What's the difference between bipap and apap with EBR?

Hi all,
I'm getting (more) confused - i understand an apap or auto-cpap can lower the air pressures (inhalation and exhalation) and raise them as needed to curb and event - and i believe a bipap has pressure 1 for inhalation, and pressure 2 for exhalation.
some of the machines have easy breath, etc. where it lowers the exhalation pressure by 1, 2 or 3 cm/h20 - is this functionally a bipap? or does a bipap simply have more of a range between the inhalation pressure and exhalation pressure? many thanks!

Gary

In essence yes. EasyBreathe or EPR is kind of like a bilevel except with a full bi-level you can change a lot more of the values. The EPR settings of 1, 2 & 3 are like setting a bilevel with 1, 2 & 3 CMs between exhale & inhale.

I have used the early version of EPR and because my normal bi-level uses a 3 CMs gap between epap & ipap, I find EPR to be the next best thing. The early version has been refined a bit (not a lot) but EasyBreathe is part that refinement.

In recent times we have seen the emergence of Auto Bilevels and these have proven very popular. Best of several worlds.

EPR on a CPAP or AUTO has a couple of extra pluses these are ...

1) If the machine detects apneas it suspends EPR which means the machine goes to the higher pressure which provides the best pressure support for clearing the events

2) If the sleeper stops breathing (pressure induced central or post arousal central, the machine will also revert to the higher pressure

Speaking for myself, I regard EPR as the best pressure relief available, both technically & from using it.

RE Autos - Autos are very slow to raise pressure in response to events & thus are best set with the lowest pressure only 2 or perhaps 3 CMs below titration. We constantly see comments here about how people on Autos feel no better then we find they were titrated for 12 but given a machine set 4-20 - that is such a failing of the system. It has damaged the reputation of Autos solely because so many practitioners who supply them fail to grasp that setting the range wide open dooms many users to failure.

DSM

Thanks for the reply - you pretty much confirmed what i suspected. one last question if i may (okay, 300 more to follow) - i have the autoset ii (yippee) - and i've gone back to the cpap mode based on e-mails that said above 10 the auto won't act as expected - i'm cpap 14 - so the 2 nights i tried apap i went to i believe 9 and 14 - and the effacy was 11.6 which tells me i spent most of the night at roughly 12 - i had MANY events but that may have been nasal pillow shift, etc. - the next night with cpap 14 i also had high events - now a few nights later (but one very sore nose!!!) i am getting about 2.1 ai (far better than 11.6) - as i understand these are hourly, does that mean with 7 hours at 11.6 i have about 80 apnea events? yikes????
i did order the resscan software (3.7) and the usb reader that goes to the machine - had to get it from out of the country!!!!!! crazy resmed. hopefully i'll be able to see visually what's going on...
last question (for now) - if titration in the sleep clinic was 14, is there any major downside to setting above in cpap mode? in apap mode?
i do find lately i'm seeming to have some gasping at my desk during the day - can i be getting spoiled at having substantial airflow (and inflated, clear nostrils) while sleeping versus daytime?
Thanks!

That gasping during the day - are you a smoker? are you quite a bit overweight? have you worked in a dusty environment? have you ever worked in a chemical environment? do you have allergies? reflux or GERD? sinus problems?

Gary

If I were titrated at 14 this is how I would start off in the various modes ...

CPAP MODE
CMs = 14 - EPR = 3 (that is equivalent to epap=11 ipap=14) in fact I run my Bipap Auto at those epap/ipap settings.


APAP MODE
min CMs=10 or 11
max CMs=17 or 18 (many masks start to leak around 16+ CMs - so I go for less than max CMs for the upper limit)
Again EPR=3

RE that 10 CMs limit. There was a lot of confused misinformation spread re the meaning of A10 algorithm.

Let me restate that of course the Resmed Auto responds to apneas over 10 CMs, it is only that it changes the rules a bit as follows ...
When the machine goes over 10 CMs it will not raise pressure if a no-flow (obstructive) apnea occurs but it will raise pressure if it detects classic OSA pre-cursor signs (flow limitationss & snores). As the designer has told us, raising pressure on a central is a no-no so if a no-flow apnea occurs without any of the normal warnings it gets left alone. This is simple sanity & not any limitation of the A10 approach. I am cynical enough to believe that all that A10 hoopla & scare stuff that was put about here by some regulars, was because some prefer (as seen by the consistent recommendations over the past 3+ years) to recommend another brand of machine even if certain models of that brand were inferior quality for a time.

Fact is all brands have good & not so good features. The leaders, Respironics, Resmed & Puritan Bennett, all make some great products & *all* have had periods of manufacture & product recalls, be it flawed units with noisy blowers from a particular mexican factory or defective power cable plugs through to defective humidifiers.

Also all exhale relief innovations are just that and of great help to users, some features work better than others for the same person.

DSM

(scuse the soap boxing but that A10 scare garbage still gets to me )

#2 This doc 1st pointed to us by Ozij http://www.internetage.ws/cpapdata/resm ... 0906r1.pdf
has an interview with Dr Berthon-Jones who patented the A10 algorithm - he explains it here.

DSM, good and informative article -- Thanks!
i'm awaiting my resscan and module so i can actually see what's going on - some nights i'm getting zero leaks, other nights not so much, etc. - on the one hand i think i'd like to use the apap features, on the other hand, a cpap 14 is actually becoming comfortable to me (though my nostrils are still killing me during the callous (spelling) phase - i imagine lower pressures would mean perhaps a bit less nasal drying, and possibly less leaks? i've been having some serious rain out so i'm waiting for my hose cover to arrive.
I know you can't give me "medical advice" but in your opinion, do you think apap settings of roughly say, 9 to 17 will provide greater comfort or performance? the two nights i tried apap it mentioned efficacy of 11.6 though i did have more mask leaking (straps were very tight - ouch) and i had a lot of events (again, probably the straps)
Thanks!!!!

GaryGarland wrote:DSM, good and informative article -- Thanks!
i'm awaiting my resscan and module so i can actually see what's going on - some nights i'm getting zero leaks, other nights not so much, etc. - on the one hand i think i'd like to use the apap features, on the other hand, a cpap 14 is actually becoming comfortable to me (though my nostrils are still killing me during the callous (spelling) phase - i imagine lower pressures would mean perhaps a bit less nasal drying, and possibly less leaks? i've been having some serious rain out so i'm waiting for my hose cover to arrive.
I know you can't give me "medical advice" but in your opinion, do you think apap settings of roughly say, 9 to 17 will provide greater comfort or performance? the two nights i tried apap it mentioned efficacy of 11.6 though i did have more mask leaking (straps were very tight - ouch) and i had a lot of events (again, probably the straps)
Thanks!!!!

Gary,

I am sure APAP at those settings will be significantly better than running the machine with low setting at 4 or thereabouts.
9CMs is not that bad a starting pressure & ramp can make it easier to handle if it feels highish.
Good luck

DSM

dsm wrote:I am cynical enough to believe that all that A10 hoopla & scare stuff that was put about here by some regulars, was because some prefer (as seen by the consistent recommendations over the past 3+ years) to recommend another brand of machine even if certain models of that brand were inferior quality for a time.

The only "regular" I saw who hammered at ResMed regarding their A10 algorithm was Snoredog. Count me as a regular who never once criticized the A10 algorithm.

dsm wrote:(scuse the soap boxing but that A10 scare garbage still gets to me )

I thought the way the dawg would trot that out over and over was very misleading. Bothered me, too.

dsm wrote:#2 This doc 1st pointed to us by Ozij http://www.internetage.ws/cpapdata/resm ... 0906r1.pdf
has an interview with Dr Berthon-Jones who patented the A10 algorithm - he explains it here.

That was an excellent explanation that Ozij posted. Yep.