bipap vs CPAP

I have looked at the videos and I am now locked into a series of lectures on the internet all about bipap. Somehow the series of videos is missing something. When is bipap warranted rather than CPAP. It seems that the exhale needs to maintain a strong pressure, but of the settings they illustrate are quite comparable to CPAP with exhale relief? I know this forum has existing threads on this. Can anyone comment? And maybe give me a link on bipap vs CPAP. Thanks.

Bilevel machines are made to handle higher pressure settings than normal CPAPs (top pressure of 25 or so for bilevel and top pressure of 20 or so for CPAP).

CPAP exhalation relief is limited to 3 cm pressure reduction. Bilevel can have a greater differential.

bilevel machines also (at least the resmed VPAPs) offer a number of tweaking settings to change *how* the machine presents the pressure differential.

including ti control: http://www.resmed.com/uk/products/s9_vp ... ntrol.html

trigger cycle control: http://www.resmed.com/uk/products/s9_vp ... cycle.html

timing modes: http://www.resmed.com/uk/products/s9_vp ... modes.html

and the complicated stuff: http://www.resmed.com/uk/products/s9_vp ... s/asv.html

and http://www.resmed.com/uk/products/s9_vp ... ivaps.html

When is bipap warranted rather than CPAP.

Are you asking out of intellectual curiosity or do you intend to determine if BiPAP might be suitable for your case?

If the latter, please advise your diagnosis, prescription, current pressure settings and AHI and any other pertinent details.

ButtermilkBuoy wrote:

When is bipap warranted rather than CPAP.

Are you asking out of intellectual curiosity or do you intend to determine if BiPAP might be suitable for your case?

just lookit that face, it reeks..... of curiosity!

Pesser wrote:I have looked at the videos and I am now locked into a series of lectures on the internet all about bipap. Somehow the series of videos is missing something. When is bipap warranted rather than CPAP.

The line between CPAP and bipap is "fuzzy" to say the least.

The most common reasons people are switched to bipap are:

• The AHI has not come down to 5.0 even though the patient is adhering to CPAP and exhalation relief is set to the maximum for the patient's machine AND pressure adjustments to CPAP have been tried; this may not actually fix the problem (if the person is having lots of centrals), but it is often the next step due to insurance companies rules and regulations.
• The patient is having trouble exhaling against the prescribed pressure and reports serious discomfort and different pressure settings have been tried and leaks are not the issue.
• The patient is having serious problems with aerophagia and different pressure settings have been tried and different masks have been tried and leaking is not the issue.
• The patient's titrated CPAP pressure is AT or ABOVE 15 and (patient reports discomfort OR patient was very restless during the PSG while at high CPAP pressures).

It seems that the exhale needs to maintain a strong pressure, but of the settings they illustrate are quite comparable to CPAP with exhale relief? I know this forum has existing threads on this.

The Resmed EPR algorithm is indeed very, very similar to a bi-level algorithm, but there are some very minor differences between how the Resmed VPAP S with PS = 1, 2, or 3 behaves vs. a Resmed Elite with EPR = 1, 2, or 3. A very small minority of people those differences may be able to tell the difference, but most cannot. The big difference is that on the VPAP S (or any other S9 VPAP), the PS setting can be set to numbers higher than 3. So you can get a pressure relief of 4cm or more on every exhalation with the VPAP, whereas you can't with the Elite or AutoSet and EPR.

The PR CPAP's exhalation relief systems (C-Flex, C-Flex+, and A-Flex) do NOT provide a constant, consistent drop in pressure on each exhalation. The drop in pressure depends on the force of the exhalation, and even the most forceful exhalations with Flex = 3 are only going to provide a drop of 1.5-2 cm in pressure. And the pressure will start to increase before the exhalation is finished. But the PR BiPAP does drop the pressure at the beginning of every exhalation by a fixed amount (the PS) and it keeps the pressure at the EPAP level until the next inhalation is detected. As with the Resmed VPAP, the PS on a PR BiPAP (and BiPAP Auto) can be set to 4 or more cm if desired or needed.

palerider wrote:

ButtermilkBuoy wrote:

When is bipap warranted rather than CPAP.

Are you asking out of intellectual curiosity or do you intend to determine if BiPAP might be suitable for your case?

just lookit that face, it reeks..... of curiosity!

Now how on earth can I argue that!!!

I'm actually concerned with GERD and UARS. I got rid of my GERD by increase my pressure to 10 from 7. It worked for about 3 weeks...no GERD. I went to a website that showed what a person with UARS looks like when asleep. My wife said "that's you". I was surprised. I guess when you have UARS; its really hard on the chest. So now that my GERD is back I'm considering increasing my pressure to see if indeed the UARS is creating the GERD. My AHI is 0.2 to 0.5. My fear is that I'll keep increasing pressure till I need to consider bipap!

Pesser wrote: My AHI is 0.2 to 0.5. My fear is that I'll keep increasing pressure till I need to consider bipap!

and, beyond that, NIV. the vpap st-a goes up to 30cm

I have been told by many people in my profession to avoid forums. I’m an accountant in public practice. The warning in my profession is warranted. It certainly doesn’t apply to this forum. What robysue has written above proves that you guys know more than the video series I’m watching and the guides I’m reading!

palerider wrote:

Pesser wrote: My AHI is 0.2 to 0.5. My fear is that I'll keep increasing pressure till I need to consider bipap!

and, beyond that, NIV. the vpap st-a goes up to 30cm

Thanks for this!!!

Pesser wrote:

palerider wrote:

Pesser wrote: My AHI is 0.2 to 0.5. My fear is that I'll keep increasing pressure till I need to consider bipap!

and, beyond that, NIV. the vpap st-a goes up to 30cm

Thanks for this!!!

bilevel really isn't scary... I was looking for an autoset and ended up with a bilevel, cuz that's what the drug dealer, er, craigslist guy had laying around second hand that he was willing to sell for cheap... if I didn't LIKE the bilevel, I could set the pressure support to 0 and it'd behave like an autoset.

I've twiddled the settings around, and it's working pretty well for me, often having sub 1 ahi.

palerider wrote:I've twiddled the settings around, and it's working pretty well for me, often having sub 1 ahi.

So PR, do you think the algorithm employed to change from EPAP to IPAP in a non-timed ResMed VPAP is similar to that used in CPAP with EPR?

If so, do you think the trigger settings of a VPAP might allow it work at a lower EPAP than CPAP in the EPR mode? Near subtherapeutic?

Or, asked another way, do you think an inspiratory flow corresponding to a "very Low" trigger setting for VPAP is lower than that used to change from EPAP to IPAP in CPAP with EPR?

What differences have you noticed or felt with different trigger settings? Does a trigger setting of "very low" feel like the machine is forcing you to breath before you're ready?