A Little Advice on Choosing CPAPs, BiPAPs and CPAP Masks
By Andrew Senske, President CPAP-Supply.com
Last Updated 6/20/2007 06:04:00 PM


Click here for our September 2011 article on equipment recommendations.

Here's a common scenario. You've just been diagnosed with sleep apnea. You've searched for one of the following keyword phrases on Google:

  • CPAP machines
  • CPAPs
  • C pap
  • CPACK
  • CPAT
  • CPAC
You may have used one of the last few keywords listed above if you had no idea what the doctor was saying when he told you that you needed a CPAP machine! Trust me. Lots of people do searches using these keywords; you're not the only one! Remember, though, that CPAP is an acronym for Continuous Positive Airway Pressure.

After conducting the search, you undoubtedly landed on one of the most highly regarded and esteemed CPAP web sites of all time: CPAP-Supply.com. Naturally, you find the web site extremely compelling and the prices unbeatable, so you give us a call. Did I mention our phone number yet? It's 888-955-CPAP.

You explain over the phone that you're just starting out with CPAP and you need some help finding the right equipment. At the request of your doctor, perhaps a local supplier paid you a visit trying to sell you equipment you really didn't want for $2,000. The equipment from the local guy may have been outdated, and it was definitely 2 or 3 times the price of the same or better equipment on our web site. So, you're looking for some good, solid answers that you feel comfortable with.

And I've got some for you, so keep reading.

When I have a conversation with someone who needs a recommendation for a CPAP machine and or CPAP mask, I usually try to ask most or all of the following questions so that I can make some sort of reasonable assessment of the customer.

  1. What's your prescribed pressure setting?
  2. Have you used CPAP therapy before, and if so what CPAP equipment have you used?
  3. What type of equipment did you use in the sleep lab, and did you like it?
  4. Do you have any breathing issues like a deviated septum, allergies which block your nasal passage, etc.
  5. Do you breathe mostly through your mouth?
  6. Has your doctor recommended any specific equipment based on information he knows about you?
  7. Are you a particularly active sleeper, moving from one side to the other frequently throughout the night?
Recommendations for CPAPs
I define a low pressure setting as being between 4 and 7 cm H2O. An average pressure setting is between 8 and 12 cm H2O. A pressure setting of 13 cm H2O or higher is considered high by my standards.

If you've got a low pressure setting a basic CPAP machine will be a great choice for you. The Puritan Bennett 420G or the REMstar Basic M Series would be my first two recommendations. If size and weight are a primary factor (because you travel a lot, or because you just really like small things), then I'd give a slight edge to the 420G, since it's our smallest and lightest CPAP machine, weighing just 1.5 pounds.

If you have an average pressure setting - between 8 and 12 - I'd recommend taking a look at a CPAP machine with exhalation pressure relief. The REMstar Plus, Pro and Auto M Series CPAP machines have a feature called C-Flex (or A-Flex) which is a comfort feature that allows the pressure to be reduced every time you exhale. This is a great feature especially if you're just starting out with CPAP therapy, since breathing against the incoming air can be a little uncomfortable.

If your prescribed CPAP pressure setting is high, then I'd recommend an automatic CPAP machine. Automatic CPAP machines are also good if you have a prescription which doesn't indicate a specific pressure setting. Automatic CPAP machines are more expensive because they determine the pressure setting automatically, and constantly adapt to your specific needs throughout the night. If you like the smallness of the 420G then you'll equally like the 420E which is the automatic version. It's our smallest, lightest and least expensive automatic CPAP machine. If you want the capability of an automatic machine along with exhalation pressure relief, then I'd recommend the REMstar Auto M Series with C-Flex or A-Flex. This machine will adjust automatically throughout the night, providing optimal CPAP therapy, and it will also drop the pressure every time you breathe out to make CPAP therapy more comfortable.

The absolute best value in an automatic CPAP machine with an integrated heated humidifier is the DeVilbiss IntelliPAP AutoAdjust with Heated Humidifier. It's got a great humidifier design which significantly reduces the chances of spilling water from the humidifier into the flow generator, it's relatively inexpensive, it's got the best warranty in the industry (3 years on the flow generator and 2 years on the heated humidifier), and it's the quietest CPAP machine available. Also, since the heated humidifier attaches to the bottom of the machine, the entire footprint is kept to a minimum saving you valuable real estate on your nightstand. The DeVilbiss IntelliPAP machines - both the Standard and the AutoAdjust - also come with the best carrying case.

A BiPAP machine is sometimes necessary if you have a really high pressure setting, and if exhalation pressure relief doesn't provide enough relief for you to exhale comfortably. For example, you may have a prescribed pressure of 18 cm H2O. The most relief you'll get with a technology like C-Flex is a drop of 3 units of pressure. In our example, you'll still be breathing against a pressure of 15 cm H2O during exhalation, which can be difficult and uncomfortable - if not impossible for some CPAP users. With a BiPAP machine you could have an inhalation pressure of 18 and an exhalation pressure of, say, 6. If you need a BiPAP machine, your doctor will have probably told you as much. Take a look at the Respironics BiPAP Auto M Series.

Recommendations for CPAP masks
I believe that for the most part, your CPAP mask is the key to successful CPAP therapy. The major concern with CPAP masks revolves around getting a good fit and minimizing or eliminating leaks. A common leak area is around the bridge of the nose, so I generally recommend nasal pillows masks. Nasal pillows masks are very popular now because they're generally lighter weight, most of them come with all sizes of pillows, they don't obstruct vision, and they're pretty easy to fit without leaks.

The Respironics OptiLife is a very compelling choice, but if you have different sized nostrils (seriously), you should opt for the RespCare Bravo or the Puritan Bennett Breeze SleepGear Nasal Pillows CPAP mask which allow you to use different sized nasal pillows for each nostril.

Another factor to consider is the way in which the tubing connects to the mask. If you're a side sleeper then tubing that connects to the side of the mask (e.g. Mirage Swift I and II, RespCare Bravo) may not be the best choice for you.

If you breathe with your mouth or if you have any sort of problem with your nasal passage, then a full face mask may be more suitable for you. I tend to recommend the RespCare Hybrid and the Mirage Liberty, since these are full face masks that incorporate nasal pillows for the nose portion. If you like the idea of a more traditional full face mask, then the ResMed Mirage Quattro is the best choice. The Quattro covers both your nose and mouth.

(Whatever you do, don't get the Respironics Total Face Mask unless you've exhausted all other options and simply cannot achieve a good seal with any other mask!)

Of course, we believe in all of the CPAP equipment we sell. In fact, we don't sell equipment we don't like or that we wouldn't use ourselves (except, perhaps, for the Respironics Total Face Mask which is a bit extreme). My recommendations above are based on my own personal preferences as well as feedback we've received directly from customers.

As always, if you need assistance selecting CPAP equipment, feel free to give us a call. We'd be happy to help.

Andrew Senske
President
www.cpap-supply.com

CPAP-Supply.com is a leading online retailer of CPAP equipment. Located in Spokane, WA CPAP-Supply.com has been serving thousands of customers around the world since 2001. Founded on a belief that patients are their own best primary care providers, CPAP-Supply.com understands the importance of educating patients and customers on both the effects of and treatment for obstructive sleep apnea. For more information visit CPAP-Supply.com or call toll free 1-888-955-2727.