I have a choices of 4 xPAP for OSA and CSA, any tips?

[DanGr]

Hello,

First of I am from Canada so model availability and name seems to change a little, here are my 4 options (that my DME gave me), as per my prescription I need a BiPAP 16/8 Frequence 14. (I know I have a 54 events per hour, mostly OSA but some CSA also).

Here are my options that my DME gave me (Price are in Canadian, although now the american and canadian dolor has the same value):

Respironics Bipap Harmony2 5175$

Respironics BiPap Synchrony ST 5860$ (the one he suggest me)

Respironics Bibap Auto SV2 6910$

ResMed Autoset CS2 6910$

(RESMED VPAP doesn't seems to be available in Canada)

Note: Autoset CS2 seems to be the equivalent of the Adapt SV, is there any difference between them?

I know I need a ST (or Timed) xPAP as a minimum, I am just wondering if the Auto SV2 or Autoset CS2 would be worth it at 1000$ more, as in, would it be more comfortable than a normal ST.

At those prices, even though the insurance will pay most of it, I want to be sure of my purchase!

Oh while at it, any mask recommendation? I don't think I breath using my mouth at all or very little.

Thanks for any Input,
Daniel

[Sergey45]

You can take a look at my mask’s diary. It’ll give you some ideas and directions to go (perhaps). Good luck.

[Snoredog]

if it were me I'd get the AdaptSV models, they have shown to stabilize breathing much better than the S/T models, if that is what happens in your case you don't need the timed back up mode.

I'd be looking at this one:
https://www.cpap.com/productpage-advanced.php?PNum=2471

[Snoredog]

You can take a look at my mask’s diary. It’ll give you some ideas and directions to go (perhaps). Good luck.

You are starting to get annoying just like SPAM, it is obvious you only post to promote and peddle your own CPAP accessories. Your response has nothing to do with this persons question, it wasn't about masks at all.

[ozij]

Here's a comparison form someone who used many of them and has severe CSA.

chrisitinequilts comparing machines

I suggest you read the whole - long - post.
Here are the last 2 paragraphs; she's referring to the Adapt SV; note the comment on how it handles obsturctive apneas. And do read the whole post which explains a lot of the differences between the machines.

So why does it work exactly- that's still a little fuzzy, the 'magic dust' component I mentioned. CSA and CSDB are extremely complex disorders and its a machine built to match. It is very good at stabilizing unstable breathing of central events for some people, when all else has failed. Its almost scary sneaky, uncanny, in how it can get me to breath, even if I try to hold my breath it has me inhaling before I even realize it; the same goes for trying to breath through my mouth with a nasal mask on. So if its that great for centrals, what about obstructive events? It doesn't do much and the the base pressure, or EEP, has to be set above were obstructive events would be cleared (or in my case, where I was comfortable, based on several years pressure on BiPAP ST). If we go back to the Drill Sargent analogy with the BiPAP ST at times, the Adapt, to me, feels like a graceful ballroom dancer who sweeps you off your feet. Dancing on air is an apt description, as is having someone reading your mind & giving you what you need before you realize you need it. If anyone can't tell, I love my Adapt, especially since its the first thing that's been able to normalize not only my breathing, but also my sleep on many levels neither my sleep doctor nor I anticipated. I think having more Stage 3/4 sleep in my Adapt titration then in 4 previous PSG's combined can give a glimpse at what it can do in some cases of extremely complex sleep disorders.

The Adapt has its drawbacks- price and insurance coverage are two cannot not be overlooked. It is equal price wise to regular BiPAP ST and has the same basic requirement for documentation of medical necessity. Its not widely used and not all sleep doctors & sleep labs are familiar with it, or set up to titrate it. It is very picky about which masks are used with it, limited to 4 of the 5-6 ResMed masks being approved and able to pass a Learning Circuit which much be run any time something is changed in the circuit. It also uses a specialized hose, with an external sensor line.

O.

[rested gal]

I don't know a thing about your medical history, nor about what exactly showed up in your sleep study, Dan. Nor am I a doctor.

With all that said, and just giving my layman's opinion, I'd get the Respironics BiPAP Auto SV. The machine at the link Snoredog provided.

The "Frequence" number you referred to is probably the timed backup rate the machine will be set for... the number of breaths per minute the machine will be calculating you are taking.

As I understand what a timed backup rate does (I could be stating this wrong) is... if your breathing doesn't indicate you'll be taking 14 breaths during one minute, the machine will switch to IPAP (inhale) pressure prematurely...before you've finished exhaling...in an attempt to nudge you to take another breath sooner. That's in case your slowed breathing is a central apnea -- brain not sending a timely signal to "breathe now."

As long as you're breathing spontaneously (on your own) at a rate that will be at least 14 breaths per minute, the machine will go along smoothly with your inhale/exhales and not deliver a "timed" pressure change.

I mention all this because once you get ANY machine that has an adjustable timed backup rate set, you may occasionally feel like the machine is fighting you...hitting you suddenly with a higher pressure while you're still exhaling. If that happens a lot, you might want to speak to your doctor about lowering the "Frequence"...the timed backup rate...to 12 or 10.

If I had pure Central Sleep Apnea, I'd want the resmed machine. But if I had mostly Obstructive Sleep Apnea accompanied by a significant number of central apneas, I'd want the Respironics BiPAP Auto SV.

Another thing about those two different brands. You'll have a very limited selection of masks that can be used with the resmed machine. The mask should be able to pass a "Learn Circuit" routine with that machine. You can use any mask with the Respironics machine.

Actually, before I accepted that I really, REALLY had to have a machine set for timed backup rate operation, I'd want to get a second opinion on my sleep study results. A second opinion from a doctor completely unassociated with the first doctor. I'd want to know that the central apneas that showed up on the study were a significant enough problem that I really needed a timed backup rate machine or an adapt servo type of machine.

As I understand it (again, I'm no doctor) central apneas can show up during a sleep study for a number of reasons that don't necessarily mean a person will have that many centrals during more conventional cpap/bipap treatment later. I've read that it's normal for some people to have quite a few random centrals during sleep... doesn't mean they have "Central Sleep Apnea."

I'd want to know if I truly had a significant central sleep apnea problem. Timed backup machines could be less comfortable due to the pressure changes being sent to you...ready or not. I'd want the resmed adapt servo machine if I had pure central sleep apnea or more central than obstructive.

If, by chance, you happen to have CHF (congestive heart failure) then you probably do have a significant central apnea problem when you sleep. I'd want the resmed machine in that case.

[AdmiralCougar]

Oh while at it, any mask recommendation? I don't think I breath using my mouth at all or very little.

Thanks for any Input,
Daniel

You can take a look at my mask’s diary. It’ll give you some ideas and directions to go (perhaps). Good luck.

You are starting to get annoying just like SPAM, it is obvious you only post to promote and peddle your own CPAP accessories. Your response has nothing to do with this persons question, it wasn't about masks at all.

Hey Snoredog, bit snippy today? You sounding like you need a huggle *huggles up Snoredog* OK just had to say he did ask about mask suggestions.

And Daniel good luck on picking the right equipment for you. I'm really glad they are giving you the choice, and not just shoving one or the other at you.

Christy

[DanGr]

Thanks all for those fast replies!

First: As per the previous reply, that is what the DME propose based on my prescription (actually they only proposed the Harmony2 and Synchrony ST, I am the one that inquired about the other ASV models).


I did read a lot of information on this forum including many posts from Christine, heck the post you are refering to ozij I have it on bookmark! (many from rested gal too). I am glad to have found this forum!

The first test I did were from home one night (not titrated), this one reported 51 events on average per hour:

CA= 1.5 (13 sec average - 20sec max)
OA=36 (20 sec average - 67 max)
Mixed=2 (30 sec average - 63 max)
HY=11 (32 sec average - 87 max)

So it seems I do have some Central apnea but it seems very little (or is it that the home test isnt accurate for Central Apnea?), I know I notice them from time to time when I am about to fall asleep (or I wake up from them often when I fall asleep watching tv, etc). I have the test from this session, not always easy to understand what they mean.

Then I did a manual titration in a sleep clinic for a full night with a mask and all (that test I am waiting on the result, my lung specialist gave me the first summary page since he got it faxed in advance). I know they started me on cpap then to bipap and as per the specialist conducting my test she implied to activate a module to counter the central (I think it woke me up since it felt like the ipap/epap seemed to be out of synch with my natural breathing).

But yeah, I am pretty sure by frequence they mean the times backup rate, to ensure I will at least inhale 14 times per minute.

So I do have Central Apnea, I just don't know if it is a lot or not (it seems to not be a major problem) and if it would justify to spend 1000$ to get either the Autoset CS2 (Adapt SV) or the BiPAP auto SV2 (assuming the insurance would want to pay the extra 1000$!).

I do not have CHF as far as I know.

Based on what you are saying Rested Gal, if my Central Apnea is very little then I might not need a ST/ASV xPAP that cost more, if I do get one worse case I don't use the Time functionality much or not at all and it is the same (I just spend a little more for nothing) right?

So in the end, do I get the Synchrony ST or it is worth trying to fight for a AutoSV PAP?

Note: Any good thread about the REpironics BiPAP Auto SV (or SV2) I can't seems to find them well when using the search). based on what you are saying both ASV (Resmed and respirnonics) seems to be doing pretty much the same but respironics would open more option for mask so maybe that would be the bext option (respironics).

Based on Christinequilts the Resmed version seems to work very well.



Regards,
Daniel

[DanGr]

Hey again,

I got my titration test tonight, I think they must take a course on how to write that stuff so we can't understand what they mean! Basically it seems I had weird patterns during my test including some OSA, CSA and Mixed but it seems to imply I had more CSA than OSA (then again I guess its normal that the OSA would be less sicne I was under 'pressure'). My home test was showing lots of OSA for few CSA/Mixed (can see it in my previous message).

Unfortunatly I don't think my lung doctor knows much about special cases so I need to assume many things or learn for myself.

I re-read a bunch of threads, the DME suggested the Repironics Synchrony ST based on my prescription (BiPAP 16/8 FR14), the way I see it the Respironics BiPAP Auto SV2 would do the same or maybe a little better for just a little more $$ so I think I will try for that and see what my insurance say (I don't want to wait for too long before I submit my request and lose a few weeks waiting for answers).

I would rather have a better model and not use it all than a slightly less advanced model then finding out I should have gone with the better one.

I plan to lose at least 45-55 pounds so at that point maybe my main problem will be the CSA and less the OSA.

Anyway, I wish my decision was for a 1000$ CPAP instead of a 6000-7000 ST or ASV!

Always open to comments if you think I am making a mistake or something!

Daniel

[Snoredog]

Thanks all for those fast replies!

First: As per the previous reply, that is what the DME propose based on my prescription (actually they only proposed the Harmony2 and Synchrony ST, I am the one that inquired about the other ASV models).


I did read a lot of information on this forum including many posts from Christine, heck the post you are refering to ozij I have it on bookmark! (many from rested gal too). I am glad to have found this forum!

The first test I did were from home one night (not titrated), this one reported 51 events on average per hour:

CA= 1.5 (13 sec average - 20sec max)
OA=36 (20 sec average - 67 max)
Mixed=2 (30 sec average - 63 max)
HY=11 (32 sec average - 87 max)

So it seems I do have some Central apnea but it seems very little (or is it that the home test isnt accurate for Central Apnea?), I know I notice them from time to time when I am about to fall asleep (or I wake up from them often when I fall asleep watching tv, etc). I have the test from this session, not always easy to understand what they mean.

Then I did a manual titration in a sleep clinic for a full night with a mask and all (that test I am waiting on the result, my lung specialist gave me the first summary page since he got it faxed in advance). I know they started me on cpap then to bipap and as per the specialist conducting my test she implied to activate a module to counter the central (I think it woke me up since it felt like the ipap/epap seemed to be out of synch with my natural breathing).

But yeah, I am pretty sure by frequence they mean the times backup rate, to ensure I will at least inhale 14 times per minute.

So I do have Central Apnea, I just don't know if it is a lot or not (it seems to not be a major problem) and if it would justify to spend 1000$ to get either the Autoset CS2 (Adapt SV) or the BiPAP auto SV2 (assuming the insurance would want to pay the extra 1000$!).

I do not have CHF as far as I know.

Based on what you are saying Rested Gal, if my Central Apnea is very little then I might not need a ST/ASV xPAP that cost more, if I do get one worse case I don't use the Time functionality much or not at all and it is the same (I just spend a little more for nothing) right?

So in the end, do I get the Synchrony ST or it is worth trying to fight for a AutoSV PAP?

Note: Any good thread about the REpironics BiPAP Auto SV (or SV2) I can't seems to find them well when using the search). based on what you are saying both ASV (Resmed and respirnonics) seems to be doing pretty much the same but respironics would open more option for mask so maybe that would be the bext option (respironics).

Based on Christinequilts the Resmed version seems to work very well.



Regards,
Daniel

You need to go by what the PSG titration said and what the doctor prescribed. "IF" your doctor left your therapy into the hands of the DME to fill, I'd be looking for a new doctor.

NO you don't have Central Apnea, you have central and mixed apnea that show up on your PSG but it doesn't mean you have Central Apnea and need a Bipap S/T machine. In order to have Central apnea it has to be your primary disorder or a CA indice greater than >11 per hour. You are only at 1.5, those may go away with CPAP therapy.

Mixed apnea is simply a obstructive apnea combined with a central apnea. Apply CPAP therapy and those turn into residual CA events. If you have long periods of CA where you forget to breathe then yes you would need a machine like a S/T to hopefully kick start your breathing.

If you had a case where you needed that or the AdaptSV machine, I'm sure the sleep lab would have recommended that on your PSG, otherwise you can get by with a Bipap Auto. If you have the waxing and waning seen with Cheyenne Stokes Respiration then the AdaptSV would be the machine I'd want. I would want something that restores normal breathing.

I'm not a doctor and haven't seen your PSG but from the numbers posted I don't see where a Bipap S/T or a Bipap AutoSV is even warranted.

Because of the 15cm pressure requirement the Bipap is a good way to go, but do you really need that $4300 machine as opposed to the $1250? one. Now if you did worse on CPAP (lab should have seen that), then hey the SV is the way to go.

[Snoredog]

Oh while at it, any mask recommendation? I don't think I breath using my mouth at all or very little.

Thanks for any Input,
Daniel

You can take a look at my mask’s diary. It’ll give you some ideas and directions to go (perhaps). Good luck.

You are starting to get annoying just like SPAM, it is obvious you only post to promote and peddle your own CPAP accessories. Your response has nothing to do with this persons question, it wasn't about masks at all.

Hey Snoredog, bit snippy today? You sounding like you need a huggle *huggles up Snoredog* OK just had to say he did ask about mask suggestions.

And Daniel good luck on picking the right equipment for you. I'm really glad they are giving you the choice, and not just shoving one or the other at you.

Christy

[Guest]

You need to go by what the PSG titration said and what the doctor prescribed. "IF" your doctor left your therapy into the hands of the DME to fill, I'd be looking for a new doctor.

Thanks for the reply, actually no, the lung doctor did prescribe a Frequence 14 (so I need a ST xPAP as a minimum), he did not suggest a specific xPAP (don't think he has the right to) so on the prescritopn it says: BiPAP 16/8 FR 14

NO you don't have Central Apnea, you have central and mixed apnea that show up on your PSG but it doesn't mean you have Central Apnea and need a Bipap S/T machine. In order to have Central apnea it has to be your primary disorder or a CA indice greater than >11 per hour. You are only at 1.5, those may go away with CPAP therapy.

Mixed apnea is simply a obstructive apnea combined with a central apnea. Apply CPAP therapy and those turn into residual CA events. If you have long periods of CA where you forget to breathe then yes you would need a machine like a S/T to hopefully kick start your breathing.

I read my titration lab result yesterday and it seems under titration there was lot more CSA / more than expected. They started with a Timed backup of 9 and had to increase it a few time up to 14.

So does this mean what you said might still apply based with this information? (if so I might really need to ask for another doctor)

If you had a case where you needed that or the AdaptSV machine, I'm sure the sleep lab would have recommended that on your PSG, otherwise you can get by with a Bipap Auto. If you have the waxing and waning seen with Cheyenne Stokes Respiration then the AdaptSV would be the machine I'd want. I would want something that restores normal breathing.

Thats the problem, the PSG lab recommendation is: BiPAP 16/8 FR14 (basically the lung doctor copied that on his prescription). Based on this the DME suggested the Respironics Synchrony ST.

So if the Lab and the DME think I need a Respironics Synchrony ST, what I am wondering is since I will already be paying much more than a normal CPAP should I just pay a little more to get the Auto SV? Would it be worth it?

Or maybe I should just not bother with ASV and go with the Synchrony ST?

Thanks,
Daniel

[rested gal]

Dan, I wonder if the jury is still out regarding whether you have a true problem with centrals or not.

What kind of home study did you have to begin with? Do you know the name of the equipment they used for the home test? Presumably there was a belt around your chest or abdomen since they came up with a Central Apnea Index (which was so low as to be insignificant.) I wouldn't think there were any electrodes on your scalp monitoring any EEG stuff, were there?

But what really has me wondering... is whether the later study in the sleep lab was competently performed or competently scored. It's always possible that the tech conducting your titration rushed the cpap pressure changes and that you were having temporary centrals popping up just from the change from one pressure to the next.

If the tech didn't know to just leave you at a pressure for quite awhile (not talking about just a few minutes) to see if the centrals subsided during the cpap titration, he/she might have started a bi-level titration prematurely, still cause the same problem rushing the changes, and then started slapping timed back up rates on top of it all.

I'd want several more expert opinions (not from the doctor in charge of the lab or the pulmonologist who has prescribed a timed back up rate) about the titration study before I'd accept that I had a significant enough problem with centrals to warrant the expense of an S/T and the possible discomfort and sleep disruptions of using a timed back-up rate that I might not even need.

[Snoredog]

Dan, I wonder if the jury is still out regarding whether you have a true problem with centrals or not.

What kind of home study did you have to begin with? Do you know the name of the equipment they used for the home test? Presumably there was a belt around your chest or abdomen since they came up with a Central Apnea Index (which was so low as to be insignificant.) I wouldn't think there were any electrodes on your scalp monitoring any EEG stuff, were there?

But what really has me wondering... is whether the later study in the sleep lab was competently performed or competently scored. It's always possible that the tech conducting your titration rushed the cpap pressure changes and that you were having temporary centrals popping up just from the change from one pressure to the next.

If the tech didn't know to just leave you at a pressure for quite awhile (not talking about just a few minutes) to see if the centrals subsided during the cpap titration, he/she might have started a bi-level titration prematurely, still cause the same problem rushing the changes, and then started slapping timed back up rates on top of it all.

I'd want several more expert opinions (not from the doctor in charge of the lab or the pulmonologist who has prescribed a timed back up rate) about the titration study before I'd accept that I had a significant enough problem with centrals to warrant the expense of an S/T and the possible discomfort and sleep disruptions of using a timed back-up rate that I might not even need.

I agree, I think the S/T machine is rapidly becoming a dinosaur in the presence of these new AdaptSV machines. For example look at Christine's history, she had a S/T for years and didn't see much if any improvement, they put her on the AdaptSV and she got her life back. So to me that was improvement.

That back up "Timed" mode is old school, if a machine can stabilize your breathing then you don't need that backup timed mode. The FR=14 rate is simply the back up breathing rate you need (your doctor's best guess or from the titration) when the patient stops breathing. Value seems a bit high to me but I could easily be wrong.

What they should have done was titrated him in the lab on a AdaptSV and observed the improvement.

[AdmiralCougar]

Oh while at it, any mask recommendation? I don't think I breath using my mouth at all or very little.

Thanks for any Input,
Daniel

You can take a look at my mask’s diary. It’ll give you some ideas and directions to go (perhaps). Good luck.

You are starting to get annoying just like SPAM, it is obvious you only post to promote and peddle your own CPAP accessories. Your response has nothing to do with this persons question, it wasn't about masks at all.

Hey Snoredog, bit snippy today? You sounding like you need a huggle *huggles up Snoredog* OK just had to say he did ask about mask suggestions.

And Daniel good luck on picking the right equipment for you. I'm really glad they are giving you the choice, and not just shoving one or the other at you.

Christy

You have the gull to say that after as much complaining you've done?

I think I nailed it in the first post, pretty obvious from this end especially when you go to his mask review site and there is nothing but links to his preferred medical supply sites.

So I stand by what I said above.

You know Soredog I've always thought I liked you. I only mentioned anything at all because It looked like you over looked that line in the first post. I tried to be light hearted when I posted that, which for me has been real hard lately. I never intended to offend you. Apparently I've just been getting under you skin. I never thought I complained about any other user. Like your attack at both Sergey and then Me. Now I've never gone to Sergey's site. I've not felt I needed to research much on others mask choices because there are very few I know I could possibly stand wearing. Now if you hadn't said that Dan never asked the question I never would of said anything, and you could of pointed out that it's just a bunch of links to medical supply sites without attacking me as well. So your problem with me must be that I'm new and having a number of problems, and like most I'm not getting much support from those who should be giving it, and I brought them here. To a place where I thought was an environment where you could feel to ask for help, or vent if need be. Forgive me because apparently I was wrong. You wont be seeing that anymore because apparently this isn't the place to do that. Just so you know Snoredog, what you said really hurt.

To anyone else who may want to talk with me send me a PM, most I'll probably be doing for a while at least is checking my messages and a few of the threads currently up that I've taken interest in until they die out, because apparently I've been complaining to much.

Dan I'm sorry I brought this to your thread, I almost took it to PM's but I felt publicly assaulted. I wont post anymore here.