Machine recommendations

[Shari]

I am currently using the ResMed VPAP III. I am looking to upgrade. I do not fully understand all the different components. C-Flex, Bi-Flex, A-Flex - What are they and why might I want one over the other?

I would also like recommendations for a data capable BiPAP. And why you would recommend this machine?

Thanks
Shari

[rested gal]

Since you are already using a bi-level machine, I'd go for the Respironics BiPAP Auto with bi-flex.

Why?

Because:

1. If you turn on "auto-titrating" you'll be using it as two machines in one...as a bipap and as an autopap, at the same time. Or, you can always use it as just a bipap if you prefer.

2. Ability to use Encore Pro software. Much more useful, imho, than the Autoscan software resmed machines use.

3. Bi-Flex. More comfortable, imho, than using a "rise time." However, the machine does have a rise time setting if a person prefers that to using bi-flex.

[Shari]

Thanks for the recomendation I was looking at that machine....

But, what is Bi-Flex? I am still pretty ignorant of these things. I don't understand rise time, but I set my machine the way you recommended for someone else and it is much more comfortable. I could not tolerate BiPAP until I made that change.

[Can't remember username]

Perhaps Rested Gal can answer this for both of us.

What about the Respironics Biflex SV? Do you have any experience with it - any comments? My machine, RemStar Auto sometimes runs away with the pressure and when the pressure is so great I wake up and am breathing really shallow. I know it is an expensive machine. Is it worth it? Of course, I have to see if my insurance will go for it.

[rested gal]

What about the Respironics Biflex SV?

I'm not sure which machine you're thinking of. There's no machine named exactly that. You're probably thinking of one of these:

Respironics BiPAP Auto with Bi-Flex

or

Respironics BiPAP Auto SV (nicknamed "HeartPAP")

The first is the one I use. Not because I need to use a BiPAP, but because I really like the comfort of complete exhalation relief when using a "bipap." I also like auto-titration varying the pressure as needed. So I like that machine for being "two machines in one" that can be used both ways (bipap and autopap) at the same time.

Bi-Flex in BiPAP machines: softens or rounds out the inhale pressure and exhale pressure. Instead of abruptly starting each of those pressures right at the pressure, bi-flex makes it be a softer transition. For example, when you breathe out using bi-flex, the already lower EPAP pressure will drop even a tad lower right at the beginning of the exhalation...softening it even more. It will let the "regular" EPAP pressure appear before you finish exhaling. Much the way C-Flex drops the beginning of pressure when exhaling with a cpap with C-flex or autopap with C-Flex. I think of bi-flex as "icing on the cake" for extra exhalation relief while using a bipap machine.

The second machine is a very specialized machine -- not what the vast majority of us need at all. I wouldn't be looking to buy an ASV (Adapt Servo Ventilation) type of machine just as an "upgrade" or because it might be the most expensive type. The SV or ASV type machine is for a particular purpose...to normalize breathing disorders than involve a LOT of central apneas (not just a "few" centrals.) I'd rule out thinking of buying an "SV" type of machine at all unless a sleep doctor said there was a specific reason you needed that kind of machine.

For people who don't absolutely need Adaptive Servo Ventilation (SV, AS, ASV), that kind of machine could be a most uncomfortable type of machine to try to use.

[Nazareth]

The ASV is ,ore like a Bipap S/T with, I believe, Spontanious pressures and timed pressures,- the machine is used for treating Central Apneas, and complicated Apneas that don't respond well to regular CPaps and Bipaps. The mahcine will run around $4000 or so- I think you would need a doctor's ok and be prescribed the ASV or Resmed SV- These machines however are fairly 'new' to the markety and not many Docs hav3 experience with htem yet- Also, another drawback, is that DME's don't have much experience with htem either (Although I'm sure you can find some that do- but it seems quite a few won't have used them much or at all) so one thing you'd have to decide on as well would be the fact that you might not get good service for hte machine (unless you have a good DME)

[Can't remember username]

I appreciate the information. I will get the Respironics BiPAP Auto with Bi-Flex. At my original sleep study that I had a few years ago it was suggested that a BiPap would be good for me, but it wasn't available in an AUTO so that is why I initially got the RemStar Auto. At my last visit I asked my doctor to prescribe the new BiPAP AUTO and he did. My doctor is a nice guy and will basically go along with what I want and he is a sleep doctor! I'm lucky. Thanks for explaining why I don't want/need the other machine.

Also, I'm hoping to access my username and password that I can't remember.

[StillAnotherGuest]

For people who don't absolutely need Adaptive Servo Ventilation (SV, AS, ASV), that kind of machine could be a most uncomfortable type of machine to try to use.

While the ResMed AdaptSV can create patient dyssynchrony with it's Target Ventilation philosophy (seen most often in Wake/Stage1 transitions), fidddling with the Respironics BiPAP AutoSV seems to indicate that that might not be an issue with that machine. Even though it looks at a 4-minute floating window, AutoSV seems to be far more "breath-to-breath friendly" than AdaptSV.

And of course, this only relates to the Wake state, with a study group of "one", and he don't have CompSAS either.
SAG

[Slinky]

Shari, I'm not familiar w/your current Resmed VPAP III but in checking it out at cpap.com

https://www.cpap.com/productpage-advanced.php?PNum=803

altho it doesn't come w/a data card or have data card capabilities the info does say it can use AutoScan which is the Resmed software.

Have you tried holding down the Left and Right buttons simultaneously for 3-4 seconds? Does Efficacy Data pop up in the LED screen?

Also if you scroll down the above URL page there is a link to "Understanding Bipap, Bilevel, and VPAP" which is a video 02:42 minutes long that helps to clear up some of the differences between Bipap, Bilevel, and VPAP.

[Nazareth]

My BipaP S/T isn't very breath to breath friendly at all when awake- when hte machine Ipaps- you'd better be breathing in or else lol.

Guest- are you on the Respironics ASV? If so, do you find that your breathing goes out of sych with the machine and find youself breathing out whilke the machine is Ipaping? Wikll your machine autoswitch to Epap immediately when htis happnes?

I find I can deal alright with the out-of-sync breathing with my S/T but it does get kind of annoying- I'n not sure what happens after I fall asleep- but it would seem to me that if I get out of sync, it would semi-wake me up- thus kind of defeating the purpose of the machine as far as getting a more restful sleep. Sure would like to give the Respironics ASV a try- but doubt my Doc would recomend it unfortunately.

Can't remember username- Could you tell your Doc to take me on as a patient? lol I NEED a good doctor who will work with me and not treat me like I'm bothering them, or they are in a hurry, and can't take 5 extra minutes to explain anything to me. My Doctor held up the whole process for getting hte machine for 6 long months- insisting that he needed a 'Variance" from Medicare before he would write the perscription- like a dummy, I didn't check with Medicare myself for 5 1/2 months- I just took it on faith that the Doc needed a variance- but lo and behold- Medicare doesn't issue variances, and the Doc shouldn't have even requested one from them- so, I could have had the machine in the first month if I had checked it out myself, but unfortunately, I just assumed that's what was needed before I could get my maching-- Then, His office lied to me, saying Medicare 'just changed the rules for requirements," and that I now "Was covered and my results met the requirements" -- Sounds reasonable, right? Well guess what- Medicare didn't 'just change anything', and I my test results had met the requirements all along!!! Needless to say, I'm VERY dissappointed not onyl with my Doc- but with the DME who instigated the whole hting by telling the Doc they needed the Variance in the first place. I was in a 6 month "Pass the buck" circular run arouind- not knowing who to speak to or what even to ask- Medicare said to me "They told you they need a Variance? We've never heard of a doctor requesting a Variance for a machine"

I'm like the reverse of King Midas- Everythign I get invovled in turns to mud very quickly- I just can't seem to find a Doc that is willing to go out of their way and help- instead, I get Docs that can't be bothered and get all crabby when asked for help. We finally got one good Doc in town, and he's actually the one who suggested my health problem might be apnea related, but now he's left for another city- sigh - Just my luck

[Shari]

Have you tried holding down the Left and Right buttons simultaneously for 3-4 seconds? Does Efficacy Data pop up in the LED screen?

Yes, but the data is very limited. It is better than nothing but I would like something with a bit more detail.

Auto BiFlex is sounding very appealing.

[Nazareth]

Yeah, that's one hting about my Bipap S/T- no data available onscreen- so i have no idea if I'm even benifitting properly, how many apneas I'm having, or anything.

[Slinky]

I thought all bi-level machines were fully data capable. Live and learn!!! If I ever need a bi-level I will have to be sure to thoroughly check out which one I want vs which one they "try" to give me!!!

[StillAnotherGuest]

Guest- are you on the Respironics ASV?

No, I really don't have anything to give it a real workout. I can "feign" events to see how it works:

BiPAP AutoSV 10/5 Addressing "Central Apnea"



but the goal of ASV should really be to stabilize breathing, break the cyclical nature of CSA or CompSAS, rather than simply try to drive through it, so that will be the real test.

I find I can deal alright with the out-of-sync breathing with my S/T but it does get kind of annoying- I'n not sure what happens after I fall asleep- but it would seem to me that if I get out of sync, it would semi-wake me up- thus kind of defeating the purpose of the machine as far as getting a more restful sleep.

In Wake, this thing seems to be very comfy. In Auto Mode, when a central apnea occurs, BiPAP AutoSV waits for 8 seconds before it sends in a breath. I'd really like to see how that will address events in practice, or if that turns out to be too long, and creates an issue.

You can, of course, set a back-up rate, but choosing a back-up rate might require a little more intervention than simply wingin' the dial around, and you might end up in the same boat you're in now. But right, if overall you don't gain anything in regards to sleep quality, ya gotta wonder.

Sure would like to give the Respironics ASV a try- but doubt my Doc would recomend it unfortunately.

It might be a little early, the rule of thumb is never buy a car made on a Monday.
SAG

[dsm]

SAG,

Great to see your highly valued input & presence again

I gather you have your hands on a Bipap SV ?

DSM