Hi,
I have Ahi 100 and had more than 640 apnea in on night. I was asked to buy bipap machine and I'm waiting for my approval. I have started to hit the gym again. Have stopped my occasional smoking and drinking. Pls do let me know what's should I be careful of and what else to do. Also suggest me a the best bipap machine, with my internet research I have decide to buy 'PHILIPS RESPIRONICS Dreamstation BIPAP Auto Machine,'. Buying in India is an option as it's ecpensive in dubai.
The first thing you should do is ask for a detailed sleep study report which should breakdown the incidences and rate of the obstructive apnea, central apnea, hypopnea, and snoring. That will give you a better idea of what capability you need in a machine. I presume at this point you have been tested and verified that you need a BiPAP rather than an Auto CPAP? The BiPAP will be capable of up to 25 cm of pressure compared to an APAP at 20 cm. Also the BiPAP will provide more than 3 cm difference in pressure between inhale and exhale.
The best report I have seen on sleep apnea machines is at this link:
There are a couple of limitations to this report though. It is for APAPs not BiPAPs, and it was written in 2015 and many of the model names have changed. I suspect however that the basic capability in most cases has not changed, and there are a lot of similarities between and Auto CPAP and an Auto BiPAP.
Without getting into all of the models, in my opinion the two top machines in the 11 they tested are also probably the two most popular and most available machines. My comments on them:
ResMed S9 Auto - It is designated D8 of the machines tested, and the current model name is ResMed AirSense 10 AutoSet
It does an excellent job of normalizing obstructive apnea. See figure three, left hand column. It also does an excellent job of normalizing hypopnea, the right column. From figure 4 it increased pressure modestly to stop snoring (left column), and from the right column it does NOT increase pressure in response to central or clear airway apnea. That is important. Increasing pressure does not correct clear airway apnea, but many machines increase it anyway. These other machines probably have no way to distinguish between central apnea and obstrutive apnea. The ResMed does.
PR1 Remstar Auto P-Flex, Philips Respironics - It is designated D7 in the report and the current model name is the Respironics DreamStation Auto
It increases pressure to normalize obstructive apnea, but does not fully normalize it like the ResMed does (left column of Figure 3). It increases pressure to respond to hypopnea (right column), but then it cuts pressure back and does not fully normalize the hypopnea. In figure 4 left column it increases pressure rapidly and holds it up in response to snoring. The concern would be that it may increase it too fast and too high causing a comfort issue. While it makes a slight initial increase in pressure in response to a clear airway central apnea, it immediately reduces it and holds low pressure. Response to central apnea is essentially just as good as the ResMed.
So assuming you have obstructive apnea, hypopnea, central apnea, and snoring, I think either the ResMed or the Dreamstation would work, but the ResMed is the better of the two - based on this benchmark test report.
The BiPAP version of the ResMed is the AirCurve 10 VAuto. I suspect it behaves very much like the ResMed S9 tested in this report, but has the extra pressure, pressure support, and features of a BiPAP machine.
Hope that helps some. You may want to try the UK for an on line store. I have seen vendors there that will ship internationally and the prices for the equipment seemed reasonable.
One last caution if your sleep test indicates you have a high portion of central or clear airway apnea events. A BiPAP machine may help a bit to reduce them, but not a lot. A high portion of central apnea events may need a more sophisticated (and much more expensive) ventilator style machine like the ResMed AirCurve ASV. This would be something to discuss with a qualified sleep doctor.
I am a dentist working in dental sleep medicine. Unfortunately, your high AHI numbers do place you in a dangerous situation and there is real urgency to get your treatment started right away. Assuming that you have only obstructive sleep apnea, propping yourself up on two pillows at night at a 45 to 90 degree angle at night might help a little(emphasis on A LITTLE), but there is really no substitute for proper treatment. Arthur B. Luisi, Jr, D.M.D.
Just one further note about your high AHI. My wife was diagnosed with an AHI of near 80. She uses the ResMed S9 Auto APAP (like the one in that test report) and averages an AHI of 1.0 after nearly 4 years on it. On the other hand I was diagnosed with an AHI of about 34 and am doing well to average 3.0. The difference is that her apnea is essentially 100% obstructive apnea while mine is now probably about 70% central or clear airway apnea. So a CPAP can do a very good job even with a high initial AHI, unless the apnea is of the central variety...
Who are you waiting approval from for the machine purchase? An insurance company? In any case, I would definitely pick a major maker rather than a cheaper no-name off brand machine. I have learned about machines on this forum that I have NEVER heard of and they must sell cheaper and low volume and I would wonder about warranty and support. Did you get a prescription for the bipap and do you have a copy? That really would be a great jumping off point for therapy as you will then be able to drive your own treatment with a little more direction rather than lay it all on a med professional.
Why are they selling you BiPAP? Obstructive sleep apnoea (OSA) is treated by CPAP, not BiPAP, and a CPAP would probably be over a thousand dollars cheaper. BiPAP is only necessary for central sleep apnoea, hypoventilation and other more complex forms of respiratory failure. which is for more rare than OSA. Did anyone tell you which you have?
Thank you all for your concerns and reply. I have had almost 600+ apnea in a single night and my ahi is 100 and that'd the reason the Dr. Suggest me to go for bipap machine. I'm waiting for my insurance to approve purchase of BIPAP and in middle east its not covered usually but as I have extreme apnea I may get it covered and will know the result by early next week. With all my discussion and online review I have decided to buy PHILIPS RESPIRONICS Dreamstation BIPAP Auto. I can share my report to any one needed for if you can can your mail id
If you are paying out of your pocket, I would ask for more detail on the sleep study report before spending the extra money on a BiPAP. One thing you really need to know for sure is whether or not you have any significant amount of central or clear airway apnea. Even a BiPAP machine is not going to be really helpful if your main issue is central apnea. When central apnea becomes a problem you can get back to back apnea events over a long period of the night. That really ramps up your AHI count.
If your apnea is all obstructive then you may only need an APAP, not a BiPAP. The way some insurance companies work is that they will approve an APAP first, and if that fails to do the job, then they will approve a BiPAP.
The DreamStation is a good machine, but my view is that the ResMed is better.
Unfortunately the guy that does those annoying youtube videos is not the most credible. If you want credible information read that link I gave you a few days ago. Not only that, I believe he is not correct about how the DreamStation responds compared to the ResMed. Have a look at the SleepyHead report from a Respironics BiPAP machine. You can pick them out from a mile away based on the constant spikes in pressure (red trace in the graph). The machine seems to spend the whole night responding to events, and then quickly ramping the pressure back down. It is actually the more aggressive one. It is aggressive in spiking up pressure and then spiking it back down again. The key here is "responding". The DreamStation keeps needing the trigger events all night long. Each trigger event is another apnea that you must endure. The ResMed is smarter and says OK, this guy needs at least 8 cm of pressure to prevent an apnea. I will hold it there and see what happens. If nothing happens it then SLOWLY ramps pressure down. If another event comes along, it will notch up a little higher. At the end of the night, I believe the ResMed method achieves a lower residual AHI. That said, you can deal with a DreamStation and make it work. What you have to do is take away some control and set the minimum pressure higher. Both machines work, but I would suggest the ResMed is more sophisticated in the algorithm it uses to control pressure.
Do you have any model suggestion in resmed... Lumis 100 VPAP S or should I consider some thing to else?
I can't make any recommendation because I don't understand why you need a BiPAP machine over a standard APAP. You said that your doctor recommended a BiPAP because your AHI is so high. A BiPAP will provide more pressure so I guess if the doctor has not done any kind of titration testing to determine your pressure requirements, I suppose it is a safer choice. If that is all there is behind it, then the ResMed model in North American terms that I would suggest is the AirCurve 10 VAuto. It can operate in the S mode which seems to be just a bilevel pressure mode with no auto adjustment up to 25 cm, or in the VAuto mode which gives you auto adjustment of pressure up to 25 cm, or in the CPAP mode which is limited to 20 cm and no auto pressure adjustment. You would have to do some comparisons to see which Lumis model offers that. This manual may be helpful. It details what the options of each machine are.
That sleep report is very helpful. What it shows is that while your AHI is very high at 100, it is 80% obstructive apnea, 20% hypopnea, and 0% central apnea. This indicates you do not need any special features to address the central apnea. The obstructive apnea and hypopnea should be very well treated with pressure. The issue however is how much pressure. The traditional next step would be to do another overnight sleep test, but this time the pressure will be adjusted during the night to determine how much you need. This is called a titration test. This can be expensive, and may not be available to you. The other option is to prescribe an auto adjusting machine that adjusts the pressure for you. In Canada where I am, they give you a free trial, and would likely try a standard APAP machine first which goes up to 20 cm of pressure. By reviewing the detailed data the machine captures you will quickly find out if that is enough. If it isn't then they would do a trial on a BiPAP that would go up 25 cm. Trials are very helpful because the other thing you find out beside pressure is whether or not the person can tolerate the pressure. Not everyone can tolerate up to 25 cm of pressure.
In your case it sounds like your doctor has decided you may need the extra pressure so he is prescribing a BiPAP. There is no downside to that, other than the cost. In Canada from on line places, the basic APAP machine (ResMed or DreamStation) is about $900. The BiPAP versions are about $1100, so about a 20-25% extra cost. However around the world the cost of machines varies widely depending on the country and whether your buy on line or from a clinic. Here is a link to an example of BiPAP costs in Canada. I don't think they ship outside of Canada though.
You said you are waiting for approval of the purchase. That suggests your insurance or healthcare system is paying all or part of the costs?? If someone else is paying then I would go for the BiPAP. You may not need the extra pressure, but it is there if you need it. I you are paying out of your pocket with no opportunity for a trial to see what works, then it becomes a bit harder decision.
This all said, I hope that another contributor here, sleeptech, comments on your situation. I understand he/she is a sleep technician from Australia, and probably sees hundreds of these sleep reports and has lots of experience to judge what pressure is needed and whether or not you could get away with a standard APAP. My guess would be that you probably could, but it is not 100% sure.
From what I can see there does not seem to be a direct equivalent to the ResMed AirCurve 10 VAuto machine in the ResMed Lumis line. The AirCurve 10 VAuto is the closest to a standard APAP but with more pressure. It is the least expensive machine in the AirCurve series as well. In Canada it is the same price as the DreamStation BiPAP and as before I would select it over the DreamStation, but both will work.
Hope that helps,
Thank you for taking interest and spending your time for me. Thanks a lot it means a lot me. I have ordered Lumis 100 w/AirFit F20, It's costing me around usd 978 and I got it from India with 2years warranty. Will get the delivery in Dubai by weekend as one of frnds are traveling from India will hand carry it. Will start using it by end of the coming week.
I hope it works out for you. I don't think the Lumis 100 model provides auto pressure adjustment. It may be essentially a CPAP with a fixed pressure and adjustable inhale and exhale differential. Perhaps it is too late now but if I was given the choice between a fixed pressure CPAP type Lumis machine and the DreamStation Auto BiPAP, I would take the Dreamstation Auto BiPAP. The advantage of an Auto machine over a fixed pressure CPAP outweigh differences in the brands.
Just in time info, will check fefore payment the other model mentioned by you is not available right.now in india.
Have a look at this document on the Lumis line of machines. I believe to get an Auto BiPAP in the Lumis series you may have to go with the Lumis 150 VPAP ST, or the Lumis 150 VPAP ST-A. They both have the AutoEPAP feature. The other machines do not. These machines probably are quite expensive, and you may be much better off with the DreamStation Auto BiPAP, if you can get it.
According to the results you posted, you didn't have a single central event. Based on that there is no need for you to get a BiPAP. Just having a high AHI is no reason not to use CPAP. A BiPAP can operate in CPAP mode and deliver slightly higher pressure, but this is rarely required, and a high AHI is no indication that you will require a high pressure. If your doctor is suggesting you get a BiPAP based on those results, I would suggest getting a different doctor.
I feel bad about advocating the ResMed AirCurve 10 VAuto machine to you when it is not available to buy where you are. If you go with the DreamStation Auto BiPAP, here is a link to a technical manual on it. They are fairly complex to set up. If you have any questions just ask. I would also advise downloading SleepyHead and getting it set up. You need a computer and SD card reader. It will be invaluable in helping you get the machine set up properly.
Sleeptech has also confirmed what I was thinking, which was that you are unlikely to really need a BiPAP machine. If you want to go with an Auto CPAP which will be limited to 20 cm pressure, the ResMed AirSense 10 AutoSet does appear to be available in India.
Hi all, today is my first night with my philips dream station auto bipap. Setup was simple. Mask is comfy but I'm in the bed past midnight trying to sleep. The sound or me breathing is very audiable with the mask on and it feels diff and I feel my mouth is getting dry faster. Got a flight to catch tomorrow morning and will be carrying the kit with me as I got more time to explore. Will keep you all posted on development and my journey. With regarding to sleepy head will be downloading it for my Mac tomorrow. Good night all
It will take some time to get used to the mask and the machine. My first night using a CPAP was awful. With respect to the dry mouth are you using a DreamWear nasal or nasal pillow mask, or the full face? If using the nasal type, and you open your mouth in the night, air can leak out, and give you a dry mouth. If using the full face that should not happen.
Do you have a heated hose, and have you put the humidity control in auto? A heated hose, humidity control in auto, and a temperature of 27 deg is usually very comfortable. I have not been able to tolerate a full face mask, but for the limited time I used it, I must mouth breathe and I do seem to get a bit of a dry mouth compared to the nasal pillow mask I normally use (ResMed P10).
I have read some reviews on the DreamWear mask where the air flow goes through the tubes up around your face to a tee connection on top of your head. Some complain that the mask is noisy. That said, I have a friend that uses the DreamWear Nasal Pillow mask and likes it. Give it some time before you make a change.
When you get SleepyHead working, let us know what pressures you are getting, or better still post a Daily screenshot. Depending on your pressures and whether or not you are opening your mouth, there may be better masks to try...
First the good news. An AHI of 1 is way better than an AHI of 100! The machine can obviously do a good job of normalizing the breathing compared to no machine. That long period of time from 3:30 to 6:30 is a bit odd. Were you awake during that time?
I think your settings are basically OK for the basic phase of determining what pressure you need. Eventually you may want to consider limiting the pressure once you determine that will not impact your obstructive apnea frequency. Your mask leak rate is a bit high, so you may want to work on adjusting that.
Some suggestions to make your daily screen shot more useful.
The DreamStation reports the VS2 Vibratory Snore, and nobody really seems to know what it is useful for. The flags for it make a mess of the display, and most with a DreamStation turn that function off in SleepyHead. Click on that blue box near the center bottom of the screen. There is a set of switches which will be green. You can switch VS2 to red or off.
The full month calendar does not add anything and clicking on that little triangle to the left of the current date suppresses the calendar. Clicking on it again restores it, if you need the calendar.
The Pie Chart does not add any info not already there and takes up space as well. On a PC you can suppress that by going to File, Preferences, Appearance, and then uncheck the Show Event Breakdown Pie Chart. This will let more important information display.
On a PC pressing F10 suppresses the right navigation screen which is not necessary, but it seems you have done that already.
Left clicking on the grey dividing lines between the graphs, and dragging lets you scrunch down the graphs to show more on the screen.
Gather and then post some more daily screen shots and any further adjustments may become apparent.
You should continue to gather more data, but just based on this one daily report I would discuss the following possible opportunities with the sleep doctor that recommended you get a BiPAP.
There may be a possibility you are not gaining anything from the pressure support which appears to be set at a variable 2-8 cm. Ask about simply reducing the pressure support to zero. This could significantly lower your maximum mask pressure and reduce your mask leakage problem and provide more comfort.
Reducing the pressure support to zero may leave you too little pressure when going to sleep. Ask about increasing the minimum EPAP which is currently set at 4 to say 7 cm.
If you go ahead with those changes and it reduces pressure, then next ask about reducing Maximum IPAP pressure. It looks like the highest you reach now is 16.5 cm. It may be possible to set the max IPAP to 13 cm or possibly lower. You would need to see what effect setting pressure support to zero has first before settling on a revised max pressure. The idea is to limit the pressure when more pressure is not doing you any good. It may put a bit of a limit on that pressure spiking that DreamStations typically do (the red trace on the graph).
