BPAP or VPAP vs CPAP

[mickenglish]

I have been looking through the topics but not having much luck. I would like to know whether a Bilevel PAP would make mask leakage any more manageable. Specifically, I am wondering whether it would allow a slightly lower strap tension if the pressure during exhale is not as high. Can anybody throw some light on this for me? Any input will be appreciated.

[Denial Dave]

at the risk of it sounding like a non-answer... "it depends".


what are your pressure settings now?

Instead of sealing mask leaks at a steady pressure while on CPAP, when you are on VPAP/BPAP you are dealing with a flexing cushion and "might" be more prone to leaks.

I'm at a higher Bipap pressure of 21 ipap / 15 epap.... The higher pressures did cause leak additional issues for me from the cushion flexing all night. it took me a while to resolve them.

[Pugsy]

I asked this question a long time ago when trying to help a friend using 16 cm cpap...having trouble with both leaks and exhaling against the pressure. I didn't want to suggest something that would make leaks worse.
Everyone of the people I ask said that leaks were easier to manage on bilevel than they were on fixed cpap even with the variability between EPAP and IPAP factored in.
I do think that the greater the pressure support (difference between EPAP and IPAP) that the inflation factor that denial dave talks about might come into play but it has never been a factor for me and my friend had great success going to bilevel.
She used a full face mask to (chronic nasal issues).

[Sclark08]

I use a bipap because I have Copd. My pressures are quite but the bipap senses what you need and allows the flow or lack of glow of air. It is kind of hard to get used to but I did it after a couple of months and I am feeling much better

[Pugsy]

BTW...if your pressure needs are 17 cm (I seem to remember your mentioning that number in another thread) using the bilevel machine would be a BIG comfort relief for you over the Icon's exhale relief (whatever it is).
Heck, even the S9 with EPR of 3 (that's as high as it will go but bilevel allows greater) would be a big improvement over the Icon's relief.

IMHO...the relief it offers would greatly out weigh any minor issues with controlling leaks IF the pressure difference caused any.

I don't know why anyone would be given the Icon with pressure needs in the teens. There are much better options available.
Edit: I see you are in Australia..they do things differently down there. You likely purchased your machine and cost was maybe a factor. I understand that cost is important...but the Icon doesn't have the most optimal form of exhale relief (when compared to bilevel or even EPR) for high pressure needs. It's a nice machine...but there are better machines in terms of comfort when higher pressures are used. Just comfort...though..nothing wrong with how the Icon does it's job.

[Denial Dave]

I'm pretty sure that I have higher pressures then quite a few people here.

BPAP/VPAP certainly makes breathing much easier at those pressures. But I was chasing leaks for quite a while in the beginning.

I'd be fine for about 3-4 hours and then I'd get leaks just at the peak transition of my IPAP pressure of 21. I'd fix those leaks and then I'd get leaks at the lowest transition point for my EPAP.

it took me quite a while to finally reach a happy solution to those leaks via headgear adjustments, pad-a-cheek liners, etc..

[DAG]

The way that I took care of my leaks was by using some of the liner products. Well, at first I just took a 'short-napped' towel and cut it up to cover my mask and it worked great! In fact, that is what I still use. Took care of all of my problems.

[mickenglish]

Thanks folks. I wish I had known about this forum before I made the purchase. Anyway I will try some of the things that have been mentioned.

[djhall]

I hate to say it, but I have to agree with the "it depends" people. It is possible you could lower your pressure slightly with BiPAP instead of CPAP, but you add a new leak factor of the mask "pumping" as the pressure alternates between the higher and lower settings.

However, at higher pressures the BiPAP is so much more comfortable that I'd recommend trying it anyway if you are at all uncomfortable on exhale.