CPAP vs.BiPAP Pressures

[Gallandro]

OK, I meant to make a few meaningful comments on some threads before directly asking for advice, but I just gotta ask about my latest development.

I have been having aerophagia problems since I started my treatment about a week ago. My doc has been very cool about helping me try things and they finally lowered my pressure from 12cm to 10cm as a last ditch effort. It was no good, so today the got an order out for a BiPap for me.

And finally......My question is with my original pressure at 12 and 10 still causing problems, does a BiPap pressure of 14/10 make sense?

Seemed odd to me to go 2cm higher and stay with the still problematic 10cm on exhale. But maybe BiPap makes the difference.

Just wondering

Gallandro

[Goofproof]

To me it makes more sense to go APAP, with the software to see your treatment, stop mouthbreathing leaks and only use the pressure you need when you need it. A Auto Bi-PAP, can also do this, But by increasing the number of variables, getting it dialed in will be much harder.

The main thing in treatment, if you use a nasal mask, stop mouthbreathing leaks, and get the software to monitor your treatment. Jim

[Gallandro]

Thanks for the info Jim.

I've been taping AND using a chinstrap to make sure no air is leaking into my mouth too. Leaks seem to be good based on my lower leak rate than the mask says there should be. I'd love to have the software to monitor myself, unfortunately now I need the 1.8 software (not that 1.6 seems to be easy to get lately) . hopefully something wil come along soon .

I asked doc about APAP but they didn't seem to like the idea of it. Something like it only reacts once you start having trouble. I figured a BiPap/Auto BiPap would do the job just as well. The pressures worry me though.

[dsm]

Speaking from my own experience - went from an Auto at 15 CMS (10-17 range) to a BiLevel at 8/15 - that really did ease the areophagia markedly (almost have none) but I also had to conceed to using a full face mask (I get regular bouts of nasal restriction).

Then after awhile changed that to 8/14 then 10/14 then 10/13. In Feb had a new PSG & the RT said "stick with what ever you are doing as it seems it is spot on (for me)"

So I am one who believes that aerophagia can be reduced/removed by Bilevel.

I recently got my hands on a Resmed S8 Vantage & am going to start trialling the EPR once I get an S8 datacard reader & the latest version of their software. EPR is a mini BiLevel function that allows the user to set an ipap CMS (say 12) then set up an epap setting that is 1 2 or 3 CMS below the ipap. As you breath in and out it changes from the ipap to epap setting.

What strikes me as interesting is if you have a central - that is you exhale then fail to breathe in with 4 seconds - the EPR will switch back to ipap and thus provides a trigger to get back into a regular breathing pattern. This type of capability is usually associated with upmarket BiLevels. Also, if you have any apneas or snores, the machine will suspend EPR until breathing reverts to normal.

I want to measure the various aspects of this so am purchasing the gear needed to do so. I already had an S8 Escape but as it didn't collect nightly data I never got the required card reader.

I have already tried this Vantage S8 in EPR mode - just one night & for my 1st go, found it 'heavy' compared to my PB330 BiLevel which tends to be very 'snappy & crisp' in going from ipap to epap & back. One positive observation was that there was no whine from the motor like I get with the Vpap III BiLevel models from Resmed. The S8 with EPR wasn't a lot different in noise level from the PB330 Knightstar.

What I am very keen to see is does the EPR feature reduce aerophagia as well as the PB330.

Good luck with your own quest & if you are getting a BiPap that is as good a choice as any.

DSM

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap, auto, aerophagia

[Gallandro]

Thanks too dsm.

Sounds like I may have to mess with it a bit to "dial in" the correct numbers.

Well, I'm off to give it a try. Here's to no aerophagia!

[rested gal]

My question is with my original pressure at 12 and 10 still causing problems, does a BiPap pressure of 14/10 make sense?

Seemed odd to me to go 2cm higher and stay with the still problematic 10cm on exhale. But maybe BiPap makes the difference.

Won't hurt to try the 14/10 but if that continued to cause aerophagia problems, I'd drop the IPAP down to 12 and keep the EPAP at 10. That's if it were me -- I'm not a doctor.

If that bothered me, I'd try 12/9 or 11/9. I'd not take the EPAP down below 9 if I could help it.

EPAP needs to be high enough to prevent apneas. Perhaps less than 10 would be able to prevent your apneas. There's no way to know that without your seeing the titration table from your sleep study to see if obstructive apneas disappeared at a pressure lower than 10. And I'd want to see that they disappeared while in REM and on my back.

Of course everything about xpap treatment is a trade-off. You might need to use less pressure than ideal simply to be able to "do" this treatment at all. 'Cause painful areophagia can sure put a stop to being able to "do this" at all. Better some pressure than none at all if it means a person would have to to quit.

I'd be trying to get the Respironics BiPAP Auto with Bi-Flex in hopes of getting two kinds of possible relief at the same time.

I asked doc about APAP but they didn't seem to like the idea of it. Something like it only reacts once you start having trouble.

Typical mistaken idea by some doctors (even "sleep" doctors) about how autopaps can work IF they are set properly. Most doctors think of a range of 4 - 20 or 5 - 20 when they they hear the word "autopap."

An autopap can prevent...not just "react"...to events IF the minimum pressure is set reasonably up close to what it takes to prevent apneas.

As I understand it, the pressure needed to prevent obstructive apneas is usually somewhat lower than the final pressure prescribed from a sleep study, since (odd though it sounds) it takes more pressure to prevent hypopneas, flow limitations, and residual snoring than it does to prevent an obstructive apnea.

If, instead of prescribing an autopap set wide open (4 - 20) the doctors doing research with autopaps and the doctors prescribing autopap trials would set (even as a guesstimate) the minimum pressure up to no less than 2 cms below what they think it will take to stop obstructive apneas in the user, I think they would see autopaps being very effective permanent treatment machines for many, many people. And a lot more comfortable to use than having a straight pressure (sometimes unnecessarily high much of the night) blowing at the person all night long.

To me, the best of both worlds is the BiPAP Auto with Bi-Flex.

But, hey, I'm not a doctor!

[christinequilts]

What strikes me as interesting is if you have a central - that is you exhale then fail to breathe in with 4 seconds - the EPR will switch back to ipap and thus provides a trigger to get back into a regular breathing pattern. This type of capability is usually associated with upmarket BiLevels. Also, if you have any apneas or snores, the machine will suspend EPR until breathing reverts to normal.

DSM-

I wouldn't considering it reverting to the prescribed pressure as acting like TIME BiPAP ST mode at all. EPR is suppose to be pressure relief below your titrated level, so it makes sense that the default is the higher, preset, prescribed pressure, KWIM? Failing to breath in 4 seconds time could just as easily be obstructive in origin & your body expressing that the lower pressure isn't able to hold your airway open as well as the higher, prescribed pressure. If we think of regular BiPAP, the lower EPAP pressure is set high enough to clear apnea, right? So it makes sense that regular BiPAP's default to lower EPAP pressure, instead of higher IPAP pressure; if it stayed at the lower pressure the entire night, all obstructive apneas should still be eliminated theoretically. But with the ResMed EPR dropping below titrated pressure to give exhalation relief, it has to default to the higher pressure to have the best chance to keep the airway supported & apneas controlled, which is why it drops the EPR relief when it senses apneas or snores, as you mentioned.

Besides, one flip back from lower 'EPAP'-like pressure to higher, 'IPAP'-like pressure isn't that likely to trigger breathing to restart in the case of centrals, as I'm all too well aware (but then I've extremely stubborn when it comes to taking a BiPAP ST not so subtle hint to breath, as we well know).

[dsm]

What strikes me as interesting is if you have a central - that is you exhale then fail to breathe in with 4 seconds - the EPR will switch back to ipap and thus provides a trigger to get back into a regular breathing pattern. This type of capability is usually associated with upmarket BiLevels. Also, if you have any apneas or snores, the machine will suspend EPR until breathing reverts to normal.

DSM-

I wouldn't considering it reverting to the prescribed pressure as acting like TIME BiPAP ST mode at all. EPR is suppose to be pressure relief below your titrated level, so it makes sense that the default is the higher, preset, prescribed pressure, KWIM? Failing to breath in 4 seconds time could just as easily be obstructive in origin & your body expressing that the lower pressure isn't able to hold your airway open as well as the higher, prescribed pressure. If we think of regular BiPAP, the lower EPAP pressure is set high enough to clear apnea, right? So it makes sense that regular BiPAP's default to lower EPAP pressure, instead of higher IPAP pressure; if it stayed at the lower pressure the entire night, all obstructive apneas should still be eliminated theoretically. But with the ResMed EPR dropping below titrated pressure to give exhalation relief, it has to default to the higher pressure to have the best chance to keep the airway supported & apneas controlled, which is why it drops the EPR relief when it senses apneas or snores, as you mentioned.

Besides, one flip back from lower 'EPAP'-like pressure to higher, 'IPAP'-like pressure isn't that likely to trigger breathing to restart in the case of centrals, as I'm all too well aware (but then I've extremely stubborn when it comes to taking a BiPAP ST not so subtle hint to breath, as we well know).

[Gallandro]

Well, I tried the 14/10 pressure and it inflated me like a ballon in just under 60 seconds

Called the doc on call and he said to bunch it for the night, wasn't sure what pressures to put me at.

Called the Sleep Doc the next morning and they sent an order to my DME for a lower pressure. They wanted to change it and wanted me to wait 2 days for an appointment, instead, I politely informed them in my research I came across instructions on how to adjust it (thanks you all). There was a long pause then they went to find out what the pressures were adjusted to. 10/6 was the verdict.

It's been three wonderful nights! Very minor aerophagia. 7+ hours all (my normal sleep length) All that and my AHI at 1.7 from 62 Very cool!

Once school is out in a week (I teach), and I get my software (just ordered it tonight, one of the four cpap.com posted) I am on my way to tweaking my AHI to nil.

Thanks all for your posts and help via this and all your other wonderful threads!

[dsm]

Will just add a further 0.2c worth - 10/6 - my bet is you will probably end up at 11/8 & get the lowest AHI

Just a hunch - & may be proven wrong

DSM