Auto bipap versus standard

[JLFitzfamily]

I had to send my Respironics Bi-Pap Pro 2 with bi-flex in for service, and was given a rental by my DME provider. I as given a Respironics M Series Bi-Pap Auto set for conventional Bi-Pap at 12/7. I used it for about 2 weeks, and when it became evident I may have to purchase another machine I asked by MD for a new prescription. He sent me one for the Auto machine at 25/4. I changed the settings on my loaner to Auto and set it up per my prescription. I don't have a card reader, but my AHI during the 7 day period on straight Bi-Pap was .7, and on Auto it was 1.8. Both are low and indicate the therapies are working, but why would it be higher on the Auto? If I have to buy a new machine I'd rather save the $500 and go with a straight Bi-Pap over the Auto if there's no significant theraputical difference. Compliance is not an issue.

Anyone have any thoughts?

Thank you!

[Wulfman...]

Yeah......

Some/most of us just do better on straight pressure than when using auto-adjusting.....whether it be CPAP or Bi-PAP.

An Auto (APAP or Bi-PAP) allows for more options, but for many of us they're not needed most of the time.
In my opinion, the most important feature is "data recording", so a person can monitor their therapy.

Den

[MartiniLover]

My BiPAP Pro 2 with Bi-Flex died after using it for 2 1/2 years.

Faced with buying a new machine, I bought the M Series BIPAP Auto with BiFlex.

I was fortunate to find a used one with 20 minutes on it at a very good price. I opted for it. I paid $785 which included a mask.

After using it in automatic mode, for several weeks, I reset it to straight BiPap and it has been there ever since. The machine may have all the bells and whistles but I don't use them.

I wish I had my old machine back working, as I liked it better. It was quieter, and the humidifier didn't have to be filled every day.

Live and learn. Those bells and whistles were tempting.

[rested gal]

my AHI during the 7 day period on straight Bi-Pap was .7, and on Auto it was 1.8. Both are low and indicate the therapies are working, but why would it be higher on the Auto?

My guess is it's higher on the BiPAP Auto simply because of the very low EPAP setting the doctor prescribed.

With minimum EPAP (exhale pressure) set way down at 4, that machine is starting out each night delivering only 6 for inhale and 4 for exhale. If, during the night, you have apneas that would require, say, an EPAP pressure of 10 to eliminate, the machine is going to take awhile to get up there from that low starting point of EPAP 4.

Machines that can auto-titrate (vary the pressure as needed) are designed to do their pressure changes rather slowly. They aren't going to just jump right up from 4 to 10 the instant an apnea happens. They are going to work their way up, checking to see if the situation is improving as they go. It could be very sleep disrupting for a machine to be constantly yo-yo'ing way up and down throughout the night. So, machines that can auto-titrate are designed to make the changes going either way be smooth and gradual.

However, to me, this means it's important to have the EPAP pressure set up pretty close to what will PREVENT apneas in the first place. The machine won't have so far to go to do its job if sudden apneas hit, like when you turn onto your back or go into REM sleep....situations where most people have their highest number of apneas/hypopneas.

Given that your previous bipap settings were 12 IPAP / 7 EPAP, I think (but I'm not a doctor!) that a far better setting range if the machine is going to be used in auto bi-level mode would be IPAP 20 / EPAP 7 .

Set for 20/7, the machine would start out using 9 for inhaling (it always starts out using an IPAP of 2 cms more than the EPAP pressure) and 7 for exhaling. During the night, either pressure would go up independently of the other pressure, as needed.

By the way, there's another setting to check when using the M BiPAP Auto in auto bi-level mode...the "Max Press Sup" setting. I'd set that at 8, the most it will allow, to give the two pressures (IPAP and EPAP) as much independence as possible to operate separately from each other.

To answer your main question...if you were comfortable with BiPAP at 12/7 and were getting good treatment (which it sounds like you were) there's no particular reason for you to get the bipap auto.

It's not a machine that I need at all. I get good results and quite comfortable treatment with a straight cpap set at 10 cm H20 and no exhalation relief at all. I use the bipap auto because I like the additional comfort breathing out with a bi-level machine, and I like the assurance of auto-titration giving more pressure if needed. Especially on nights when I might have congestion or any number of reasons why a little more pressure can help.