Pros & Cons of Auto BiPAP (vs regular BiPAP)

[BCinDC]

I have been using a regular BiPAP (Respironics BiPAP Pro @ 12/8) for 6.5 years and it is finally starting to sound shaky . SO, I am looking at new BiPap machines (and I have to buy this year, for insurance purposes).

After much research here, reading reviews at CPAP.com and other forums, I think the two machines that look best are the Sandman Duo and the PR System One BiPap Auto. The biggest differences I can see between the two machines are:

a) the PR is an auto BiPap,
b) the PR has a very water tight humidifier (is spilling really a big problem?),
c) the PR uses less helpful, more expensive software.

The biggest of these, to me, is the "auto" feature. I would really appreciate feedback on how beneficial people feel an auto BiPap is vs. regular. Since I have not previously had software, I don't really know how well I do each night, though I would say, generally, I am pretty happy with my current standard BiPap on 12/8 (of course, I was a zombie for years before I got it, so anything is an improvement ).

I also would appreciate hearing about the other key differences (and anything else I might have missed) but I think these are the key points.

Bob

[JohnBFisher]

... The biggest of these, to me, is the "auto" feature. I would really appreciate feedback on how beneficial people feel an auto BiPap is vs. regular. ...

Well, I'll take a stab at this. Perhaps others can chime in once I get the ball rolling.

Auto versus normal. Well, this is essentially the same issue as CPAP versus APAP. The Auto BiPAP will attempt to find the correct pressure for you at the moment. It attempts to minimize any respiratory events (Apneas, Hypopneas and potentially Vibratory Snores). As the machine notes any of these events, it will tend to boost the exphilation pressure and inhalation pressure. If they stop, it tries to decrease the pressure toward minimum. Why search up and down? Well we tend to have different pressure requirements throughout the night. For example, as you enter REM sleep you may need a higher pressure since the body will tend to relax the throat muscles that much more than normal. Bingo, more apneas. So, a slightly higher pressure might help stent open the airway.

But an Auto BiPAP is not for everyone. For example, if you are prone to central apneas, an increase in pressure can actually make the situation worse. In that instance, an Auto BiPAP would be contraindicated (not advisable).

Hope that helps.

[Goofproof]

No Brainer, AUTO features can be turned off, More features, more options. Correctly set, the AUTO won't go too high causing centrals, because the set range limits can keep it below the level that causes centrals. Any XPAP can be incorrectly set. Jim

[JohnBFisher]

... Correctly set, the AUTO won't go too high causing centrals, because the set range limits can keep it below the level that causes centrals. Any XPAP can be incorrectly set. ...

Actually, it depends on the individual. For many, if not most people, that may be true. For me (based on my own experience) that is definitely NOT the case. At one pressure, I am fine. Bump the pressure 1cm H2O (or less) and I start to have significantly more centrals.

As I noted, Auto BiPAP is not for everyone. It may be find for most people who need BiPAP. Just as CPAP (and/or APAP) is adequate for most people who need xPAP therapy. I offer the caution to be certain the original poster realizes he/she may need a titration study. Clearly it may not be needed and will depend on the experience of the sleep specialist and how well the poster already tolerates BiPAP.

[Goofproof]

It sounds like you have found your correct pressure, as I said setting the machine incorrectly, (More pressure than you need) triggers centrals in some people that's why even in AUTO there are adjustable limits. Jim

[Gerryk]

For me an auto saved my insurance a bunch of money on retitrations. I was at a high pressure and had surgery last spring. The day of my surgery my machine was set to auto and if it wasn't an auto, I wouldn't have been able to use it as the surgeon said I couldn't have my pressure that high after surgery. My pressure requirement dropped to 2/3 of what it was and slowly went down. My doc had said if I didn't have the auto she would have sent me in for a retitration a couple weeks after surgery because I would not have been able to use mine at that pressure. She also said I would have had to have one or possibly two other titrations this year to get where I am now because my pressure requirements dropped as I heeled up.

I am going to have another surgery next spring and the same thing would happen then too.

So having an auto for me was very convenient and it saved my insurance company several thousand dollars on retitrations. I guess their investment paid off.

Gerry

[JohnBFisher]

It sounds like you have found your correct pressure, as I said setting the machine incorrectly, (More pressure than you need) triggers centrals in some people that's why even in AUTO there are adjustable limits. Jim

I don't think I made my point clear enough. High enough to clear obstruction and centrals occur (at a higher rate than at lower pressure). But I have centrals ALL the time. It appears my brain stem is not regulating breathing well enough. For most people, Auto is a much better choice. But there are situations where it is contraindicated. Period. My point remains the poster should involve their healthcare team in use of Auto BiPAP. It will probably be a no-brainer. But they should be involved.

[jnk]

My opinion is that John and Jim are both right, since an auto can be run as an auto or as a non-auto. I think an auto could always come in handy one day, even if you run it in a non-auto mode nearly all the time. An auto can be run with a 1 cm window of play, or wide open, or locked down. An auto can be most anything you and your doc want it to be.

The main thing is to have data so you can balance comfort with efficacy. Like John said, make sure your doc doesn't have a problem with your running in auto mode. And if you get one, you will want to double-check how the RT sets it up. ResMed and Respironics autobilevels have to be set up according each brand's approach to autotitrating your pressures. Speaking of which, don't forget to consider the ResMed Auto 25 autobilevel. You may not like it, but it is worth checking out.

[BCinDC]

The main thing is to have data so you can balance comfort with efficacy. Like John said, make sure your doc doesn't have a problem with your running in auto mode. And if you get one, you will want to double-check how the RT sets it up. ResMed and Respironics autobilevels have to be set up according each brand's approach to autotitrating your pressures. Speaking of which, don't forget to consider the ResMed Auto 25 autobilevel. You may not like it, but it is worth checking out.

I appreciate all of the feedback. I guess part of what puzzles me is how much control I would have over the "auto" settings vs. how much needs to be set by a doctor & RT. What can the user typically adjust with an auto?

Also, I have read a lot of good things about the ResMed, and I am going to look at it again. But as I recall, it runs off of 24v, which requires a special power adapter for battery use, and when on battery, the humidifier doesn't work. Also, the humidifier lacks the room humidity/temperature monitor of the other two, so rain out could be more of a problem (I have an HC150 now, so I manage without that, but rain out can be a pain at times).

Bob

[jnk]

The main thing is to have data so you can balance comfort with efficacy. Like John said, make sure your doc doesn't have a problem with your running in auto mode. And if you get one, you will want to double-check how the RT sets it up. ResMed and Respironics autobilevels have to be set up according each brand's approach to autotitrating your pressures. Speaking of which, don't forget to consider the ResMed Auto 25 autobilevel. You may not like it, but it is worth checking out.

I appreciate all of the feedback. I guess part of what puzzles me is how much control I would have over the "auto" settings vs. how much needs to be set by a doctor & RT. What can the user typically adjust with an auto?

Also, I have read a lot of good things about the ResMed, and I am going to look at it again. But as I recall, it runs off of 24v, which requires a special power adapter for battery use, and when on battery, the humidifier doesn't work. Also, the humidifier lacks the room humidity/temperature monitor of the other two, so rain out could be more of a problem (I have an HC150 now, so I manage without that, but rain out can be a pain at times).

Bob

Both machines are very customizable in their settings. It depends on what you are comfortable with. Some RTs are not all that comfortable adjusting them, either, I have heard. As you know, a bilevel stays at two pressures. The M-Series Respironics allows you to set a minimum breathe-out pressure and a maximum breathe-in pressure and allows you to set the maxiumum distance allowed between those two pressures. (The minimum distance between the two is not adustable.) I don't know about the new system, though. As for the ResMed, it similarly allows you to set a minimum and maximum to give the pressures a window to work in, but with that brand you set the distance between the pressures so that the distance between them never varies.

If I were going to be running off a battery a lot and felt I needed the new humidity-management system, I would lean toward the new Respironics machines, myself. The power stuff is a little over my head, but I think that with the ResMeds a regular inverter with a modified sine wave does the trick just fine IF you don't use the integrated humidifier with it. But it is worth searching posts from the likes of Bill Bolton to verify that sort of thing.

[BCinDC]

Well, I ended up buying the PR System One Auto BiPAP. The biggest downsides to it, vs the Sandman Duo, were price and lack of consumer software. I've figured out that the software can be worked around, and my share of the price difference isn't that great. I've always been a big fan of having options in life, so having the auto feature as an option seemed worthwhile (plus the dry box humidifier, though I'm still not sure if spilling water into the machine is really a big problem).

I had been trying to figure this out for a while, but I am down to the wire now; I am on a high deductible insurance plan, and we've met our deductible for the year. If I waited until next year, it would be 100% on me.

I'm now going to have to do more research on how to understand the feedback I get from the machine, to make sure everything is optimal. I have been pretty happy with my basic bipap, but there have been times when I've wondered whether I am sleeping properly. Having feedback will be really nice.

Thanks again for the help.

Bob