Bi-Level Therapy Causes Leaking?

[momexp5]

I don't really think they put you on BiPAP because your end exhalation pressure would be too high as there is always CFlex for that.

I think in actual practice that probably does happen a lot - moving someone to bi-level simply because they have too much trouble exhaling against a high straight pressure, even if they have no underlying pulmonary or other respiratory problems.

Reason I say this is that up until now there has been no manufacturer other than Respironics (with C-Flex) who made a straight cpap machine with any kind of relief during exhaling. However, many sleep doctors and DMEs in some areas use only ResMed machines. There would be no exhalation relief with a ResMed straight cpap, until the past few months, when EPR was introduced.

Patients who needed "comfort" relief during exhaling would be prescribed bi-level from doctors who believed in ResMed products and DMEs who carried only ResMed machines. Often, those patients had to endure straight cpap for a month to "prove" they couldn't use a single straight pressure before insurance would ok switching them to bi-level. But bi-level is what many eventually got...to make them able to use this kind of treatment at all, not because of a pulmonary problem.

RG, what you're saying is what I thought I got put on BiPAP for - I had too much trouble exhaling against my pressure, I was getting a lot of aerophagia, so the dr. prescribed BiPAP. And I get Respironics machines - though he didn't prescribe BiFlex, I talked the DME into the Pro 2 because of the BiFlex availability (and I'm using it). I was "maxed down" at 8 and 4, since the lowest settable ePAP was 4, I was prescribed that lower point, and I wanted to be able to kick it down a notch more via the BiFlex.

Since I've been on BiPAP, not much aerophagia, maybe just a little burp in the morning. No lump-in-the-throat sensation of an air bubble trying to sneak down, that's gone.

And I haven't had *any* mouth leak problems in the few nights I've been on BiPAP - I think my tongue got trained while on CPAP to minimize mouth leaks, that might have helped. I forgot about mouth leak problems!

[rested gal]

Lori, you wrote:

Please accept my apologies if I didn't write it clearly enough.

Heavens, Lori, you have nothing to apologize for. Your post was very clear and I did read all of it. Problem was....I didn't see your post at all until after I had already hit "submit" on my post. LOL!

I really should hit refresh each time before I post something I've spent awhile pausing a lot and mulling it over before I finally hit the button to send it. By now you'd think I'd have learned that something else may have been posted in the meantime. You're fast! heheh.

[dkeat]

That was mentioned in a chat at TAS when the Activa was introduced almost 2 years ago. Since I'm on BiPAP, it caught my attention. The rep didn't answer my question in the official chat, but did address afterwards. If I remember correctly, it isn't as bad as the stats make it out to be...

Hi Christine

Many thanks for that very complete response! I think that more or less explains the situation, the context and why my kitchen sink is there! No, seriously, very good.

It sounds like the quote I cited was not a very correct statment to begin with and what validity it had has been lost due to the modernization of equipment to compensate for such problems.

[Sleepless on LI]

RG,

Thanks for the reply. I didn't want you to think for one moment that I was trying to be rude or obnoxious. I was just trying to remember the lesson I got from my son on Sunday (boy, was it full of things to remember-his college tuition was worth the money). I'm glad you took it in the way it was meant.

And, as usual, your point was right on the mark. I learned something new from it. The way I understood it, bi-level is only when you cannot use CPAP due to health reasons. But maybe inability to exhale to that degree could be considered a pulmonary deficit? I don't know at what pressure the normally healthy person should be expected to be able exhale against without having a problem. Good question, though. No? I'd love to know the answer to that. Where is Ozij???

[momexp5]

But maybe inability to exhale to that degree could be considered a pulmonary deficit? I don't know at what pressure the normally healthy person should be expected to be able exhale against without having a problem.

It could be considered a pulmonary deficit, Lori. Maybe it's according to one's definition. lol - makes me think of - according to the hospital's definition, I wasn't in labor with #5, so I went home and had my baby You know, what are the limits and thresholds? Are these things defined for the men, or for little women like myself as well? What would be normal for a 5'2" small-boned thing like myself, and what's from a generation of parents smoking with their kids in the house (or subsequent years of their own smoking?), what's just a fragile person, and what's pathological?

Oh - and I would say, too (editing my post here), that my problems with the exhale were sort of more in my throat, rather than my chest. Like some exhale switch-over in my throat wasn't being allowed to do it's thing, on the higher ePAP.

[Sleepless on LI]

Oh, can I relate to your delivery story. After being in the hospital from 10:30 PM till finally giving birth to my daughter at 6 PM the next night, the OB walks in the next day and says, "So, not bad, a 2 hour labor." I said, "What, are you kidding me? I was in labor for like 8 hours!" To which he replied, "Well, you were in ACTIVE labor for only two hours."

I wonder what he would have thought had it been him having the contractions from 10 the night before till giving birth at 6!!! And this was #3!

[Guest]

Oh, you had a male OB? Didn't you just want to smack 'im, just upside the head, like "excuse me buddy, when was the last time you gave birth?"

Oh, I have a few stories - not just male OBs, either. I arrived at "always use a midwife (CNM)" and "even if you have a midwife, get a doula". Bumper sticker: "Every Woman Deserves a Doula"

[Sleepless on LI]

Oh, you had a male OB? Didn't you just want to smack 'im, just upside the head, like "excuse me buddy, when was the last time you gave birth?"

Uh, yeah! They only know from books and watching. I used to tell my husband, I think there should be a pill all expecting fathers should be forced to take that makes them have the same pains as full blown contractions for about 5 mins., which would probably be more than they could handle, just so they'd see what we go through. It wouldn't be a bad idea, though, to give one to the male OB's of the world, too.

[momexp5]

And, actually, give one to the female OBs, too, the ones who've never given birth themselves!

[Sleepless on LI]

And, actually, give one to the female OBs, too, the ones who've never given birth themselves!

Good idea!!! They should only know, too.