Auto PAP with EPR, Respironiocs Quality, etc.

I have some decisions to make and looking for your experience...

I have swallowed air all my life which is uncomfortable, but now that I am on CPAP it is causing very painful, and I'm afraid harmful, PAPgas nightly. I use a ResMed CPAP with EPR set to 10 - the lowest that clears most of the time. The EPR is so comfortable that I refuse to be without it and that is causing a bit of a problem.

My gastro and sleep docs agree this has to stop, yet my o2 averages in the mid 70's without CPAP so I really need it. My DME wants me to try BiPAP but that has the 10 on inhale where I believe I swallow. I'm looking far an Auto that may range from 4-10. I did better gas wise with a lower setting so I think if the unit ran 5-8 most of the night I'd be as good as I can get.

That's the background, now my questions:

1. Does Auto PAP really work? My DME says only for some, that the programming is set to an average profile and if you aren't average it won't work and can harm you as it doesn't go high when needed or goes high when not needed.

2. I know Respironics makes an auto that has EPR at the same time. I told my DME that's the unit I wanted and she said they break all the time and that I really need a ResMed. So, is Respironics a good machine? How about compared to ResMed?

3. The ResMed materials state that their auto unit can be set for Auto *or* EPR not Auto *with* EPR. Does that unit offer both Auto and EPR at the same time? Do any others besides Respironics?

4. Finally, given my long story, what do you recommend?

I do appreciate your input. I've read many posts from those who have "used" for years and while I'm closing in one I realize I don't know very much about this stuff.

OldLincoln

Respronics makes a good machine. The "BREAKAGE" on the Respronics is mostly due to a poorely designed Heated Humidifier that leaks and has a tendency to put water in the machine. A lot of people have bought the machine and then used the Fisher & Paykel HC150 Humidifier. Problem solved. Respronics Autos do a better job of adjusting above 10cm.h20 and the C-Flex and A-Flex exhalation relief works in auto mode.

Jerry

Bi level machines actually do help many people with aerophagia.
Since both your doctors are convinced you need a solution for it, for it, why not go for a Respironics Auto BiPAP? This machine will give you bi level therapy, Resprionics's version of exhalation relief, and automatid adjustment of each pressure level separately.

O.

Good information, thanks.

Resperionics: The DME told me their water tanks can be leaky. I'd think they would have fixed this by now - how hard can that be? Lets say the tank doesn't leak. Does the Respironics last a long time? How about noise levels?

BiPAP: There's a lot I do not understand about this whole subject, and one is how a BiPAP will help that aero thing - swallowing air. I watched both ResMed videos (well done) with the animated model etc. and pictured swallowing air during the cycle. It seem's that BiPAP would only help if the exhale pressure drop is sudden and early, and then only if the swallow happens at the end of the inhale.

Ozij, you wrote about the "Respironics Auto BiPAP". I went to the site and see a lot of machines to do the same thing. I think I need to start over and revisit what each technology does. I thought I read that the Respironics APAP also does the BiPAP and the CPAP and all with their EPR feature.

My ideal is to get just 1 machine and use it for a very long time. I like the notion of have all 3 technologies in 1 machine. But it has to work for me.

OldLincoln

http://systemone.respironics.com/faq.aspx

Respironics A-Flex Faqs wrote:How is A-Flex different from C-Flex?
C-Flex comfort is achieved with expiratory relief. A-Flex comfort is achieved with expiratory relief combined with inspiratory comfort. The pressure cycle mirrors a sinusoidal breathing pattern found with normal breathing patterns and, as a result, feels most natural.

How is A-Flex different from C-Flex and Bi-Flex?All three are comfort technologies. A-Flex is a hybrid of C-Flex and Bi-Flex. Like C-Flex, A-FLex delivers pressure relief during exhalation. Like Bi-flex, A-Flex will also soften the transition as the patient moves from inspiration to expiration.

So isn’t this Bi-level Positive Airway Pressure?
No. Bi-level systems, including Respironics’ BiPAP devices, deliver a bi-level therapy modality with a set inspiratory pressure and expiratory pressure achieved on each breath. A-Flex is a comfort technology only delivered by REMstar Auto with A-Flex, coded as an E0601 or CPAP device. With the REMstar Auto with A-Flex, there is no way to set an IPAP or EPAP pressure or fixed delta.
Does A-Flex change the Auto Algorithm? Its proactive logic? Its reactive logic?
No. A-Flex is simply a comfort feature built upon the intelligence of the existing REMstar Auto algorithm. The algorithm itself is no different.

Added color mine.

A bi-level machine, if set with a pressure difference, between EPAP and IPAP, will give you lower pressure every time you exhale, it is built to respond that way.

A self adjusting machine (an APAP) which is not a bi-level will lower (or raise) your pressure for both inhale and exhale, but only after it has calculated that the pressure will be good for both. Autos use a number of breathing cycles for their calculation, and respond after calculating that sample. The inhale and exhale pressure on an APAP will always be the same.

On a bi-level auto the machine calculates the inhale, separately from the the exhale, and has rules for the amount of pressure support (difference allowable) between those two.

O.

Just to add to the above: the x-Flex of the Respironics devices are similar to the Resmed EPR (both offer expiration pressure relief - each w/their own criteria for when and how). So when you talk EPR one assumes Resmed and when you talk "-Flex" one assumes Respironics.

The Respironics M Series has a very poorly designed integrated humidifier system. Despite a recall and a "fix" of the problem, there is STILL a problem due to the poor design that makes for its being a PITA to work with.

The Respironics M Series xPAP itself is a GOOD device, whichever model, w/some good technology. For longevity of use it really is wiser to get the F& P HC 150 humidifier as suggested. Respironics didn't get to be the leader in xPAP machines by producing "rubbish".