CPAP-APAP vs BiPAP-VPAP for OSA

[GrumpyHere]

Greetings,

New member in Taiwan.

I just had a type 4 home test done by a company who uses these tests as a sales tool.
ApneaLink report shows AHI of 45 with 96% OSA 1% central 3% mixed

Apnea.jpg

So am going to follow up with an ENT doc.

The pricing for the machines here in Taiwan are outrageous.
The ResMed dealer pricing for entry level machine starts around US$2000.

So it is likely that I will be filing paperwork to the local FDA for an exemption to import a machine for personal use.

Meantime I started exploring this CPAP world.

For some people it appears, that they are more likely to be compliant with BiPAP.
But I have read here that for some people BiPAP can trigger CSA

Anyways, after that long winded intro, the question.

Setting aside the higher cost, what are the cons to using a BiPAP for OSA instead of a CPAP?

Thank you for your insights.

[babydinosnoreless]

A bilevel can be set to straight cpap mode, if you need it. You can not get a cpap to give the higher pressures and relief of the bilevel.

[Pugsy]

For some people it appears, that they are more likely to be compliant with BiPAP.
But I have read here that for some people BiPAP can trigger CSA

Actually the number of people who find that bilevel pressures will trigger central apneas is quite low. It's not enough of a problem to keep someone from buying a bilevel device though. I am talking very small percentage of people who have this problem and it can happen with just using exhale relief even on a cpap/apap machine if it is going to happen because exhale relief use creates a bilevel pressure situation.

If you did happen to be a member of that very small minority who find that bilevel pressures trigger centrals there are ways to tweak the machine settings to significantly reduce the chance of that happening.
As an example...I have a friend who gets about 18 centrals per hour when she uses a 4 cm difference between inhale and exhale with the bilevel but essentially has only a rare central apnea when she uses a 3 cm difference between inhale and exhale.

The chances of you being in that very small minority....very slim but if you are in that group there are ways to deal with it.

[Miss Emerita]

In addition to what BabyD points out, I see that your study shows a lot of flow limitation, which is best treated with pressure support. You can get up to 3 cm H2O of PS with a ResMed Airsense 10 Autoset, and it's possible that would address your FLs. But it's also possible you would need more than that.

Just to keep things complicated: for some people, FLs lead to poor sleep; for others they make no real difference.

Yes, PS can lead to central apneas in some people. Of those people, many find that the CAs diminish on their own as the breathing-signal mechanisms adapt. There's no way of knowing ahead of time whether this would be an issue for you.


You could pursue one of two strategies. (1) Go ahead and get a ResMed Aircurve VAuto, knowing it may be more machine than you really need but secure in knowing it has the capacities you might need. (2) Get the Airsense 10 Autoset, knowing that if FLs bother you and PS of 3 is not enough, you will need to try to sell your machine and buy a VAuto. You're really the only person who can weigh the pros and cons.

[GrumpyHere]

Thanks to everyone. This is a great forum. Am learning a lot.

A bilevel can be set to straight cpap mode, if you need it. You can not get a cpap to give the higher pressures and relief of the bilevel.

Good point.

If you did happen to be a member of that very small minority who find that bilevel pressures trigger centrals there are ways to tweak the machine settings to significantly reduce the chance of that happening.
As an example...I have a friend who gets about 18 centrals per hour when she uses a 4 cm difference between inhale and exhale with the bilevel but essentially has only a rare central apnea when she uses a 3 cm difference between inhale and exhale.

The chances of you being in that very small minority....very slim but if you are in that group there are ways to deal with it.

Good to know there are solutions for the problem.

In addition to what BabyD points out, I see that your study shows a lot of flow limitation, which is best treated with pressure support. You can get up to 3 cm H2O of PS with a ResMed Airsense 10 Autoset, and it's possible that would address your FLs. But it's also possible you would need more than that.

Just to keep things complicated: for some people, FLs lead to poor sleep; for others they make no real difference.

Yes, PS can lead to central apneas in some people. Of those people, many find that the CAs diminish on their own as the breathing-signal mechanisms adapt. There's no way of knowing ahead of time whether this would be an issue for you.

You could pursue one of two strategies. (1) Go ahead and get a ResMed Aircurve VAuto, knowing it may be more machine than you really need but secure in knowing it has the capacities you might need. (2) Get the Airsense 10 Autoset, knowing that if FLs bother you and PS of 3 is not enough, you will need to try to sell your machine and buy a VAuto. You're really the only person who can weigh the pros and cons.

FL !!! So I might have additional problems that could be addressed by a higher end machine.

So other than the extra cost, there appears no downsides.

Given the hassles of importing machines, the Aircurve seems a better choice.

The extra cost spread over the 5 years expected operational life isn't too bad.

[Miss Emerita]

That sounds like a good analysis, and it's so fortunate you can afford to go the VAuto route. When your machine is on the way, let us know if we can advise about masks, getting started, etc. Good luck!