Can I Get a Mini Lesson From the Experts Here?

[Madalot]

I tried searching for this, both here and on google, but couldn't find what I wanted quickly.

I understand cpap and bipap and how they work, but I've seen here apap and vpap. Can someone give me the quick, Cliff Notes version, of what those are and how they are different? My husband is trying desperately to keep up with all of this and figure out why they went from bipap straight to ventilator.

Note: I apparently have not been making it clear (other places) that while they are giving me a ventilator today, they are going to do everything possible to set it up like a regular bipap and only use the more advanced features of the ventilator if we absolutely have to.

I've tried explaining to my husband how they believe I need the ventilator's more sensitive settings because of my muscle weakness. He keeps asking me questions about vpap that I just can't answer.

Any insight would be greatly appreciated. Thanks everyone in advance.

[bdp522]

From cpap.com;

The ResMed S8 VPAP Auto 25 is an easy to use design that provides the most comfortable therapy available. One-touch settings and a simple set-up make this machine very attractive. The VPAP series has a wider pressure range, accommodating pressures from 3cm to 25cm H20.

The VPAP Auto 25 uses VAuto technology to adjust automatically using ResMed's unique AutoSet algorithm. VAuto is engineered to prevent obstructions before they occur by responding quickly and accurately to flow limitations. The algorithm works on a breath per breath basis and automatically adjusts to find the lowest required pressure needed to prevent most snoring and apnea events. VAuto is so consistent in response to events it often adjusts on the very next breath after a flow limitation or obstruction.

Enjoy the new Easy-Breathe technology which offers smoother, comfortable pressure by synchronizing with the CPAP user's normal breathing patterns, allowing for a natural and stable breath. Easy-Breathe Technology imitates normal respiration that makes breathing more comfortable than traditional CPAP or BiLevel machines. The transition from EPAP to IPAP pressures is gentle and slides into an exhalation curve that feels more natural. The final result is a VPAP machine that is intuitive, effective and produces only 26dB decibals at 10cmh20 at a distance of 1 meter.

Additional features include the TiControl, Vsync and five sensitivity settings that provide additional fine-tuning to the VPAP Auto 25. TiControl allows CPAP users to set minimum and maximum inspiratory time limits that provide a range to accommodate treatment for chronic obstructive pulmonary disease and respiratory conditions. ResMed has also included five trigger and cycle settings that help manage patient inhalation and exhalation patterns. Vsync is unique to the VPAP Series that automatically minimizes pressure loss due to mask leaks. All three technologies help regulate IPAP/EPAP intervals through monitoring the breathing cycle (BPM) and Rise time.

The machine is suited with three mode options, VAuto, Spontaneous, and CPAP, proving to be one of the most flexible flow generators in the market, delivering all of the comfort available for successful compliance and treatment.



AND

On a breath-by- breath basis, the revolutionary algorithm uses Digital Auto-trak Sensitivity to change pressure support, when necessary, to maintain a stable breathing pattern.

In addition to this breath-by-breath adjustment of pressure support, the Bipap Auto SV algorithm also calculates the patient's spontaneous breathing rate and will automatically trigger a breath should the patient have an apneic event. This algorithm rapidly helps normalize respiration and turn the pressure to the minimum required therapy pressure once ventilation has been normalized.




AND

The REMstar Auto M Series with C-Flex is is an auto-adjusting CPAP machine which is set for a range of pressures, then seeks out and delivers the lowest level of pressure needed to keep the airway open. With CFLEX technology, not only with the pressure level vary as needed, but it will drop with each exhalation.

The auto-adjusting CPAPs were designed for patients who are unable to participate in a sleep study or whose pressure needs vary during the night according to their stage of sleep or sleep position. However, any patient will receive very comfortable therapy from this type of CPAP.



Hope some of this helps

Brenda

[ozij]

BIPAP and VPAP are the terms used by Respironics and Resmed for Positive Air Pressure machines that supply a separate inhale pressure and exhale pressure.

The BI comes from bi-level the V comes from variable, but they are essentially the same.

Ventilators can go to far far higher pressures than either BIPAP or VPAP - pressure strong enough to move your rib-cage when you can't do it on your own.

As far as I know, all ventilators have a BIPAP options.

APAP is short for Automatic Positive Air Pressure and refers to machine that adjust the pressure the supply automatically -- based on analysis of breathing patterns. APAP refers to machines that supply the same pressure for inhale and exhale - the are not bi-level machines.

The BIPAP and the APAP respond to flow variations -- however you need something that will ensure you have the proper volume of air breathed in and breathed out for each breath. For example, suppose your breathing is consistently on 60% as deep as you need, and suppose a flow based simple PAP machine only responds when your breath flow is 50% or less of the the maximum. That would mean that on that PAP machine, you would never get the 100% ventilation you need -- it would never raise you above that 60% level you're stuck on.

Regular PAP machines (BIPAP and VPAP included) assume your basic breathing is OK, but it get interrupted for various reasons. That does not seem to be your case, however. Your breathing may get interrupted, but you basic level is too low and has to be supported. That's why you need a machine that take volume into account -- a type of ventilator.

O.

[Madalot]

Many, many, many thanks for this information and so quickly! I basically read the responses to my husband and he understood. Said it made perfect sense!!

One of the problems I've had with people (not here) is they see "ventilator" and assume total life support. I've tried to express that we're not doing that (now anyway) but that the ventilator is where I need to go because of what has been said here. Then I get them telling my that "needing" a ventilator isn't that big of a deal.

It is to me because it illustrates that my problem is more serious than originally thought. I have a family member that is using cpap and thinks they know everything, but when told I needed to move up to bipap, asked "what the heck is a bipap??" This person only knows what THEY deal with and has absolutely no concept about anything beyond that.

i still don't know the details of exactly how we're going to set everything up, but my understanding is that we will be using a backup feature of sorts to make sure I get the inhale pressure and there won't be any waiting to sense my breathing, since it's obviously too shallow.

Thanks again and I'll post the specifics after I get the ventilator today.

[LinkC]

I'm no expert, but I can give you my simplistic understanding of the differences.

CPAP provides constant increased pressure to your airway (as the name implies). However, most machines have some sort of exhalation relief (c-flex) so you aren't breathing out against the full pressure. Usually you can select from 1cm to 3cm reduction below the set pressure.

APAP works like CPAP except the pressure will vary in response to apnea events, rising as events are detected, and falling back after periods of no events. APAP supports two types of exhalation relief: c-flex as described above, and a-flex where the amount of relief varies as the pressure changes.

BiPAP is like CPAP but the inhale and exhale pressures are set separately. It is most often used for patients who require an inhale pressure greater than 20 (which is the typical upper limit on CPAP and APAP machines.) Most patients can't exhale comfortably against those higher pressures.

I *think* VPAP is just another tradename for the same thing, but I'm not sure, so I'll leave that one for others.

[Catnapper]

I am no medical professional in any way, so this is just my experience I am reporting. Indeed, I am no expert either! All of this is my opinion, nothing more.

From my experience, I can say that bi-pap can be used to provide easier, more comfortable breathing while asleep. I don't require high pressure - actually the higher pressures wake me up. I am a very light sleeper and the ease of exhaling with bi-pap improves my ability to stay asleep and was prescribed for comfort. The bi-pap is sometimes prescribed simply because a person cannot deal with straight cpap. My daughter was given a bi-pap within a few minutes in her first titration because she was unable to tolerate cpap. My daughter-in-law borrowed my extra bi-pap for a couple months, collected the data, and when she presented the data to the doctor, he ordered a bi-pap titration for her so she could have a machine of her own. She had been on regular cpap for 10 years previously, but found the bi-pap so much more comfortable. None of us require pressure higher than 13 at the max.

Although the machines are more expensive, I think anyone can use one, not just those people who need extra pressure. I think they may go to higher pressures than a regular cpap, so high pressure is a good indicator. I know someone who had pulmonary fibrosis who had a bi-pap because his lungs were weak. He said even the a-pap made his chest feel like it was exploding.

Perhaps it is just the difference in the e-pap and the i-pap (exhale pressure and inhale pressure), but exhaling with the bi-pap feels like there is no pressure against your breathing, as if there is an empty hose with normal everyday air.

Again, this is my opinion, not based on any medical knowledge or expertise.

Catnapper - Joanie

[Madalot]

I am so glad I opted to continue here (and was asked to stay too!). This is exactly why. A fairly complicated question that confuses people, spelled out very simply so that anybody can understand the differences. This is exactly what I was looking for and needed.

Armed with this information, I will be better able to understand the ventilator settings today.

Again -- many, many, many thanks. I'm not sure you all realize how much help you give.

[Fred D]

Please be sure you let us know what they bring and set up for you today. I am so happy it will finally be brought to you. I know how frustrated you have been from your earlier posting and you have been in my thoughts and prayers.

Fred

[Madalot]

Thanks Fred --

Actually, we have to go to the DME's office for this. I think they should bring it out, too. But we're willing to go there so there's no chance of them NOT having something they need.

This is one of the reasons we were so aggravated yesterday. My husband intentionally didn't plan anything yesterday so he could take me to their office. We were just waiting for the call to say "please come in at" and we'd go if it was soon, or he'd go do something else until it was time to go.

But, we're leaving here in about 30 minutes. I'll post a new thread after we get back and get situated.

Wish me luck.

[-SWS]

i still don't know the details of exactly how we're going to set everything up, but my understanding is that we will be using a backup feature of sorts to make sure I get the inhale pressure and there won't be any waiting to sense my breathing, since it's obviously too shallow.

It sounds as if they're going to set up your new machine in ordinary BiPAP S/T mode. A number of users here have their BiPAPs (a.k.a. BiLevel machines) set up that way.

Your previous machine could be set up as a BiPAP S---meaning spontaneous mode only rather than a BiPAP S/T with a backup rate (the S/T suffix) to kick in for missing or too-shallow breaths (meaning too shallow for the purpose of IPAP-trigger detection).

As it stands, you could have probably accomplished that initial configuration with an ordinary BiPAP S/T, BiLevel S/T, or VPAP S/T machine (those are all functionally the same---just different names). However, none of those would ever allow you the option of experimenting and comparing with some of those more sophisticated vent modes. Your machine is like a Swiss Army knife. And for starters it appears the only feature you will try is the same ordinary BiPAP S/T functionality that quite a few people here rely on. That's all a tentative interpretation on my part---based on what you have gleaned from your RT/DME and conveyed back to us.

[Madalot]

i still don't know the details of exactly how we're going to set everything up, but my understanding is that we will be using a backup feature of sorts to make sure I get the inhale pressure and there won't be any waiting to sense my breathing, since it's obviously too shallow.

It sounds as if they're going to set up your new machine in ordinary BiPAP S/T mode. A number of users here have their BiPAPs (a.k.a. BiLevel machines) set up that way.

Your previous machine could be set up as a BiPAP S---meaning spontaneous mode only rather than a BiPAP S/T with a backup rate (the S/T suffix) to kick in for missing or too-shallow breaths (meaning too shallow for the purpose of IPAP-trigger detection).

As it stands, you could have probably accomplished that initial configuration with an ordinary BiPAP S/T, BiLevel S/T, or VPAP S/T machine (those are all functionally the same---just different names). However, none of those would ever allow you the option of experimenting and comparing with some of those more sophisticated vent modes. Your machine is like a Swiss Army knife. And for starters it appears the only feature you will try is the same ordinary BiPAP S/T functionality that quite a few people here rely on. That's all a tentative interpretation on my part---based on what you have gleaned from your RT/DME and conveyed back to us.

This is one of the questions I need to ask today -- if we could get the same result sticking with a bipap, why did he talk my doctor into going straight to ventilator? I'm not saying he's wrong, but I'd like to hear his thinking on this so I can understand.

[JohnBFisher]

... This is one of the questions I need to ask today -- if we could get the same result sticking with a bipap, why did he talk my doctor into going straight to ventilator? I'm not saying he's wrong, but I'd like to hear his thinking on this so I can understand. ...

I suspect he was a bit concerned that you could not trigger a normal switch in pressure when you could not too long ago. That's a significant change. My guess is that your doctor also perceived that as a possible concern. If that's the underlying cause, I suspect they may think that the unit they recommended will be more agile as they need to meet your changing needs.

[Muffy]

I tried searching for this, both here and on google, but couldn't find what I wanted quickly.

I understand cpap and bipap and how they work, but I've seen here apap and vpap. Can someone give me the quick, Cliff Notes version, of what those are and how they are different? My husband is trying desperately to keep up with all of this and figure out why they went from bipap straight to ventilator.

Note: I apparently have not been making it clear (other places) that while they are giving me a ventilator today, they are going to do everything possible to set it up like a regular bipap and only use the more advanced features of the ventilator if we absolutely have to.

I've tried explaining to my husband how they believe I need the ventilator's more sensitive settings because of my muscle weakness. He keeps asking me questions about vpap that I just can't answer.

Any insight would be greatly appreciated. Thanks everyone in advance.

"IMHO", when someone uses the term "ventilator", they are interesting in utilizing

• A back-up rate
• An enhanced alarm system
• Precise measurement of supplemental oxygen
• Volume-oriented therapy

The best answer to this question is to ask your physician what their goals are. As noted, a BiPAP S/T can do most of this stuff. However, if the goal is precise control of pCO2 (which is sorta what it sounds like), then purely volume-oriented therapy will have a little more control than AVAPS (or perhaps your physician is not familiar with that mode).

Muffy

[rjjayrt]

Sounds to me like your physician is going to put you on something like the Quantum PSV by Respironics. We used to use those machines alot a while back. I personally have not used since the advent of the Bipap S/T type machines. If my memory serves me correctly this machine should take care of the problems you've been describing. Although technically a ventilator (its a non invasive pressure support vent) Its usually used as a Bilevel device (IPAP and EPAP) with a spontaneous timed mode that allows you to change the sensitivity or ease of triggering.

[Muffy]

Also, the ability for back-up battery power, which Trilogy appears to have (both internal and external):

http://trilogy100.respironics.com/clinical/faq.aspx#12

Muffy