cpap v. bipap

When I first was diagnosed in 2003 there was no doubt I had OSA but the sleep study was useless because I may have slept a 1/2 hour and maybe the second night I slept a little longer. The RT told me they couldn't get any information from the studies so he gave me a Sullivan BIPAP and set it at very average pressures, 10/8. He admitted, that was a guess. Guess or not, it was a godsend for me.


I know BIPAP is easier for initial compliance but in the long term, is CPAP or auto CPAP, with one constant pressure (even if itadjustedsted), better for getting you closer to 0 AHI than BIPAP. Is that constant pressure better for mask stability, causing a lower AHI?


Do people ever move from BIPAP to CPAP? I have heard of it going the other way from CPAP to BIPAP.


alan

Sure, people who start with a guesstimate (as you did) can move back to CPAP (or APAP). In fact, I would think a better option would have been to send you home with an APAP and find the pressure range that worked well for you. Or use an BiPAP auto for the same purpose.

So, yes. It can and does happen, though it occurs less frequently than moving the other way, as you note.

allend wrote:I know BIPAP is easier for initial compliance but in the long term, is CPAP or auto CPAP, with one constant pressure (even if itadjustedsted), better for getting you closer to 0 AHI than BIPAP. Is that constant pressure better for mask stability, causing a lower AHI?

Hi,

A BiPAP is a more advanced type of xPAP machine. There are other even more advanced machines, such as the ST machines and the ASV machines. What is most important is to get a good diagnosis, then an accurate titration, and finally get a machine that treats the disease that you were diagnosed with using the pressures that you were titrated at. If your sleep study was inconclusive, then there is no way to know what type of machine it is that you really need. The progression generally goes CPAP, APAP, BiPAP, VPAP, ST, ASV. BiPAP and VPAP are essentially the same thing.

If your case doesn't need a BiPAP or above machine, then your decision is likely going to be straight CPAP versus APAP. Since APAP machines can shift into CPAP mode, that is probably the best machine to shoot for. Some types of OSA deal well with APAP, such as folks who have positional apnea, while others do better on a single pressure such as that delivered by a traditional CPAP.

If you are dependent on insurance, they will typically give you the least expensive machine that they can, which is why it is surprising that you started off on a BiPAP. Did you sleep study show anything unusual, such as central events? In any event (bad pun), make absolutely sure that any machine that you get is "fully data capable".

-john-

The VPAP Auto 25 is a very versatile machine. It can function as a CPAP, ann APAP or an autoadjusting BiPAP or Bilevel machine. It is also very comfortable to breathe against. The big shortcoming with this machine (besides the poor data capability) is that it has ResMed's A10 algorithm, which does not help you much if you still tend to experience OSA with a pressure greater than 10 cm. But, from what you posted, it sounds like your OSA is pretty much dealt with by a pressure of 10 cm.

The usual disclaimers about me not being a doctor applies to the following advice.

If you find that 10/8 is a comfortable pressure for you, try working down to 9/8 and then to 8/8 (straight CPAP). If that helps you, or does not affect things, I somehow suspect that straight CPAP might be a better choice.

You can also try setting up an APAP mode (it has been long enough since I last used this machine that I have forgotten how to set this, but it is straightforward. I can look this up if you want.) You may find a (likely in your case) a small range of pressures that work for you, especially if your apnea is position (or some other thing) dependent.

In any case, make your changes slowly and in smallish steps. Take careful notes. And keep your doctor in the loop!

allend wrote:When I first was diagnosed in 2003 there was no doubt I had OSA but the sleep study was useless

You need another sleep study.

because I may have slept a 1/2 hour and maybe the second night I slept a little longer.

Sleep tech should have drugged you for more TST.

The RT told me

RT? Respiratory Tech? Respiratory Techs should not be running polysomnagrams. You need a sleep study at a real lab, not a lab that uses unqualified, untrained personnel.

they couldn't get any information from the studies so he gave me a Sullivan BIPAP and set it at very average pressures, 10/8.

*facepalm*

He admitted, that was a guess. Guess or not, it was a godsend for me.


I know BIPAP is easier for initial compliance but in the long term, is CPAP or auto CPAP, with one constant pressure (even if itadjustedsted), better for getting you closer to 0 AHI than BIPAP. Is that constant pressure better for mask stability, causing a lower AHI?


Do people ever move from BIPAP to CPAP? I have heard of it going the other way from CPAP to BIPAP.


alan

You need another polysomnagram. Until you get one, no one will even stand behind the diagnosis.