BI-PAP or APAP

[REMemberWhen]

As you can see, I am currently using a CPAP machine(as is shown below)...I have been on it for 9 days. For the first 7 days my pressure was set at 18, but when it would get to about 16 or so I would start getting leak issues. I called the doctor and he seemed annoyed that I questioned the pressure setting and only decided to change it (to 15) after I told him that the noise from the leaks would wake me up. I also brought up the question of what's the difference is between a CPAP and an APAP (at that point I had never heard of a Bi-PAP), and he sounded like he was all about the CPAP. I found out from the therapist that he always uses CPAPs, while his partner almost always uses APAPs. I guess first off I am wondering what the difference between a Bi-Pap and an APAP are. I know that one of the two of those are most definately more suited for me than the CPAP. In the first sleep study I had double the disturbances on my back than on my side (56/120). I prefer to sleep on my side, but with the pressure so high, I would always leak on my side. I am only 10 (my AHI has avg. 3.3 for the past 7) days in and am trying to find out as much as I can. The Dr. seems to go on data alone. "Well your data showed, well your data showed, blah, blah, blah." He doesn't seem very willing to recognize that there is a real person behind that mask blowing catagory 4 huricane winds in my face. I know that this treatment is going to completely change my life, I can tell that from reading many of these posts. I will make this work, but it's been a tough first week. A lot of my discomfort and frustration is me being a newbie and getting used to sleeping with a mask and straps on my head. But I also don't think, from what I've read here, that I am getting the proper treatment. I am looking for some opinions and advice so I am educated enough to tell the Dr. what I need; it is my body after all. Any input would be greatly appreciated...i just want to get all my ducks in a row before my visit with the Doc on Sept. 11th. He is very nice when he thinks he's in charge, but in my few conversations with him I could tell that he gets "pissy" as soon as you start to question his "wisdom" in the slightest. Thanks again!

[Wulfman]

Yeah, I had a moron for a sleep doctor who seemed to believe that more pressure is better. I was titrated to 16 and he wrote 18 on the prescription. I got my (data-capable) Pro 2 and card reader/software combo so I could monitor my therapy. After about 45 minutes or so at 18, I decided that I HAD to start at something lower. So, I reset it to 10 and the numbers looked pretty good, so I left it there for almost a year. Then I started experimenting with 11 and 12, which is where I finally left it. My AHI was identical across those three pressures......the only difference was that my snoring was eliminated with the extra two centimeters of pressure.

My doc wasn't happy that I had changed my pressure, either, but he had trouble arguing with the reports I showed him. (although he didn't believe that the reports could be "accurate")

Den

[Snoredog]

I'd call your doctor's office back and tell them you'd like to switch to his partner.

Sometimes you wonder if these damn doctors are afraid you might get optimal treatment. Seems they set you up either for failure or
on the edge of failure just to insure re-occurring revenue to their pocket books. Once patient realize their sham they are gone.

I say give the patient the machine they need that allows them to tolerate therapy. Doesn't matter if its a CPAP, Auto or Bipap. We would all get better treatment if they would remove insurance from providing machines. If you could buy one at Wal Mart, it would probably only cost $99 or less, you would have a wide variety of selection.

Autopaps offer much greater flexibility in addition to being data capable. You are more likely to be compliant on a auto than a cpap. I think as your pressure requirement approaches 15 cm or higher Bipap should be first machine of choice, below that the Auto. I've yet to find a good use for a plain jane CPAP, they are a lousy boat anchor and too small to be a door stop.

[darlj]

I am a Bi pap uses pressure at 24 over 16 I sleep mostly on my back and do have a difficult with leakage and also a sore nose bridge. I manage with fine tuning of the straps and had to add extra padding on my neck strap to spread the pressure around. It was cutting off circulation and causing numbness I found a shoulder pad from some thing that serves well to spread out the pressure and this helped a lot it also seems to help with leakage because it keeps every thing in place better. If any one is interested in seeing what it looks like just ask I can post a picture of the set up. Hope this info may help some of you out My name is Darrell from Ontario Canada.

[gasp]

Welcome! You are in charge - pick the doctor you want and if they don't listen to your needs pick another. Best wishes!

[Slinky]

Ah, Gasp! I do enjoy seeing your avatar. I haven't been seeing too many posts by you lately.

[rested gal]

I called the doctor and he seemed annoyed that I questioned the pressure setting
---
I found out from the therapist that he always uses CPAPs
---
He doesn't seem very willing to recognize that there is a real person behind that mask
---
He is very nice when he thinks he's in charge, but in my few conversations with him I could tell that he gets "pissy" as soon as you start to question his "wisdom" in the slightest.

Sounds like a doc that prefers his patients to file through like cattle. I don't think he'd make a good vet, though.

I will make this work

With that attitude, you will. You've definitely come to the right place for ideas about how to make it work for you.

I'm not a doctor or anything in the health care field, but... if it were me and I were prescribed "cpap at 18", I'd get one of these machines and the Encore Viewer software and card reader to monitor/tweak my own treatment:

Respironics REMstar Auto with A-Flex M series -- can be used as a straight cpap or as an autopap (autotitrating cpap.) If you wanted to buy this machine from an online store like cpap. com, all they need is a copy of the "cpap @ 18 cm H2O" prescription you already have. The Rx doesn't have to say "auto" on it. You could set the machine to auto mode and a range of minimum/maximum pressure after you received the machine.

Respironics BiPAP Auto with Bi-Flex (M series or the older non-M series model) -- can be used as a straight cpap, or as a "regular" bilevel machine with separate fixed inhale/exhale pressures, or as an autotitrating bilevel machine using a range for the inhale/exhale pressures to vary as needed, independently of each other.

Either of those machines would probably be a LOT more comfortable to use than the "cpap" you were given. For me, the auto with A-Flex gives as much exhalation relief as a bilevel (BiPAP) machine does. But I don't have to use as much pressure as you do. In your pressure shoes, so to speak, the second machine...the BiPAP Auto... would probably be my first choice. But that involves getting a whole new Rx to be written for "bilevel" with the two pressures (IPAP/EPAP) stated on the Rx.

At your pressure, chances are very good that the Auto with A-Flex would give you comfortable, effective treatment. Chances are almost for sure that the BiPAP Auto would. And of course, if it turned out that straight cpap is better for you, either of those machines can be set as straight cpap.

Good luck!

[gasp]

Ah, Gasp! I do enjoy seeing your avatar. I haven't been seeing too many posts by you lately.

Ah, that's nice to hear you missed the ol' one-eye : ) I have been busier than bees whose hive was just cleaned. However, you may have by now noticed that I posted a bunch over the last couple of days. I posted so much I hoped I wouldn't be mistaken for a spammer