAP)...that 5 cm difference let's a person perceive or "feel" and marked ease in exhale. It's amazing. Almost like there is no pressure at all being exhaled against. This is wonderful especially for people with trouble exhaling against pressure...like with COPD. BiLevel machines are a real benefit for people who have high prescribed pressures like 15 cm...that is going to take some work even for healthy lungs. BiLevel machines make it much easier to tolerate and thus hopefully increase comfort and compliance.

Respironics BiPap machines also offer BiFlex relief which is again a little more exhale relief.
ResMed VPAP machines don't offer EPR in bilevel mode because I guess they think the EPAP and IPAP difference is sufficient relief. When I tried it I found it was more than sufficient for my needs.

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archangle
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by archangle » Tue Jan 03, 2012 6:40 pm

derek70 wrote:What's the difference between exhale relief on APAPs (EPR and A-Flex) and BiPAPs?
Bilevel can do a wider pressure change between inhale and exhale. EPR/FLEX may attempt to do more shaping of the pressure waveform to make it feel better. Some of these distinctions are getting blurred as machines are improved.

BiPAP/VPAP are trademarks for bilevel.

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heartchakra
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Is a titration study needed ?

Post by heartchakra » Sat Jan 07, 2012 1:57 am

So , my father has been trying a CPAP Auto and a Bipap manual machine.

The doctor here said using a CPAP auto negates the need for a titration study to see how much pressure is needed as the machine automatically decides that.

Now my question is this - My father finds the Bipap machine more comfortable. As of now I keep it on a pressure of 6 and 8.

Is there any way what would be the optimal pressure settings for him without a titration study and getting hooked up to all the sleep study machines again ?

With love,
Deepak

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Pugsy
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Sat Jan 07, 2012 9:21 am

heartchakra wrote: My father finds the Bipap machine more comfortable. As of now I keep it on a pressure of 6 and 8.

Is there any way what would be the optimal pressure settings for him without a titration study and getting hooked up to all the sleep study machines again ?
Sure...easy to do. Check the SD card data on the PR System One BiPap and make sure those pressures are controlling the events well. You can adjust pressures based on the software data.

You can also confirm the needed pressure by looking at the data from the S9 Autoset. See where the Auto pressure trended to want to level at and set the Bipap maybe EPAP 2 cm below that pressure and IPAP 2 cm above. A 4 cm range like that will feel super comfortable to your father.

I used an APAP for over 2 years (similar to the S9 auto that your father used).. I used 10 cm minimum and 20 maximum. Overall average was 11.5 to 12 cm. I can use my Bipap in manual mode with EPAP of 9 and IPAP of 13 quite comfortably and it treats my events well and I confirm it using SleepyHead software.

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heartchakra
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by heartchakra » Sat Jan 07, 2012 1:12 pm

Thank you so much Pugsy

Are you near columbia ? My uncle is teaches nuclear engineering to Phd students there

Love,
Deepak

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Pugsy
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Sat Jan 07, 2012 2:00 pm

heartchakra wrote:Are you near columbia ?
Not too far from Columbia, couple of hours drive mainly because of 2 lane road from where I live.
I am about an hours drive east of Joplin, MO which is right at the Oklahoma/Missouri line. So sort of SW corner of Missouri is where I live. Columbia is more central Missouri. I am out in the country. The deer in my avatar were babies that I watched grow up in my pasture from small babies to adults last year. I have lots of deer around here.

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heartchakra
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Pugsy

Post by heartchakra » Sat Jan 07, 2012 10:02 pm

Wow, lucky to be around so many deer . I live in a big city and all I have around are many cars but yeah I do have the sea right opposite me .

What numbers are the most important to read from the SD card ? I have just downloaded the sleepyhead software. So now I just take the card out and plug it in my computer ??


Thanks sincerely to you, archangle and everyone else who helps so mindfully and so patiently.

Love,
Deepak

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Pugsy
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Sat Jan 07, 2012 10:32 pm

To start with look for the AHI data and how each component add in to the overall AHI.

Look at leak line numbers for now, stay below 70 L/min for most of the night and things are fine.
Will fine tune your understanding of it all later as you get a chance to study up on things.

Most common mistake for download problems is that people navigate to the drive where the SD card is and then to the P Series folder. The new SH version looks for the files need in the drive letter itself...so choose only the drive letter as the place to select. If you try the first folder it is too far and won't work.

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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Sat Jan 07, 2012 10:35 pm

Well said Robysue. I am simply too tired to even think straight must less compose what you just wrote and it definitely needed to be said.

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heartchakra
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by heartchakra » Sat Jan 07, 2012 11:34 pm

Hmm. How come I dont see anything from robysue

heartchakra
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Pugsy

Post by heartchakra » Wed Jan 18, 2012 11:26 am

Hello,

Like I have said earlier dad has been trying the Respironics auto cpap and also the respironics bipap.

The auto cpap he has tried for a week and the bipap for 3 days.

I got the readings today from the representative from the card he had removed from the machines yesterday and these are the readings.

Auto CPAP summary :

Auto CPAP mean pressure 8.6
Auto CPAP Peak Average pressure 10.4
Average Device Pressure < = 90% of time 9.7
Average Time in Large Leak Per day 0 secs
Average AHI 1.9


BIPAP summary :


Average Time in Large Leak per day 0 secs
Average AHI 1.8
EPAP Pressure 6
IPAP Pressure 8


Could you please tell me what you think of these numbers.

I wanted to put him on the BIPAP for a few days since you say you find that more comfortable. What settings would you advise ?

Also, dad removes his mask at 4 am though he gets up at 5 am. He wears the mask at around 11pm. Is it ok to take out the mask at 4 am or should one wear it till the entire duration of sleep.

Thanks a lot for the guidance. It means a lot

Love,
Deepak

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Pugsy
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Post by Pugsy » Wed Jan 18, 2012 11:57 am

Your dad should wear the mask any time he is asleep...even after the 4 AM wake up if he goes back to sleep. Naps also...need to wear the mask. Wearing it for 5 hours won't prevent events for the next hour if you don't wear it. There is no "cumulative" keep the airway open thing.

AHI for both machines are great.

On the APAP machine it looks like he spends a lot of time around 9 cm.

BiPap 6 EPAP and 8 IPAP seems to be doing a good job though..from a comfort standpoint only...the more difference between EPAP and IPAP the greater the comfort and ease of breathing is. 6/8 gives 2 cm difference..not much. Though your father is lucky that he doesn't need extremely high pressures to deal with his OSA. If it were me..and I wanted to encompass the 9 cm pressure that APAP wants to use I think I would do BiPaP at 6 EPAP and 10 IPAP. Cover all bases and have that 4 cm difference which is where the comfort factor comes in.

From my experiments....4 cm difference in IPAP and EPAP was hugely more comfortable than a 2 cm difference if we are just talking about ease in breathing with the machine. It is the difference between EPAP & IPAP that gives us the sense of no effort during exhale against the pressure.

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