BiPAP Cures Aerophagia

[NightHawkeye]

Just set automatic log-in each computer that you use to peruse the forum. Then you won't get guested....

OK, I'll give it a try. I'm not optimistic about it though, cuz the cookies and things get automatically cleared whenever I close the browser.

Regards,
Bill

[rested gal]

It's only happened a couple of times when I was taking a long, drawn-out breath that I've felt like I've been cut off.

Hi Bella,

Same with me when using BiPAP or VPAP III. It's only on the rare occasions that I took a very long breath in, that the IPAP switched to EPAP before I was finished inhaling.

As far as I know, all the bi-level machines, not just the S/T machines, have a time limit built in for how long the machines will deliver the IPAP pressure. ResMed's VPAP III has a setting called "IPAP Max" that lets the user set the time for IPAP duration -- up to the built-in limit...4 seconds tops, if I remember correctly. I set it for the max.

I don't recall there being a setting to change the IPAP timer in the Respironics BiPAP Pro or Pro 2. There was a "comfort control" for rise time, which is different...governing only how long it takes to go up to full IPAP when you start to breathe in, but there was no setting that I can remember like the "IPAP Max" adjustment the ResMed bi-level machine had.

[Guest-DSM]

Just to clarify

The particular problem I am seeing is not to do with the length of a breath, but the strength of one. That is why I have obtained a volume meter, to accurately measure the volume of air that causes the problem.

I agree re long deep breaths that any Bipap in S/T mode is going to switch within a normal time.

What I found was that if my breath is low volume (nose) vs high volume (mouth), and using a F/F mask, that the machine flips very quickly from IPAP to EPAP.

If I use a mask that has a very low fixed leak rate, the machine flips normally.

And as already mentioned, this issue does not occur on PB330 or Healthdyne Tranquility Bilevel.

Both those machines seem able to handle the tiniest air flow without flipping.

The PB330 does have a setting on the menu for adjusting to different masks. The Heathdyne Bilevel doesn't.

It seems that AUTO-TRAK tries to monitor the airflow but may come to erroneous conclusions when the airflow overall (fixed-leak + normal nose breathing) is lower than it likes.

Cheers

DSM

[rested gal]

Rested Gal,

I didn't realize you would consider getting the Respironics BiPAP Ato over and above the Remstar Auto as your machine of choice.

So after all of your experiences, (and knowledge) you would get at BiPAP machine?

---

BTW, my prescribed pressure is just "10 cm".
---

Tim

Tim, actually ANY cpap machine, even the most basic, would give me good treatment that I could be comfortable with. The pressure it takes to treat me well is 9 or 10. I could use a straight 10 all night, every night, and do just fine. I have no problem exhaling against any pressure up to about 12.

I just like more bells and whistles that really have nothing to do with what I "need".

Probably if I were starting over, had never used any kind of cpap machine at all, and all I knew about what pressure I might need was that the Rx was for 12 or less, I'd get the Respironics REMstar Auto with C-Flex.

If the Rx was for a pressure of 13 or more, I'd go for the Respironics BiPAP Auto with Bi-Flex. That would cover all the bases -- to vary the pressure as needed, and to give very definite pressure relief when exhaling.

If money were absolutely no concern, I'd get the Respironics BiPAP Auto with Bi-Flex. Not 'cause I'd need that machine. Just 'cause I wanted it.

I don't really need relief during exhalation at the pressures of 9 and 10, or even 11 occasionally, that my PB420E autopap uses for me. I can exhale fine against those pressures and not even notice it.

Having used several bi-level machines, I did like the feel of the way the pressure dropped for exhaling. I don't need that drop, but I like it. I liked the way a bi-level machine will stay down on the lower exhale pressure until the person actually starts to inhale.

I also liked the drop at the beginning of exhalation that one can get with the Respironics REMstar Auto with C-Flex. C-Flex lets the "regular" pressure back in long before the exhalation is finished, but that didn't bother me after I found out it was supposed to work like that and I stopped trying to play catch-up.

While I like a drop on exhale, I don't really miss it while using my 420E auto. Nor did I miss it when using a REMstar Auto before they added C-Flex.

I used a Respironics REMstar Auto with C-Flex for about a year -- was very happy with it and with the Encore Pro software it uses -- still have that machine tucked away.

So...why do I use a 420E auto instead of other machines that I talk about and recommend to new people? I like the Silverlining software the PB machines use. I like the small size of the machine. I don't need exhalation relief.

If I had a Respironics BiPAP Auto with Bi-Flex, would it be my primary machine? Yes. Would I enjoy the exhalation relief even though I don't need it? Yes.

[Bella]

DSM, I think I understand a bit more clearly now what you are describing. I had mentioned the "safety" maximum of 3.0 seconds because I thought the issue of "flipping" was related to not getting a long enough breath rate, rather than it only happening when you take a long deep breath. Again not a techie - but just reading the manual about the Auto-Trak, I think you are on to something there. In Auto-Trak, there are 2 algorithms for leak tolerance and 3 more to track "sensitivity". One of those algorithms - the shape trigger/shape cycle is a slightly delayed shadow image of your actual inspiration and expiration - and it adjusts the spontaneous trigger. So, I think, what you would be receiving is not really a spontaneous breath. Would that be right?

Not that I know what I'm talking about here, and I bet you understand all of this thoroughly. I just have an inquisitive mind, and like problem solving.

By the way, right now I am using a Swift mask and feel quite comfortable. I want a new ffm and thanks to you I know not to get the Ultra Mirage!

Thanks again for your work. It will be almost five more years before I qualify for a new machine, and I certainly want the best of the best then!

[pratzert]

Rested Gal,

Thanks for your exceptionally clear response.

I have decided I will just go ahead and order the Remstar Auto w/C-Flex & heated humidifier, based on my relatively low pressure of 10cm.

To spend an additional $800 for the BiPAP "out of pocket" when most people feel the RemStar Auto will do me fine probably does not make a whole lot of sense. I'll save the $800 to use to start my "Mask Collection".
Although, I am ordering the Mirage Activa, and hopefully that will be the only mask I need. I will be trying some of the nasal pillows sooner or later.

It's still a big step up from the Remstar Plus that the DME ( Apria ) was going to give me.

Still aggrevates the heck out of me about Apria and their total lack of cooperation in giving me what my Doctor Prescribed.

One last thing.... my Doc prescribed a setting of 10cm. What do you recommend? Should I start off with using the machine as a straight CPAP and use C-Flex with the pressure kept at 10cm?

Or... do you think I should start off using the Auto feature and set my pressure range to 8cm-12cm and use C-Flex?

Thanks again, Tim.

[NightHawkeye]

Pressure Settings:
I went back to 9/6 pressure setting last night and had a pretty good night's sleep with only a little aerophagia. It amazes me how much more comfortable this setting is than 10/6. Even though apneas and hypopneas were up a little higher last night, sleep quality was much better at 9/6 than 10/6 pressure settings.

Aerophagia:
One thing I noticed in a half-awake state last night was a little puff of air frequently escaping through my mouth as I breathed (on exhale I think). At first I thought it was mouth breathing, but then it actually felt more like a little bit of a burp. I don't know enough about physiology to know the mechanics that would allow me to continue to breathe nasally, yet burp through the mouth, but that's what seems most likely to me.

It may begin to explain why the pressure setting is so critical. I suspect this means that the air is still getting pumped in during IPAP but the lower pressure during EPAP allows it to come back out. At least that's the way it seems to me now.

To be continued . . .

Regards,
Bill

[rested gal]

One last thing.... my Doc prescribed a setting of 10cm. What do you recommend? Should I start off with using the machine as a straight CPAP and use C-Flex with the pressure kept at 10cm?

Or... do you think I should start off using the Auto feature and set my pressure range to 8cm-12cm and use C-Flex?

Thanks again, Tim.

You've already seen this, Tim, but I'll put the link in this topic in case anyone else wants to go to it:

viewtopic.php?t=9105

If it were me, I'd start out just as you're planning: AFLE (auto mode with C-Flex), pressure range 8-12, C-Flex set at "2".

[Bella]

[quote="Guest-DSM"]Just to clarify

The particular problem I am seeing is not to do with the length of a breath, but the strength of one. That is why I have obtained a volume meter, to accurately measure the volume of air that causes the problem.

I agree re long deep breaths that any Bipap in S/T mode is going to switch within a normal time.

What I found was that if my breath is low volume (nose) vs high volume (mouth), and using a F/F mask, that the machine flips very quickly from IPAP to EPAP.

If I use a mask that has a very low fixed leak rate, the machine flips normally.

And as already mentioned, this issue does not occur on PB330 or Healthdyne Tranquility Bilevel.

Both those machines seem able to handle the tiniest air flow without flipping.

The PB330 does have a setting on the menu for adjusting to different masks. The Heathdyne Bilevel doesn't.

It seems that AUTO-TRAK tries to monitor the airflow but may come to erroneous conclusions when the airflow overall (fixed-leak + normal nose breathing) is lower than it likes.

Cheers

DSM

[wading thru the muck!]

[quote="Bella"][quote="Guest-DSM"]Just to clarify

The particular problem I am seeing is not to do with the length of a breath, but the strength of one. That is why I have obtained a volume meter, to accurately measure the volume of air that causes the problem.

I agree re long deep breaths that any Bipap in S/T mode is going to switch within a normal time.

What I found was that if my breath is low volume (nose) vs high volume (mouth), and using a F/F mask, that the machine flips very quickly from IPAP to EPAP.

If I use a mask that has a very low fixed leak rate, the machine flips normally.

And as already mentioned, this issue does not occur on PB330 or Healthdyne Tranquility Bilevel.

Both those machines seem able to handle the tiniest air flow without flipping.

The PB330 does have a setting on the menu for adjusting to different masks. The Heathdyne Bilevel doesn't.

It seems that AUTO-TRAK tries to monitor the airflow but may come to erroneous conclusions when the airflow overall (fixed-leak + normal nose breathing) is lower than it likes.

Cheers

DSM

[dsm]

Bella,

Your posts are most welcome - it is equiring minds seeking absolute clarity that change the world


I have now got a copy of the provider manual are you refering to section 3.5 Digital Auto-Trak sensitivity.

DSM

#2 also just got a setback in my volume flow investigative work The Ohmeda Volume meter was sent to me without the airflow attachment. I will have to try for another that clearly states it includes that critical component

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CPAPopedia Keywords Contained In This Post (Click For Definition): auto

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CPAPopedia Keywords Contained In This Post (Click For Definition): auto

[rested gal]

You might find it interesting to know that I find this occurring with my REMstar Auto w/C-flex. On occasion, I have experienced the c-flex flipping prior to the end of my expiratory cycle. This is ALWAYS coincidental to the pillows of my Aura losing their seal and leaking. I can leave the set-up "as is" and this premature flip to inspiratory c-flex mode will continue as long as I allow the leak to continue. If I adjust the nasal seal to stop the leak with a just gentle push, the premature flip immediately stops and continues completely in sync with my normal breathing pattern.

Wader, that's most interesting. Are you saying that for you, under non-leaking conditions, C-Flex in your REMstar Auto continues delivering a lower pressure throughout your entire exhalation?

I thought C-Flex drops the pressure only at the beginning of an exhalation, and that the "regular" pressure always comes back in before the exhalation is finished.

Or maybe I'm misunderstanding what you mean by "the premature flip immediately stops and continues completely in sync with my normal breathing pattern." (emphasis mine.)

When I think of a machine being in sync with a normal breathing pattern, I think of a true bi-level machine. A machine where the higher pressure does not start again until the user initiates an inhalation. A machine that sits there holding at the lower exhale pressure even after you've finished it. A machine that waits, even if you hold your breath...waits until the instant you start to inhale before the higher pressure is delivered.

A machine with C-Flex is always going to bring the regular (higher) pressure in again before the exhalation is completely done, isn't it?

Granted, the transition back "up" again while the exhalation is still going on can be smooth for most of us with C-Flex. So maybe it can "feel" in sync...feel comfortable, in other words.

I think I understand what you're describing, though. The few times that I experimentally set my REMstar Auto with C-Flex to a single high pressure (like 16 or more), using it as if it were a straight CPAP with C-Flex just to test a mask or something, my natural exhalation was not forceful enough to cause more than a split-second tiny drop at the beginning of the exhalation. Not anywhere near long enough to be helpful to me before the higher pressure came rushing back in.

Perhaps the leak was causing your machine to compensate by blowing harder at you. Same thing, in effect, as using a higher pressure. C-Flex is so dependent on the force of a person's exhalation, at high pressures it's not going to give anywhere near the wonderful exhalation pressure relief one gets from a real bi-level machine.

I don't think that's a fault of the algorithm that controls C-Flex, as much as it's simply the way C-Flex works -- giving a "relative drop", and giving it only at the beginning of an exhalation.

Not at all like the way (and I know you know this...I'm mentioning this for new readers) a bi-level's exact EPAP setting maintains the drop all the way through an exhalation, even through holding one's breath at the end of the exhalation...waiting for the next inspiration to begin before increasing the pressure again.

[Guest]

You might find it interesting to know that I find this occurring with my REMstar Auto w/C-flex. On occasion, I have experienced the c-flex flipping prior to the end of my expiratory cycle.

Muck-
-that is how cflex is supposed to work. If you want a machine that will maintain a reduced pressure throughout your expiratory cycle you need to get a bipap. For an excellent explanation to learn how cflex works, see

http://cflex.respironics.com/PDF/102456 ... d63005.PDF

[wading thru the muck!]

Wader, that's most interesting. Are you saying that for you, under non-leaking conditions, C-Flex in your REMstar Auto continues delivering a lower pressure throughout your entire exhalation?

I'm NOT saying that, but what I am saying is under non-leak conditions the transition(s) of C-flex are imperceptible.

I thought C-Flex drops the pressure only at the beginning of an exhalation, and that the "regular" pressure always comes back in before the exhalation is finished.

This is correct, but under leak conditions I've noticed that there is a perceptible boost in pressure shortly before the natural beginning of my inspiratory cycle. What I am experiencing reminds me of a circumstance described by others regarding the effect of c-flex they referred to as "stacked breathing."

The conditons in which this occurs seems very similar to what Bella was describing and being that c-flex and the function of a bi-level are similar in nature, my guess is that it could be the very same algorithmic sequence that is causing what I have experienced and what dsm has experienced.

[wading thru the muck!]

Gee RG, Will you marry me

Bella,
Your posts are most welcome - it is enquiring minds seeking absolute clarity that change the world

Hey Doug,

How many women on the forum are you trying to woo with all your flattering remarks! (all in one thread!)

LOL!

If only your "down under" dialect would translate via the computer, you'd have them all swooning.