Are you on a Bi-Level machine and if so why?

It is gradually coming back to me how I got started on a Bi-level machine.

I was an active member of this forum about 10+ years ago until I thought I was sorted.

I remember backchannel discussion with a forum user (IIRC based in Seattle) who kindly took a look at some of my data, as I managed to install Encore Pro on my old Win XP computer. I may also have sent a scan of sleep study results. Again, IIRC, she had some kind of medical expertise in apnea and said I needed a Bi-Level machine. I am 99 per cent sure this was because I was having central so this suggests my centrals are NOT caused by BiPAP therapy.

This does not rule out BiPAP causing some additional centrals of course but I think it is not the sole cause, if at all.

Many because they equate more costly with better treatment, only true if you need it. In the meantime playing around doesn't help your treatment. Jim

My wife and I were both put on bi-level machines because we did not do well with CPAPs. We both started off with high pressure that needed more pressure support than the CPAP could provide.

I have Complex Apnea.. CPAP and Auto BiPAP wouldn't do it for me so was switched to BiLevel ASV and it is amazing ... It just works while others didn't come close to getting to those centrals. Also regular BiPAP made the AHI through the roof upwards to 50+ a night ... Now I am sitting under 5 most nights 0.5-1 ...

I am on a bipap because I started at 20/16 pressure, too high for a cpap.

I'm on bilevel, but it's because I was looking for an autoset, and came across a sweet deal on a vpap auto, after some research, I found out that it could be set up to work exactly like an autoset, so I bought it.

Then I found some times when I was starting to take a breath before an apnea, and the machine wasn't switching to ipap, so I took advantage of the resmed bilevel customizations and increased the trigger sensitivity, so it could help me breathe when my throat started to close up, ... and also that it was cutting off the higher pressure a lot of times when I was breathing slowly, so I changed the max time it would stay at IPAP. Having those customizations, which aren't available on a regular apap gave me better sleep. (AHI usually under 0.5).

gwc2795 wrote: ↑

Tue Apr 24, 2018 11:46 am

I am on a bipap because I started at 20/16 pressure, too high for a cpap.

A CPAP will do 20, it just won't do that much pressure support.. best you could get would be 20/17.

Here are some of the reasons that one might want a BiPAP. Note that if you already own a Bi-Pap and you need a plain old CPAP, you can just set it to work like a CPAP.

1. For patients with Central or Mixed Sleep Apnea, BiPAP is indicated, as a lower pressure on exhalation can reduce the number and severity of central events.
2. Patients who need a pressure greater than 20 would need a BiPAP. BiPAPs will generally go as high as 25 (some higher), and can even be on a fixed pressure above 20.
3. Patients who have difficulty exhaling against a fixed pressure and find that “exhalation relief” on a standard high-end CPAP is not sufficient. This can be due to additional medical issues such as Asthma, COPD, emphysema, or due to having a very high pressure setting (even if it’s not quite 20), or can just be idiosyncratic.

BTS wrote: ↑

Tue Apr 24, 2018 11:31 am

I have Complex Apnea.. CPAP and Auto BiPAP wouldn't do it for me so was switched to BiLevel ASV and it is amazing ... It just works while others didn't come close to getting to those centrals. Also regular BiPAP made the AHI through the roof upwards to 50+ a night ... Now I am sitting under 5 most nights 0.5-1 ...

The more I read about ASV the more I feeI I need this...unless tweaking BiPAP settings and reducing leaks gets my apnea under control as well as yours.

My reason for switching was simply to increase the upper limit of pressure the device could provide. With my Auto Set 10 I was regularly hitting 19'ish / 20 and staying there for hours at a time. It looks like I needed a bit more pressure but the APAP I had simply couldn't go any higher.

With my new BiPap It will sometimes go as high as 23 but I haven't seen it go any higher thankfully. My numbers are now averaging between 0.5 to 1.5 most nights. Bad night for me now is 3 or 4. Before my bad nights were like 8 or 9 or way worse and I was lucky to keep my overall average under 5.

Determining what you need is going to be based on experience. Get to know your machine, and your condition and how what you have now is treating it. Work out what the limits might be. Watch the data and see if you can work out any trends. (Get sleepy head, if you haven't already)

For me it was watching my pressure levels shoot up and flatten out at the machine's upper limit.

For you it might be issues with untreated centrals or other breathing anomalies you would want to work through.

When your starting out you work with your doctor as much as possible and hope they know what they're doing and care to look at your data for the details not just pat you on the back if your compliant. If you don't think your getting that sort of support you'll have to be your own advocate. There's a lot of combined knowledge on this site and plenty of people who can help you dig through the details.

Good luck in getting your therapy dialed in.

Rest well.

Gryphon

I was switched from S9 Autoset to PRS1 960 ASV because of centrals. Now my AHI stays below 3. I have had a few ZEROs. Seldom any centrals.

Chalkie wrote: ↑

Tue Apr 24, 2018 12:38 pm

BTS wrote: ↑

Tue Apr 24, 2018 11:31 am

I have Complex Apnea.. CPAP and Auto BiPAP wouldn't do it for me so was switched to BiLevel ASV and it is amazing ... It just works while others didn't come close to getting to those centrals. Also regular BiPAP made the AHI through the roof upwards to 50+ a night ... Now I am sitting under 5 most nights 0.5-1 ...

The more I read about ASV the more I feeI I need this...unless tweaking BiPAP settings and reducing leaks gets my apnea under control as well as yours.

There are folks on this forum that do a fantastic job of helping you sort out what's going on with your treatment. Posting Sleephead data and turning them loose on what if anything you can do might be worthwhile.

As to using an ASV machine, that is what I have and use, but to be honest I much preferred the Bipap Machine the insurance company insisted I tried prior to spending for the ASV. The ASV machine works, and gets my numbers quite a bit better than the Bipap machine did due to my having some significant central issues from time to time. On the other hand, it's quite a bit harder to fall asleep with this machine even now that I'm quite used to it. To put it mildly, it gets very persistent on wanting you to breath in a very certain way, which I tend to not do right at the sleep transition point. As a result, getting to sleep can sometimes be quite difficult on those nights where I end up fighting with the machine. Personally I'd make sure my apnea couldn't be adequately treated with a BiPap prior to switching to an ASV.

SeekSleep wrote: ↑

Tue Apr 24, 2018 5:48 pm

Chalkie wrote: ↑

Tue Apr 24, 2018 12:38 pm

BTS wrote: ↑

Tue Apr 24, 2018 11:31 am

I have Complex Apnea.. CPAP and Auto BiPAP wouldn't do it for me so was switched to BiLevel ASV and it is amazing ... It just works while others didn't come close to getting to those centrals. Also regular BiPAP made the AHI through the roof upwards to 50+ a night ... Now I am sitting under 5 most nights 0.5-1 ...

The more I read about ASV the more I feeI I need this...unless tweaking BiPAP settings and reducing leaks gets my apnea under control as well as yours.

There are folks on this forum that do a fantastic job of helping you sort out what's going on with your treatment. Posting Sleephead data and turning them loose on what if anything you can do might be worthwhile.

As to using an ASV machine, that is what I have and use, but to be honest I much preferred the Bipap Machine the insurance company insisted I tried prior to spending for the ASV. The ASV machine works, and gets my numbers quite a bit better than the Bipap machine did due to my having some significant central issues from time to time. On the other hand, it's quite a bit harder to fall asleep with this machine even now that I'm quite used to it. To put it mildly, it gets very persistent on wanting you to breath in a very certain way, which I tend to not do right at the sleep transition point. As a result, getting to sleep can sometimes be quite difficult on those nights where I end up fighting with the machine. Personally I'd make sure my apnea couldn't be adequately treated with a BiPap prior to switching to an ASV.

That is the struggle and the downside of ASV for me atm too . It is very hard to get use to the breathing thing it does .. I am working hard on getting use to it and trying to sleep a solid set of hours straight through ... I am waking up still 4 or 5 times a night .. It has only been a week and I do already feel the benefits of the AHI dropping and killing off the Centrals but yeah if you can get by with BiLevel on its own I say stay there .. There was no way I could keep on doing BiPap it was tearing me apart, causing a lot of issues . Everyone's different...

Yes - because of chronic respiratory failure. Without it I wake up with severe headaches from CO2 retention.

Whether I eventually get an ASV or not I suspect I will have to persevere with BiPAP for a while. It does not appear the pressure settings are right for me so I need to deal with that first and I am sure as hell the hospital won't hand me an ASV until I have. I understand it would have to be under special dispensation anyway.