BiPap vs Cpap/Apap

I just want to confirm that my thoughts on the differences are correct as they pertain to my particular situation. I have a friend that has switched from Cpap to BiPap, and keeps telling me how I need to get one for myself. She says it has made a huge difference in her quality of sleep.

The reason I don't think it would make much difference in my case is because of the pressures I use. My study AHI was just across the line of moderate at 16, and my prescribed pressure was a constant 8cm. Since then I have switched the Autoset to Apap mode with a Min 6/Max12 and EPR of 2. When I look at my data with SH, I find most nights my average pressure is running at the minimum pressure of 6, or very close to it. On occasion I get a spike to 8+, but it's pretty infrequent, and even then it returns to a lower pressure quickly.

I am one that doesn't like breathing against pressure, but I figure with my settings as low as they are, a BiPap would be of very little use to me. In the case of my friend, her pressures are significantly higher, which I can see how it would make a huge difference for her.

Is my thinking correct on this subject, or would a Bipap be a good thing for me also?
Thanks for any feedback as always.

Try your current machine with EPR set to 3 and see if you like it even better.
The main difference between your current machine and a bilevel machine is you can have a bigger difference between inhale and exhale than just the 3 cm difference you can get with EPR.

You don't have to be using higher pressures to enjoy the comfort. I actually prefer PS of 4 or 5 and I can't get that with EPR but the price was right and I got to try the new for Her algorithm...so I am using the AutoSet. One day when I stumble across a killer hot deal on the AirCurve 10 VAuto I will most likely grab it up. It's just not a critical need for me at this time.

But yes...when comparing bilevel to regular apap (back when I was using AFlex at 2)...I actually slept about 45 minutes longer on average with bilevel than I did with apap. Never could figure out why...it was just one of those things that I noticed long term.
For me that extra 45 minutes made a substantial difference in how I felt during the day.

I have some other issues messing with my sleep right now but once I get those sort of addressed then maybe I need to look closer at moving getting a bilevel to the top of my list if I still am not sleeping so great.

I switched EPR from 3 to 2 to try and see if the number of CA events dropped any, plus in Apap mode my pressure runs at the minimum setting of 6 most of the night, and I thought 4 was the lowest it would go?

I know I tried a constant 6cm in Cpap mode one night and the EPR didn't even work set at 3.

At a fixed pressure of 6 cm EPR can't go any lower than 4 cm no matter what EPR is set at. So 2 is what you get and for those with 5 cm fixed pressure all they can get is a 1 cm drop no matter if it is set to 3 or 2.

This thing about EPR/bilevel pressure and central triggering...this is not a very common happening at all. It's extremely rare.
If it was that common and that big of a deal we wouldn't be having EPR or any exhale relief (which creates a bilevel situation) be considered a common comfort feature.
It's the bilevel situation that is sometimes the trigger for centrals ....and sometimes there is a fine line in the sand where a person uses Pressure support and had centrals and they don't. It's still a very small percentage of people who will have this happen.

And all this panic over a handful of centrals anyway...I don't understand it.
A few centrals are normal real centrals....like sleep onset centrals. We can't do anything about them except hope for minimal sleep onsets or minimal fragmented sleep to lessen the number of transitions to sleep from awake status.
Centrals are only a problem when present in large numbers...and they are real...and they are creating a problem like desats or a bunch of sleep onset centrals back to back keep bouncing a person out of sleep and they don't progress into the normal sleep stages.

Pugsy wrote: ↑

Sun Aug 19, 2018 12:27 pm

At a fixed pressure of 6 cm EPR can't go any lower than 4 cm no matter what EPR is set at. So 2 is what you get and for those with 5 cm fixed pressure all they can get is a 1 cm drop no matter if it is set to 3 or 2.

This thing about EPR/bilevel pressure and central triggering...this is not a very common happening at all. It's extremely rare.
If it was that common and that big of a deal we wouldn't be having EPR or any exhale relief (which creates a bilevel situation) be considered a common comfort feature.
It's the bilevel situation that is sometimes the trigger for centrals ....and sometimes there is a fine line in the sand where a person uses Pressure support and had centrals and they don't. It's still a very small percentage of people who will have this happen.

And all this panic over a handful of centrals anyway...I don't understand it.
A few centrals are normal real centrals....like sleep onset centrals. We can't do anything about them except hope for minimal sleep onsets or minimal fragmented sleep to lessen the number of transitions to sleep from awake status.
Centrals are only a problem when present in large numbers...and they are real...and they are creating a problem like desats or a bunch of sleep onset centrals back to back keep bouncing a person out of sleep and they don't progress into the normal sleep stages.

I wasn't in a panic over the CAs when I 'experimented' with the EPR pressure initially, I was just curious if it had any effect,.....it didn't btw. My CA events are minimal, spaced apart usually, and short in duration, so I don't pay any attention to them anymore.

So here's my question now,.....as before, I am running 6Min/12Max Apap mode, and my inhale pressure hovers around 6cm 90+% of the night, where is my exhale pressure going to be if EPR is set at 3? Will it go to the lowest pressure of 4cm, or stay at a fixed 6cm since it can't go to 3?

I guess the other option could be that it jacks my inhalation pressure up to 7cm to allow the EPR of 3 down to the 4cm minimum?

I've never tried a 3cm EPR with the 6/12 APAP mode settings, only in fixed 6cm CPAP where the EPR ceased to come into play.

Mark55 wrote: ↑

Sun Aug 19, 2018 5:15 pm

So here's my question now,.....as before, I am running 6Min/12Max Apap mode, and my inhale pressure hovers around 6cm 90+% of the night, where is my exhale pressure going to be if EPR is set at 3? Will it go to the lowest pressure of 4cm, or stay at a fixed 6cm since it can't go to 3?

I guess the other option could be that it jacks my inhalation pressure up to 7cm to allow the EPR of 3 down to the 4cm minimum?

I've never tried a 3cm EPR with the 6/12 APAP mode settings, only in fixed 6cm CPAP where the EPR ceased to come into play.

You can see your answer if you look at a sleepyhead graph, if you do pressure 6, epr 3, you'll see that the ipap pressure is 6, epap 4, until your ipap gets above 7.

So, EPR 3 drops pressure by 3, but no lower than 4. EPR never changes the inhale pressure.

If you want full effect of epr3, you'd need to set your min pressure to 7.

Pugsy wrote: ↑

Sun Aug 19, 2018 12:27 pm

And all this panic over a handful of centrals anyway...I don't understand it.
A few centrals are normal real centrals....like sleep onset centrals. We can't do anything about them except hope for minimal sleep onsets or minimal fragmented sleep to lessen the number of transitions to sleep from awake status.
Centrals are only a problem when present in large numbers...and they are real...and they are creating a problem like desats or a bunch of sleep onset centrals back to back keep bouncing a person out of sleep and they don't progress into the normal sleep stages.

Yeah, I don't understand it either, but there's a pervasive, irrational fear of 'centrals'...

OHHHH, DON'T RAISE YOUR PRESSURE, YOU MIGHT GET CENTRALS! *insert scary music*

EPR CAN CAUSE CENTRALS *run around with hands flailing in the air*

DON'T TREAT YOURSELF, YOU MIGHT GET CENTRALS!" *hide under the blankets*

As you say, they're nothing more than just *not breathing for a bit*... I've held my breath for a minute, my spo2 barely wavers... of course, that may be different for other people, but it's going to take a lot more than not breathing for 10 or 30 seconds here and there to cause an issue.

Centrals aren't disturbing, like obstructive breathing events are, they don't cause your body to go into fight or flight mode, they don't make your heart race, or bp spike, or any of the deleterious effects that fighting to get air cause... Like you said, if there's not so many that they cause desats, they're just basically something to ignore...

and not

palerider wrote: ↑

Sun Aug 19, 2018 5:32 pm

Mark55 wrote: ↑

Sun Aug 19, 2018 5:15 pm

So here's my question now,.....as before, I am running 6Min/12Max Apap mode, and my inhale pressure hovers around 6cm 90+% of the night, where is my exhale pressure going to be if EPR is set at 3? Will it go to the lowest pressure of 4cm, or stay at a fixed 6cm since it can't go to 3?

I guess the other option could be that it jacks my inhalation pressure up to 7cm to allow the EPR of 3 down to the 4cm minimum?

I've never tried a 3cm EPR with the 6/12 APAP mode settings, only in fixed 6cm CPAP where the EPR ceased to come into play.

You can see your answer if you look at a sleepyhead graph, if you do pressure 6, epr 3, you'll see that the ipap pressure is 6, epap 4, until your ipap gets above 7.

So, EPR 3 drops pressure by 3, but no lower than 4. EPR never changes the inhale pressure.

If you want full effect of epr3, you'd need to set your min pressure to 7.

Thanks for the simple explanation PR.

I'm doing fine at the 6Min/12Max - EPR 2 APAP settings with my current machine. I really don't see a benefit for me worth changing to a Bi-Pap at this time.

Mark55 wrote: ↑

Sun Aug 19, 2018 5:58 pm

Thanks for the simple explanation PR.

I'm doing fine at the 6Min/12Max - EPR 2 APAP settings with my current machine. I really don't see a benefit for me worth changing to a Bi-Pap at this time.

The advantage *to me* is that my system gives me a higher pressure support (6) and is very sensitive to partial inhalations when my airway starts to close, thus helping me take that breath. that's gotten my AHI down to under 0.5.

For most people, EPR is just for comfort, set it for whatever works for you.

Didn't mean to upset you. I was mainly just thinking out loud with the centrals and panic thoughts.
Said more for general information than anything else because so often I get "OMG I had 5 centrals last night...do I need an ASV machine for my central apnea".

The reason I use the minimum of 7 on my apap is so I can get the full benefit of EPR set at 3. I simply like 3 better than 2.
It matches my own respiration pattern better....4 or 5 is even better but I can do pretty good with 3.

Pugsy wrote: ↑

Sun Aug 19, 2018 6:40 pm

Didn't mean to upset you. I was mainly just thinking out loud with the centrals and panic thoughts.
Said more for general information than anything else because so often I get "OMG I had 5 centrals last night...do I need an ASV machine for my central apnea".

The reason I use the minimum of 7 on my apap is so I can get the full benefit of EPR set at 3. I simply like 3 better than 2.
It matches my own respiration pattern better....4 or 5 is even better but I can do pretty good with 3.

Pugsy,...if you're talking to me, I'm not the least bit upset.
I happen to agree with you about all of the hoopla over CA events. I must admit that when I was totally new to this that even the few I was getting DID concern me, until you and a few others said they were insignificant, and I kind of learned to read the charts and get a feel for if they were real or just SWJ.

Last BiPap question.
Am I assuming correctly that the lowest a BiPap will go is also 4cm, or is it even lower?

Mark55 wrote: ↑

Sun Aug 19, 2018 6:56 pm

Am I assuming correctly that the lowest a BiPap will go is also 4cm, or is it even lower?

Respironics the lowest EPAP can go is 4 cm.
Bilevel works a little different though...instead of PS being taken away from minimum pressure like with the apap....it's added to EPAP on a bilevel.
So you set EPAP and then you add PS to get IPAP.
Using EPR on the single pressure machines you are essentially setting IPAP and then EPR subtracts from IPAP to give you EPAP.

I think maybe the Devilbiss bilevel will go to 3 cm EPAP... not sure about any of the others.

Per ResMed product page...The AirCurve 10 S has a 4 cm minimum.
https://www.cpap.com/productpage/resmed ... #specs-tab

Operating Pressure VPAP Mode: 4-25 cm H2O (0.2 cm increments)

Operating Pressure CPAP Mode: 4 - 20 cm H2O (0.2 cm increments)

And the AirCurve 10 VAuto

Operating Pressure VPAP Auto Mode: 4 - 25 cm H2O (0.2 cm increments)

Operating Pressure VPAP S Mode: 3 - 25 cm H20 (0.2 cm increments)

Operating Pressure CPAP Mode: 4 - 20 cm H2O (0.2 cm increments)

I don't remember what the AirCurve 10 ST had for a minimum EPAP and I only used S mode.

Pugsy wrote: ↑

Sun Aug 19, 2018 7:03 pm

Mark55 wrote: ↑

Sun Aug 19, 2018 6:56 pm

Am I assuming correctly that the lowest a BiPap will go is also 4cm, or is it even lower?

ResMed and Respironics the lowest EPAP can go is 4 cm..

Resmed will let you set epap to 3, in s (maybe ST) mode, but not vauto. Don't know about Respironics.

palerider wrote: ↑

Sun Aug 19, 2018 8:24 pm

Resmed will let you set epap to 3, in s (maybe ST) mode, but not vauto. Don't know about Respironics.

I clarified my earlier statement.
Respironics is 4 cm minimum EPAP no matter what mode.

I switched from APAP to BiPAP (my choice) to see what happened to both my comfort levels and my overall numbers. I could see how how breathing out against less pressure should be better for a full nights sleep. It was a good move as my numbers and general feeling of wellness have improved. I do have higher pressure requirements than you do and this was my main reason for changing - an easier exhalation.

Looking at your numbers, if you set PS to a certain point you go to the lowest exhalation pressure that the machine can provide - 4. Many users have complained about feeling somewhat suffocated at this pressure. What I am saying is that I agree with your original statement in that you don't really need BiPAP as your comfort levels are already well catered for.