Is BiPAP not for mouth breathers?

[NightHawkeye]

Thanks for the gentle correction, DSM. .

My apologies for mis-stating. I've got to wonder now though how much difference there is in treatment with a machine which provides constant pressure dynamically as breathing changes, and as measured with a pressure sensor (as I described), versus a machine which provides constant static pressure as you've indicated some machines provide.

For sure there are some fundamental differences between machines - more than I'd realized previously.

Regards,
Bill

[dsm]

Bill,

The revolution has only just begun.

I am happy to predict these machines will continue to change dramatically and get more & more sophisticated as the big players improve their algorithms and introduce smarter mechanics.

The contrast between the insides of a Respironics BiPap S/T and a Respironics AUTO with CFlex, is quite marked.

The BiPap S/T is very cleverly designed but is super expensive to manufacture. The Auto much less so.

The Respironics BiPaps (all models AFAIK) use a complex mechanical 'air-valve' to adjust the air flow & use a brushless motor that more or less pumps air at a constant rate.

The Auto uses a high performance brushless motor to drive the airflow & it can adjust its pressure output very quickly by quickly changing its speed (very quickly).

The air pump (fan) in the PB330 is a wonder to behold allowing that it is so tiny and yet can push pressure up to 40 CMS is bursts. The PB420 units use the tiniest pump I have ever seen in an xPAP - if I didn't have a PB420 to prove it, I would have said it would never work or never last.

The move is to replace all the expensive approaches & adopt small brushless motors wrapped in sound proofing, to deliver air. I predict too that all xPAPs (all successful ones that is) will soon have pressure-sensors & flow-sensors, as standard.

What I want to see next is integrated SpO2 analysers and masks with SpO2 probes built in.

Then off into the future I want to see shoe box sized Oxygen generators (there is already one model of this type on the market but costing about $3,000). Then the ability to integrate an Oxygen generator that is controlled by the SpO2 sensors built into an xPAP so that when our SpO2 drops too low, it allows more oxygen into the air flow.



Dreams

Cheers

DSM

[dsm]

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[oneantonee]

So, to sum some of this up...

C-Flex, while being comfortable for some/most/many, will not work for everyone, with APAP or CPAP. However, since I am already going to get the Remstar Auto with C-Flex, I should try the first prescribed setting (5-13cm) with each level of C-Flex, and without, to see which, if any, I tolerate and adjust to. Then, since the machine is capable of straight CPAP, if I should fail APAP then I should try CPAP, with and without C-Flex, because C-Flex is not the solution for everyone.

I guess I’ll take it one step at a time and leave it at that. If, after trying ALL those options, I still need something else, then I will post with exactly what my experience is, for analysis and comment, then decide what to switch to.

Am I on the right track?

Antonio

[dsm]

My 1st machine was a Remstar AUTO with c/flex and to this day I rate it as one of the better machines I have owned. My only gripe with it was the software (a PITB to install & use) and the accuracy and meaning of some of the reported data. But as long as you don't regard the reported data as a new gospel yet to be included in the good book, it doesn't really matter. The main and primary issue is how the machine helps you with your therapy.

The c/flex is a very helpful feature but does have side effects that will impact some people more than others.

You can only take one step at a time and that includes trying c/flex at varying levels & see how you feel. The side effects to watch out for are 'mouth-pops' (air bursts from your mouth) and aerophagia. The latter is an unfortunate reality for many people on high CMS settings but it does appear to get a lot worse if high c/flex settings are used.

You are doing the right thing in grilling us here & this place has a lot of really helpful and competent people willing to help. I have no doubt you will learn quickly who to pay attention to. There is a great deal of collective experience and knowledge here.

Cheers

DSM

[Guest]

I should try the first prescribed setting (5-13cm) with each level of C-Flex, and without, to see which, if any, I tolerate and adjust to. Then, since the machine is capable of straight CPAP, if I should fail APAP then I should try CPAP, with and without C-Flex, because C-Flex is not the solution for everyone.
Am I on the right track?

Brilliant! You are most definitely on the right track. My only suggestion is that as you are trying different settings, you give it a couple weeks with each variable to get a better statistically significant sampling of how it effects your results. Good work!

[dsm]

<SNIP>
On all of them, there is a setting for "rise" time. Getting that setting right is crucial for getting a bi-level machine in synch with the length of time you normally inhale.
<SNIP>
Unfortunately, many DME's probably are not aware of the "rise" setting. They probably set a bi-level for IPAP pressure, EPAP pressure, and that's it. The factory default setting for "rise" time may not suit a person...in which case the machine will, indeed, cut out too early during inhaling.

RG,

I believe there may be a misunderstanding about what the purpose of rise time is in a BiPap S/T machine.

It is not a parameter used for adjusting when IPAP to EPAP flipping occurs but adjusts the speed with which the flipping takes place. Slowing it from fast (1) to slow (6) at best would mask any problem in the real algorithm.
Repeating, 'rise time' adjusts the speed of the flipping, not when to flip.

Also, the new BiPap S/T compared with a BiPap Pro (& Pro 2) is a much more sophisticated machine (but still not as sophisticated as a PB330).

To help explain the new BiPap S/T I will start a new thread called
"Taming a new BiPap S/T"

and it will include a link to 20 odd photos on which I will comment on in the thread.

Cheers

DSM

[rested gal]

RG,

I believe there may be a misunderstanding about what the purpose of rise time is in a BiPap S/T machine.

It is not a parameter used for adjusting when IPAP to EPAP flipping occurs but adjusts the speed with which the flipping takes place. Slowing it from fast (1) to slow (6) at best would mask any problem in the real algorithm.
Repeating, 'rise time' adjusts the speed of the flipping, not when to flip.

You're right, dsm. I was describing rise time all wrong. Thanks for the correction.

I was confusing "rise time" with a special setting that the ResMed VPAP III and VPAP III ST bi-level machines have, called "IPAP Max." IPAP Max governs the duration of time the inspiration pressure will continue -- up to a point. Unless, of course, a person begins to exhale.

[ruthven78]

Im sure this has probably been answered but a nasal mask can work with BIPAP as long as the person does not open their mouth. The laws of physics state that pressure takes the path of least resistance, much like electricity. So if pressure is being applied to your nose and your mouth is open, it will simply blow right back out through your mouth. Most mouth breathers that want to use a nasal mask opt to also wear a chin strap to hold their mouth closed. We have used the Vision BIPAP here at the hospital I work at with nasal masks.

Now there might be an issue as to why the person mouth breaths in the first place. A lot of people with septal defects or other defects to their nares will mouth breath because they are not able to get enough air flow through their nasal passages. Application of a nasal mask in these instances may or may not improve their clinical issues or could even cause discomfort to some....these people would want a full face mask. Sinus congestion or sinus infection could also be included in this area....which is always a good reason to have a full face mask on hand for back up.

Craig Baker, RRT

[garym4444@gmail.com]

After using the bipap for many years, the machine changed my breathing to waking up with dry mouth (mouth breathing) and holding my breath. That is to say the machine makes you dependent on it. The brain functions less to tell you to breath.!