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What type of machine do I actually have?

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Francesco +0 points · 30 days ago Original Poster

I have a ResMed Airsense 10 Autoset machine. To this day I remain a bit confused as to what type of machine it actually is.

I understand that sleep apnea therapy machines are generally classified as either CPAP, APAP or BiPAP, but given the Airsense's ability to change pressures thru the night, and its EPR feature that can differentiate between inhalation and exhalation pressure settings it seems to be providing features of all three. Thoughts?

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Sierra +0 points · 30 days ago Sleep Innovater

This is ResMed's Automatic (AutoSet) CPAP machine, or APAP. They really only make two. One is the standard AirSense 10 AutoSet, and the other is the AirSense 10 AutoSet For Her. With the automatic machine, you set the minimum and maximum pressure supplied on inhale (IPAP). During the night the machine raises and lowers this pressure to address obstructive apnea and hypopnea events. It ignores central apnea events.

A CPAP machine uses a fixed inhale or IPAP pressure, and does not adjust during the night.

A BiPAP machine have different flavours, but most are similar to an APAP, but they allow you to set both inhale (IPAP) and exhale (EPAP) pressures. And they allow the difference between the two pressures to be quite high. This can be used to assist breathing. Last they usually have a maximum pressure of 25 cm, instead of 20 cm like a regular APAP.

EPR or expiratory pressure relief is a ResMed term and feature. It reduces the exhale pressure by a set amount of 0, 1, 2, or 3 cm. Yes, this does essentially the same thing as a BiPAP machine that has a differential in IPAP and EPAP of the same set amount. EPR can be found on both APAP and CPAP machines.

But to get to the question you may be really asking, is which machine is appropriate for central apnea? My thoughts are that the first approach to central apnea is to minimize pressure, as pressure often aggravates the incidence of central apnea. To do that you want to avoid any differential between IPAP and EPAP, or avoid EPR. For that approach a CPAP with a fixed pressure can often get the best result, although an APAP can be adjusted to do nearly the same thing.

So why do you hear about BiPAP machines being used for central apnea? Good question that is difficult to answer. For the minimizing pressure approach they offer no advantage. However, they often have features that can detect that the person is not trying to breathe (central apnea), and then automatically cycle the inhale and exhale pressure by a large amount to help them breathe. When they are of that type and set up that way, they can help central apnea to some degree. However the machine that is best suited to addressing central apnea if it cannot be controlled to acceptable values (<5 AHI) is the ASV machine. It follows each breath and adjusts pressure on a breath by breath basis to maintain breathing. They are fairly expensive ($4000 or so) and carry some risks in using them.

Hope that helps some,

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sleeptech +0 points · 27 days ago Sleep Enthusiast

A few thoughts to clear up some of your confusion about treatment of central apnoea.

Firstly, elevated pressure does not always lead to an increase in central events. Sometimes it does but mostly it doesn't.

Secondly, not all central are caused by hyperventilation. In fact, most are not. When central events are the product of hyperventilation (breathing too much) that is when ASV is the appropriate treatment. It will only increase the amount of air it's pushing when the patient's own effort decreases, and when the patient's own breathing muscles are working it backs off. Thus it works to fill in the gaps in breathing and ventilate the patient as little as possible. This is desirable in cases of hyperventilation.

When there are central events and the patient is hypoventilated, which is more common in my experience, then BiPAP is the treatment of choice. It can fill in the gaps in breathing caused by central events and also increase the overall level of air breathed in and out by the patient. This is useful in raising oxygen saturation levels and decreasing CO2 levels. It is often used in managing conditions such as COPD, motor neuron disease, muscular dystrophy, severe scoliosis and more.

Both BiPAP and ASV have range of controls beyond just the 2 pressure levels which are set. They primarily affect the timing of breaths and can get rather complex. BiPAP in particular has a lot of different settings and different modes, which is why I so often say that it should be set up by technician with the appropriate training.

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Sierra +0 points · 26 days ago Sleep Innovater

I am not confused about central apnea. I have it, and get more experience every day.

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Francesco +0 points · 21 days ago Original Poster

BTW Sierra, I recently took your recommendation to try turning of EPR completely. I got immediate improvement in AHI and a reduction in central events. So far so good.

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Sierra +0 points · 21 days ago Sleep Innovater

Good to hear.

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