SleepyEyes21 wrote:Isn't bipap also used more for those with central sleep apneas, or is this a misunderstanding?
There is a type of bilevel machine that is used primarily to treat central apneas. This would be one of those ASV (Adapto Servo Ventilator) machines that will actually breathe for you in the event your brain doesn't tell the body to breathe. Non invasive ventilation...invasive would be like you see in the movies where a person has a tracheotomy and the machine is hooked up that way.
There are what I call "plain" bilevel machines which don't have the capacity to do the ASV modality. Pretty much cpap machines that allow a bigger difference between inhale and exhale than we can get with typical exhale relief. These machines can be used to treat centrals sometimes when it's just the pressure that is causing the centrals to occur and if a fine line between central triggering and still treating the obstructive events can be found. Sometimes it works out...but sometimes it doesn't.
These plain bilevel machines are often used when a person has higher pressure needs (in the teens) and the cpap user is having difficulty exhaling against those pressures. Or maybe someone has significant aerophagia issues and using bilevel pressure machines can keep the aerophagia at bay.
It's the difference between inhale and exhale that "feels" so much easier to exhale with. For some people it can make the difference between using the machine successfully and not being successful.
In a way the cpap/apap machine with whatever form of exhale relief they offer (Flex or EPR) sort of works like a bilevel machine but the difference that Flex and EPR offer is limited to a relatively small difference between inhale and exhale and for some people that just isn't enough. It's much easier to exhale with a pressure of 12 inhale and 8 exhale than it is 12 inhale and 10 exhale (EPR of 2)...big difference actually in comfort and maybe a bigger difference in keeping aerophagia issues at bay. It's not exactly the same as the timing is just a bit different with the bilevel machines vs the cpap/apap with exhale relief enabled but it's very similar.
If you used a pressure of 18 cm.....it's much easier to exhale with 18 inhale and 13 or 14 exhale with a bilevel pressure machine...much easier. Might not be so critical at pressures in the single digits but for people who get really bad aerophagia even at at low pressure of 7 cm...it can make the difference between using the machine and not using it if the aerophagia is severe.
So not just for centrals...but can be for centrals if someone needs that special high dollar ASV type of bilevel.
There's also a couple of other types of bilevel machines with special uses...like people with really bad COPD.
Oh.. CPAP or APAP can offer up to 3 cm exhale relief with the use of EPR set at 3....it's a cm reduction per setting...3 EPR feels an awful lot like 3 Pressure support when using a bilevel machine. I tried both to see what it felt like... 13 cm with EPR at 3 and 13 inhale and 10 exhale on the bilevel machine. Tiny difference in the timing but for all practical purposes...felt the same.
Respironics machines and their Flex exhale relief is flow based relief and doesn't automatically do a per cm reduction and the most they can do even at a setting of 3 is 2 cm...and that's with a very forceful respiration pattern. So the most a person can get on Respironics with AFlex or CFlex is 2 cm reduction. It isn't something that is dramatic though.
With a bilevel device the difference is fairly dramatic when the difference is 4 or 5 cm between inhale and exhale.
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