CPAP and BiPAP?

[sherriselph]

What is the Difference Between CPAP and BiPAP?

[djhall]

CPAP provides a single pressure to hold the airway open for both inhale and exhale. BiPAP provides two pressures, a higher one for inhale and a lower one for exhale.

[golfingrl]

BiPAP provides two pressures, a higher one for inhale and a lower one for exhale.

This may be a dumb question but isn't that what APAP with a-flex is?

[Wulfman...]

BiPAP provides two pressures, a higher one for inhale and a lower one for exhale.

This may be a dumb question but isn't that what APAP with a-flex is?

No.


Den

.

[golfingrl]

No.

Den

What is the difference? My inhale is 9.5, my exhale is 6 on APAP with A-flex, sounds the same. Would you explain the difference?

[Wulfman...]

No.

Den

What is the difference? My inhale is 9.5, my exhale is 6 on APAP with A-flex, sounds the same. Would you explain the difference?

The answers are up in the CPAP Wiki (lightbulb icon) and on all the manufacturers' websites.

I know, it can be confusing, but, an APAP can run in a RANGE of pressures (APAP mode) or in single pressure (CPAP mode).
An APAP has been known as an "auto-adjusting" or "auto-titrating" CPAP machine. They were designed years ago to help determine a therapeutic (CPAP) pressure for people who couldn't tolerate a full-blown sleep study in a sleep lab.

The A-Flex or C-Flex is only exhale relief.....just as Bi-Flex is the exhale relief for Respironics (P/R) Bi-PAP machines.
The "Flex" technology used by Respironics (P/R) is dependent on the user's exhale effort and does not drop the pressure on exhale by a specific numbers of centimeters of pressure.

Bi-Level therapy is basically TWO pressure levels.......one for inhale (IPAP) and one for exhale (EPAP). The EPAP pressure setting is supposed to be set to eliminate Apneas and the IPAP pressure setting is to eliminate Hypopneas. These can be set quite a bit apart.

To complicate it further, an AUTO Bi-PAP can also run in RANGES of pressures, too.

Does that help......or further confuse you?


Den

.

[Wulfman...]

No.

Den

What is the difference? My inhale is 9.5, my exhale is 6 on APAP with A-flex, sounds the same. Would you explain the difference?

Your pressure may be set to 9.5 and your A-Flex may be set to "3", but that doesn't mean your pressure is dropping that far when you exhale. And, with A-Flex and C-Flex, the technology allows there to be a little "back pressure" so it doesn't completely drop that far. As I said before, it's dependent on the users exhale effort. Some people have Apneas occurring at the point of finishing exhale and the beginning of inhale. The Flex technology helps prevent that.......and the reason that it is different from the ResMed "EPR" exhale relief.


Den

.

[golfingrl]

Bi-Level therapy is basically TWO pressure levels.......one for inhale (IPAP) and one for exhale (EPAP). The EPAP pressure setting is supposed to be set to eliminate Apneas and the IPAP pressure setting is to eliminate Hypopneas. These can be set quite a bit apart.

To complicate it further, an AUTO Bi-PAP can also run in RANGES of pressures, too. Does that help......or further confuse you?

Den

No that makes sense thanks

[golfingrl]

What is the difference? My inhale is 9.5, my exhale is 6 on APAP with A-flex, sounds the same. Would you explain the difference?

Your 560 model machine can't do inhale at 9.5 and exhale at 6...no such settings available on that machine....
Now you might have it set in apap mode with minimum of 6 and maximum of 9.5 but that's a whole different situations

The 560 machine only offers a single pressure...now it can auto adjust within a range but it is still one single pressure.
Bilevel pressure machines offer 2 pressures that are totally distinct and separate and there can be a wide range between them.

AFlex (or any of the other flexes) doesn't ever tell us anything (or show on the report) exactly how much exhale reduction there is but they do say that it is "UP to 2 CM at the maximum setting". That's the most it could ever possibly be.
It's flow based. If you breathe rather shallowly the amount of reduction even at 3 setting is going to be less than someone who breathes big and forcefully at the same setting.

No my settings are 9.5 and 15 with A-flex 3, the RT explained it in a way that made me believe that it was 3 cm lower than my minimum pressure. The hubby explained it all when I scratched my head and had a puzzled look on my face after reading your post. It sure seems much less pressure than only 2 cm lower on my exhale, if I shut off my A-flex and attempt to exhale at 6 it's much harder to exhale, on 4 cm it still seems to be more resistance than the A-flex setting of 3.

[zoocrewphoto]

No my settings are 9.5 and 15 with A-flex 3, the RT explained it in a way that made me believe that it was 3 cm lower than my minimum pressure. The hubby explained it all when I scratched my head and had a puzzled look on my face after reading your post. It sure seems much less pressure than only 2 cm lower on my exhale, if I shut off my A-flex and attempt to exhale at 6 it's much harder to exhale, on 4 cm it still seems to be more resistance than the A-flex setting of 3.

It sounds like your auto range is 9.5 to 15. So it can go up as needed during the night. The A-flex will reduce it some, but it can't reduce it more than 2 cm. Your RT may not fully understand it, many don't. Resmed has a 1, 2, and 3, and theirs are straight drops of 1, 2, and 3cm. So, the RT may think that Respironics machines do the same (but they don't).

Also, that means that as your inhale pressure goes up, your exhale pressure goes up as well. They stay proportional to each other. A bi-level machine can do a wider range difference of pressures. So, somebody who needs a higher pressure like 18 or 20 can have more relief when exhaling, something a regular cpap or apap can't do. And bi-level machines can go up past 20cm. There's no reason for a regular machine to go that high since anybody that high really needs the extra relief.

[ubnoxus]

No the tech told her correctly she just didn't understand all the info

[golfingrl]

It sounds like your auto range is 9.5 to 15. So it can go up as needed during the night. The A-flex will reduce it some, but it can't reduce it more than 2 cm. Your RT may not fully understand it, many don't. Resmed has a 1, 2, and 3, and theirs are straight drops of 1, 2, and 3cm. So, the RT may think that Respironics machines do the same (but they don't).

Also, that means that as your inhale pressure goes up, your exhale pressure goes up as well. They stay proportional to each other. A bi-level machine can do a wider range difference of pressures. So, somebody who needs a higher pressure like 18 or 20 can have more relief when exhaling, something a regular cpap or apap can't do. And bi-level machines can go up past 20cm. There's no reason for a regular machine to go that high since anybody that high really needs the extra relief.

Yes that is exactly right a minimum of 9.5 and a maximum of 15 with a-flex of 3

No the RT knew what he was talking about I just misunderstood what he was saying. I got a lot of info thrown at me and just didn't interrupt it correct.

I was warned about asking questions but did anyway, I learned my lesson

[golfingrl]

No my settings are 9.5 and 15 with A-flex 3, the RT explained it in a way that made me believe that it was 3 cm lower than my minimum pressure.

The 560 simply cannot do 9.5 exhale and 15 inhale...it can't do 9.5 exhale and 10.5 inhale...
What it can do is raise that 9.5 minimum pressure setting up to 15 since that is likely your maximum.
I have had 4 various Respironics APAP machines and 3 different bilevel machines (Bipaps) and trust me...I know these machines.
They don't do separate inhale and exhale...they can't.
Yes...they will drop the pressure some during exhale but it is NOT the same thing as bilevel pressures and that drop during exhale. The timing is not the same and the amount of reduction with Flex is sure no where near what is available with the BiPap.

Yes I understand what my machine does and doesn't do, wasn't attempting to tell you otherwise. I'm new and attempting to understand everything and didn't explain it correctly to you. It won't happen again I promise.

[zoocrewphoto]

No my settings are 9.5 and 15 with A-flex 3, the RT explained it in a way that made me believe that it was 3 cm lower than my minimum pressure.

The 560 simply cannot do 9.5 exhale and 15 inhale...it can't do 9.5 exhale and 10.5 inhale...
What it can do is raise that 9.5 minimum pressure setting up to 15 since that is likely your maximum.
I have had 4 various Respironics APAP machines and 3 different bilevel machines (Bipaps) and trust me...I know these machines.
They don't do separate inhale and exhale...they can't.
Yes...they will drop the pressure some during exhale but it is NOT the same thing as bilevel pressures and that drop during exhale. The timing is not the same and the amount of reduction with Flex is sure no where near what is available with the BiPap.

Yes I understand what my machine does and doesn't do, wasn't attempting to tell you otherwise. I'm new and attempting to understand everything and didn't explain it correctly to you. It won't happen again I promise.

Don't worry about it. CPAP has a steep learning curve for a lot of terminology, different things going, etc. It takes awhile to learn these things. I have been here almost 2 years, and I Am still learning new things about how the machines work, the differences, etc.

[purple]

By Medicare rules, so my doc said, A bi-level (whether you use the PR proprietary name Bi-Pap, or the Resmed VPAP) must have a difference of at least five points between inhale and exhale. Flex is much less. But it is more complicated in how the machines deliver the pressure flow. I do not do well on an Auto, nor with a flex, but do great with a Bi-Level machine. The two big manufacturers, Resmed and PR, use a different algorithm to determine when to increase pressure when using auto, and I suspect a different algorithm for the way the pressure changes during the bi-level changes. Meaning they supply a different rate of change of pressure during the inhale or exhale. altho that seems counterintuitive on some level.

Pugsy said that there is not a dimes worth of difference between the two different manufacturers. My sleep doc, when he wrote a script for my Resmed VPAP auto said, "that he felt Resmed patients were more satisfied." I like my VPAP, but on some level I would prefer to have a PR machine, which I think is really well built. Not to mention that that humidifier tank on my VPAP has to be refilled during the night, which never happened with my earlier PR machines (which were not bi level machines)

I think Bi Level machines are under prescribed. Anyone whose pressure is over 12, should be more thoroughly tested for a Bi-Level machine. Part of the problem being Bi Level machines are pricey, which I also think is un necessary, as most of the machines we get have the same guts, just a different firmware, and a different name on the plastic. Problem being if all the machines were, at least, a Bi-Level with Auto capabilities, then some manufacturer will come along with a real brick, sell it for less, and insurances would force everyone to get the brick.

Medicare now says that one must fail ordinary xPAP before getting a Bi Level (or have an unusual medical condition) This rule caused me a lot of cost and difficulty in getting a Bi-Level machine.

I also think that in my case, I have one pressure to stop apneas, but I can not get a full breath of air at that pressure level, which interferes with my sleep. The solution is to have a higher pressure on intake, so I get more air. Now I wonder if that higher pressure might be a culprit in that when I slow down inhaling, the machine switches back to exhale too quickly. I say this so the OP has an idea of why a bi level might be useful.

Using a bi level has reduced my GERD, a regular xPAP gave me incredible amounts of Aerophagia, (Air being pumped into my stomach from the machine). My A1C (from diabetes) is much improved, which my regular doc thinks likely occurs with better sleep.

There are also machines called Ventilators, (Vents), an ASV, which can be programmed to do some spectacular things for those who need them.

Somebody please correct me where I am wrong.