Can a BiPAP Machine Function Like an APAP Machine?

[pratzert]

I know that an APAP machine, such as the RemStar Auto can be set to function like a straight CPAP machine.

Can a BiPAP machine be set to work like an APAP machine ?

It seems like if you are going to go for the Top end in machines, the BiPAP machine is the way to go. But I also get a feeling, that it can be a little dangerous to use a BiPAP machine unless you have a specific need for it.

Is it that the BiPAP continues to give exhalation relief until you start to inhale, which limits it's ability to deliver the required pressure to stop an apnea event?

Obviously, I'm still a little bit hazy on the true function of a BiPAP and why you should.... or SHOULD NOT... be using one.

But if if it can run like an APAP... why not ? That way you're ready for any change required for your therapy.

Tim

[Guest]

Can a BiPAP machine be set to work like an APAP machine ?

If you get the Respironics Auto BiPAP with BiFlex it can:

[Sleepy Dog Lover]

The difference between CPAP and bipap is that you can set the exhale pressure much lower on the bipap. With CPAP using cflex or epr, you are limited to a 3cmh20 reduction in pressure. However, with the regular bipap, there is one set inhale pressure and one set exhale pressure.

Autopap will vary the pressure according to your needs of the moment, but the maximum pressure relief is still 3cmh20. There is an auto bipap out now, I believe tht respironics makes it. Hope this helps.

[dsm]

Tim,

This is already available. Respironics (who pioneered the 1st Bilevel machine) released an AUTO BiPap last year. This was another big leap forward in xPAP therapy & design.

Nighthawkeye uses one right at this moment.

BiLevels are not at all dangerous.

There are 2 types - standard Bilevel & Timed Bilevel.

Timed Bilevels (usually have the ST or S/T designation after their model#)
are still very expensive & best suited to patients with special needs because of their cost. They are fiddly to set up & normally require expert assistance.

The standard BiLevel (usually designated with S after the model name)
are really just a CPAP with a fantastic exhalation relief capability. Again they used to cost so much that they were only recommended to special needs patients but times & costs are changing.

So the only reason there was any hesitation in recommending them was because of their cost not their function.

In recent times Respironics added c-flex to their CPAP & AUTO machines as a low cost way of achieving some exhalation relief (that comes standard in a Bilevel). More recently Resmed added EPR to their machines which truly turns those models into 'mini' Bilevels.

The diff between c-flex and EPR is that EPR provides relief for the full exhalation cycle whereas c-flex only does so at the start of an exhalation cycle. Both c-flex and EPR are merging the function of CPAP with Bilevel.

So, a Bilevel offers the exhale relief right through the exhale cycle & until you basically reverse your breathing at which time it reverts to full inhale pressure.

Bilevels allow the inhale pressure (the IPAP setting) to be split from the exhale pressure (the EPAP setting). So a Bilevel machine can have someone on 15 CMS for inhale (IPAP) and switch to say 9CMS for exhale (EPAP). The IPAP and EPAP can be set to suit the user.

c-flex is only a momentary 'dip' in pressure and has been a great help to many users. EPR offers a 1,2 or 3 CMS drop in pressure on exhale so is more like a BiLevel.

Some of us have tried various Bilevel machines & notice that some machines are better with particular masks. So there is still improvement taking place.

The Respironics AUTO BiPap is a landmark move forward in combining the best of all capabilities of standard (non timed) Bilevels and Cpaps and AUTOs.

Cheers

DSM

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, bipap, C-FLEX, CPAP, auto

[Moogy]

But I also get a feeling, that it can be a little dangerous to use a BiPAP machine unless you have a specific need for it.

Is it that the BiPAP continues to give exhalation relief until you start to inhale, which limits it's ability to deliver the required pressure to stop an apnea event?

The primary danger of getting an unneeded BiPAP is to your wallet. .

It is not my understanding that BiPAP is limited in any way in its ability to deliver the required pressure in order to avoid apneas. The only thing I have seen along these lines are posts from individuals that indicate that bipaps were either not needed or not helpful for them personally.

In my own situation, I have gone from 102.5 AHI pre-bipap to 3.0-6.0 AHI with bipap. Seems to be working just fine for me!

Moogy

[dsm]

I meant to add that the really interesting thing about the AUTO Bipap is that it does its AUTO thing separately on the IPAP pressure & EPAP pressure.

It will monitor each (IPAP & EPAP) and if the machine believes there is a problem at a particular pressure during say EPAP, it will adjust only the EPAP pressure, then monitors the IPAP for the same.

Someone please correct me if I am wrong on this point, but IIRC the AUTO Bipap can & does adust the EPAP & IPAP pressures independently of each other.

I believe there are some built-in parameters relating to how close EPAP can be raised by the AUTO function, up to the IPAP cms setting.

DSM

[Moogy]

I believe there are some built-in parameters relating to how close EPAP can be raised by the AUTO function, up to the IPAP cms setting.

DSM

On the Respironics Auto BiPAP, there is a setting called "pressure support" on the clinical menu. The max. is 8 cm and I think the min. is 2 or 3. As I understand this, this is the MAXIMUM difference to be maintained between IPAP and EPAP.

Moogy

[Guest]

Moogy,

Was there a specific medical reason you got the BiPAP instead of an APAP or Standard CPAP machine? Or did you just want the best machine available ?

What are some of the reasons that Doctor's prescribe a BiPAP over the others?

It's definately a premium price over the others. The Remstar Auto w/htd. humidifier is $725 or so, but the Respironics BiPap w/BiFlex is $1,330 WITHOUT the Humidifier.

Tim

[Guest]

Moogy,

Another question since you actually have the BiPAP and the experience with it's operation.

Can you use the "Ramp" feature in the AUTO mode ?

The Remstar Auto cannot use the ramp in the Auto setting, so I was wondering if is the same with the BiPAP ???

Thanks, Tim

[Guest]

What are some of the reasons that Doctor's prescribe a BiPAP over the others?

BiPAP is the Respironics trademarked name for their particular bi-level device. I am assuming you are inquiring about all bi-levels.

From a previous post by Mikesus:

Conditions Frequently Treated with Bilevel Devices &/or NPPV

Now, physicians typically use bilevel therapy to treat a broad range of conditions, including some conditions that require 24-hour ventilatory support.

o Respiratory muscle dysfunction (CO2 >45 mm Hg)
o previous poliomyelitis
o muscular dystrophies
o myopathies
o Neurological disorders (CO2 >45 mm Hg)
o neuropathies
o bilateral diaphragmatic paralysis
o spinal cord injury
o brainstem lesions
o primary alveolar hypoventilation
o Chest wall deformity (CO2 >45 mm Hg)
o scoliosis
o thoracoplasty
o Upper airway disorders
o severe OSA
o obesity hypoventilation
o Lung disease (CO2 >52 mm Hg)
o COPD
o cystic fibrosis
o bronchiectasis
o Acute respiratory failure (CO2 >52 mm Hg)
o hypercapnic respiratory failure
o hypoxemic respiratory failure

Bilevel therapy is not typically prescribed for OSA patients; however, OSA patients who require high treatment pressures, OSA patients that can not tolerate exhaling against the set pressure of CPAP or OSA patients that have another respiratory condition like underlying lung disease (COPD) may be candidates for bilevel therapy.

[Ric]

The difference between CPAP and bipap is that you can set the exhale pressure much lower on the bipap. With CPAP using cflex or epr, you are limited to a 3cmh20 reduction in pressure. However, with the regular bipap, there is one set inhale pressure and one set exhale pressure.

Autopap will vary the pressure according to your needs of the moment, but the maximum pressure relief is still 3cmh20. There is an auto bipap out now, I believe tht respironics makes it. Hope this helps.

SDL, I made the same assumption, that a setting 3 equates to 3cmh2o, for example. Then RG (spanked my hands and) pointed me to the Respironics interview, wherein they "disconnect" the "1,2,3" C-flex settings from the pressure units.

LINK: Respironics C-Flex, Remstar Auto with C-Flex, Remstar Pro 2 with C-Flex Interview
(scroll down to "Technical Information")

Subjectively the setting of 3 FEELS (to me) like MORE than 3 cm relief.

Also, while watching the watt meter on the KILL-A-WATT gizmo, the change in wattage between the inhale and exhale cycle suggests a greater pressure difference than 1-2-3 cmh2o.

I could be wrong.

(again!)

*sigh*

[Sleepy Dog Lover]

Looks like I assumed incorrectly. Thanks for the link.

[Bella]

What are some of the reasons that Doctor's prescribe a BiPAP over the others?

BiPAP is the Respironics trademarked name for their particular bi-level device. I am assuming you are inquiring about all bi-levels.

From a previous post by Mikesus:

Conditions Frequently Treated with Bilevel Devices &/or NPPV

Now, physicians typically use bilevel therapy to treat a broad range of conditions, including some conditions that require 24-hour ventilatory support.

o Respiratory muscle dysfunction (CO2 >45 mm Hg)
o previous poliomyelitis
o muscular dystrophies
o myopathies
o Neurological disorders (CO2 >45 mm Hg)
o neuropathies
o bilateral diaphragmatic paralysis
o spinal cord injury
o brainstem lesions
o primary alveolar hypoventilation
o Chest wall deformity (CO2 >45 mm Hg)
o scoliosis
o thoracoplasty
o Upper airway disorders
o severe OSA
o obesity hypoventilation
o Lung disease (CO2 >52 mm Hg)
o COPD
o cystic fibrosis
o bronchiectasis
o Acute respiratory failure (CO2 >52 mm Hg)
o hypercapnic respiratory failure
o hypoxemic respiratory failure

Bilevel therapy is not typically prescribed for OSA patients; however, OSA patients who require high treatment pressures, OSA patients that can not tolerate exhaling against the set pressure of CPAP or OSA patients that have another respiratory condition like underlying lung disease (COPD) may be candidates for bilevel therapy.

[dsm]

For a very clear cut and accurate description of a Bilevel, this link is easy to read (it gets right to the point ) ...

http://en.wikipedia.org/wiki/Bilevel_po ... y_pressure

Cheers

DSM

[Moogy]

Moogy,

Was there a specific medical reason you got the BiPAP instead of an APAP or Standard CPAP machine? Or did you just want the best machine available ?

(1) I was titrated at a fairly high pressure (15 cm, not as high as some, but not low). (2) I had a lot of trouble exhaling during the titration study. (3) I have claustrophobia, and the difficulty exhaling was triggering the panicky feeling during my second sleep study. (4) I had a very high AHI, over 100.

My local DME actually advised the BiPAP based on the above. (I was going to ask for an Auto with CPAP instead.) The therapist said that the BiPAP would greatly improve the exhaling.

So...I asked my primary care doctor to prescribe the Auto BiPAP. All this happened BEFORE I got the official report from the Sleep Doctor. (He suggested an Auto CPAP, but I already had the BiPAP.) Fortunately, my insurance does not insist that people FAIL with the CPAP before they will approve a BiPAP. Fortunately, I have a primary care doctor who listens to his patients and trusts them. I talked to the doc about what to document in my records in case the insurance asked for justification.

Moogy

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, auto cpap, bipap, Titration, CPAP, DME, auto, APAP