How fortunate we sleep apnea patients are to have the advanced technology and tools available today to treat our sleep disorders. Long gone are the days of having behemoth size machines that weighed so much we anguished at the thought of traveling with them. Gone are the days when our machines were so noisy that the sounds they produced had as much to do with our sleep disruption as our apnea events, not to mention our bed partners’ distain and thoughts that our snoring might be quieter than the machine noise.
Choices, we have more choices today than ever before. Machine choice is a subject that should be discussed with our sleep doctor but we should be well informed as to the different machine options that are available for our therapy. This discussion will revolve around the newly launched ResMed S9 VPAP Series. I personally use the ResMed S9 VPAP Auto and I wanted to learn more about this machine and the other bilevels in the S9 Series. I share my findings with you in “patient speak”. I am not a doctor, nor an engineer. In my studies, I try to break down information to its simplest form of understanding; it’s the only way I can learn and retain.
There was a time when bilevel machines were primarily used for treating the patient who required very high inhalation pressure or for the patient that failed on CPAP. In recent years, a new form of sleep apnea became recognized and distinctly termed Complex Sleep Apnea (CompSA). Research is ongoing but my understanding is that some patients diagnosed with obstructive sleep apnea (OSA) experience the onset of central sleep apnea events as a result of their CPAP use. The reason is unknown, but the preferred treatment therapy in most cases is bilevel.
What sets one bilevel apart from another? One important feature is algorithm technology. There are many features, I refer to as bells and whistles, but algorithm technology (an algorithm is the process by which a problem is solved) has greatly advanced and is the means to an end in regard to the detection of events while we sleep and the delivery of proper therapy. Huh? What did she just say, you ask?
A CPAP machine (continuous positive airway pressure) is the simplest form in the family of flow generators – I liken it to a fan in a box that is preset to “blow” – deliver one constant flow of air – from machine via mask in through the nose and mouth at a pressure high enough to keep soft tissue and tongue from blocking our airway thus resolving the apnea event. This allows us to breathe and receive the precious oxygen in to our lungs that our body requires.
Most patients receive CPAP as first line treatment upon initial diagnosis of apnea and it works well. For those challenged with difficulty exhaling over the constant pressure it delivers, benefit by a feature called expiratory pressure relief (EPR) which cuts back pressure up to 3 cm H2O. If one needs more expiratory pressure relief than 3 pressure points, bilevel should be considered.
Auto CPAP technology was introduced in the 1990’s when it became clear that any given patients inhalation pressure needs change during sleep due to position or the various factors in the different sleep stages. A patient may require higher pressures to resolve apnea events in the deep sleep stages or when they sleep in the supine position (back). Auto CPAP incorporates algorithm technology; a “smart” process that can read/ detect and determine, on a breath by breath basis, what machine pressure we may need at any given moment. It is this technology which I credit as the biggest advancement in flow generator performance over the years. Think of it as the brain inside of our machines. It was deemed so successful for increasing compliance; Auto Bilevel technology was subsequently introduced.
VPAP stands for variable positive airway pressure. ResMed provides 4 such bilevel units and all have distinct features suited for a variety of patient needs depending on diagnosis. Learn along with me, and discuss these biLevel options with your treating physician if you think they might be a better fit for your therapy. After all, no one is more attuned to the therapy challenges you are facing than you. If what you are doing is not working, consider changing what you are doing! Take advantage of today’s advances in technology. All of the machines below have optional and fully integrated heated humidification and are compatible with the Climate Control and ClimateLine tubing. All have operating pressure up to 25 cm H2O. All feature enhanced Easy-Breathe motor which makes them virtually silent, and all have Easy-Breathe waveform which differentiates between obstructive and central events and delivers the lowest most comfortable pressure to treat, automatic leak management, accommodation for integrated oximetry and come with SD data card and have S9 wireless module for compliance and efficacy data transfer. All have simple to use controls and a color LCD display making it all easy for us patients to read data any time we want.
If you have OSA and have tried CPAP or AutoCPAP and are not compliant or treatment is ineffective; discuss this machine with your doctor. This machine detects central sleep apnea events. This machine is a bilevel without auto-adjusting pressure capability.
If you have Obstructive Sleep Apnea and have tried CPAP or AutoCPAP and are not compliant or treatment is ineffective; discuss this machine with your doctor. This machine detects central sleep apnea events
If you require bilevel pressure support for ventilatory assistance, includes overlap, if you have COPD or obesity hypoventilation, discuss this machine with your doctor. This machine is a good choice for patients who require bilevel with a back up rate without alarms.
If you have Central Sleep Apnea, mixed apnea and periodic breathing, discuss VPAP Adapt with your doctor. This machine provides servo-ventilation support when needed and is an ideal choice for Central Sleep Apnea in all its forms including mixed events.
So, there you have it; a brief but I hope easy to understand explanation of the differences in the ResMed S9 bilevel series. A bilevel user for 21 years, I have owned many different brands and models. Although bilevel therapy was a definite success for me, it was not a choice, rather a necessity for the treatment of my severe mixed apnea. It has not been without challenges.
Most bilevel patients struggle with receiving the delivery of very high pressures and then the transition of exhalation at pressure reduction. This can be awkward both audibly as well as psychologically. One is definitely made aware of their inhalation and exhalation when using bilevel. Today’s technology eliminates the audible “whoosh in – whoosh out” sounds, for me, akin to a hospital ventilator in the ICU. The virtually silent, smooth transition afforded by ResMed’s Easy-Breathe motor and Easy-Breathe waveform removes the fear factor and oft sleep disruptive reminder that we are using a serious piece of medical equipment for our serious potentially life threatening sleep disorder called sleep apnea. The ease in which therapy is delivered by my S9 VPAP Auto allows me to get down to the business of sleep – quality, restorative sleep. It provides me a feeling of security knowing that my central and obstructive apnea are being resolved and all I have worry about is sleeping. No worries there!