AVAPS vs Bilevel and which machine is best

[LookingUp!]

Raisedfist,

I noticed that you posted this on another thread:

"PR BiPAP AVAPS is a non-invasive ventilator...the machine auto-adjusts when AVAPS is enabled but to target an average tidal volume. Treating OSA is not the primary intention and the machine will not respond to OSA events."


I guess I'm confused as to why the PR BIPAP AVAPS will not respond to OSA events. Should I not be concerned about those? I don't actually have many other kinds besides centrals at my current pressure but I thought that was because of using the AirCurve 10 VAUTO. I also have more hypopnea than obstructives but very few of both kinds overall.

I think I've decided to start out with the ResMed AirCurve ST-A since insurance will pay for it. But I've found a place where I can buy a new PR BiPap AVAPS if the AirCurve doesn't work well for me. I just keep thinking that even after the sleep study I came home short of breath for several hours. I will always wonder if the ST-A might have worked better if I don't give it a try.

I'm sure the DME isn't happy to see machines brought back used, hopefully they have a great way to make money from selling used equipment. If I go ahead and buy the PR BiPap AVAPS, I'll know that I need to just keep working at it get it to work the best I can for my need.

[Matt00926]

Raisedfist,

I noticed that you posted this on another thread:

"PR BiPAP AVAPS is a non-invasive ventilator...the machine auto-adjusts when AVAPS is enabled but to target an average tidal volume. Treating OSA is not the primary intention and the machine will not respond to OSA events."


I guess I'm confused as to why the PR BIPAP AVAPS will not respond to OSA events. Should I not be concerned about those? I don't actually have many other kinds besides centrals at my current pressure but I thought that was because of using the AirCurve 10 VAUTO. I also have more hypopnea than obstructives but very few of both kinds overall.

I think I've decided to start out with the ResMed AirCurve ST-A since insurance will pay for it. But I've found a place where I can buy a new PR BiPap AVAPS if the AirCurve doesn't work well for me. I just keep thinking that even after the sleep study I came home short of breath for several hours. I will always wonder if the ST-A might have worked better if I don't give it a try.

I'm sure the DME isn't happy to see machines brought back used, hopefully they have a great way to make money from selling used equipment. If I go ahead and buy the PR BiPap AVAPS, I'll know that I need to just keep working at it get it to work the best I can for my need.

With the BiPAP AVAPS, you set a static EPAP to deal with obstructive events and keep your airway open. Same with the AirCurve ST-A devices. So, you set your volume target, then raise EPAP until OSA events all but go away. The EPAP will not auto-adjust on either of these machines.

Only a device with the "AVAPS-AE" mode will use Auto-EPAP. ResMed has a device with Auto-EPAP as well. I believe for both Resumed and PR you would need their advanced ventilators to use Auto-EPAP (Such as the PR Trilogy or ResMed Astral), but I don't know the specifics. And it's not really necessary.

As i mentioned earlier, in light of your NMD, most likely the central apneas are just due to muscle weakness and you aren't able to trigger a breath on your own sometimes. Most likely it's not the case of complex sleep apnea that is traditionally known. ResMed recommends those with central apneas and respiratory illness to use either ST or iVAPS modes. I think I mentioned this before, but the ASV machines would more than likely underventilate you and they are not cleared for those with respiratory insufficiency (they call it profound hypoventilation).

Good luck with the ST-A. If you make further posts using that machine, and include charts, I will do my best to help you if I can.

I wouldn't read anything into still being breathless after your sleep study. You probably didn't sleep well in a foreign environment and you had wires all over you. Plus they titrated as the night went on, so they tweaked things as the night went on. Either way, even with a perfect night of sleep, I doubt you'd feel THAT much better after just one night of proper sleep.

[LookingUp!]

Hi Matt,

Thanks for the input. Both Raisedfist and you have recommended the PR BiPap Pro over the Resmed ST-A. Should I just go ahead and buy it and not try the ST-A, just cancel that even though insurance will pay for most of the cost?

I'm fed up with DME's right now and my doctor doesn't respond to messages so I feel like I'm on my own anyway. I also think I would do better without the worry of needing to be in compliance constantly.

I woke up early a few days ago, stayed in bed but kept watching the clock. I was dealing with some pain but continued to lay there instead of getting up. I realized that the only reason I was still laying there was for DME & Insurance compliance purposes.

Can I send you a private message with a website that sells the PR BiPap AVAPS? It's the lowest cost I could find, yet it's still expensive. They give very little information. I sent that company a message a few days ago asking if the units they sell are new and if they come with any kind of a warranty. I think by the model number there isn't a heated hose. I use one of them now on my ResMed and want one if I get the DreamStation.

Do I need to buy something with a cellular or WIFI connection? I think the base model is BlueTooth only. If my doctor ever took the time to see the info from the machine, is Blue Tooth good enough if I'm uploading it onto my phone? I assume when I would upload it to see the info through the app on my phone that it also gets uploaded to Philips Respironics but don't know that either.

I know almost nothing about the DreamStation. I would need to get a heated hose and extra filters, that shouldn't be too hard.

I think I would have already ordered it but don't know if I've covered all bases. I wasn't sure if I should venture out completely on my own asking ones like you, raised fist and others for help on the forum for help. Sometime early next year I'll probably try to find a new doctor but I don't want to wait any longer to try to switch to either an AVAPS or IVAPS.

I'm trying hard to learn about my own SleepyHead results and what all of you can see that I don't. I don't want to be in the dark.

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[LookingUp!]

I don't know how to do thumbnails, sorry.

[LookingUp!]

Since my doctor set the Tidal Volume at 470 for the new machine, it's easy to see that's too low. I can also see the minute ventilation is too low and often the Respiratory Rate as well. I can understand that its' due to the muscle disease and weakening diaphragm, possibly chest wall muscles too. What else do I need to know, what does those of you that know how to read the charts see?

I fully understand that none of you are my doctor so no worries there. I just want to understand what my doctor is seeing if he were to see those charts.

Whether getting the ResMed through the DME or buying the AVAPS outright, I hope to have a new machine here by Friday if possible.

[Matt00926]

My other username is RaisedFist...sometimes I just forget to switch because I have a few different computers.

How you get more tidal volume is by raising PS...but if you do that, most likely you'll just get more centrals...until you can get a machine with a backup rate.

You definitely don't want a BiPAP Pro model...you specifically want the System One BiPAP AVAPS, or the DreamStation BiPAP AVAPS. They both have the same exact therapy modes and settings, but the System One is much cheaper since it's older.

It's really up to you on ResMed vs PR. With the ResMed, most likely you won't get much help from your doctor. This forum is 99.9% for sleep apnea...there are not very many active users here using a bi-level device for ventilation purposes.

[LookingUp!]

Is there a different forum with more people that use a BiLevel device for ventilation purposes? I just want to learn all I can.

[palerider]

I don't know how to do thumbnails, sorry.

See the instructions in my sig on how to pose screenshots that aren't just a waste of your time.

[LookingUp!]

It's been a while since I updated this thread. I ended up with Shingles for a while and other health issues.

In January, I got a DreamStation BiPap AVAPS. It's a good machine. I think the Sleep Technician did a good job finding the right settings for me. I don't have a desire to change them.

I still have too much shortness of breath but I think that's neuromuscular related not because of the machine.

It's nice having the backup rate. I've also felt a little increase in my muscles due to getting more air at night.

I've never used the ResMed AirCurve ST-A so I can't compare that but as far a ResMed compared to the DreamStation, there are things I like about the ResMed better.

1. The humidifier tank is bigger on the ResMed. I always run out of water in tank at night with the DreamStation. Hopefully when winter is over that won't happen.

2. I like the smaller size of ResMed on my table. But that's not a big deal, just a difference.

3. I can't use SleepyHead with the BiPap AVAPS. I miss SleepyHead. I've already sent a message to Bonjour letting him know that I'll gladly Beta Test at some point or just offer information from my SD Card if development gets that far.

I am using EnCore but it's just not the same. Nevertheless, I am very grateful for the BiPap AVAPS. It is a good machine for me.

My AHI has never been above 1.5 since I started on this machine. 90% of the time it's .5 or lower.

Another interesting thing is that I'm actually dreaming again sometimes. It had been years since I was dreaming before the BiPap AVAPS. So I guess that means that I'm going into the various sleep cycles now. I am still somewhat tired but that's getting a little better too.

My biggest issue at the moment is I've gained weight and water weight since starting BiPap last summer. But I've changed my diet some in the last few days and can already tell a difference in some of the water retention. Now to start working on a different diet. My hunger seems to have gone crazy since starting on a machine.

Its kind of crazy and sometime scary how dependent I am on needing to use the machine now. I think because of the neuromuscular issue, I no longer have a choice to use it.

I know that many of you would never choose to not use a machine. My attitude isn't quite their, but I'm getting there.

Thanks for all the help and encouragement getting this far.

[palerider]

Another interesting thing is that I'm actually dreaming again sometimes. It had been years since I was dreaming before the BiPap AVAPS. So I guess that means that I'm going into the various sleep cycles now.

It means your sleep is being interrupted during your dreams.

The brain doesn't form memories while asleep, so, you won't remember a dream unless you're waked up during, or right after it.

You can dream in any sleep stage.

[LookingUp!]

Another interesting thing is that I'm actually dreaming again sometimes. It had been years since I was dreaming before the BiPap AVAPS. So I guess that means that I'm going into the various sleep cycles now.

It means your sleep is being interrupted during your dreams.

The brain doesn't form memories while asleep, so, you won't remember a dream unless you're waked up during, or right after it.

You can dream in any sleep stage.

So is it a good thing or not a good thing that I'm dreaming sometimes now? I guessing you're saying that dreaming causes poorer quality of sleep? I didn't know that!

[palerider]

I guessing you're saying that dreaming causes poorer quality of sleep? I didn't know that!

I'm saying that remembering your dreams is a sign of interrupted sleep. Dreaming doesn't affect the quality of sleep.