Although a CPAP machine has been proven to be the most effective and popular treatment in the sleep apnea battle, some CPAP machines tend to end up under the bed or in a closet gathering dust. For various reasons, people, although having been diagnosed with sleep apnea, decide that they cannot tolerate a CPAP machine. This is understandable since the idea of a constant stream of air keeping your throat open even when you’re not asleep is uncomfortable to many.

Standard vs. Automatic CPAP Machines

Prior to the release of APAPs, the only option available for treating sleep apnea was a standard CPAP machine. CPAP machines have treated millions of people successfully over the course of many years. But, as you may understand, a standard CPAP machine pushes a constant flow of pressurize air into a mask in order to keep the airway open during an apnea event. However, as the pressure increases, so too does the level of discomfort from the use of standard CPAP machines. The discomfort is genrally caused from dryness in the nasal passages due to the constant pressure, inability to tolerate high pressures or too much air coming through at times during the sleep cycle. Considering the typical sleep apnea sufferer seldom has the exact same pressure needs during each breath throughout the sleep cycle, it is understandable why a standard CPAP machine might not be optimal for some. In fact, a person’s pressure can change if they are sleeping on their side as opposed to their back, if they have gained or lost weight, and even if they had a few cocktails prior to bed.

It is true that some standard CPAP machines have added features such as Philips Respironics’ C-Flex and ResMed’s EPR to help reduce the pressure during non-apnea sleep. These features offer some relief by ramping slightly up or down to make CPAP therapy feel more natural. C-Flex and EPR work well but are quite limited in their ability to significantly reduce the standard pressure. Nevertheless, at high pressures, the level of discomfort can still be quite significant enough to stop CPAP therapy.

The design and technology behind an automatically adjusting CPAP machine make perfect sense. Why not give a person with sleep apnea the least amount of pressurized air needed to maintain air passage integrity at every given moment? Sometimes CPAP users will need less pressure and other times they will require a more. Since the air passages of a person with sleep apnea is not in a constant state of being closed, a CPAP machine which can automatically adjust to the needs of the individual on a breath by breath basis has plenty of merit.

An APAP machine does just that; it provides just enough air to keep the windpipe open on a breath by breath basis, increasing or decreasing depending upon the needs of the user. If a CPAP user is sleeping on their side without an apnea event, the pressure is automatically reduced to make it comfortable to sleep. If that person flips to their back and has an apnea event, the APAP automatically adjusts up with just enough pressure increase to keep the windpipe open. Once over, it will re-adjust down to appropriate levels. Obviously, the goal is to make it unnoticeable with a completely natural feeling in order to maintain quality sleep.

APAP’s have undoubtedly been doing exactly what they were designed to do; making CPAP therapy more comfortable and tolerable which increases compliance and quality of sleep. For this reason, most people new to CPAP therapy or who are buying a new CPAP machine most often choose an automatically adjusting machine. Not only is the slightly higher price worth it in the long run, the quality of sleep increases.

Best Auto CPAP Machines - ResMed’s S9 Autoset and Philips Respironics PR System One Auto

Both ResMed and Philips Respironics have advanced their CPAP platforms to include some high quality APAP machines.

The ResMed S9 Autoset has proven to be a big hit amongst CPAP users. Technologically, it offers many features such as a highly sensitive algorithm, heated tubing, ultra quiet motor, and advance data management that will satisfy even the most discriminating CPAP user. The S9’s modern design also gives the APAP machine a stylish and modern look.

The Philips Respironics PR System One Auto has also proven to be extremely popular among APAP buyers. Although the design is less stylish, the PR System One succeeds on technology. This enhanced APAP has an advanced event detection and response system that can detect symptoms outside of typical obstructive sleep apnea. Moreover, the “flex” technology enhances therapy beyond typical APAP adjustments, while the CPAP mask fit and seal monitoring checks the seal of the mask in real time. Overall, the Philips Respironics PR System One Auto will meet the needs of nearly every CPAP user.

Ease of Use

One of the advantages of the ResMed S9 Elite CPAP is the machine’s ease of use. The S9 Elite includes an LCD screen and functionality, making it simple for people to turn on and make any necessary adjustments for optimal sleep quality. Separating the humidifier from the main unit is also quite easy thanks to the effortless latch sytem. This makes it easy to clean the humidifier or to leave the humidifier at home for overnight travel.

Less Noise, More Sleep

Since the original CPAP machine was basically a vacuum motor pushing air out instead of sucking it in, it’s easy to understand why early CPAP models were large and noisy. Noise has been one of the most common complaints of CPAP users. But the ResMed S9 Elite has tackled this problem with improved technology. The superior design of the main motor creates less turbulence than older CPAP machines. In addition, noise-reducing materials located throughout the base of the machine help to muffle any sound. These improvements result in a much quieter machine, and less noise means more quality sleep for the CPAP user and any bed partner. In fact, clinical tests have shown that the new model has a noise level of approximately 24 decibels. How quiet is that? About the same amount of noise created by a person breathing normally and through their nose without obstruction.

Adapts to Your Room’s Environment

Heated humidification is an option on nearly all CPAP machines today. The advancements with the heated humidifier for the ResMed S9 Elite are second to none. First, the system has a heated tube which helps to eliminate rainout by reducing the affect of ambient temperature. This single feature adds a level of comfort for CPAP users never before seen. Secondly, the ResMed S9 Elite CPAP machine has an optional heated humidifier, the H5i, developed by ResMed to remove any congestion or dryness from CPAP use. The H5i humidifier regulates output based on the existing humidity and ambient temperature. This type of “intelligent” technology makes the machine adaptable to almost any climate and condition experienced by the average consumer.

More Feedback from the Machine

The ResMed S9 Elite also records data about the patient’s sleep cycle. Patients can assess the information to review any leaks, amount of usage, and AHI data. Sleep information is stored on the system for up to one year. This is valuable data for people who wish to see how many hours of sleep they are getting per night, how long they have been using their machine, and the average air pressure supplied during the sleep cycle.

If you are uncertain about the type of CPAP machine to purchase, consider the ResMed S9 Elite. The quietness, ease of use and one-of-a-kind climate adaptability makes this a remarkable machine.

Fast forward to today – through extensive clinical research and education by Fisher & Paykel, they have essentially convinced the sleep community of the benefits of heated humidification.  Now, every machine on the market has an optional heated humidifier.  Fisher & Paykel itself offers a comprehensive range of CPAP machines integrated with advanced heated humidification technology.

Why Heated Humidification

According to sources, a person’s lungs function best when receiving air that is 89.6° Fahrenheit (37° C) and 100% saturated with water. Obviously, the air we breathe is generally not at this temperature or humidity, especially if you live anyone in the Northeast.  Thus, before making its way to the lungs, air needs to be warmed and moistened.  The nasal airway is the body’s heated humidifier.  By converting each breath into the perfect air temperature and moisture level, the lungs are able to operate optimally.

When a person is using CPAP, the nasal airway’s ability to add warmth and moisture can be sabotaged.  Basically, the body attempts to heat the increase in air flow by directing more blood to the blood vessels in the nasal area.  This increased blood flow to the nose causes swelling and congestion of nasal tissues, better known as nasal congestion. With a congested nose, breathing on CPAP is not only difficult but much more uncomfortable.

One way to minimize or prevent this nasal congestion is to use a heated humidifier with your CPAP machine.  In adding a heated humidifier, air from the CPAP machine passes over the warm water before it is delivered into the mask for inhalation. Nasal congestion is prevented due to the ability of the heated humidifier to balance out the system.  Of course, in order to balance effectively, determining appropriate and comfortable heater settings is necessary.

Heated humidifiers can come as a separate piece of equipment that attaches to a CPAP machine via some tubing—alternatively some CPAPs come with an integrated humidifier (see below).

The Importance of a CPAP humidifier

During CPAP therapy, a significant number of users experience side affects such as a sore/dry throat, nasal congestion, a runny nose, or in extreme cases, a bleeding nose a result of the dry CPAP air.  As mentioned, healthy lungs function under very specific conditions and, thus, it is important to add warmth and moisture from the CPAP air for our lungs.  A heated humidifier can be used to minimize or eliminate nearly all of the irritating symptoms of CPAP therapy.  By preventing unnecessary nasal symptoms, CPAP compliance and quality of sleep rise.

Fisher & Paykel’s Answer to Humidification – ThermoSmart Technology

The effectiveness of conventional humidification is limited by room (ambient) temperature.  As air travels from the humidifier, it tends to cool due to the room temperature.  This drop in temperature causes condensation to form in the tube.  Anyone who has awoken to a rush of water coming through the tube and into the mask understands the annoyance of rainout!  As a result of this imbalance in temperature levels, CPAP therapy is less than optimal.

To combat rainout, Fisher & Paykel introduced ThermoSmart™ Technology which includes an advanced humidification algorithm and a heated breathing tube.  This combination works together to provide optimal humidity and reduce condensation.  ThermoSmart™ Technology, with its unique heated breathing tube, delivers higher, customized humidity levels that are maintained through the night, regardless of ambient temperature change.  These higher humidity levels help maintain normal airway conditions without the side effect of condensation.

In essence, the ThermoSmart™ Technology mimics the ability of the nose to heat and humidify the air. CPAP users will experience new levels of sleep comfort as humidity levels remain constant through the night, regardless of ambient temperature change.

The clinical evidence to support the effectiveness of ThermoSmart™ is clear:

• ThermoSmart™ provides a more comfortable CPAP experience¹
• ThermoSmart™ improves sleep quality and total sleep time²
• ThermoSmart™ lowers nasal airway resistance for 10% lower pressure³
• ThermoSmart™ virtually eliminates condensation even in a cool sleeping environment² whilst delivering high levels of absolute humidity⁴
• ThermoSmart™ is as effective as a nasal steroid in improving compliance and nasal symptoms⁵

Those who will benefit the most from ThermoSmart™ include:

• Patients over 60.
• Patients on medication.
• Patients who prefer a cold room.
• Patients with pre-existing nasal conditions.

Along with the various nasal CPAP masks, Fisher & Paykel’s line of full face masks include the Flexifit 431, Flexifit 432 and the Forma.  Although each mask is slightly different, they all bring a level of comfort equal to any other full face mask available.  Below is a brief description each of these full face masks from Fisher & Paykel.

Fisher & Paykel Flexifit 431 CPAP Mask

The Flexifit 431 was the first full face CPAP mask from Fisher & Paykel.  Unlike all other full face masks, Fisher & Paykel decided to utilize an under the chin design to increase stability and enhance comfort.  This under chin fit provides a constant point of reference when putting the mask on and maintains the seal even with jaw movement during the night.  Another obvious difference with other full face masks is the unique “milk bottle” mask shape which tends to provide a more accurate representation of a person’s nose and mouth structure.

An important part of any CPAP mask is the cushion.  The Flexifit 431 utilizes the pressurized air from the CPAP to help automatically adjust to a wide range of facial features.  The cushion is also frosted to optimize the seal and give it a smooth feel.  To help with proper sizing, the CPAP mask frame assembly can actually accommodate a small, medium or large cushion.  Finally, the CPAP headgear is crown shaped so there is no strap to irritate the back of the head while sleeping.  The headgear attaches to an innovative “glider” strap which reduces leaks by helping to maintain equal force when the head rotates from side to side.

Overall, the mask is a well made and comfortable with most users giving it positive feedback.  The ability to replace the cushion and headgear give the mask a good cost per use ratio.

Fisher & Paykel Flexifit 432 CPAP Mask

Fisher & Paykel’s second generation mask, Flexifit 432, improves upon the under chin design of the 431, making it an excellent option for people looking for something slightly different but with similar design features.

The primary difference between the Flexifit 431 and 432 is the cushion.  The Flexifit 431’s cushion is a soft, frosted silicone which seals well due to the flexiifit technology that automatically adjusts to the facial contours.  The Flexifit 432 offers an improved seal and more comfortable fit with the inclusion of a soft foam cushion that interacts with the silicone seal.  The foam cushion is a separate piece which can be removed for cleaning or replacing when necessary.  With the addition of the foam cushion, the Flexifit 432 increases the stability and comfort over the 431.  Moreover, the Flexifit 432 maintains the under chin design which further increases the comfort factor.

The Flexifit 432 preserves all the excellent features of the 431 including the frosted silicone seal to optimize fit and the “glider” and easy release strap for ease of use.

Similar to the Flexifit 431, the 432 gets high marks from users.  The addition of the foam cushion produces a more comfortable feel along with increased stability.  By incorporating the under chin design with the foam cushion, the Flexifit 432 improves upon the already popular design of Fisher & Paykel’s full face mask offerings.  Again, the cost per use ratio is high due to the replaceable cushion and headgear.

Forma Fisher & Paykel CPAP Mask

The Forma’s shape and lightweight design provides full face CPAP mask users with the basics for a positive experience.

As mentioned, the cushion is one of the most important features of a CPAP mask.  The Forma’s cushion sets the mask apart from competitors.  The cushion is composed of an outer silicone shell with a unique foam insert.  This uniquely designed FlexiFoam cushion is a soft, light and supportive foam which provides an excellent seal and advances the active contouring that conforms naturally to a CPAP users face.  The silicon seal which surrounds the foam is also frosted which again enhances the feel and optimizes the mask seal.  Fisher & Paykel Forma employs their patented Flexifoam Technology which automatically adjusts to a wide range of nasal and facial contours.

The Final Word on Fisher & Pakel CPAP Masks

Although all of Fisher & Paykel’s CPAP masks are highly effective in meeting the needs of CPAP users, they do have obvious differences which may or may not be beneficial to users’ individual needs and tastes.  Choosing a CPAP mask is a personal decision and should be based on comfort, fit, usability and design.  It is important to remember that the choice rests with the user not the equipment provider.  The Flexifit 431, Flexifit 432 and Forma are just a few choices in the full face CPAP mask world but each offers a unique option which is attractive to nearly any CPAP user.  At The CPAP Shop, we strive to bring you products we trust.  If you have additional questions, we are happy to discuss them with you.

In particular, Philips Respironics has built in even more CPAP machine intelligence. This new Auto CPAP machine addresses advanced sleep assessment parameters, including Apnea Hypopnea Index, Leak, Flow Limitations, snores and leaks to provide optimum therapy for obstructive sleep apnea (OSA).  Moreover, it can also detect symptoms beyond classic OSA such as clear airway apneas and periodic breathing that may indicate the need for specialized therapy.

With this new system, events can now be verified by looking at detailed patient flow waveform data captured by the device. The PR System One REMstar Auto CPAP includes all of the great features you come to expect from a sleep therapy system including a wide pressure range (4-20cm), patient adjustable ramp, automatic altitude adjustment, data card, the latest “flex” comfort technologies, and a universal power supply. In addition, the REMstar Auto CPAP is an auto-adjusting CPAP system so it will adjust your therapy levels throughout the night to ensure you are receiving optimum pressure for the most comfortable and successful sleep experience.

Detailing some of the Philips Respironics PR System One Remstar Auto CPAP include:

System One Resistance Control: System One Resistance Control achieves complete system comfort by enabling the device and mask to work optimally together. Through simple settings, the technology instructs the device to compensate for variable resistance characteristics related to different masks. The result is synchronous pressure delivery and the assurance you can enjoy the full benefits of Respironics Flex comfort technologies no matter which mask is used.

Advanced Event Detection & Response: The System One Sleep Therapy System tracks many common OSA related systems like Apnea Hypopnea Index, Flow Limitation, Respiratory Effort Related Arousal, Snores, and Leaks; but it can also detect symptoms beyond classic OSA. With intelligent technology the System One REMstar Auto can identify conditions such as clear airway apneas and periodic breathing that may indicate the need for specialized therapy.

Mask Fit and Seal Monitoring:  The Mask Fit feature gives patients the ability to check the seal of their masks in real time and lets them and their clinicians know what leaks may result when pressures increase from baseline throughout the night.

System One Humidity Control with Dry Box Technology: The optional PR System One Heated Humidifier analyzes ambient temperature, changing environmental conditions, relative humidity, and therapy flow to deliver optimum humidity – and ultimate comfort – throughout the night while also dramatically reducing rainout. Dry Box technology isolates the humidfier’s water source from the inner workings of the device to protect against accidental spillage and water damage.

Proponents of the auto-adjusting CPAP machine suggest the automatic pressure adjustments lead to more effective Obstructive Sleep Apnea therapy.  The auto-adjusting process ensures the minimum amount of pressure is provided leading to less apnea and hypopnea events.

The APAP aids in reducing incidents of aerophagia. Aerophagia is the act of swallowing air which leads to gas and bloating.

The auto-adjusting CPAP machine is a bit more costly than the standard CPAP machine. However, this cost is considered to be offset by the lack of need for subsequent sleep studies.