Disadvantages of Bi-Level?

Hi All,

My doctor is considering prescribing an auto bi-level machine with the hope that it will allow me to have higher minimum pressures without aerophagia symptoms.

I've read extensively on the board about the bi-level machines (thank you RobySue & Pugsy in particular but also to the others who've contributed to the various discussions of pros & cons and how the different brands work differently!) and am interested in trying bi-level.

That said, if I switch machines (through my DME & using insurance), I have to start over with a new rent-to-own contract (I won't get credit for the 5 months I've already paid for my current ResMed S9 Autoset), and if I switch back, I have to start over again with month #1 on a non-bi-level machine. So I'm wondering, ARE THERE ANY DISADVANTAGES TO BI-LEVEL?

It seems to have a lot of potential upsides for my situation, but just wondered if there would be any downsides.

I'm also curious if any of you have suggestions regarding:

*Air Curve V10 Auto or S9 VPAP Auto? Should I wait a month (according to cpap.com the estimated release of the Air Curve series is the end of October) to get the new ResMed Air Curve V10 Auto Bi-Level or take the current ResMed S9 VPAP Auto Bi-Level?

*PR versus Resmed: My doctor and the DME have both said that ResMed machines break down less than PR machines so they are recommending ResMed and I'm already using a ResMed machine so I'm used to it. I'm curious about the PR machine because of the fact that the IPAP can increase without increasing EPAP and wondering if that is enough of an advantage for me (given aerophagia issues and relatively low pressures) to go with PR instead of ResMed?

If you're curious & haven't read about my personal journey on APAP you can see my previous post here:
viewtopic/t100510/Energized-After-Sleep ... -CPAP.html

Thanks for any feedback and advice!

Joyful Sleeper

Why don't you just add this note to the other thread (cut & paste), then delete this one (me included ?

Hi Julie,
How do I delete a thread? I tried yesterday when I posted a mask that was available & couldn't figure out how to delete it after the mask was taken (I was able to edit the original post and add a reply saying the mask was no longer available, but not able to delete the thread in entirety).
I made a new thread because I was afraid people wouldn't read the old one because it was technical. I was hoping someone might respond to the question of cons of bi-level (or bi-level machine choice) that might not be interested in or able to comment on the technical aspects of optimizing therapy. Is that incorrect?
Thanks,
Joyful Sleeper

There are no disadvantages that I can think of.

A ResMed autobilevel should be able to run as a CPAP, as an APAP, as a bilevel, or as an autobilevel.

Bilevel will help you if getting overall average pressure down helps YOUR form of aerophagia. It may or may not. Only one way to find out.

Autobilevel will help if your pressures only need to be raised occasionally and if that cuts down on YOUR form of aerophagia.

Air-swallowers may find that sleeping mostly on a particular side or in a particular position helps them. Also, not eating within three or four hours of bedtime can work wonders for a few.

The ResMed machines are particularly adjustable for dialing things in to see what works. Personally, I consider the way ResMed autobilevels lock in the delta, the difference between IPAP and EPAP, to be a GOOD thing.

-Jeff

Joyful Sleeper wrote:I'm curious about the PR machine because of the fact that the IPAP can increase without increasing EPAP and wondering if that is enough of an advantage for me (given aerophagia issues and relatively low pressures) to go with PR instead of ResMed?

That is a BIGGie IMO. I wouldn't wait for a new untested machine when you have other problems. Have you looked on Craigslist to see if there are any deals there?

I will admit I prefer a Respironics for others reason too; such as it works on 12V if you want to use it for camping or when the power is out. You can get the DC power cord from our host for $30. Resmeds is close to $100. People say that the Resmeds don't break as often when they are trying to sway to their profit center; they think lying is part of marketing.

Your insurance sounds like a disadvantage; have you spoken to them directly or are you getting this repeat compliance info from the DME?

The only other disadvantage I can think of is the cost of a bilevel machine. Other than that they are the "Ultimate" in therapy for sleep disordered breathing (SDB).

There's no disadvantage to having the bilevel machine. They can be even set so that they will function like a plain APAP if needed and of course they have cpap mode always available.

The one very minor disadvantage to the ResMed Auto bilevel is the fixed Pressure Support which makes EPAP and IPAP always tied to each other and the PR S1 Auto bilevel allows for a more customizable PS so it can sort of roam around a but it isn't a huge disadvantage. I have owned both brands in the bilevel models...both are fine machines. I don't know that I have seen anymore failures of the Respironics than with the ResMeds but DMEs and doctors get these ideas fixed in their heads and it's hard to get them removed.
The roaming PS is only available on the PR S1 model 760 Auto BiPap...has to be in auto adjusting mode to have it. In fixed bilevel mode it's fixed. With the S9 VPAP....PS is fixed in both modes ...fixed and auto adjusting bilevel.

There will be no need to go back to the APAP though so don't worry about that aspect of things. Whatever you would want from an APAP can be done with the Bilevel machine with a bit of tweaking of the settings if needed.

I don't know if it would be worth the wait for the new AirCurve models unless you just really like the looks of them.
I don't know if they are going to offer anything that would be new in terms of therapy unless they end up offering a PS that isn't fixed...which would be nice if they did that but I haven't seen anything about those models to be able to figure out if they changed anything along those lines.
Perhaps you could have someone check on the fixed PS thing.
Supposedly so far from what I am hearing from folks who used the S9 and are now using the AirSense...the AirSense is being reported as being more quiet but the S9 wasn't loud by any means.

As long as your Dr orders the different machine you DME should give youcredit

I got a different machine half way through my first rental and My DME gave me a new machine with credit for old machine

My DME made me start all over when switching from CPAP to BiLevel. It is a totally different CPT code for insurance purposes and costs significantly more. So they start you over. your monthly payment will be about $10 more per month from my experience.

I have the ResMed S9 BiLevel. EPAP and IPAP will be 4 point difference but you can get an additional 1-3 by setting EPR. So that's a maximum difference of 7. So don't see how that would be any disadvantage over PR.

But I do not see how this machine can function as an APAP as some have said. You can set a maximum for IPAP and minimum for EPAP but pressure will ALWAYS be at exactly those levels. IPAP for inspirations and EPAP for exhalation. There are no changes if your breathing situation doesn't need it that high as an APAP does.

Another advantage of BiLevel is maximum pressure. The maximum for CPAP is 20. BiLevel can go up to 25 if you need it. But you can set the maximum at any level so if max pressure isn't a problem than this isn't an advantage.

VikingGnome wrote:I have the ResMed S9 BiLevel. EPAP and IPAP will be 4 point difference but you can get an additional 1-3 by setting EPR. So that's a maximum difference of 7. So don't see how that would be any disadvantage over PR.

Are you sure about this? Every Resmed VPAP I have seen doesn't offer EPR when in bilevel mode...it's only available in cpap mode on the VPAP machines.

Now the difference between EPAP and IPAP can vary greatly (from as little as 1 to 8 and maybe more as I can't remember exactly) but it has nothing to do with EPR at all.

yes, EPR is available on my machine. I have it set EPR at 2 with IPAP at 22 and EPAP at 18. So I'm getting 6 point difference.

Pugsy wrote:There's no disadvantage to having the bilevel machine. They can be even set so that they will function like a plain APAP if needed and of course they have cpap mode always available.

The one very minor disadvantage to the ResMed Auto bilevel is the fixed Pressure Support which makes EPAP and IPAP always tied to each other and the PR S1 Auto bilevel allows for a more customizable PS so it can sort of roam around a but it isn't a huge disadvantage. I have owned both brands in the bilevel models...both are fine machines. I don't know that I have seen anymore failures of the Respironics than with the ResMeds but DMEs and doctors get these ideas fixed in their heads and it's hard to get them removed.
The roaming PS is only available on the PR S1 model 760 Auto BiPap...has to be in auto adjusting mode to have it. In fixed bilevel mode it's fixed. With the S9 VPAP....PS is fixed in both modes ...fixed and auto adjusting bilevel.

There will be no need to go back to the APAP though so don't worry about that aspect of things. Whatever you would want from an APAP can be done with the Bilevel machine with a bit of tweaking of the settings if needed.

I don't know if it would be worth the wait for the new AirCurve models unless you just really like the looks of them.
I don't know if they are going to offer anything that would be new in terms of therapy unless they end up offering a PS that isn't fixed...which would be nice if they did that but I haven't seen anything about those models to be able to figure out if they changed anything along those lines.
Perhaps you could have someone check on the fixed PS thing.
Supposedly so far from what I am hearing from folks who used the S9 and are now using the AirSense...the AirSense is being reported as being more quiet but the S9 wasn't loud by any means.

In just this short commentary you have already answer emphatically my main concerns in buying a bipap (from PR). The only thing left to ask is this: is there a sound difference between PR 760 and PR 560?

VikingGnome wrote:yes, EPR is available on my machine. I have it set EPR at 2 with IPAP at 22 and EPAP at 18. So I'm getting 6 point difference.

Okay. I will take your word on it but the 4 cm difference between EPAP and IPAP isn't the only selection available...there are more choices.
The S9 VPAP that I had did NOT have EPR available in either the S mode (that's the fixed mode ) or the auto adjusting mode.
It simply wasn't available.
I wasn't aware that EPR has been added because the function of selection the Pressure support (difference between EPAP and IPAP) is really nothing more than what EPR does except it lets you use more than 3 cm reduction.
Bilevel is just EPR with greater capabilities.

Pesser wrote:In just this short commentary you have already answer emphatically my main concerns in buying a bipap (from PR). The only thing left to ask is this: is there a sound difference between PR 760 and PR 560?

I used one of the earlier 550 machines (never used a 560) and went to a 750 bilevel and then 660 and finally the 760.
I couldn't tell that there was any difference in the sound. Some people have said that the bilevel was a bit louder but I never heard it myself.
It would make sense that there would be a motor noise sound change with the change in pressures when using bilevel but it was never something that I noticed. If there is much of a difference I never heard it. Might be more noticeable at the higher end pressures...I only used 10/14 and was asleep when it would go higher so never noticed.
My husband would roll on the floor laughing when I would tell him I wanted so and so machine because it was supposed to be quieter. He says he has never heard any machine noise no matter what machine I have used. Says sometimes he hears my breathing in and out but not anything from the machine.

I get a minor Darth Vadar like sound with inhale and exhale no matter what machine I have ever used. Always have but it is coming from within my head and not the machine.
If I plug my ears with my fingers....that noise doesn't change at all. It's not from the machine itself but from the conductive nature of the hose and the bedding.

I did sit the PR S1 750 down on the bed and sat the S9 VPAP down on the bed right next to it and got my husband to help me listen to see if either one was more quiet than the other. To both of us we really couldn't tell any difference from just the machine noise.

Pugsy:

I appreciate this very much; thank you!!

Pugsy wrote: I don't know that I have seen anymore failures of the Respironics than with the ResMeds but DMEs and doctors get these ideas fixed in their heads and it's hard to get them removed.

I've heard more reports of people with 50 series problems, PR changed the 60 series and put a big honkin screw through the circuit board where the pressure and flow sensors are, and I've heard of some adventurous people opening up their 50's, and reseating the board over the sensors, and clearing up error messages they were having.

sounds like a design flaw, but, again, fixed in the 60 series.