Newbie--Wondering why BiPap?

[sburke91]

I finally got my hands on my inital PSG and titration PSG today. The doctor that reviewed my study, and my GP are perscribing BiPap at 13/9. Looking at the results of my study, I'm really not sure why they're perscribing BiPap rather than straight CPAP or one of the Flex machines.

Looking at the titration results, it looks like I did as well or better on straight CPAP at 12 with the nasal mask as I did on BiPap at 13/9. I'm going to schedule a chat with my physician on this, but with the holidays coming up, it's likely going to be after that. Can anyone help shed some light on this? Below is a link to my PSG results.

http://www.slipangle.net/xpap/SleepStudy1_Redacted.pdf

[Guest]

My last machine was a Bipap and I found it to be much easier to tolerate than CPAP. If it hadn't been for Bipap I would probably not ever have been able to tolerate treatment wit straight CPAP.. Of course with the new machines with A-Flex and C-Flex I don't see that much difference.

[rested gal]

Thanks for the link to your study, sburke. The chart of pressures used was confusing to me. Surely they didn't switch masks back and forth (nasal then Quattro) at each pressure level. I guess they just lumped "with or without the Quattro" all on the same chart?

Did they start you out with a nasal mask (covers just the nose) and then switch you to the Quattro FF mask for the last part of the titration night because of mouth breathing or something?

I'm sure no expert, but looks to me like you did fine at straight 10 and straight 12.

At any rate, be very happy you were prescribed a bilevel machine instead of a straight cpap machine. As Guest pointed out, a bilevel can be much more comfortable -- can feel much more like natural breathing than straight cpap.

And, if it turns out you really do better on one straight pressure, any bilevel machine can always be set to work like straight cpap at a single pressure. Simply by setting the EPAP and IPAP pressures to the same number.

I'd want the Respironics BiPAP with Bi-flex, myself. Or better yet, the Respironics BiPAP Auto with Bi-flex. Even though that machine has "auto" in its name, it is a bilevel machine. The DME would get reimbursed for a bilevel whether they gave you the BiPAP with Bi-Flex, or the BiPAP Auto with Bi-flex.

I've used several models of the two leading manufacturers' bilevel machines. Bi-flex, which only the Respironics bilevel machines have, makes quite a difference in comfort and smoothness to me.

[sburke91]

Thanks for all the great feedback. The tech woke me up at about 4am (my guess) and switched me to the full face mask. He said there was some mouth breathing--not a lot--but he wanted to try me on the FF mask. I'm glad though as I'm going to get both. I'm sure there will be a point where I'm congested and need the FF mask. I did have more leakage problems with the FF mask though.

It sounds like the BiPap is a blessing in disguise.

[rested gal]

You got a great machine, sburke, if its the one showing in your profile. And that's smart to have a FF mask, even if it turns out you can control the mouthbreathing and can use other masks.

Check your Private Messages...button at top right of this page.

[khvn]

[quote="sburke91"]I finally got my hands on my inital PSG and titration PSG today. The doctor that reviewed my study, and my GP are perscribing BiPap at 13/9. Looking at the results of my study, I'm really not sure why they're perscribing BiPap rather than straight CPAP or one of the Flex machines.

Looking at the titration results, it looks like I did as well or better on straight CPAP at 12 with the nasal mask as I did on BiPap at 13/9. I'm going to schedule a chat with my physician on this, but with the holidays coming up, it's likely going to be after that. Can anyone help shed some light on this? Below is a link to my PSG results.

http://www.slipangle.net/xpap/SleepStudy1_Redacted.pdf

[DreamStalker]

Holy cow, 40% minimum O2 saturation!! Perhaps your breathing is very shallow? In any case, I’m no expert but you are in serious need of treatment regardless of whether it is CPAP, APAP, BiPAP or BiPAP auto.

I’m guessing that maybe your RDI with the nasal mask (Comfort Gel) was suspect if you were indeed leaking air from your mouth. Sometimes, if the air is leaking from your mouth, the RDI or AHI or whatever cannot be accurately measured if at all. That would explain why they made the second titration attempt with the full face mask (Quattro) which allowed them to get accurate measurements of the RDI. However, that second attempt showed that you were sensitive to central apneas (maybe that shallow breathing?). So they put you on BiPAP which took care of all but one obstructive apnea for an RDI of 3.

Anyway, I think you are going to notice a night-n-day difference with proper treatment. My min O2 only went down to 60% and I had immediate positive results with my first night of treatment and have continued for the past year and a half.

Best wishes!

[sthnreb]

Excellent response Rested Gal. I don't see how he could go wrong with the Bipap Auto. It's the best of Cpap and Bipap with its features. It's like a titration every night. I was diagnosed with severe sleep apnea myself and I imagine you would be more likely to comply with a machine that is more natural in breathing than constant pressure. They measure all your saturation levels and evidently figured you did best with the bipap. They can adjust the pressures from their station and monitor it as they do. I think as they run it down, if you struggle or start to awake, they would take the pressure back up until they hit the one right for you. Evidently it was 13/9, extremely similiar to mine of 12/8. My auto hardly ever runs 12/8 but that still seems to be the best overall for me if I run straight bipap. Sometimes when I put my mask on, it can take me up to 5 minutes to fall asleep.

[khvn]

[quote="DreamStalker"]Holy cow, 40% minimum O2 saturation!! Perhaps your breathing is very shallow? In any case, I’m no expert but you are in serious need of treatment regardless of whether it is CPAP, APAP, BiPAP or BiPAP auto.

I’m guessing that maybe your RDI with the nasal mask (Comfort Gel) was suspect if you were indeed leaking air from your mouth. Sometimes, if the air is leaking from your mouth, the RDI or AHI or whatever cannot be accurately measured if at all. That would explain why they made the second titration attempt with the full face mask (Quattro) which allowed them to get accurate measurements of the RDI. However, that second attempt showed that you were sensitive to central apneas (maybe that shallow breathing?). So they put you on BiPAP which took care of all but one obstructive apnea for an RDI of 3.

Anyway, I think you are going to notice a night-n-day difference with proper treatment. My min O2 only went down to 60% and I had immediate positive results with my first night of treatment and have continued for the past year and a half.

Best wishes!

[DreamStalker]

Hat's off to your fine analysis, DreamStalker!

One thing though: One would think that leakage, if anything, would increases number of events, not hidding them since treatment pressure is reduced. Just wonder what's your thought on this.

Correct. Leakage produces inadequate pressure which increases events ... but leakage also prevents machine from scoring the increased events so that machine may show lower (or zero) event number than actual event number.

leaks = misleading and under-represented RDI or AHI numbers

Not a real hard concept for most to understand.

[sburke91]

Thanks everyone for your replies and insight, both on the forum and in the chat room. There seem to be two main themes here:

• It's likely that the central apneas were at least part of what lead to the decision to perscribe BiPap.
  If you can get a BiPap, go with it.

I have an appointment with a DME in town at 8:30 Monday. The seem to be pretty decent to work with, and were open to my requests for specific equipment, at least on the phone.

Additionally, yesterday I received my M Series auto BiPap from cpap.com and spent my first night with it last night. We're visiting my parents, so the sleep environment wasn't optimal, but I managed. It took a little be of time to get the mask tweaked, and a bit longer to stop concentrating on my breathing (that seems to be a bit tougher with BiPap than with straight CPAP)

I feel pretty good, especially considering I only got about 6 hours of sleep last night, and the AHI readout on the box said 0.7. I'm not sure how accurate that is, but I feel much better than I normally would with 6 hours of sleep.

My wife said I'm doing a little mouth breathing, not constantly, but for short spells, so it looks like it's going to be mouth taping or chinstrap time.

Thanks again to everyone that took the time to help a newbie understand this all.