Auto-CPAP vs. Bi-Pap

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Re: Auto-CPAP vs. Bi-Pap

Post by palerider » Mon Sep 01, 2014 4:16 pm

pdeli wrote:I have no idea what that means or who "someone else " is, but I've seen some of your other posts and it would appear that you must think that ridicule is helpful. If your intent is to put a sour tone on this site, it would seem to me that you have been successful.  

I don't understand why you are otherwise here.

As someone with a learning disability, I find your snide remarks humiliating. 
if you have a learning disability, then please help me to provide the information in a way that you can understand it.

instead of simply being directly insulting.

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Re: Auto-CPAP vs. Bi-Pap

Post by HoseCrusher » Mon Sep 01, 2014 4:41 pm

Phil, look at it this way...

Some people need a higher pressure to keep their airway open. At this higher pressure they find it difficult to exhale.

Think of it like blowing up a balloon and then breathing in a little and trying to exhale into the blown up balloon.

The difference between the two machines is the amount of relief offered when you exhale. Auto Cpap can offer up to 3 cm pressure relief. Bi Level can go higher and Pugsy thinks it may be as high as 8 cm pressure relief.

Another difference is the maximum pressure the machine can provide. Auto Cpap machines go up to 20 cm where Bi Level machines go up to 25 cm.

Here is an example. If you need something like 22 cm of pressure to keep your airway open you can't get that high a pressure with an Auto Cpap. You need a Bi Level machine. Next breathing out against 22 cm of pressure is difficult so the Bi Level allows you to set the exhale pressure lower to something like 16 cm of pressure.

Notice that is a 6 cm difference. If all you needed was 20 cm an Auto Cpap machine would work but the pressure relief has a maximum of 3 cm so the lowest you could go would be 17 cm. When exhaling the extra drop in pressure may be much more comfortable.

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Re: Auto-CPAP vs. Bi-Pap

Post by Guest » Mon Sep 01, 2014 4:43 pm

An auto could be set to go from say 6 to 14cm. Starting at 6cm and only increasing the pressure if/when it needs more pressure to keep events from happening. Snores can drive the pressure higher and you will have to exhale against that pressure.

Where a bipap say is set at 10/14 - 10 epap and 14 ipap. the epap has to be high enuff to prevent Obstructive events (OA's) and the ipap helps to suppress snores, flow limitations, and hypops. The concept helps tremendously on exhale where you have an automatic reductions in the exhale pressure (10cm) - where when the auto get up to say 12 or 14 you have to exhale against that pressure.

Keep in mind that is just an example and some people have to exhale against 17, 18cm, or more. A bipap is a much more sophisticated machine and (I think) the exhale feature helps when you get above say 15cm or more. Some people may have a lung disease and could have trouble exhaling against pressures as low as 8 or 10 cm.

Does that help?

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Re: Auto-CPAP vs. Bi-Pap

Post by palerider » Mon Sep 01, 2014 4:48 pm

HoseCrusher wrote:Another difference is the maximum pressure the machine can provide. Auto Cpap machines go up to 20 cm where Bi Level machines go up to 25 cm.
another point is that auto cpaps vary their pressure, and regular bilevels don't, they're fixed on the two ipap/epap pressures.

auto bilevels, however are like auto cpaps, just with greater, and more fine tunable, pressure differences betwee ipap and epap.

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Re: Auto-CPAP vs. Bi-Pap

Post by SleepyEyes21 » Mon Sep 01, 2014 5:40 pm

HoseCrusher wrote:Phil, look at it this way...

Some people need a higher pressure to keep their airway open. At this higher pressure they find it difficult to exhale.

Think of it like blowing up a balloon and then breathing in a little and trying to exhale into the blown up balloon.

The difference between the two machines is the amount of relief offered when you exhale. Auto Cpap can offer up to 3 cm pressure relief. Bi Level can go higher and Pugsy thinks it may be as high as 8 cm pressure relief.

Another difference is the maximum pressure the machine can provide. Auto Cpap machines go up to 20 cm where Bi Level machines go up to 25 cm.

Here is an example. If you need something like 22 cm of pressure to keep your airway open you can't get that high a pressure with an Auto Cpap. You need a Bi Level machine. Next breathing out against 22 cm of pressure is difficult so the Bi Level allows you to set the exhale pressure lower to something like 16 cm of pressure.

Notice that is a 6 cm difference. If all you needed was 20 cm an Auto Cpap machine would work but the pressure relief has a maximum of 3 cm so the lowest you could go would be 17 cm. When exhaling the extra drop in pressure may be much more comfortable.
This is interesting info, hosecrusher - I didn't understand the difference between cpap and bipap either. You explained this very well - ty

Isn't bipap also used more for those with central sleep apneas, or is this a misunderstanding?

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Re: Auto-CPAP vs. Bi-Pap

Post by OhHelpMe » Mon Sep 01, 2014 5:49 pm

SleepyEyes21 wrote:

This is interesting info, hosecrusher You explained this very well - ty
Well he got this part wrong,
Auto Cpap can offer up to 3 cm pressure relief.

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Re: Auto-CPAP vs. Bi-Pap

Post by HoseCrusher » Mon Sep 01, 2014 5:51 pm

SleepyEyes, I think Pugsy would be a better person to ask where Bi Level machines are indicated. I know the difference between them but in my situation Cpap works fine. Since I don't use a Bi Level I don't know all the details about it.

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Re: Auto-CPAP vs. Bi-Pap

Post by englandsf » Mon Sep 01, 2014 6:07 pm

Let me try again.

Bipap would involve a set inhale pressure of say 15 and exhale of 10 and they alternate with every breath.

APAP is set to an inhale range of say 10-20 and "hunts" the best pressure for each breath based on encountered resistance and then separately can drop the exhale pressure by a fixed amount each breath - usually up to about 3.

Make more sense now?

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Re: Auto-CPAP vs. Bi-Pap

Post by M'ohms » Mon Sep 01, 2014 6:10 pm

SleepyEyes21 wrote:
HoseCrusher wrote:Phil, look at it this way...

Some people need a higher pressure to keep their airway open. At this higher pressure they find it difficult to exhale.

Think of it like blowing up a balloon and then breathing in a little and trying to exhale into the blown up balloon.

The difference between the two machines is the amount of relief offered when you exhale. Auto Cpap can offer up to 3 cm pressure relief. Bi Level can go higher and Pugsy thinks it may be as high as 8 cm pressure relief.

Another difference is the maximum pressure the machine can provide. Auto Cpap machines go up to 20 cm where Bi Level machines go up to 25 cm.

Here is an example. If you need something like 22 cm of pressure to keep your airway open you can't get that high a pressure with an Auto Cpap. You need a Bi Level machine. Next breathing out against 22 cm of pressure is difficult so the Bi Level allows you to set the exhale pressure lower to something like 16 cm of pressure.

Notice that is a 6 cm difference. If all you needed was 20 cm an Auto Cpap machine would work but the pressure relief has a maximum of 3 cm so the lowest you could go would be 17 cm. When exhaling the extra drop in pressure may be much more comfortable.
This is interesting info, hosecrusher - I didn't understand the difference between cpap and bipap either. You explained this very well - ty

Isn't bipap also used more for those with central sleep apneas, or is this a misunderstanding?

SleepyEyes, the type of bilevel machine that treats central apneas is called an ASV, Adaptive Servo Ventilator. It is a high dollar machine with a more sophisticated algorithm.

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Re: Auto-CPAP vs. Bi-Pap

Post by Pugsy » Mon Sep 01, 2014 6:12 pm

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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Re: Auto-CPAP vs. Bi-Pap

Post by Pugsy » Mon Sep 01, 2014 6:21 pm

englandsf wrote:Bipap would involve a set inhale pressure of say 15 and exhale of 10 and they alternate with every breath.

APAP is set to an inhale range of say 10-20 and "hunts" the best pressure for each breath based on encountered resistance and then separately can drop the exhale pressure by a fixed amount each breath - usually up to about 3.

Make more sense now?
Bilevel devices can do just what the APAP does...hunt and peck within a range of pressure settings (depending on what parameters have been set) so while they can do fixed bilevel pressures...the auto units also offer an auto adjusting mode just like your APAP machine.

My PR S1 BiPap Auto model 750/760 actually offers 3 modes of operation
Regular cpap mode...fixed single pressure
Fixed bilevel mode....fixed dual pressures...2 pressures that never auto adjust.
Auto bilevel mode.....auto adjusting dual pressures...example shown in my above screen shot of one of my reports.

Both Resmed and Respironics have "plain" bilevel machines that may be fixed bilevel machines without auto adjusting ability.
Just like ResMed has the Elite that can't auto adjust.

In ResMed....the S9 VPAP S is a fixed bilevel machine with 2 modes of operation...cpap mode with a single pressure and fixed bilevel mode. The S9 VPAP Auto is like the PR S1 760/750....offers the 3 modes. In Respironics they have the 660/650 models which won't auto adjust...and just do cpap mode and fixed bilevel mode..

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Re: Auto-CPAP vs. Bi-Pap

Post by palerider » Mon Sep 01, 2014 6:24 pm

OhHelpMe wrote:
SleepyEyes21 wrote:
This is interesting info, hosecrusher You explained this very well - ty
Well he got this part wrong,
Auto Cpap can offer up to 3 cm pressure relief.
hosecrushers statement is absolutely correct for non-bilevel resmed machines.

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Re: Auto-CPAP vs. Bi-Pap

Post by SleepyEyes21 » Mon Sep 01, 2014 6:26 pm

M'ohms wrote:
SleepyEyes21 wrote:
HoseCrusher wrote:Phil, look at it this way...

Some people need a higher pressure to keep their airway open. At this higher pressure they find it difficult to exhale.

Think of it like blowing up a balloon and then breathing in a little and trying to exhale into the blown up balloon.

The difference between the two machines is the amount of relief offered when you exhale. Auto Cpap can offer up to 3 cm pressure relief. Bi Level can go higher and Pugsy thinks it may be as high as 8 cm pressure relief.

Another difference is the maximum pressure the machine can provide. Auto Cpap machines go up to 20 cm where Bi Level machines go up to 25 cm.

Here is an example. If you need something like 22 cm of pressure to keep your airway open you can't get that high a pressure with an Auto Cpap. You need a Bi Level machine. Next breathing out against 22 cm of pressure is difficult so the Bi Level allows you to set the exhale pressure lower to something like 16 cm of pressure.

Notice that is a 6 cm difference. If all you needed was 20 cm an Auto Cpap machine would work but the pressure relief has a maximum of 3 cm so the lowest you could go would be 17 cm. When exhaling the extra drop in pressure may be much more comfortable.
This is interesting info, hosecrusher - I didn't understand the difference between cpap and bipap either. You explained this very well - ty

Isn't bipap also used more for those with central sleep apneas, or is this a misunderstanding?

SleepyEyes, the type of bilevel machine that treats central apneas is called an ASV, Adaptive Servo Ventilator. It is a high dollar machine with a more sophisticated algorithm.
Thanks M'ohms- I have seen that acronym and had no idea what it meant either I appreciate your help!

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Re: Auto-CPAP vs. Bi-Pap

Post by englandsf » Mon Sep 01, 2014 6:32 pm

Thanks Pugsy, that completes the picture for me on Bipaps...

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Re: Auto-CPAP vs. Bi-Pap

Post by SleepyEyes21 » Mon Sep 01, 2014 6:37 pm

Pugsy wrote:
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.
Wow - thanks for all the detailed information, Pugsy! I have a much better understanding of the bipap now

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