Diminished Lung function need Bi-pap ?

[mommaw]

I was told Friday by my heart doctor that I have a 78% lung usage. I will be going back tuesday for more testing for COPD. My question is do I need a bi-pap instead of my auto. I have been noticing for the last year that I wake up in the mornings feeling very congested and it takes me the better part of the morning to clear up. I have been short of breath for quite awhile also. Currenty I am also in a-fib, have been for about 3 months. I am on coumidin to thin the blood and will go to the hospital the last of the month to have shock treatments to put back in rhythm, then meds to control beats. Anyway I thought I read somewhere that a bipap was better for people with diminished lung usage. I have felt for the past year that I was going down hill in my apnea treatment. Sometimes I just cant seem to get enough air at night with the auto, I wake up gasping for air and have to take the mask off and take some deep breaths. Currently my auto is set at 9-14 and my numbers are good, never over AHI of 2.5-3.0. I will make an appointment to see my sleep doctor but wanted to get the forums advice on the auto versus bipap.
Thanks,
Gilda

[Slinky]

Bi-level is often needed for COPD and other lung conditions. Most insurances insist that one try CPAP first and to "fail" CPAP therapy before they will pay for a bi-level due to the high cost of the bi-levels.

By all means, you should contact your sleep doctor for re-evaluation and possible bi-level therapy. An overnight oximetry would be an excellent idea if your current CPAP isn't fully data capable.

[Snoredog]

I would agree on the bilevel, it would also help your cause if your sleep doc was a Pulmonolgist as opposed to any other type of doctor.

[dsm]

Absolutely a bilevel can be expected to offer an improvement from what you have described.

I am now using a 'tri-level' (my new name for the BipapSV)

1 - It has an epap (ehale) pressure
2 - an ipapMin (inhale pressure) and
3 - an ipapMax pressure that can auto range up to a max ipap and this is what 'servo ventilates' the user

Under normal circumstances it operates between epap and ipap but
if needed will boost ipap to a higher pressure on a breath-by-breath basis and based on what it believes is needed to keep the volume up to a tracked target

My machine is set at 11 CMS for epap and 14 CMS for ipap but it typically averages 16 CMS - that tells me how often it needs to boost ipap to keep my volume ventilation up.

These SV machines are the best cpap therapy device I have ever come across. I like the BipapSV because it can be made to work in any mode
cpap, bipap, sv.

The concept is not complicated, the results are (AFAIKT) outstanding for most types of cpap (OSA, Centrals, Periodic Breathing) and copd complications. The only area of caution I see in using them are the very complex cases involving CO2 levels where the patient needs their CO2 level adjusted by some other type of therapy machine.

IMHO the BipapSV is what the Auto always dreamed of being. But to be fair, Autos focus on OSA whereas the BipapSV sets epap & leaves it at that setting.

Perhaps the ultimate BipapSV machine will add Respironics Auto algorithm so it can auto adjust epap based on detecting OSA events, - it already can adjust ipap based on peak flow - but I suspect that handling that level of complexity in one box is still in the future.

DSM

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, CPAP

[mommaw]

Just to update what has happened. I do NOT have COPD. That was good news! The cardioversion went good and heart is now beating normally. I will be on medications always to control the rhythm and blood thinners, but I can take that. I saw my sleep doctor and he did not think a bipap would help my nightly problem of feeling like I am suffocating. It has gotten better since my heart problems have been addressed but is not completely eleminated. I still do not have full lung compacity and I succept that might be the cause of the shortness of breath at night. I find that if I sleep with my head elevated, it is not so bad.

DSM do you think I should push for the bipap or think it might help since I do not have COPD.

Thanks to all that replied, I really appreciate it.
Gilda

[Slinky]

Well, I'm delighted to hear you don't have COPD! Congratulations on that good news. I'd be inclined to ask my family doctor to script an overnight oximetry. Then go from there as to what decision to make regarding a bi-level. If the overnight oximetry shows you are still desatting and your sleep doc (is he a sleep pulmo?) just wants to up your pressure I might be inclined to find a new sleep doc.

[Snoredog]

I'd get a 2nd opinion,

http://www.rtmagazine.com/issues/articl ... -12_08.asp

As starting points, an IPAP of 8 mm Hg and an EPAP of 4 mm Hg are generally used. Protocols should be used to adjust the pressure. For example, IPAP should be increased to improve alveolar ventilation or Paco2, and EPAP should be increased to improve oxygenation and/or obstructive sleep apnea. It is important to remember that if the EPAP is increased, the practitioner must also increase the IPAP to maintain the same pressure difference. The minimum EPAP level recommended by most manufacturers is 4 mm Hg. If supplemental oxygen is needed, it can be supplied through the NPPV system. Most manufacturers publish a bleed-in chart for oxygen to help the practitioner maintain the patient’s ordered flow rate or fraction of inspired oxygen.

Patients should be monitored on a regular basis. Monitoring should include the parameters that were used for patient selection; in addition, patients should be monitored for symptom relief, levels of daytime activity, signs of cor pulmonale, pedal edema, and respiratory rate. In most cases, the practitioner should see improvements in the patient’s resting respiratory rate, oxygen saturation, level of activity, decreased Paco2, and fewer hospital admissions.

Conclusion
Any therapy for the COPD patient may yield only marginal benefits, but even small improvements may lead to significant functional benefits, improving the quality of life. Due to the short life expectancy of patients with severe COPD, it may be difficult to conduct long-term studies of large populations. For properly selected patients who are willing to comply with this form of therapy, however, nocturnal bilevel NPPV can create significant improvements in function, activities of daily living, and quality of life.

see that Slinky? you are supposed to be at 8/4 starting out

How much pressure support are you using?

[Arizona-Willie]

A lung doctor told me I had COPD and Asthma a few years ago. I was a bad boy and didn't think I needed those inhalers he prescribed because I sit in front of the computer all the time and don't feel short of breath.

Until I do something

I've done fairly well on CPAP but have been wondering about Auto or Bi-pap and I see several posts that claim COPD needs bi-pap.

I haven't even used the EPR on my S8. Seem to do ok without using it but now I'm wondering if it would be better to turn that on and simulate a bi-pap as well as possible.

I don't have too many apneas on most nights but sometimes I'll have 10 most nights just 4 or 5 it seems but LOTS of hypopneas. Usually 30 or so.

I've been gradually increasing my pressure and it seems to be reducing the hypopneas some.

I wonder if EPR would help somehow.

[Slinky]

Only way you'll know is to try EPR at each setting, Willie.

SnoreDog, the doctor set my at 8 cms EPAP and 13 cms IPAP w/a Pressure Support of 4. But he didn't do that totally blind. He did have me come in to the lab for a bi-level titration. I'm having some doubts about the pressure support of 4. I wonder if a wider spread should be allowed. W/COPD breathing can vary greatly from night to night.

[MikeK]

test

[Slinky]

... see that Slinky? you are supposed to be at 8/4 starting out

How much pressure support are you using?

IPAP 13, EPAP 8, Pressure Support 4, Ti Maximum 4.0s, Ti Minimum 0.5s, Exhalation Medium, Trigger Sensitivity Medium, Cycle Sensitivity Medium. (I suspect that all are Defaults except the IPAP 13, and EPAP 8 'cause I see NOTHING on my script to indicate anything else).

[jnk]

Info on adjusting TiMax/TiMin and a mention of COPD patients. (Note that adjustments can affect tidal and minute volumes):

http://www.resmed.com/en-us/products/fl ... =products2

Info is for VPAP III ST, but the VPAP Auto has similar adjustments. The trigger and cycle section is interesting too.

[Slinky]

Thanks, jnk!!! How DO you find all this stuff??!!! I'm impressed. I'm here to tell you that there was NO MENTION of ANY SETTINGS except IPAP and EPAP on my bi-level script. I wonder if my sleep doc would even have a clue if I asked about them and adjusting them? I've FAXed my Mayo coordinator and asked that I also be scheduled for a consult in their sleep studies department whilst I am there in October.

[jnk]

I just figured MikeK must have done his test on a month-old thread for a reason.

In this case, I googled "copd" and "ticontrol," I think.

Anyway, hope there was something there useful, if you hadn't seen it.

[Slinky]

Hey, jnk!!! Here's the Trigger and Cycle Sensitivities from Resmed!

http://www.resmed.com/en-us/products/fl ... =products2