CPAP vs BIPAP/CO2 issue?

[Jake B]

Hi all,
I'm wondering what experiences people have on BIPAP vs regular CPAP? I've had a rough time with APAP/CPAP (see my previous threads) and I am currently not using my machine due to it making me feel WORSE. All my data looks good according to my doc and OSCAR (low leaks, AHI normally around 1, etc), so it seems the machine is working as far as breathing IN.

I've been trying to come up with theories about what might cause this, and I floated the idea of possible CO2 rebreathing to my sleep doc. I've always felt like it was more difficult to breathe out, and CPAP only offers a max relief of 3cm on exhale. Doing some independent research I found that some symptoms of CO2 rebreathing might explain what I'm feeling. I wonder if it's possible that after beginning treatment, I'm inhaling better and it's eliminating my apnea events, however now the issue is exhaling against the pressure.

I'm scheduled for another sleep test to try out a BIPAP machine, but it's not for a couple of weeks so I was just looking for some input from anyone who's experienced CO2 issues or had more success with BIPAP vs CPAP. Any info appreciated!

[Pesser]

I've tried both. Bipap was much easier at exhale. My pressure was 14/8. I could have gone to 20/8 and still would have been find, although I didn't try 20/8. I found bipap gives a wide range of options. If it's auto bipap one can use something like 14/5; which at least gives you a chance of getting used to it.

[chunkyfrog]

Carbon dioxide is vented out tiny holes in the mask.
The output of these vents was rigorously tested in labs before any mask can be offered to the public.
It is not a problem.
Your malaise is likely to be caused by other factors.
If you fail to use your cpap EVERY time you sleep, you can expect problems.

[babydinosnoreless]

Hi all,
I'm wondering what experiences people have on BIPAP vs regular CPAP? I've had a rough time with APAP/CPAP (see my previous threads) and I am currently not using my machine due to it making me feel WORSE. All my data looks good according to my doc and OSCAR (low leaks, AHI normally around 1, etc), so it seems the machine is working as far as breathing IN.

I've been trying to come up with theories about what might cause this, and I floated the idea of possible CO2 rebreathing to my sleep doc. I've always felt like it was more difficult to breathe out, and CPAP only offers a max relief of 3cm on exhale. Doing some independent research I found that some symptoms of CO2 rebreathing might explain what I'm feeling. I wonder if it's possible that after beginning treatment, I'm inhaling better and it's eliminating my apnea events, however now the issue is exhaling against the pressure.

I'm scheduled for another sleep test to try out a BIPAP machine, but it's not for a couple of weeks so I was just looking for some input from anyone who's experienced CO2 issues or had more success with BIPAP vs CPAP. Any info appreciated!

I have a bilevel. I find that certain masks make me feel like I'm not breathing out enough. It has nothing to do with the pressure support of my machine. Have you tried one of the masks without the filtered diffusers ? The N20 is always blowing out a fairly strong jet of air.

[MFRep]

Frankly, unless you have very mild sleep apnea, I cant comprehend why you wouldnt just
go ahead and do bipap.

Granted the insurance might not cover the more expensive machine.

But to my understanding, Cpap only props your airway open as long as youre inhaling.

I mean, then it can snap shut, and what exactly is the point of allowing that??

[Jake B]

Carbon dioxide is vented out tiny holes in the mask.
The output of these vents was rigorously tested in labs before any mask can be offered to the public.
It is not a problem.
Your malaise is likely to be caused by other factors.
If you fail to use your cpap EVERY time you sleep, you can expect problems.

The problem is I used it consistently without issues for 2 months. All numbers were good, the machine just makes me feel worse than not using the machine at all.

[chunkyfrog]

Frankly, unless you have very mild sleep apnea, I cant comprehend why you wouldnt just
go ahead and do bipap.

Granted the insurance might not cover the more expensive machine.

But to my understanding, Cpap only props your airway open as long as youre inhaling.

I mean, then it can snap shut, and what exactly is the point of allowing that??

Wrong! The airway is splinted through exhale as well.
Nothing "snaps shut"--that assertion is incorrect.

[palerider]

Frankly, unless you have very mild sleep apnea, I cant comprehend why you wouldnt just
go ahead and do bipap.

Granted the insurance might not cover the more expensive machine.

But to my understanding, Cpap only props your airway open as long as youre inhaling.

I mean, then it can snap shut, and what exactly is the point of allowing that??

If it's properly adjusted then it holds your airway open when you're not inhaling too.

But, most people don't *need* their airway to be held open while exhaling, think of it like how you don't have to hold the neck of a filled balloon open when you release it, and the air comes blubbering out of the balloon.

[Norma45]

I struggled like heck with a cpap and my sleep quality went down, not up - I was waking up a lot because I could not breath well.
Breathing out was difficult, even when I was awake, even at a middle setting.
A bi-pap made a huge difference. Then being able to set a longer inhale time and a bigger pressure difference made the bi-pap much easier so breathing feels very good now and I almost wish I had a portable bipap to carry around and wear 24/7.
I had problems (likely have my whole life) of exhaling fully - not bad enough any Dr cared about it, but enough it is showing up when mucking with xPap machines and bi-pap makes it much easier for me to breath out.

See my thread under viewtopic/t179452/BiPap-settings--doubl ... stion.html
See where I talk about doing short strong bursts of exhales to see if that made me feel less oxygen hungry. Note: Watch when you are taking extra inhales or those strong exhales, if you start to feel even a little light headed stop - you don't need that breath that way and your body is trying to compensate by making you pass out.

Note: I had to do a lot of learning to figure out what works for me (and am still doing that).
But if your AHIs are down, you might be much further along than I am currently.

FYI, I found Drs or DMEs of no use to help figure out how to set up the bi-pap to work well for me. This group and reading old posts helped tons.
Though I just changed Drs and she talked about me seeing (in person) a respiratory therapist to work with me and the machine. Nice! The last Dr had no offer like that at all, just said things like wait a few months, it takes time.

[Jake B]

I struggled like heck with a cpap and my sleep quality went down, not up - I was waking up a lot because I could not breath well.
Breathing out was difficult, even when I was awake, even at a middle setting.
A bi-pap made a huge difference. Then being able to set a longer inhale time and a bigger pressure difference made the bi-pap much easier so breathing feels very good now and I almost wish I had a portable bipap to carry around and wear 24/7.
I had problems (likely have my whole life) of exhaling fully - not bad enough any Dr cared about it, but enough it is showing up when mucking with xPap machines and bi-pap makes it much easier for me to breath out.

See my thread under viewtopic/t179452/BiPap-settings--doubl ... stion.html
See where I talk about doing short strong bursts of exhales to see if that made me feel less oxygen hungry. Note: Watch when you are taking extra inhales or those strong exhales, if you start to feel even a little light headed stop - you don't need that breath that way and your body is trying to compensate by making you pass out.

Note: I had to do a lot of learning to figure out what works for me (and am still doing that).
But if your AHIs are down, you might be much further along than I am currently.

FYI, I found Drs or DMEs of no use to help figure out how to set up the bi-pap to work well for me. This group and reading old posts helped tons.
Though I just changed Drs and she talked about me seeing (in person) a respiratory therapist to work with me and the machine. Nice! The last Dr had no offer like that at all, just said things like wait a few months, it takes time.

Thanks for the info. I'm hoping another sleep study reveals the BIPAP will be better for me. Like you my sleep quality has gone down using CPAP, so I'm not even bothering to use it until my next study. My numbers are good and I've tolerated the machine well since the beginning, but nothing ever changed (actually got worse).

[Norma45]

I should add, check your respiration rate, inhale time, and exhale time in your Oscar charts.
I don't know if these show for cpap, but when I got put on the bi-pap and looked at mine, they were wacko (all over the place and often very high or very low).
The bi-pap has more things to adjust, like time to take in a breath (Ti Max - time inhalation max). When I increased Ti Max it was much easier to breath overall and my respiration rate, inhale time, and exhale time all normalized out. That turned out to matter more than the pressure difference (having 4 vs 3 pressure differences between Inhale pressure (IPAP) and Exhale pressure (EPAP).
Though once I figured out a few other big things, being able to have that higher pressure difference between the Inhale pressure and Exhale pressure also made things more comfortable.

Another item - my first mask was an issue. It felt comfortable overall and I never felt it was bothering me, however with the cpap running I realized that the air pressure made the mask push on some spots and I had some discomfort. Enough I think that I didn't sleep well (not deeply). After a short while I also suspected my mask didn't really seal well even though Oscar reports didn't report leak problems. Changing masks made a big difference in my sleep quality (from miserable to just plain bad ), though the bi-pap is what got me back to the level (and above at times, still working on this) that I am without a machine. Still a work in progress, but I am happy to see light at the end of the tunnel.

All this figuring out takes time - it took me a couple of months to figure out what worked for me.

I personally don't accept the it is ok to feel awful (worse than without the machine) and after some/many months it will be better.. I have read of people who after a year or two still feel awful. And like you, it made me miserable.

So keep trying things until you figure out what works for you.
A bi-pap hopefully will make a big difference.
And know that masks can also make a big difference, even when they feel ok. Maybe just trying a new one when your insurance will cover one will help. Many manufacturers give you 30 days to return the mask. Some DMEs only let you do that for one mask, not all masks, some DMEs will let you do a 30 return on most masks, some will never allow you to do that, so see what works for your insurance and DME.

[palerider]

feel less oxygen hungry

It's highly unlikely that you had any sort of "oxygen hungry", most people have no feeling of needing oxygen, all the way down to where the suffocate, which is why people that work in enclosed spaces wear oxygen monitors, to ensure that there is sufficient oxygen in the space for them to continue to live.

What you may have felt is excess CO2, which increases your Respiration Rate.

[Norma45]

Pale rider, the respiratory therapists teachers on the videos I watched used the term "oxygen hungry" to describe any time the patient felt they were not getting enough oxygen. They said that this can be caused by several things and yes too much Co2 is one of them. And yes they said it showed by the person either breathing faster or breathing deeper (but not faster) - basically trying to get more air into and out of their lungs.

I personally can feel the sensation in both situations - not having a strong enough exhale and not having strong enough Ipap pressure getting air in - very distinct things for me. But then I track physical sensations much better than most people and our society teaches people not to pay attention to how they feel. This is why I brought this up as people can learn to feel the various sensations and that can help them do adjustments.

[palerider]

You can lead a horse to knowledge, but you can't make them think. :shrugs:

Are you, or they, confusing the term "Air hunger" with "oxygen hunger"? Because the first is a thing.