Should I consider BiPap

[allinknots]

Hi,

I've been an on-again off-again cpap user for a few years now. I have an apap machine, and a mask that fits and feels relatively comfortable. (I've tried many masks, but the Resmed Fx seems to work best.) I've tried non-pillow nasal masks, but I don't like the feeling of the air blowing around my nose. I'm also very sensitive to temperature, and if the air feels cold, it will keep me awake. The Resmed Fx delivers air that is warm enough for me. (I also keep my heated humidifier going, and I have an Aussie heated hose and a cover for the small hose, too.)

I have my machine on the apap setting, and my pressure usually records between 10-11, with very few apnea or hypopnea events (maybe up to 3). But (finally) here is my problem.

I find it difficult to exhale to inhale but mainly exhale enough air.

I trouble-shooted (troubleshot?) this way: I altered my mask. I made the exhalation ports on my mask larger by poking a fat needle through some of the exhalation ports, enlarging them. I carefully cut the nasal holes on the pillows larger, as suggested on this board. Doing those two things has helped quite a bit!

But, here's the problem. I'm normally a shallow breather, and I have narrow airways, both in my throat as well as my nasal passages. (Had deviated septum surgery years ago which also helped the situation.) My mask alterations have helped me to intake enough air for my inhalation, but it seems difficult to exhale enough air before it's time to take the next breath. So I open my mouth.

I've tried a chin-strap, but the opening my mouth is not really the problem--it seems to be necessary. I don't want to tape my mouth shut, because I feel it's my body's way of compensating for not being able to exhale with enough natural pressure through my nose.

I've played around with the EPR settings on my machine, but that didn't help enough.

I'm not sure what to do, but this issue causes spotty compliance for me. Even though my apap pressure is not high, would I benefit from bipap therapy instead?

Your thoughts?

Thanks so much,
AllinKnots

[Mary Z]

On my S8 I increased the Ti Max to three which gave me plenty of time to exhale.

[greatunclebill]

that's a question for your doctor and will involve another sleep study probably. altering you mask so you can breathe easier beats the purpose of cpap, rendering treatment ineffective. you could take the mask off altogether and breathe even easier.

[allinknots]

Mary--changing your Ti--isn't that only possible to do with a bipap machine? I have a ResMed S8 autopap (not bipap) machine. I don't think I can change a Ti pressure with that one, right (??)

UncleBill: I'm not sure that altering my mask has negated therapy. It has allowed more air to enter and then more easily exit than how it was designed. Otherwise, I would not be able to breathe, and would suffocate. I've accidentally forced myself to keep my mouth completely shut one time, and then woke up in a panic, gasping for air. I'm able to keep my mouth shut for a good part of the time when wearing my tinkered-with mask. But sometimes I awake with my mouth open, to get more air.

(Other than opening my mouth) I don't understand why tinkering with my mask this way would negate apap therapy? I get air. My machine increases pressure if I'm having apneas or hypopneas, and my data shows that those events are well-controlled with the pressure. So, just wondering--why do you think I'm not receiving therapeutic benefits?

Thanks,
All in Knots

[archangle]

Increasing the size of the vent holes won't make exhaling easier unless you make them so large that your pressure drops. If you do that, your treatment will suffer. They would never help your inhaling unless your machine is seriously broken and isn't pumping enough air.

The S8 Autoset doesn't have any setting related to "time to next inhale" or "TI".

Your description sounds a bit like what bilevel is about. (BiPAP is simply a trademark for bilevel. ResMed calls it VPAP.)

[avi123]

Allinknots, seeing that you're a jeweller I am not surprised by you tinkering with those holes. I don't see how a BiPAP (that's how Respironics called it and they were the first) or a BiLevel by Resmed, would supply you more air without increasing pressure. If your air passages are narrow and clogged then you may need higher pressure on your APAP, and probably use full face mask. The full face mask would help you with your exhaling by opening your mouth, which will not jeopardize the treatment. Since you're now at a pressure of 10 to 11 cm you still have about 5 cm to go higher before you might be uncomfortable to exhale into the higher pressure. At that point a BiPAP might be a consideration. Doing it, you could set the inhale pressure at 15 cm and set the exhale pressure at 10 cm or below. But then it requires a new sleep test for the BiPAP.

[allinknots]

Thanks for your replies!!

Opening my vent holes did seem to help me with exhaling. My thoughts: Since I neither inhale nor exhale with much force, and is probably even less forceful when sleeping, my exhalation didn't have time to leave the ports before it was time to take the next breath. Since I enlarged the holes, the exhalation air could escape.

I'm not exactly sure why that would affect my therapy (?) I have the apap machine, so my pressure adjusts if an apnea is present. My numbers are good--usually just a couple apneas and hypopneas, and a low leak rate. (Unless the whole ahi thing isn't correctly recording due to my mask tinkering??)

I must be getting some benefit, because I *do* notice a difference between the nights I use the machine and when I don't. But I get frustrated when I wake up with my mouth open. I know there are ways around this (duct-taping, etc.,) but I *need* to open it when I do, mainly to get air out.

To make matters worse, I'm a finnicky sleeper, and am not thrilled with having anything on my face. I have tried full face masks, nasal masks without pillows, nasal masks with pillows, the Sleepweaver mask, etc. The only masks that have worked for me are the Aeiomed mask (retro-fitted headgear) and the Swift FX. I am not able to fall asleep with a full face mask.

I will probably need to quit cpap unless I figure out how I can exhale against the air, even though my therapy pressure is not very high.

I set up an app't with the sleep dr., and an app't was available for this week. I'll discuss it with him then.

Any of you who have bilevel machines: Please weigh in on this!

Thanks a bunch,
All in Knots

[Pugsy]

Does using EPR at 3 help at all when compared to maybe using EPR of 1 or 2?
BiPap machines just offer a larger difference between inhale and exhale pressures than is available with EPR of 3 and its 3 cm reduction. The timing is a bit different also but the main thing with bilevel machines is that you can have EPAP (Exhale pressure) much lower than IPAP (inhale pressure) and it is a remarkable difference and might help you.

You are using the Swift FX nasal pillow mask? What size nasal pillow....have you tried going up one size? Some people feel like they don't have enough air movement with the nasal pillows and when they go up in size the greater volume offered by a larger size seems to really help that suffocation feeling.

So make sure what your problem is...is it actually exhaling against the pressure or the fact that you feel like not enough air is moving and thus the suffocation feeling.