If you could have any pap machine, what would you pick?

Are vpaps or apaps better than a cpap?
Will certain machines deliver cpap therapy better?

The following is a medical review published in 2012 comparing CPAP to APAP. In reading the abstract you can see that the APAP has some slight benefit with two sleep indices, but performed worse in another. From the article it appears that the benefit is marginal if at all.

From the paper.

Results
Twenty-four randomized controlled trials met the inclusion criteria. In individual studies, APAP and fixed CPAP resulted in similar changes from baseline in the apnea-hypopnea index, most other sleep study measures and quality of life. By meta-analysis, APAP improved compliance by 11 minutes per night (95% CI, 3 to 19 minutes) and reduced sleepiness as measured by the Epworth Sleepiness Scale by 0.5 points (95% CI, 0.8 to 0.2 point reduction) compared with fixed CPAP. Fixed CPAP improved minimum oxygen saturation by 1.3% more than APAP (95% CI, 0.4 to 2.2%). Studies had relatively short follow-up and generally excluded patients with significant comorbidities. No study reported on objective clinical outcomes.

Conclusions
Statistically significant differences were found but clinical importance is unclear. Because the treatment effects are similar between APAP and CPAP, the therapy of choice may depend on other factors such as patient preference, specific reasons for non-compliance and cost.

Link to above article.

http://www.systematicreviewsjournal.com/content/1/1/20

araris wrote:Are vpaps or apaps better than a cpap?
Will certain machines deliver cpap therapy better?

The answer is: It depends.

Scientific studies (including the one cited above) have shown that there's not much of a difference in terms of therapy outcomes or patient compliance between CPAP and APAP, but anecdotal evidence is that some people strongly prefer one or the other. A script that says CPAP at ncm allows you to legally buy either a CPAP or an APAP from DME, provided the DME is willing to sell you the APAP. The insurance billing code for CPAPs and APAPs is the same, so your insurance company will pay the same amount regardless of whether the DME sells you a CPAP or an APAP.

One major advantage of an APAP is that is can be set to run in either CPAP or APAP mode. A straight CPAP can only run in straight CPAP mode. So you can set up an APAP both ways to figure out whether you are in that group of patients who strongly prefer one or the other and then use the mode that is both most comfortable and gives you the best results.

As for VPAP vs APAP/CPAP: A VPAP requires a prescription that specifies bilevel PAP; a script for CPAP at 10cm is not enough to allow one to legally buy a VPAP from a DME. Some people really need a VPAP to treat their OSA, and others do not. For people who don't need the VPAP, the VPAP may be more comfortable than an APAP/CPAP. Or it may be less comfortable. VPAP (or bi-level) may help some people get over aerophagia problems (it did me), but it can make aerophagia worse. VPAP is usually more comfortable to exhale against because the PS is not limited to 0-3 cm the way it is on APAP/CPAP with EPR. But the fact that the pressure is constantly changing between EPAP and IPAP is quite annoying to some people. If the machine has trouble tracking your breathing pattern, that change can occur at the wrong spot in your breathing cycle, and that can make it feel as though the machine is trying to force you to inhale or exhale before you want to.

araris wrote:Are vpaps or apaps better than a cpap?
Will certain machines deliver cpap therapy better?

different people have different needs, just like different shoe sizes.

most people don't *need* anything more than a basic cpap.

many people *want* more, but that's because they've heard of newer and fancier things "gotta have the best" even if it's not any better for *them*.

araris wrote:Are vpaps or apaps better than a cpap?
Will certain machines deliver cpap therapy better?

In my opinion, your "Subject" (question) "If you could have any pap machine, what would you pick?" differs considerably from your actual posted questions.

But, I agree strongly with the previous posted responses you've received.
For me, I've acquired ten of the machines that provide me with the therapy I need. So, I HAVE picked the machines I want to use for the rest of my life. They were all made between 2005 and 2007 (Respironics Legacy models......4 APAPs and 6 straight pressure CPAPs). I found that the changing pressures of an APAP wreck my sleep, so all are set to single pressure....12 cm. They're all fully data capable and provide me with the therapy I require. Newer machines require different software and other things I will not be changing anytime soon. I'm sticking with what works for me.


Den

.

For me, I would like to try a bilevel machine. I have a pressure that runs high lots of the night (around 18-20) and I just wonder if the help from a bilevel would be nicer. I'll eventually get the extra money to try one. Unless of course my Dr. decides it would be a good thing, then my insurance might buy me one. That I doubt, since I'm doing relatively fine on my current machine. Starting in about 2-3 weeks, I'll probably be using straight CPAP, I plan to set it on my old setting of 19, because I'll be spending most nights with my mother-in-law when she goes home from rehab. I'm just too lazy (and tired) to pack up my PR S1 560 to take back & forth, so I'll just use the Icon at her house. I feel blessed to have a back up machine to use for this. In the past, I used to break down & set up my old M series for every trip. Now I have choices.

While you are wishing, you might want to wish for a backup exactly like your home machine, it makes travel easier.

Jen

jencat824 wrote:For me, I would like to try a bilevel machine. I have a pressure that runs high lots of the night (around 18-20) and I just wonder if the help from a bilevel would be nicer.

I imagine that if you're not having any problems exhaling against the machine you have, then you wouldn't get anything out of a bi-level.

do you use aflex/cflex?

palerider wrote:

jencat824 wrote:For me, I would like to try a bilevel machine. I have a pressure that runs high lots of the night (around 18-20) and I just wonder if the help from a bilevel would be nicer.

I imagine that if you're not having any problems exhaling against the machine you have, then you wouldn't get anything out of a bi-level.

do you use aflex/cflex?

Not necessarily. Needing a bilevel is not the same as benefiting from a bilevel. I am fine with epr off, never bothers me really. However epr 3 is super nice and I like it a lot. I would guess a delta of 4 would be super dupper nice!

palerider wrote:

jencat824 wrote:For me, I would like to try a bilevel machine. I have a pressure that runs high lots of the night (around 18-20) and I just wonder if the help from a bilevel would be nicer.

I imagine that if you're not having any problems exhaling against the machine you have, then you wouldn't get anything out of a bi-level.

do you use aflex/cflex?

Aflex.

jencat824 wrote:

palerider wrote:

jencat824 wrote:For me, I would like to try a bilevel machine. I have a pressure that runs high lots of the night (around 18-20) and I just wonder if the help from a bilevel would be nicer.

I imagine that if you're not having any problems exhaling against the machine you have, then you wouldn't get anything out of a bi-level.

do you use aflex/cflex?

Aflex.

aflex is a pressure relief when exhaling, instead of a flat pressure, the main difference between a cpap and a bilevel is that the difference between inhilaiton and exhalation can be set to be larger than what you get with aflex/epr (on resmed machines). (and bilevels typically go up to 25 cm/h20 instead of 20)

there's no other magic in a bilevel. if you're comfortable exhaling, then you're good.

I've got a vpap (bilevel) because I wanted a S9 autoset, (I didn't like the respironics auto that I had as much as I liked the resmed elite I'd been using before I picked up the respironics... but I came across a deal on the vpap auto, which, if I set the pressure support to 0, behaves like an autoset... I've tried different pressure support and am currently running 3, which makes it the equiv of an autoset with epr at 3.

jencat824 wrote:Aflex.

Hey Jen, since you are curious about bilevel and if you ever get a chance to try one...go for it.
Did I ever tell you the story behind my switching? I talked about it this thread.
viewtopic/t71442/viewtopic.php?f=1&t=71 ... te#p656179

AFlex is nice but the most reduction in exhale you can maybe get is 2 cm and that's with the max level of 3 setting and also your own flow rate factors into the drop. So it could be less of a drop.

I did fine on the APAP with AFlex and technically didn't "need" bilevel but that higher PS is soooooo nice and I actually documented that long term I was averaging 45 minutes longer sleep time on bilevel than I did with APAP and I felt better with the extra sleep. My sleep is rather fragile anyway due to chronic pain.

If you can swing it and it doesn't take food off your table....give it a try. I haven't heard of anyone being sorry they did.
I talked about how I ended up trying it in the thread. First time I even turned it on to see what if felt like to have a 4 cm difference between inhale and exhale I knew I was hooked and I hadn't even slept with it yet.

If I had not bought my AutoSet, I would never have known that I had been "titrated" up to four cm too high.
That may not be significant in the higher ranges, but it made a huge difference in comfort for me.

Pugsy & Chunkyfrog,

You have convinced me, I'm gonna get me a bilevel, sounds like I'm missing something wonderful.

Jen