APAP -vs-BiPAP (bi-level)

[mommaw]

Ok folks, I need some answers here. I keep reading posts stating that they want an APAP. What is the difference/advantage of both the APAP anf the BIPAP? I am on a BiPap which my DME and to fight with my insurance to let me have. They only approved rent to own if I comply. They will request data from my DR. after 2 months. Should I have tried for an APAP instead? My Dr wrote the prescription for the bilevel, said that was what I needed. I am just 2 weeks into this and appreciate all the help I get from all of you.

[mommaw]

post should state my DME HAD to fight with my insurance co.

[Mikesus]

Do you have some other breathing problem that your doc would have specified a bipap?

[mommaw]

Not that I am aware of. He said I needed a bipap because my pressure has to be so high 18 and I was struggling to exhale at that level. So I am at 18 dropping to 14 to exhale.

[Liam1965]

The difference is that a biPAP has two different set pressures, one for inhalation and one for exhalation.

An APAP (or more correctly, and Auto Titrating CPAP) is a CPAP in that it has a single pressure, but it attempts to measure your apneas and hypopneas and other such evens, and increases the pressure as needed to keep you breathing.

If you really need that high a pressure, biPAP may be right for you. But if in fact you really need a lower pressure most of the night, and only need the high pressure occasionally, you might do well with an AutoPAP, especially one with CFLEX, which sort of mimics the behavior of biPAP, but instead of two SET pressures, it just drops the pressure "some" when you exhale.

I think I've got that all right.

Liam, so frustrated right now he can't think of anything funny to say. Sorry to disappoint.

[chrisp]

Good answer Liam. Give the remstar auto with c-flex a try.

https://www.cpap.com/productpage/1607

Prolific Cheers,

Chris

[sthnreb]

I use a bipap also. My settings are 12/8, not as high as yours. I don't know what machine you use but if it has the ramp feature, try using that. Set to a lower setting and see how it works. You can set the time to "ramp" to the RX setting over 5-45 minutes. However you could just try the breathing at the lower ramp levels to see how it works. I prefer bilevel.

[mommaw]

Thanks to all for responding. The information is really helpful. I have adjusted my ramp time to 30 minutes to give me more time to fall asleep. Hopefully this will help.

[cpaplady]

Have you got a copy of your sleep study? If so find out why you were ordered a bilevel. With the apap pressures are titrated per breath and delivered per breath. If you only need 18cm of pressure for a few minutes at a time then maybe you might like the apap. We have found that setting anyone over 15 cm of pressure on an apap tends to make a more them compliant with therapy. Also "most" of our apap users tend to like the resmed units better than the others.

[Liam1965]

Also "most" of our apap users tend to like the resmed units better than the others.

Really? Interesting. The impression I'd gotten on this board was that the first choice was Remstar Auto with CFLEX, and the second was the PB420E (for it's adjustability).

I even recall someone saying the ResMed units had an older algorithm.

Kind of important, since I'm trying to figure out how to buy one.

Liam, who has noticed that every time he thinks he's figured out the rules, the game changes.

[snoozin']

So, Liam, ever play FLUX?
Debbie

[rested gal]

Now that Respironics has added C-flex to its Remstar Autopap, that's the autopap I'd personally recommend to anyone thinking about switching from straight Cpap to Autopap or from a Bipap to Autopap. I'm no doctor - Bi-level devices might be better for some patients, but in general I think the tradeoff between possibly getting to sleep at lower pressures most of the night would make autopap work well for a great many people who are currently using BiPaps in order to get relief on exhalaton.

The Respironics REMstar Auto with C-flex is the only autopap, as far as i know, that can work in any of these four modes:

1. As a cpap (blows a single pressure.)

2. As a cpap with C-Flex (c-flex drops the pressure some each time you breathe out.)

3. As an autopap (varies the pressure according to what your breathing indicates you need throughout the night.)

4. As an autopap with C-Flex (varies the pressure according to what your breathing indicates you need throughout the night AND drops the pressure some each time you breathe out.

That last mode (Auto with C-flex) gives two kinds of pressure relief at once. As cpaplady pointed out beautifully, a person might not need their full "titrated" pressure all night. Mommaw might need the full "18" just a few times scattered throughout the night....she might get to enjoy more comfortable lower pressures most of time. There might even be nights when Mommaw doesn't even need "18" at all. The higher the pressure, the more chance of mask air leaks and the more chance of swallowed air (aerophagia) leading to painful bloating.

A Bi-Level machine like a BiPap or VPAP III can give relief on exhalation, but the higher inhalation pressure is always going to be the same.

Only an autopap can sense from your breathing what kind of pressure you actually need, minute to minute, and adjust the pressure to only as much as is necessary to keep the throat open and prevent most apneas, hypopneas and limited air flow situations from developing.

I put "prevent" in bold because lately it's been surprising to me how many health care professionals, including at least one board certified sleep doctor that I know of, apparently do not understand how today's autopaps work. Too many have the notion that an autopap sits by idly at a low pressure until ... "WHOOPS, there's an APNEA - better JUMP on it." They do not seem to "get it" that modern autopaps are designed to proactively prevent such events.

Anyway, if a person is getting good sleep and feels good on whatever machine they are using, that's great. But anyone who is having trouble exhaling against pressure and is on straight cpap or bi-level like BiPap, or even on "just an autopap" might find a whole new comfort level and excellent treatment with the only Autopap that can also drop the pressure every time the person breathes out:

Respironics REMstar Auto with C-flex.

Add the heated humidifier to that specific machine, and it's cadillac treatment, imho. I've used two other autopaps that worked fine for me too (PB420E auto and REMstar Auto before they added C-Flex to it.) I've been using the newest REMstar Auto with C-Flex for a couple of months now. I didn't expect C-Flex to make much difference to me since I never had any problem breathing out against pressures up to about 14.

But having experienced the combo of Auto with C-Flex.... super comfortable!

[snoozin']

Rested gal convinced me a few weeks ago. I got the 420G straight pap when I was first diagnosed, and lI ike the PB 420s, the size, the look, etc. So I was all set to get the 420E when I decided I needed an autopap. But after reading what she wrote about her RemStar auto w/c-flex, I ordered that one. I've had it for about 3 weeks now, and LOVE it. A friend got the 420E a couple of days ago, with the humidifier and the silverlining software. It's ok, but the RemStar is so much easier to use; you just have to take the little card over to the computer to download instead of unplugging and carrying the 420E machine. And since the plug in my bedroom is behind the dresser, so that I have to pull the dresser out everythime I need to plug or unplug the machine, that was a BIG plus for me. Downloading the RemStar takes only a minute or so, while the 420E took almost 20 minutes to download (and that was after she spent an hour or so figuring out the software.)
Haven't tried or seen the Resmed, so can't tell you anything about that.
Debbie

[Liam1965]

So, Liam, ever play FLUX?

I'm starting to get used to my Remstar Pro-2 with C-FLUX.

>DUCK<

Liam, Level 5 Dungeon Master, Level 75 Geek.

[snoozin']

Oh, dear, Liam,
You do keep us laughing. And why is it that most of my friends are geeks? I REFUSED to become a programmer in college - the counseler kept trying to get my in that course and I kept taking different ones (Math, Science, Business, in that order)
So now just about everyone I know and hang around with is a geek. But it comes in handy when I have a computer problem.
I must confess though - I gave everyone a good laugh yesterday.
I was cleaning off my desk (don't ask me why; I should know better. The dust is SUPPOSED to be higher than the keyboard for insulation purposes, right?) Anyway, I was moving things around, and I know I hit the keyboard a few times, I heard the beeps, but I wasn't paying any attention. When I finally looked at my display, everything was upside down and backwards.! It's loads of fun when the start button is in the top right corner instead of the bottom left. All the folders and icons were upside down - everything. And nobody would tell me how to fix it. John suggested I just put my chair on the ceiling. Bruce said that learning to read upside down and backwards would probably add more neurons or something to my brain and would be good for me. And then there was the suggestion to swicth computers with someone else while they were at lunch and freak them out. I LIKED that idea, but I have some stuff on mine that I really need. Sigh!
Jen finally (after picking herself up from the floor) told me how to fix it. I still had to get into the right things and press the right buttons, with everything upside down and the mouse going backwards. It's really, really difficult to move the mouse left when your eyes tell you it needs to go right.

Debbie, whose cumpter is right side up today and whose chair is not on the ceiling.