confused about meaning of Bilevel

surf_rower · Post by **surf_rower** » Sun Jan 25, 2015 11:00 am

Hi all,
I just spent about an hour reading threads on AutoPAP and the Definitions articles about it. There's no definition for Bilevel. I also read the description of my my machine here
https://www.cpap.com/productpage/respir ... utoiq.html

Is either of these understandings correct?
- Bi-level means you can set the machine for low and high range but must have APAP machine to do so, which my machine is not, OR
- Bi-level means the inhale-exhale pressures are different, and my machine does adjust that with AutoFlex.

Thanks.

archangle · Post by **archangle** » Sun Jan 25, 2015 11:46 am

surf_rower wrote:Hi all,
I just spent about an hour reading threads on AutoPAP and the Definitions articles about it. There's no definition for Bilevel. I also read the description of my my machine here
https://www.cpap.com/productpage/respir ... utoiq.html

Is either of these understandings correct?
- Bi-level means you can set the machine for low and high range but must have APAP machine to do so, which my machine is not, OR
- Bi-level means the inhale-exhale pressures are different, and my machine does adjust that with AutoFlex.

Thanks.

"bilevel" means that the inhale and exhale pressure are different.

In concept, CPAP or APAP deliver the same pressure for inhale and exhale, but some machines billed as "CPAP or APAP" also reduce the exhale pressure to a lesser degree than bilevel machines do. Definitions get blurred over time. Bilevels can use a bigger pressure difference and can also go to a higher pressure.

"Auto" is different from bilevel. It means the machine adjusts the pressure up and down based on apnea, snoring, and flow limitations. A bilevel or CPAP can also be auto.

"VPAP and BiPAP" are trademarks for particular brands of bilevel.

There are fixed pressure or manual bilevel machines that will deliver one inhale and exhale pressure all night long.

There are also auto bilevels that will adjust the inhale and exhale pressures as needed during the night.

There are also some bilevel machines that do even more complicated pressure variations.

Sleeprider · Post by **Sleeprider** » Sun Jan 25, 2015 11:58 am

surf_rower wrote:Hi all,
I just spent about an hour reading threads on AutoPAP and the Definitions articles about it. There's no definition for Bilevel. I also read the description of my my machine here
https://www.cpap.com/productpage/respir ... utoiq.html

Is either of these understandings correct?
- Bi-level means you can set the machine for low and high range but must have APAP machine to do so, which my machine is not, OR
- Bi-level means the inhale-exhale pressures are different, and my machine does adjust that with AutoFlex.

Thanks.

A bilevel machine is also known as a BiPAP (respironics). It is able to be set for separate inhale (IPAP) and exhale (EPAP) pressures. IPAP-EPAP=Pressure Support (PS). The bilevel machine may or may not be auto-bilevel which allows the pressure support to be set along with minimum EPAP and maximum IPAP. The machines are intended to improve ventilation by lowering pressure for each exhaltion, and increasing pressure for each inhalation. IPAP and EPAP are not ranges, but fixed pressures. An auto bilevel machine may have a range for EPAP and a fixed PS and maximum IPAP.

AutoPAP is a CPAP that has algorithms that allow the single pressure to increase or decrease within a specified pressure range, usually in response to flow limitations, snores and other breathing anomalies. The APAP is able to change pressure through the night to address different sleeping positions and sleep stages but provides the same pressure during insiration as expiration. A CPAP is a single fixed pressure machine. Most machines today also have some form of pressure or flow relief for exhalation. This is a much narrower range than bilevel, and uses somewhat different flow patterns and technology. Cflex, Aflex and EPR are all trade names for this comfort feature. It is a sorta, kinda bilevel for a CPAP or APAP.

palerider · Post by **palerider** » Sun Jan 25, 2015 12:27 pm

surf_rower wrote: - Bi-level means the inhale-exhale pressures are different, and my machine does adjust that with AutoFlex.

the first part of that statement, up to the comment, is correct, the second part is not.

bi-level is two different pressures for each breath, inhale and exhale. they can either be fixed, or autoranging.

your machine does not do this.

surf_rower · Post by **surf_rower** » Sun Jan 25, 2015 6:46 pm

palerider wrote:
surf_rower wrote: - Bi-level means the inhale-exhale pressures are different, and my machine does adjust that with AutoFlex.
the first part of that statement, up to the comment, is correct, the second part is not.

bi-level is two different pressures for each breath, inhale and exhale. they can either be fixed, or autoranging.

your machine does not do this.

My machine's description says:
<< C-Flex Plus Technology
Flex Technology provides pressure relief for every breath to make breathing with a CPAP more natural. C-Flex Plus technology reduces the pressure during exhalation based on expiratory flow. It also softens the transition between inhalation and exhalation. >>

How is that different from what you described, PaleRider?

palerider · Post by **palerider** » Sun Jan 25, 2015 7:26 pm

surf_rower wrote:How is that different from what you described, PaleRider?

how is a kiddy pool and the pacific ocean different? they both have water in them after all.

perhaps enlightmentment will be kindled by an article such as this?
http://cpap.1800cpap.com/blog/differenc ... -machines/

then this:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119924/

surf_rower · Post by **surf_rower** » Sun Jan 25, 2015 9:50 pm

palerider wrote:
surf_rower wrote:How is that different from what you described, PaleRider?
how is a kiddy pool and the pacific ocean different? they both have water in them after all.

palerider · Post by **palerider** » Mon Jan 26, 2015 12:17 am

surf_rower wrote:
palerider wrote:
surf_rower wrote:How is that different from what you described, PaleRider?
how is a kiddy pool and the pacific ocean different? they both have water in them after all.

you'd learn more if you read further in that answer

archangle · Post by **archangle** » Mon Jan 26, 2015 6:45 am

surf_rower wrote:My machine's description says:
<< C-Flex Plus Technology
Flex Technology provides pressure relief for every breath to make breathing with a CPAP more natural. C-Flex Plus technology reduces the pressure during exhalation based on expiratory flow. It also softens the transition between inhalation and exhalation. >>

How is that different from what you described, PaleRider?

There are pictures here: https://www.cpap.com/productpage/pr-sys ... center#tab

You may need to click on the videos and faq tab.

Basically, bilevel switches between two pressures. C-Flex gives a variable pressure drop at the start of exhale based on airflow. C-Flex+ and A-Flex sort of give you two pressure levels plus an additional variable pressure drop.

Bilevel machines can give you a larger pressure drop on inhale. "CPAP and APAP" machines are limited by regulations in how much pressure drop they can use. I think it's 3 cmH2O max if the machine is classified as a CPAP/APAP.

surf_rower · Post by **surf_rower** » Tue Jan 27, 2015 7:36 am

palerider wrote:
surf_rower wrote:
palerider wrote:
surf_rower wrote:How is that different from what you described, PaleRider?
how is a kiddy pool and the pacific ocean different? they both have water in them after all.
you'd learn more if you read further in that answer

I'd read further. Didn't see anything about bilevel skimming the first article, and the second article was about 10 pages long and looked like a medical paper, so I didn't even start. As I'd said, I'd already spent a long time researching by reading articles. I do try to do that before asking a terminology question. The reply from archangle is very helpful, thanks!

palerider · Post by **palerider** » Tue Jan 27, 2015 9:00 am

surf_rower wrote:you'd learn more if you read further in that answer

I'd read further. Didn't see anything about bilevel skimming the first article, and the second article was about 10 pages long and looked like a medical paper, so I didn't even start. As I'd said, I'd already spent a long time researching by reading articles. I do try to do that before asking a terminology question. The reply from archangle is very helpful, thanks![/quote]
the bottom HALF of the first linked article was about different types of bi-level.

and, yes, surprisingly, when you ask about medical issues, sometimes you have to read MEDICAL PAPERS.

apparently, you didn't actually want to learn anything on your own, you just wanted to be spoon fed some pablum.

my bad.

Chevie · Post by **Chevie** » Tue Jan 27, 2015 2:17 pm

surf_rower wrote:I'd read further. Didn't see anything about bilevel skimming the first article, and the second article was about 10 pages long and looked like a medical paper, so I didn't even start. As I'd said, I'd already spent a long time researching by reading articles. I do try to do that before asking a terminology question. The reply from archangle is very helpful, thanks!

PaleRider posts while he is supposed to be working and likes to give short answers to many posts instead of good answers to a few posts. So don't take it personally.

(I like to give short, snarly answers to just a few posts.)

surf_rower · Post by **surf_rower** » Tue Jan 27, 2015 3:27 pm

palerider wrote: the bottom HALF of the first linked article was about different types of bi-level.

and, yes, surprisingly, when you ask about medical issues, sometimes you have to read MEDICAL PAPERS.

apparently, you didn't actually want to learn anything on your own, you just wanted to be spoon fed some pablum.

my bad.

I just looked at the first link you sent again. My confusion was about the difference between C-Flex on my machine and Bilevel that everybody talks about here. I don't see C-Flex in that article.
Thanks for your reply on my other thread, though, that was helpful.
By the way I just noticed that Sleeprider mentioned C-Flex. Sorry, Sleeprider, I missed that in your reply because I was skimming for the acronym with cap letters.
Anyway, I understand the difference now.

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