What's a good AUTO-BiPAP machine, with at-home reporting?

[johntee]

Hi all... I wondered if I could get suggestions for a good AUTO Bi-Pap machine, that includes good data reporting capabilities (with software so I can check my stats at home).

I've been on Auto-CPAP (not Auto Bi-Pap) for almost 5 years, and still feel awful. AHI's are great (had a third sleep study done at my home-pressure, and the numbers were great except for Spontaneous Arousals). I don't sleep more than 6 hours a night (now; used to be 4-5 hours until Dr prescribed Seroquel + Valium). I occasionally wake up in the mornings with chest (diaphragm?) pain (at middle of chest, a few inches below nipples), which lasts most of the day and which I associate with exertion against the pressure of the machine during the night.

I have my REMStar Auto-M set at the highest C-Flex setting (3), so I'm wondering if I would benefit from a Bi-PAP to get finer control of the exhale pressure, for increased comfort. (Perhaps the exertion of breathing against the pressure is creating the arousals.)

I've also noticed when I get tired during the day, I have shallow (and audible) breathing. So I've made an appointment with a Pulmonary Dr (who is also sleep-certified) in a few weeks, and plan to ask her if a test run with an Auto Bi-PAP might help me. (Or a Bi-PAP titration study, if she "believes" that UARS (upper airway resistance syndrome) might be causing the "spontaneous" arousals, as Dr. Krakow suggests.)

Knowing the way DME's work, I'd like to have her write the Rx for a specific model, so they don't give me the bottom-of-the-line machine. Any suggestions on a good Auto-BiPAP machine that has good home software (and ideally also good algorithms)?

I've been helped immensely by being able to check my stats at home over the years; I don't want to give up that ability if she switches me to an Auto Bi-PAP machine.

Thanks!
John

[cflame1]

In my opinion... for an auto bipap, you really should only look at either the PR S1 Auto Bipap or the S9 VPAP Auto.

[Pugsy]

viewtopic/t70998/What-does-bipap-do-tha ... oesnt.html

The above link may help with the differences between ResMed and Respironics BiLevel machines.
SleepyHead software will work with both brands. Free and easy to use.
Encore Pro and Viewer are available for the Respironics machines and ResScan is easily found for ResMed machines.
For sure go with the newer technology machines that use SD cards instead of the smart cards.

What pressure do you use now on your APAP?

[johntee]

What pressure do you use now on your APAP?

My APAP is set to 5.5 to 8.5. My Average Pressure is 6.4, my Average Peak Pressure is 7.7, and my 90% pressure is 8 cm.

In my opinion... for an auto bipap, you really should only look at either the PR S1 Auto Bipap or the S9 VPAP Auto.

Thanks for that info. I found this topic on another forum -- http://www.apneasupport.org/which-bipap-why-t28636.html -- which describes in great detail the differences in those 2 machines, in terms of algorithms, data capture, etc. (In case that info helps anyone reading this post in the future.)

I thought this section of that post was interesting to note, on the difference in algorithms between the two:
The Resmed S9 VPAP adjusts BOTH the EPAP and IPAP by the same amount in response to OAs, hypopneas, snoring, and flow limitations. Like the S9 AutoSet, the VPAP tends to respond quickly to clusters of events and then slowly reduces both pressures back down at the same rate until more events occur.
The PR S1 BiPAP Auto adjusts EPAP and IPAP independently of each other: EPAP is increased in response to OAs and snoring, and IPAP Is increased in response to hypopneas, flow limitations, and RERAs. In addition to these things, the PR S1 also uses the same "hunt and peck" algorithm that the PR S1 Auto uses to test whether the shape of the wave flow data improves with a slight increase in pressure. The hunt and peck algorithm is only applied to the IPAP pressure for increasing pressure. After events that trigger an increase in IPAP or EPAP are resolved, the S1 does a reverse hunt and peck to find out how far it can lower the pressure: As long as the flow wave remains stable, the PR keeps lowering the appropriate pressure, but if the flow wave becomes more ragged, the S1 will raise that pressure back up to the last level where the flow wave was stable


Based on that, I like the sound of the PR S1 BiPAP Auto's algorithm better...

Thanks alot for the info!! (Now we'll see if the Dr. agrees that a trial with Auto BiPAP is appropriate, since Auto CPAP isn't really solving everything.)
John

[Pugsy]

I have recently changed from APAP to BiPap. Some of my thoughts are here. viewtopic/t71442/viewtopic.php?f=1&t=71 ... te#p656179 just ignore the heated hose stuff. In my post I explained how I came to try it and why I continue. It's been a while since I updated the thread but I continue to be extremely pleased with how things have turned out. Wish I had been in a position to have done this sooner.

Will it work for you? Remains to be seen. Different people respond differently. I just read today that someone had a lot of problems with the inhale and exhale difference in straight BiPap and that was the very thing that I love about it. I still don't know why I sleep the extra hour with the BiPap than I did with APAP. It just happens.

If you could do an at home trial for a couple of weeks that would probably give you a better chance at seeing how things go.

I will also mention that I have used the M Series APAP myself. First machine was APAP with CFlex and second M series APAP had AFlex. So I have used both and I will share this...AFlex was a much better fit for my breathing. Setting of 3 in both made me feel "rushed" in my breathing. Setting of AFlex 2 pretty much matched my own respiration. This continued to the PR S1 APAP I got last spring. Now with the BiPap again BiFlex setting of 2 matches my own respiration. So a setting of "3" may not be the "most exhale relief" if it doesn't match your breathing because Respironics Flex relief is based on breath flow and not a set cm drop in pressure.

[johntee]

So a setting of "3" may not be the "most exhale relief" if it doesn't match your breathing because Respironics Flex relief is based on breath flow and not a set cm drop in pressure.

I actually recently changed it from a "2" to a "3" to see if would help with the chest/diaphragm pain; not sure it's made any real difference. It still happens. (I think I originally had it at a "1" years ago.)

My biggest hope is that a ragged breath-curve is responsible for my "spontaneous" awakenings, and that an Auto BiPAP (especially if the PR S1 lives up to its claims regarding its attention to the shape of the wave flow) might help avoid the fragmented and shortened sleep...

[Pugsy]

My biggest hope is that a ragged breath-curve is responsible for my "spontaneous" awakenings, and that an Auto BiPAP (especially if the PR S1 lives up to its claims regarding its attention to the shape of the wave flow) might help avoid the fragmented and shortened sleep..

It's sure worth a try. I hope it works as well for you as it has for me. So I wish you good luck. I wish I knew why I am feeling so much better on the BiPap but I can't put a finger to anything. Obviously the extra hour of sleep will impact how I feel but even when I get 6 hours of sleep instead of 8, I still feel better than I would normally feel with the APAP and 6 hours.

Keep us posted on how it goes.