what are the indications for a bipap (instead of an apap)?

[Jeannh]

What are the indications for a bipap (instead of an apap)?

thanks

[bwexler]

Not an expert but having just changed, it seems uncontrolled central apneas seem to be one indication.

[CarpeNoctum]

Not an expert but having just changed, it seems uncontrolled central apneas seem to be one indication.

Nope, regular BiPap doesn't treat centrals. BiPap ST or ASV type machines will treat centrals.

If you're cpap pressures are so high that it's problematic to breathe against...BiPap will help with that.
CN

[JDS74]

What are the indications for a bipap (instead of an apap)?
thanks

Do you mean a straight bi-level machine rather than the auto-titrating one like you have?

A straight bi-level is used to treat plain obstructive apnea where the patient has difficulty tolerating the single pressure needed to treat the OSA's so the bi-level gives controlled pressure relief.

An APAP, autopap, is a variable pressure machine that can react to the patient's needs. Some APAP's are also bi-level machines that give the best of both regimens.

Neither deals with central apneas. For that you need a ventilator type machine, one of which is the one bwexler has and refers to.

[Pugsy]

BiPaps for those of use with no history of central apnea problems and not seeing a truckload of them on our reports...indications might be comfort with inhale and exhale as it is easier especially at higher pressures or maybe someone is having a lot of aerophagia problems and have the difference between inhale and exhale can offer substantial relief from aerophagia issues.
These are what I call "plain" bipaps.

Then there are the BiPaps that are used to treat obstructive and/or central apnea or complex sleep apnea issues where the centrals are numerous enough to present a problem...This would be the ASV type or Timed breath machines. Fancier Bilevel pressure machines.

So there is more than one type of bilevel pressure machine. Not everyone who uses a bilevel (BiPap is Respironcis trade name and VPAP is the ResMed trade name) is treating centrals. I use a "plain" bilevel pressure machine. I don't have central issues. I use it because I sleep better with it. I like the comfort.

So you have to understand what you are wanting to do and which type of bilevel machine you are referring to.

[Rick007]

I am relatively new here, and was just researching the cause and treatment for the high number of flow limitations I see on my Sleepyhead graphs. I came across a web site that seemed to be trustworthy, and the author seemed to be saying that flow limitations are best handled by a BiPAP machine.

I am really confused as to the difference between a BiPAP machine and a machine with the EPR. I looked at the descriptions of the various Resmed models, and it sounds like the purpose of BiPAP is to reduce the exhalation pressure, and yet that is the same purpose of the EPR function in Resmed's other machines like the S9 Autoset. So how is a BiPAP machine different than a machine with EPR.

Rick

[Pugsy]

So how is a BiPAP machine different than a machine with EPR.

Not a lot of difference that most people would notice as long as the greatest relief a person might want or need is 3 cm because 3 cm is as high as EPR will go. With a bilevel machine you can have 4 or 5 or 6 or 7 or more cm difference between inhale and exhale.
I did get a chance to test the ResMed VPAP in CPAP mode (12 cm ) and used 3 cm EPR which gave me 9/12 and then I switched over to bipap fixed mode with EPAP at 9 and IPAP at 12 and I could sense a very slight difference in the timing when inhale and exhale would kick in. Using EPR..the machine would end the relief and being the increase whether I was full ready to inhale or not...with the bilevel mode the machine waited for me to being the inhale and then it kicked in.
There is an adjustment to EPR that can be made that might have done the same thing and improved the timing. I didn't think to try it though and I no longer have the S9 VPAP to try it.

As it was though..I actually prefer 4 cm relief. Just something that feels really natural to me...even 5 cm felt better than 3.

On a bilevel machine the difference between EPAP and IPAP is called Pressure support.

[Rick007]

Not a lot of difference that most people would notice as long as the greatest relief a person might want or need is 3 cm because 3 cm is as high as EPR will go. With a bilevel machine you can have 4 or 5 or 6 or 7 or more cm difference between inhale and exhale.

Thanks for that explanation Pugsy. It certainly makes sense. I guess the BiPAP machines have a little more processing power as well as a pump that can increase pressure very quickly.

I plan on doing some more research into my Flow Limitations and will probably ask some questions in a dedicated thread, but early research shows at least one doctor recommends a BiPAP machine for treatment of flow limitations.

Rick

[CarpeNoctum]

Rick007 wrote: Thanks for that explanation Pugsy. It certainly makes sense. I guess the BiPAP machines have a little more processing power as well as a pump that can increase pressure very quickly.

I plan on doing some more research into my Flow Limitations and will probably ask some questions in a dedicated thread, but early research shows at least one doctor recommends a BiPAP machine for treatment of flow limitations.

Rick, it's my understanding that "flow limitations" are the precursor of hypops and apneas. They are what an auto machine senses that allows it to increase pressure to stave off the subsequent event.

So really the machine doesn't treat flow limitations per se, but used them in it's efforts to treat other more serious events (hypops and apneas).

An auto cpap is just as capable as a BiPap to prevent obstructive apneas...UNLESS they require very high pressures. In which case a Bilevel machine is indicated. Many bilevels are capable of 25-30 cmH20 (depending on make and model)

I think your research will bear this out.
CN

[chunkyfrog]

In some cases, aerophagia may be helped by using a bipap.

[DoriC]

We use Bipap for comfort and better numbers, pressure needs are average. It's also my understanding that Pressure Support differs from EPR in that PS actually maintains pressure on exhale while EPR suspends it until you inhale again. I'd like to have a definitive answer to that statement?

[johnthomasmacdonald]

comfort was the main issue for me, i felt like i was suffocating with trying to exhale against such high pressure, i needed relief. Switching to bipap allowed me to be able to use the machine through the night. Without it i would have given up.

[purple]

Curious. Why do you use APAP rather than CPAP. Some use APAP because their correct titration pressures have not yet been determined. I think there are some breathing issues for which APAP works better. In my case, my breathing patterns do not work well with APAP.

I use a Bi Level machine because I have severe Aerophagia, as well as it works better. Severe Aerophagia also means I am not exhaling against pressure, because I am swallowing air.

In my opinion. The lower pressure is what I call the stent pressure, the pressure which keeps my airway open. When I inhale, I suspect, because my airway is so narrow, I pull air faster than the machine provides at stent pressure. So the inhalation pressure is higher than my exhale.

Seems my machine does not start the inhale, until it senses I am already inhaling. Perhaps it is possible for some Bi Level machines to kick on to the inhale without my initiating it. The machine starting the inhale, perhaps at the higher pressure, without me seems to be the area of a Vent, which might be a non-invasive vent. There is another topic, in that, I know when I am awake, I have a long hesitation between inhaling and exhaling. This is what I think makes a machine set to auto to keep increasing pressure when I really do not need it.

A person with some health problems, like MS will get at least a Bi Level machine as their first machine. Eventually I would suppose they will go onto a vent.

[BlackSpinner]

Curious. Why do you use APAP rather than CPAP. Some use APAP because their correct titration pressures have not yet been determined. I think there are some breathing issues for which APAP works better. In my case, my breathing patterns do not work well with APAP.

Some people need different pressures during REM.
I have mine set 8.5 - 12. It doesn't often get that high but it is nice to know it can adjust. My cpap pressure was 9 but when I got the apap I had it open (7-20) it was often hanging around 10 so I adjusted it.

I really didn't notice the difference once I got used to the different sound of the machine.

[Jeannh]

wow- thank you all for so much info! This forum always amazes me.

Curious. Why do you use APAP rather than CPAP.

i wanted the flexibility, and my doctor was amenable. I discovered that I flex between 10-12, so set it to 9-14. I've had a lot of dry mouth problems, even with taping that is still secure in the morning, and what I thought was aerophagia. After some experimentation, I think the bloating and gas was from sorbitol (in sugarless gum), so now I'm back to dry mouth, which I am hoping to solve by lowering a medication, but it's been tough. Sleep doc asked me to lower the high limit to 12, so I'm on my second night of that.

Just trying to sleep through the night. Jean