CPAP Machine Buyer's Guide for 2021

1. Which Features Do You Have To Check Before You Buy A CPAP?

First, let's review the questions to get answered when evaluating a CPAP machine for your specific sleep therapy needs.

1.1 What modes does a machine have?

Fixed level CPAP (also known as manual CPAP) delivers constant pressure throughout use. If the prescription says CPAP of 6, the machine delivers CPAP of 6 throughout the night. AutoCPAP (also called AutoPAP or APAP) machines monitor your breaths for flow obstructions and increase or decrease the level of pressure throughout the night to continually eliminate obstructions. Some machines can only do manual CPAP but all AutoCPAP machines can do AutoPAP and manual CPAP. The prescription from your provider must request AutoCPAP for you to use that mode.

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1.2 How much does it cost?

When you purchase anything cost is a critical factor in your value assessment. CPAP and AutoPAP machines are available in a wide range of prices. Newer models cost more than older models. Devices that have more features tend to cost more. When evaluating CPAP machines, consider what accessories you need for quality therapy and what accessories are included or require an additional purchase. A humidifier is an example of an accessory to consider carefully. Is humidification essential to you? Is the humidifier included or does it require an extra purchase?

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1.3 What is the size and weight?

Weight and size may not matter much if you always plan to leave the machine at your bedside. Many people, though, like smaller machines even at home because they blend in with the environment in the bedroom. Other people do not care. If space is limited at your bedside, size can be a concern. If you travel, size and weight can be a consideration. If you take long airplane trips and know you will be sleeping on the plane, size and weight are important attributes.

Some devices have built-in power supplies that reduce the number of cords and parts. Many have external power bricks. The weight of the external power supply should be considered as part of the total weight of the machine since it is an essential component.

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1.4 What about humidification?

One of the most common complaints about CPAP therapy is that it can dry out the mouth and nose. Under normal circumstances, air from the environment is warmed and humidified by the nose before it reaches the lungs. When using a sleep therapy machine, a higher flow of dry air is delivered to the mouth and nose than during normal breathing. The nose often cannot keep up with adequately warming and humidifying the flow by itself. When a humidifier is used, the air flow picks up water vapor before it arrives at the mask.

When using a humidifier, it is generally necessary to fill the water tank with distilled water each night and clean it each morning. Also, as the warm, moist air travel throughs the CPAP tubing to the mask, it cools and water vapor condensates out. Cooling can cause water to accumulate in the tubing. How much this happens depends on the temperature in the room. Some machines include an option to use a heated circuit. The heated circuit monitors the temperature of the gas flow and adjusts to avoid condensation.

Humidifiers always add weight but may or may not add bulk to the machine. Some humidifiers are integrated into the machine shell and do not add to the size of the device. Some CPAP machines have also been validated for use with waterless humidification systems. These waterless systems use heat moisture exchangers, which are sometimes called artificial noses. HMEs collect water vapor from exhaled air. The stored water vapor is picked up by inspiratory air flow traveling up the circuit to the mask. HMEs add a bit of weight to the circuit. If the air is quite dry, HMEs may not pick up enough water vapor to be effective. HMEs also must be replaced at regular intervals once removed from the package.

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1.5 What quality of comfort features matter to you?

The current generation of CPAP machines all contain some features designed to make therapy more comfortable. In 2021, you can expect your CPAP machine to include a pressure ramp option. The basic ramp feature initiates therapy each night at a low pressure and gradually increases it over a set period. The pressure ramp lets you acclimate to CPAP while you are settling into bed.

All the machines in this guide include a basic pressure ramp, but there is some differentiation between devices with some having more complex, ramp configuration choices. Some machines, for example, may keep the pressure steady at a very low pressure indefinitely until they detect the first flow obstruction. Others initiate the ramp-up period automatically when they detect the first breath from the user.

You should expect any auto-PAP machine purchased in 2021 to have an expiratory pressure release feature. During CPAP therapy, the pressure holds the airway open so that when you breathe in air moves into your lungs without any obstructions. During exhalation, that pressure is still there. Some users find it uncomfortable to breathe out against the pressure, especially if they are new to sleep therapy or if the required pressure on inspiration is high. Expiratory pressure release detects exhalation and drops the pressure slightly to make exhaling feel more natural.

Each of the auto PAP machines in this guide has an expiratory pressure release option, and each name this feature something different. Some of the devices also have enhanced variations in the algorithms that do more than drop the pressure during exhalation. Fixed level CPAP therapy does not require software that monitors the user breath to breath so expiratory pressure release may not always be included on machines that only provide fixed level CPAP.

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1.6 Will it be quiet enough?

CPAP machines pull in air from the room using a motor. All of them generate white noise. The air travels at a high velocity through the tubing to the mask, creating a bit of a mini air tunnel that could add additional noise. Many people enjoy white noise at night and are entirely unbothered; for others, it can be a significant source of concern.

Machines that have a noise level rated at < 30 dBA are quiet enough for most people. If the acoustics in your bedroom amplify sound or you or your partner are particularly bothered by noise during sleep, look for machines that have a dBA rating 25-28. Smaller units, especially those designed for portability, need 1.7 to pack lots of power into tiny motors; as a result, they tend to be louder than full size machines.

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1.7 What are your travel plans?

Do you travel a lot? Do you need to sleep on airplanes for long overseas trips? If you do travel, will you always have access to a power supply during sleep? Do you need an external battery source? How vital is humidification to you during travel? These are all questions to ask yourself as you determine how to ensure you get your sleep therapy on the road. If you need to sleep on airplanes, verify that the machine has been FAA approved for in-air use. If you are traveling overseas, check that it can adjust for voltage and be used with a power adaptor for another country.

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1.8 Does your medical insurance cover CPAP machine purchase?

Most insurance companies cover home use CPAPs and require compliance reports to make sure you need this device and are using it every night. Some companies only cover CPAP rentals.

If the insurance covers a CPAP machine purchase, you may shop for one from your local DME (Durable Medical Equipment) stores, who usually can bill your insurance directly. Or you can shop online from dealers like RespShop.com. We do not bill insurance directly, but our invoices are accepted by most insurance companies. Online dealers will accept email/fax prescriptions, or they can call your physicians directly for the prescription record, plus the machine settings. Typically, you can save 50% or more by shopping online. Whether you shop locally or online, you are still responsible for deductibles, co-pay and co-insurance. Since local store prices are much higher, often time you may find you need to pay more copay/deductible/co-insurance than the machine price online.

If your insurance company only covers CPAP rental, you usually get a used machine and pay monthly fees for up to 13 months. After that, the machine becomes your property (double check your plan for details). We advise that you re-check the effectiveness of the CPAP therapy after one month of use. If you find the machine is helpful and you or your doctor plan for long term use, it will likely save you more money to buy a brand new machine from RespShop.com.

Note: Medical insurance usually does not cover the cost travel CPAP machines sch as the DreamStation Go and AirMini.

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2. Six Top Rated CPAPs to Consider in 2021

Here are six machines for treating obstructive sleep apnea worth a good long look, whether you are new to sleep apnea, ready to replace your current device, or looking for a travel solution.

Ranked 1 CPAP in 2021: DreamStation Go - Top Travel Machine

The DreamStation Go is marketed as a travel CPAP machine, but it has also been validated by Philips Respironics for everyday use at home as well. The DreamStation Go offers fixed level CPAP as well as AutoCPAP using the same responsive algorithm from the full size DreamStation. Many of the quality of life features found in the full size DreamStation Auto come included with the DreamStation Go: a timed pressure ramp, SmartRamp to trigger therapy at the first flow obstruction, and expiratory relief with flow smoothing.

A built-in power supply reduces the number of parts to be packed and carried along. It is also the only travel machine with an optional humidifier and battery pack. The OEM battery is rated for 13 hours at mid-range settings. Although the water tank on the humidifier holds considerably less water than a standard humidifier, software on the DreamStation Go factors in expected length of sleep and ambient temperature to make the water last as long as possible. Tap and bottled water can be used to avoid dragging distilled water around.

The DreamStation Go comes with lightweight, narrow (12mm) tubing but is compatible with any size tubing and with any brand and style of mask. Onboard Bluetooth sends data to the DreamMapper app which is cross-platform compatible to allow you to combine data from a DreamStation with the DreamStation Go. The DreamStation Go even has a USB charging port so you can recharge your other electronic devices.

The DreamStation Go could be an everyday machine, whether at home or on the go. The optional humidifier and OEM battery pack give users the confidence to know these accessories work since they have been tested and proven compatible by Philips Respironics.
Pros:

• Optional humidifier employs water-saving technology and can use tap or bottled water
• Built-in power supply and OEM battery available that averages 13 hours
• Uses the same patient sensitive algorithms from the DreamStation Auto for AutoPAP, pressure ramp and expiratory pressure relief with flow shaping
• Compatible with any mask
• USB charging port

Cons:

• Not validated for HME use
• Extra cost for humidifier (roughly $200)
• Additional charge for battery (approximately $300)

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Ranked 2 CPAP in 2021: AirMini from ResMed

The ResMed AirMini ResMed AirMini is the smallest, lightest travel CPAP machine on the market today. With a weight of only 0.66 pounds, it is no wonder it is the best-selling machine online currently. The AirMini offers three modes of sleep therapy: fixed level CPAP, auto-CPAP using the algorithm from ResMed's AirSense 10 Auto machine, or auto-CPAP using the "For Her" algorithm from the AirSense 10 Auto For Her machine. The "For Her" algorithm incorporates medical evidence that women benefit from more gradual increases in pressure than men when flow obstructions are detected.

Ramp and expiratory pressure relief settings are available. The same SmartStart & SmartStop features from the AirSense 10 Auto can trigger the machine to turn on when a breath is detected and to turn off when the mask is removed.

Bluetooth connectivity sends data from the AirMini to the MyAir smartphone application. Although there is a start/stop button on the AirMini itself, adjusting settings such as ramp and expiratory pressure relief, as well as the initial device configuration, require the use of the MyAir app.

Out of the box, the AirMini only works with five specific ResMed masks. The current compatible masks are the AirFit F20, AirFit F30, AirTouch F20, AirFit N20, or AirFit P10 for AirMini masks. When used with the AirFit N20 or AirFit P10 for AirMini masks, the AirMini offers a proprietary waterless humidification (HME) system called HumidX (or HumidX Plus). The HME sits inside a specially constructed connector that links the compatible ResMed mask with the compatible ResMed circuit. Although full face masks wearers are the most in need of added humidity during positive pressure therapy, the AirMini does not have any validated humidification system for these patients.

The tiny AirMini is bolstered by using ResMed's proven algorithms from the AirSense 10 machines for delivering effective, comfortable sleep therapy. Its size and weight are very appealing attributes, especially if you expect to travel often and need to pack light. The AirMini is tied to a handful of ResMed's masks so it may be necessary to use a different mask than you use at home. A third party adaptor is available to enable connection to a standard circuit, which then allows any mask to be used. When doing that, though, you give up the HME option and you give up the opportunity to use the small-bore, lightweight AirMini tubing that comes included.
Pros:

• Smallest, lightest machine around at 0.66 pounds
• Three modes of sleep therapy (manual CPAP, Auto-Set APAP, Auto-Set APAP for Her)
• Waterless humidification (HME) when used with specific ResMed nasal pillows and nasal masks
• Expiratory pressure relief and pressure ramp with SmartStart and SmartStop
• Lightweight AirMini tubing

Cons:

• Proprietary configurations limits compatibility with masks
• Connector that holds the HME adds weight and drag on the mask
• No humidification option for full face masks
• Setting adjustments require use of a smartphone app

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Ranked 3 CPAP in 2021: DreamStation Auto from Philips Respironics

The Philips Respironics DreamStation Auto offers both auto-CPAP and fixed level CPAP modes. The DreamStation's bright white case gives it a slim, modern aesthetic. The DreamStation Auto has settings for pressure ramp and expiratory pressure relief during either mode of therapy. In addition to a standard timed pressure ramp, the SmartRamp setting allows you to set the machine to increase pressure only after it senses the first obstructed breath. With OptiStart, the DreamStation Auto tracks your initial sleep pressure needs over time and initiates therapy each night at the optimal target pressure. C-Flex Plus and A-Flex Plus algorithms provide expiratory pressure relief and smooth out the flow during the transition back to the baseline pressure on inspiration.

The DreamStation Auto uses a Bluetooth connection for information sharing with the DreamMapper application. An ambient light sensor dims and brightens the screen as needed. The on-screen menu has the feel of a smartphone application.

The DreamStation Auto works with an integrated heated humidifier that plugs into the back of the machine, but the humidifier costs extra. An optional heated circuit lets you put the device into adaptive humidification and get the most out of the humidifier.

The Philips DreamStation looks good in the bedroom and is compact enough to travel with when the humidifier is removed, assuming you have access to a power supply and bedside table. The DreamStation has a feature-rich menu of onboard settings that let it get to know your sleep patterns so that night after night, you settle into comfortable sleep apnea therapy. The heated humidifier with heated tubing adds much value to the device despite adding cost and weight. The external power supply is bulky and packs in another two and a half pounds to the tiny base DreamStation. Since the machine is intended to be used primarily at home, most of the time, none of that will matter, however. If packing it along in onboard luggage to be used at a hotel or home of a friend or relative, the DreamStation Auto is up for the job at home and away.
Pros:

• Only 1.6 pounds without the humidifier
• AutoCPAP and fixed level CPAP modes
• Pressure ramp and expiratory pressure relief with flow shaping
• SmartRamp and OptiStart personalize therapy
• Bluetooth connection

Cons:

• Humidifier and heated tubing cost extra
• Humidifier and power supply add considerably to the size and weight

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Ranked 4 CPAP in 2021: AirSense 10 Auto from ResMed

The ResMed AirSense 10 Auto delivers both auto-CPAP therapy and fixed level CPAP. It includes all the features you should expect these days in an auto-CPAP machine, including ramp, and expiratory pressure relief. Detection of sleep onset and mask removal for initiation and termination of therapy are additional quality of life features on the AirSense 10.

A heated humidifier comes standard with the AirSense 10 Auto. Most of the water tank slides into the side of the machine, so it does not add much to the machine's footprint. ResMed's SlimLine tubing reduces weight and drag on the mask. Standard CPAP tubing can also be used. An optional heated wire circuit is also available. When the heated wire circuit is in use, the AirSense 10 provides climate-controlled heated humidification to minimize condensation caused by air cooling before it reaches the mask.

The AirSense 10 Auto records a robust array of data about sleep to an SD card. Additionally, the AirSense 10 Auto uses a cellular connection to transmit data to the My Air app. Clinical and technical support is also available through the cellular connection. Most machines rely on a Bluetooth connection for information sharing that necessitates more configuration by the user than the cellular standard on the AirSense 10 Auto.

The AirSense 10 Auto is a market leader in sales for a good reason. It's a feature-rich machine out of the box. Users and clinicians rave about its algorithm for adjusting CPAP throughout the sleep cycle. The humidifier is simply a part of the package. Pair it with a heated circuit to get the full value from the machine.

Its exterior is not that appealing, and it looks more like a machine than some other products. The external power supply adds quite a bit of weight. Traveling with it in carry-on luggage is feasible, but it will be a bit of a chore to take the AirSense 10 Auto on the go.
Pros:

• AutoCPAP and Fixed Level CPAP
• Included integrated humidifier
• Cellular connectivity

Cons:

• Heated tubing is extra
• Aesthetically underwhelming
• External power supply adds quite a bit of weight

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Ranked 5 CPAP in 2021: XT Fit CPAP Manual from Apex Medical

The XT Fit is an entry-level, low cost, fixed CPAP machine. The XT Fit is the one device on this list that does only fixed level CPAP. While the XT Fit does not have an AutoCPAP mode, it does include a pressure ramp option on startup. The XT Fit does not have an option for expiratory pressure release. With a bright screen and a dBA rating of 28, the XT Fit delivers a quiet, user-friendly experience. The XT Fit does not have any wireless connections, nor does it capture data to an on-board memory card.

The XT Fit weighs only 1.76 pounds without the optional heated humidifier. Without the humidifier, the XT Fit is the smallest home machine on this list. Indeed, it is so tiny that you might think it was designed to be a travel unit. The XT Fit is FAA approved and allows for altitude adjustments. The power supply is built into the machine itself, reducing the number of parts to be packed up if you choose to travel with the XT Fit.

The XT Fit checks all the essential boxes for fixed pressure CPAP therapy in 2021. It is a great machine to start with if you need fixed level CPAP or if you want a small, inexpensive manual CPAP unit for back-up use at home or travel, especially if you do not care about humidification for a few days away from home.
Pros:

• Very affordable (<$300)
• Small and lightweight
• Pressure ramp at startup
• Integrated power supply

Cons:

• No auto-CPAP mode
• No expiratory pressure release setting
• Humidifier costs extra and adds a fair bit to the size

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Ranked 6 CPAP in 2021: SleepStyle from Fisher & Paykel

The SleepStyle SleepStyle provides both Auto CPAP and fixed level CPAP therapy. The shape and style of the SleepStyle set it apart from similar machines. The SleepStyle looks more like a clock radio than a medical device. The included humidifier sits under the top lid like the filter in a coffee maker. This machine has numerous ergonomic tweaks to make it easy to handle deftly. It even won an American Arthritis Foundation commendation for its ease of use. The humidifier, for example, has finger holds for removing it. The SleepStyle captures data to a USB drive rather than tiny SD cards which can be easy to drop. It comes with Bluetooth, though cellular connectivity is available.

Ramp and expiratory relief are available settings, as to be expected on a modern auto CPAP device. The SleepStyle's SensAwake feature tapers pressure when it senses slight sleep arousals to keep therapy from fully waking the user up. The AirSpiral heated tubing costs roughly an extra $40-$50, but when in use, the SleepStyle automatically controls the temperature and water vapor level regardless of the room temperature.

The power supply is integrated into the case, and the entire device with the humidifier tucked inside weighs 3.7 pounds, making it more substantial than a home unit like the DreamStation but on par or lighter than others. Packing necessitates stowing just one consolidated piece and a power cord, so traveling with it is a realistic option if you expect to have a place to set it up and a power supply. The SleepStyle is not currently FAA approved, though, so it should be completely turned off and stowed during air travel.
Pros:

• Auto CPAP and Fixed Level CPAP
• Included humidifier is included and stows entirely out of the way
• Ergonomic advantages
• Attractive design
• Integrated power supply
• SensAwake remembers where to start pressures based on prior sleep history

Cons:

• AirSpiral heated tubing costs extra
• Not approved for air travel use

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Undoubtedly at least one of these six machines is a best value for your sleep needs!
Wishing you a very happy 2021 filled with sweet dreams!