CPAP, APAP, Bi-PAP? What does it all mean?

I just happen to have the equipment you see below but I have no real idea what the differences are in these machines. From looking at some machines the prices vastly vary too. Obviously, different things work for different people between the machine itself and the mask types.

I didn't pick my equipment, it was picked for me by my local sleep clinic here in Austin. I'm wondering how good it is for CPAP? So far so good but I do have a stiff neck the last couple of days and a slightly sore nose but that's mostly gone away since switching from a medium to a small pillow. All feedback is welcome! Maybe someone will read this and learn more about CPAP, APAP, Bi-PAP.

Other questions I can think of: Why pick Bi-PAP over CPAP? Why pick one of the other combo's? Are there specific uses for each type of are they all different words for the same thing? Who do you recommend for your particular type?

P.S. I like seeing the pics or being able to see what each person that posts is using. That's a really cool feature. You just might find someone who matches you.

I used the swift too and for the first couple of days I also had a sore nose. Went away after a week. Guess my nose toughened up.

hey, somebody from almost my neck of the woods, lol, whats up bro? my equipment was chosen by the sleep doc in san antonio, except for the mask, i picked that one out, they were gonna give me a nasal but i already knew i was a mouth breather so i asked for the comfortfull 2 full face, it works pretty good for a newbie setup, i also have a f&p Flexifit 431 that leaks like a sieve(sp?), so i don't use it much, alls i gotta do is get a reader so i can see how i'm doing in my sleep. so far racked up over 150 hours on my machine, have not had a prob with noncompliance since i started over 2 weeks ago, so i guess i'm able to handle my therapy.

Waall its bin a whaal since ah wuz in Owstin (or San Antone) -both faan places.

(Bin to IBM's facilities on Burnett Rd a few times over the years & San Antone to fill in a week-end.

Anyway,

Quick and dirty summary of Cpap, Apap & BiLevel (Bipap, Vpap etc:)

CPAP came 1st. Was designed as an uncomplicated way generating airflow under pressure sufficient to keep someones airway open & prevent Apneas (breathing restrictions & blockages).

Rock solid therapy but does have its challenges. The classic one being that many folk find it hard to breathe out while the air keeps trying to come in (the pressure of air from the machine remains constant).

Then Respironics invented the Bilevel machine (which they call a BiPap & Resmed call a Vpap). This provides two pressures & some more complicated circuitry such as a microchip & pressure sensors. It provides an in pressure (IPAP) for breathing in, just like the CPAP, but then it also has a lower pressure setting (EPAP) for breathing out.

This proved a great boon to cpap users but the early units were so very expensive that the only real market for them was people with complications and either fat wallets or generous insurance. Bilevels have improved over time and the cost has also begun to drop quite markedly.

(Bilevels are my favorite type of xPAP machine).

Then came the APAP - not sure who invented these or when (my guess is 1998 & by 1999 there were several brands on the market). Their goal was to solve the breathing out pressure another way while at the same time offering some extra usage benefits**. What they do is act like a CPAP but they are smart enough (micro-chip controlled) to adjust their pressure setting up and down during the night in response to what they sense as the user's breathing needs. An APAP can start of at say a minimum preset of 6 cms & during the night, sense that the users breathing is beginning to show problems (snoring vibrations, air flow changes, air flow stopping). The APAP then *slowly* adjusts the pressure up and keeps sensing the users breathing. The APAP does its best to prevent breathing slowdowns (called flow limitations) & obstructions (blockages). APAPs also have a maximum setting to which the machine can go up to.

AUTOs were more expensive than CPAPs but generally cheaper than Bilevels. That still applies today but again the gap is narrowing. There are still some reservations in some medical areas, about AUTOs but they are becoming very popular.

** A) One extra usage benefit of an AUTO is that even if one gets better therapy from straight CPAP (this varies for people), they can function as both types (cpap and apap). The really helpful extra benefit is that with an AUTO you can *effectively* do your own sleep study as the AUTO provides data that advises the optimum pressure setting for the user. B) Another extra use benefit was that AUTOs also tended to provide the better nightly recorded data (they do so much more analysing & evaluating of the users breathing). Again that gap is narrowing but still very much in evidence in the price points offered by manufacturers.

To complicate the above cpap, apap, bilevel story. Respironics did yet another innovation by introducing a Bilevel with AUTO ranging. This machine (called the Bipap AUTO), will adjust both the IPAP (Inhale pressure) and EPAP (exhale pressure) up and down during the night if the machines senses any complications in breathing. It does this independently for the IPAP & EPAP pressures which is pretty durned clever. This type of machine is expensive.

Hope this simple explanation helps

DSM

Wow, that's great. That really sheds ALOT of light on these machines. I really was wondering. Between what I've read on the web and what not I was a bit confused. It sounds like the CPAP is a good machine if you don't mind having to report to the sleep doc, that you're experiencing a change, which they need to change the setting on your machine for. Also, sounds like it might be the least expensive of the multiple options.

I will say this. The C-Flex option on my unit is a nice feature because it "blends" in a feature, or seemingly so, of the more expensive Bi-PAP. Correct me if I'm wrong. And that one feature is confusing to me. I seem to be just fine on setting 1 so I'm not really having any major issues there. I've played with that feature a bit and tried setting 2 but can't help but think (probably wrongly so) that I'm losing some benefit by changing my exhalation pressure. Logically, this also seems unfounded. It's the pressure going in that counts so using a C-flex seems like more of a comfort issue. Am I wrong assuming it's similar to that feature on a Bi-PAP?

All the extra sensors sound pretty cool. It figures that my facination with electronics (the ones that actually work and work long term) would carry over to my CPAP machine. What a geek I am But I'd rather know all the in's and out's of this things 'just in case' and to make usage more enjoyable.

Each post of mine has a little update on how I'm doing with the below equipment just in case someone new is reading this and curious. My neck ache is going away but I'm still considering getting a much better pillow. Either a memory foam or a therapeutica are the two front runners in my mind. The nose soreness on the small pillows has pretty much gone away. Sweet! Due to my computer addictions I'm still not getting a full 8 hours of sleep. My fault, not the computer's really. Last night I got 6 very restful hours of sleep. I feel pretty good today. I've done nothing but feel better since I started CPAP with C-Flex with the exception of the sniff neck and sore nose. Now that those are on the decline I'm thinking I need to set a few goals for myself. I already knew that sleeping had become MUCH more important in the last 10 years than it was in the first 25. I just need to get use to that idea (that the rest of my life revolves around a good night's rest.)

Anyway, I seem to be doing well with my setting of 13. I'm also doing pretty ok with the chin strap. I can't put it on myself yet. My wife has to help. LOL! And the bad part is she usually conks out an hour or two before me. But she's sweet and let's me wake her up to put this thing on because she's getting something back in the form of me NOT snoring loud enough to wake Popeye in the cartoons. I think he must've had Sleep Apnea too. LOL!

One of the things I really enjoyed was talking with my equipment provider about all these difference machines.

My prescription was for a CPAP, but since I was asking they showed me all the different types of machines and explained what they did, how and why.

It was pretty cool. I'm a techno-geek myself, so I love gadgets and electronics!

You are correct that CPAP is certainly the least expensive of them all, and it tends to work pretty well for a large percentage of OSA patients. Hence why the insurance companies push very hard to put patients on those first.

The CFlex ability is very much like a cheap stepchild of BiLevel therapy - meaning it just gives a slightly different pressure on exhalation then on inhalation.

Bingo

My guess is the insurance companies want us to spend their money just like we would our own. Best for the price would be the choice set of words. If CPAP tends to work best for the majority of users I can see why the recommend it. My insurance covers 100% though, so if it turns out I need something else, I'm covered, TG!

I can see how APAP would be even better because it's constantly diagnosing you and that info is very helpful. My particular unit, listed below, doesn't seem to have any place to even hook up a card reader or otherwise. But I guess it keeps a certain amount of basic info to report to the insurance company. I'm sure I'll have to do that about the 1 month mark.

Rastaman wrote:My guess is the insurance companies want us to spend their money just like we would our own.

You could not be more spot on the mark!!

It's like in another thread here, someone told another poster that they always recommended that everybody push their insurance cmopany to purchase them an auto-pap. They stated they liked the adjustability of them. They then finished with "besides, if you don't like it just run it in straight CPAP mode!".

That statement totally made me cringe, and I firmly believe is exactly why insurance companies DO NOT want to cover the 300-600 dollar upcharge for auto-paps. I know that if I were making the choice for an insurance company and I saw very many statements like that, I certainly would recommend covering them.

Spend the money as you would your own is a great way of putting it. I know I wouldn't buy a race car if thought there was even a REMOTE chance that I was only going to do city driving with it. And frankly, neither should anyone else.

Bingo

If you are into electronics & gadgets you may enjoy some of these photos showing the insides of various xPAP machines.

Also compares varios parts & models.

I am an engineer by profession (was a hardware, then a software engineer, later a systems engineer)

Note the Bilevels & AUTOs have air pressure sensors (detects output pressure) and air-flow sensors (detects movement of air in the breathing tube).

The PB318 set of photos shows what the motors used to look like (modified vaccume cleaner motors). Along side the PB318 motor is a photo of a modern Resmed S8 CPAP which is so small it is not much bigger than the old PB318 blower motor.

http://www.internetage.com/cpapinfo/

Enjoy,

Doug Marker

Ok, we're on the same page here. I don't want to unneccesarily bill the insurance company for something I do NOT need. NEED being the key word. I trust my sleep doctor. I trust him because my regular doctor recommended him. He said this is the guy who brought the sleep disorder clinics to Texas way back when this first started. Then he proceeded to tell me about the not so good "fly by night" clinics that I'm sure most insurance companies are well aware of.

Just having a recommendation by Dr Duhon or associates carries alot of weight with the insurance companies because they ARE doing things the way the insurance company would do them.

Now...sure, I would want the best machine for MY needs. But right now I'm having all this success (and while I could have even more MAYBE) I have absolutely no reason not to trust the unit provided. It's practically a BIPAP but for less money. No complaint there! It doesn't diagnose but if needed I can go spend another night at the sleep study. Not my favorite idea with all that stuff they hook up to you but I did it once and I COULD do it again. It sounds like getting the setting changed is MUCH easier than that though. It's just a wonder on what the setting should be and hopefully they'll know better than I do.

I just need to decide whether or not to buy this CPAP machine. For now, it and the Mirage Swift Pillow Systems seems to be working and why overcomplicate this whole issue? Sometimes simplicity is the key. Sometimes it's not, and we all know who we are

Bingo wrote:It's like in another thread here, someone told another poster that they always recommended that everybody push their insurance cmopany to purchase them an auto-pap. They stated they liked the adjustability of them. They then finished with "besides, if you don't like it just run it in straight CPAP mode!".

That statement totally made me cringe, and I firmly believe is exactly why insurance companies DO NOT want to cover the 300-600 dollar upcharge for auto-paps. I know that if I were making the choice for an insurance company and I saw very many statements like that, I certainly would recommend covering them.

Spend the money as you would your own is a great way of putting it. I know I wouldn't buy a race car if thought there was even a REMOTE chance that I was only going to do city driving with it. And frankly, neither should anyone else.

Bingo

Bingo, if I've understood your point correctly, you are suggesting people shouldn't push insurance companies to pay for APAPs because CPAPs will do the job?

As someone without medical insurance, I decided to purchase my own machine rather than rely on the state funded health service here in the UK. I took the view that the extra cost of an APAP was more economic in the long term. It will change with me if my treatment needs vary and, more importantly, I can also monitor the treatment without relying on regular (expensive) visits to the sleep clinic.

Doesn't the same economic logic apply to insurance-funded treatment by potentially reducing the frequency of costly visits to the sleep clinic?

As a useful by-product, the APAP has provided me with more comfortable yet fully-effective treatment by reducing the pressure below the prescribed CPAP level for much of the night.

littlebaddow wrote: Bingo, if I've understood your point correctly, you are suggesting people shouldn't push insurance companies to pay for APAPs because CPAPs will do the job?

Yes and no. Like 95% of the rest of the issues revolving around our healthcare, I'm just saying that there rarely is a blanket "Best Solution", and that is the #1 reason behind Insurance Companies setting the guidelines they do. (Not getting into the issue of wether or not you think Insurance Companies are good or bad).

BiLevel machines are NOT needed for everyone. To purchase one for everyone is a gross waste of money.

Similiarly, a CPAP is NOT the right choice for everyone either.

However, I will flat out voice the unpopular (here) opinion that they are fine for a large percentage of OSA patients.

Bingo

Bingo wrote:

littlebaddow wrote: Bingo, if I've understood your point correctly, you are suggesting people shouldn't push insurance companies to pay for APAPs because CPAPs will do the job?

Yes and no. Like 95% of the rest of the issues revolving around our healthcare, I'm just saying that there rarely is a blanket "Best Solution", and that is the #1 reason behind Insurance Companies setting the guidelines they do. (Not getting into the issue of wether or not you think Insurance Companies are good or bad).

BiLevel machines are NOT needed for everyone. To purchase one for everyone is a gross waste of money.

Auto Titrating machines are NOT needed for everyone either. Are they nice? Oh cripes, of course they are. Are they needed in many cases? Certainly. Is it fair to base a lifetime of treatment on 1 or even 2 nights in a sleep lab? It's insane to think it is.

Similiarly, a CPAP is NOT the right choice for everyone either.

However, I will flat out voice the unpopular (here) opinion that they are fine for a large percentage of OSA patients.

Bingo

I can see where the APAP is ultimately the best solution long-term. Getting a CPAP machine and relying on the sleep clinic to make adjustments assumes that you have insurance. If you didn't, going to the sleep clinic would almost NOT be an option based on the prices they charge (and hospitals and doctors for that matter) outside of a "contracted" rate. I can see where the CPAP machine would be the choice of the insurance company because they're trying to reduce costs per patient. If every single patient needs not only the expensive study but also the expensive machine, then things start to get expensive all the way around.

I can also see how the CPAP machine would be the natural choice for the sleep clinic because that keeps them in the loop for the purposes of changing your settings. If the machine could do it all, then that would illiminate the need to go see the doc for your most likely life-long condition.

I'm new to the whole CPAP thing myself. And I can see where this will do the job just fine. I realize that without insurance or with lesser insurance things would be VERY limited on options in this regard. This is probably one of the primary reasons people remain undiagnosed. People just can't afford to go. So, long live the companies with good (but deteriorating) insurance!

And correct me if I'm wrong but logically APAP just seems for the long-term user. If you can afford it, or your insurance will, then it's probably not the wrong decision by any means. But I think there is more to this that these obvious observations. This is too easy. There has to be folks out there who's pressure changes so often that they need a machine that keeps up with them. For most, CPAP at a given setting, is probably sufficient. And perhaps the sleep clinics will even make updates on it without charging you per visit? Perhaps I'm just wishful thinking.

Yep, I think I might've answered my own question there. It would seem that certain patients would require a range of settings throughout the night. Just one might not work for them. So depending on what they need throughout the night CPAP might not work. My question becomes how do you know if you're one of these people? Is the sleep clinic going to tell you or am I going to have to find this out myself after a year of having THIS particular machine. It would seem that you would want to maintain the option of upgrading.