Switching from BiPap to Auto??

meister · Post by **meister** » Sat Mar 19, 2005 5:01 pm

Anyone start out on BiPap and then successully switch to an AutoPap?

clarenceh9 · Post by **clarenceh9** » Sat Mar 19, 2005 6:31 pm

I was on the BiPap for two months, at 13/9 and switch to AutoPap at 20/10. Don't see much differents yet other than it is cheaper.

mommaw · Post by **mommaw** » Sat Mar 19, 2005 10:02 pm

meiater

I am trying an auto now. Started Wednesday. Was on bipap 18/14. I will try for a month then doctor and I will decide which I will use. Don't have the software, so don't know what my AHI is. I do know that it is much easier to tolerate falling asleep. Setting is 6-20. Much easier to fall asleep at 6 vs 14. I feel fine, so am assuming it is working ok.

Gilda

Ann N. · Post by **Ann N.** » Sat Mar 19, 2005 11:33 pm

I believe the feasibility switching from BiPAP to Auto also depends on one's AHI, and the patterns that the apneas/hypopneas exhibit. For instance, if one has a really high AHI (mine is 98 ) then another apnea begins right after one stops. Thus, an auto would not be suitable-- a bipap with its two pressures would make more sense. However, if one's osa is mild or moderate, and if the person's apneas occur with longer intervals between them, then perhaps the auto would work out better in general. But then, again, what do I know? I am not a doctor, and I don't pretend to have all of the answers (and neither does my doctor either!)
Ann

wading thru the muck! · Post by **wading thru the muck!** » Sun Mar 20, 2005 6:02 am

Ann N.

Your understanding of cases in which switching to an auto is feasible or not is correct. In gereral, if you have frequent events an auto would do you no benefit since it would just stay at the higher pressures all night. Perhaps the evolution of the auto-pap algorithm will, in the future, be able to respond more intricately. I certainly seems a shame to not utilize the wonders of todays microprocessor technology by using a 'pap that's no more than a glorified box fan.

Thanks for your post. It is very informative and relevant.

Mikesus · Post by **Mikesus** » Sun Mar 20, 2005 7:14 am

I would disagree. The clustering of events is as important as the frequency.

I.E.

You might have an AHI of lets say 50. If those are evenly spread out over an hour, then yes the autopap will more than likely stay at the higher pressure.

However, if those events are clustered, in lets say a 30 minute period, then the remaining time you might be at a lower pressure.

AHI is an average of events over an hour. You might have a 2 hour period in which the first hour you have relatively low number of events. (lets say 25) The next hour you have a higher number (say 71) The AHI for that time would be:

25 + 71 = 96 / 2 = AHI 48

In that second case, the first hour, you might be at a lower pressure overall, while in the second hour you are at a higher pressure.

(the AHI described above would of course be the events HANDLED by the autopap)

wading thru the muck! · Post by **wading thru the muck!** » Sun Mar 20, 2005 7:22 am

mikesus,

Good point. The basic premise is that the more time the auto is able to stay at a lower than titrated pressure and still treat most of the events, the more likely it will be of benefit to the user.

rested gal · Post by **rested gal** » Sun Mar 20, 2005 7:45 am

Excellent point, Mike, about clustering of events. Also, just because the AHI is an average based on events and hours, it doesn't mean that the clusters are even happening within every hour. Most of the events might be clustered within periods of REM, leaving other stages of sleep relatively untouched. Possibly even a person with "severe" OSA could benefit from long periods of lower pressures except during REM. If the clusters were very heavy in REM, the autopap might very well simply stay up high throughout that period (not yo-yo'ing up and down) for as long as it took to prevent what would otherwise be a long heavy cluster.

No different, in that respect, from having a bi-level or a straight cpap that was going to stay up at a high pressure all the time. But the benefit of the autopap would be that after the onslaught of event-heavy REM was over, the person could again enjoy lower pressures, as Wader mentioned, for quite some time (all totalled, perhaps even half the night) before the next REM storm hit.

Just two cents worth - I'm not a doctor.

Ann N. · Post by **Ann N.** » Sun Mar 20, 2005 8:32 am

It seems to me that both the severity of one's osa and the possible clustering of apneas/hypopneas would impact the successful use of AutoPap. It also seems to me that if one had the apnea/hypopnea charts from the sleep study, one could determine more easily whether AutoPAP might work for the individual. Any clustering should be apparent from these charts, also the effect of REM would be apparent. The AHI is indeed an average over a period of time, with variations based on position of the sleeper and the stage of sleep. Thus, looking at the whole nights worth of apneas/hypopneas and when they occurred, along with any patterns (clustering?) might give some guidance as to the possible effectiveness of AutoPAP for an individual.

Joe A · Post by **Joe A** » Wed Mar 23, 2005 6:02 pm

I guess the answer is "It Depends". My sleep lab told me I have a degree of positional apnea. On my side I do fine with 12 CM CPAP, on my back I need 16 CM. So I use Bipap set at 16/12. Straight CPAP I would need 16, An auto would have me on 16 when needed and 12 when needed.

If you need say BiPAP on say 18/14 and it doesn't matter what position you are in, then An autoPAP will most likely have you up and around 18 most of the night, and that isn't much better than straight CPAP.

BiPAP has its time and place...it is more expensive and much more difficult to titrate due to synchronization. That is why BIPAP is used for severe OSA only. It takes a really good RT to set you up, unlesss you are willing to plunk down 3000 bucks for a Respironics machine with Digital Auto Track and Biflex. Even then...My old BiPAP-S with Auto Trak still doesn't give me a great nights sleep with a full face mask, or some nasal interfaces.

I have my Puritan Bennet GK 425 adjusted purfectly! It gives me perfect titration...it was a bear to adjust, because my DME just left it at the defaut settings, adjusted the pressure to my prescription, and then said have a nice day. When I approached them about adjustment of the IPAP and EPAP sensitivities they looked at me like I had three heads and said....Those numbers mean nothing...it's all about the pressure! Idiots! I almost lost my job over daytime sleepyness and Brain Fog!

Ann N. · Post by **Ann N.** » Wed Mar 23, 2005 6:32 pm

Actually, perhaps some BiPAPs are more easily setup than others. I have a Respironics BiPAP Pro 2 with BiFlex with a setting of 17/13 and it really wasn't difficult at all to setup. Simple. Its advanced internal software keeps it in sync with my breathing-- I speed it, it keeps right with me, I slow down, it follows along with me. I go fast, slow, whatever it stays with me. No adjustments are needed-- it is wonderful in my opinion. It is fairly quiet also-- I don't think I could ask for a better, more sensitive machine. It is very comfortable. It also brought my AHI of 98 down to less than 2. What more could a person ask?

I don't know about other BiPAPs-- but I have seen lots of discussions about how to adjust/set them so they may not work the same.

Ann N. · Post by **Ann N.** » Wed Mar 23, 2005 6:51 pm

P.S. The Respironics BiPap Pro 2 with BiFlex, with integrated humidifer, bag, hose, is available at cpap.com for $1569. The Encore software and cardreader would be another $200. I would guess that the DME would bill the insurance company for around $3000 or so for the machine. My copay was 20% of the DMEs price, still makes it a bargain for me.

Joe A · Post by **Joe A** » Wed Mar 23, 2005 7:23 pm

Ann:

Respironics makes the best machines on the market, I wanted a small portable machine that could be easily run on 12 volts DC so I could take it along on overnight fishing safaris. The Respironics machine draws 3-5 amps and you would need a 55lb marine battery to run it off of!

Even though a Respironics machine is a better choice, I will contend that my DME should have known that the machine needed synchronization! They did not! I have a problem with that....DME's Justify creative price structure(Like 200% of List!) by claiming that they need to hire RT's to set up equiptment.

Ann N. · Post by **Ann N.** » Wed Mar 23, 2005 7:31 pm

Joe- I understand why you choose the BiPAP machine you did. You are right concerning the power requirements of the one I got. Actually, I am considering getting a CPAP with CFlex as a backup for times during power outages. I think it should work all right for me for short periods of time. I have not yet looked into its power requirements but I would guess it would be considerably less.

Mask	Humidifier

Additional Comments: Pur~Sleep Oils (Love Them) Aussie Heated Hose, Encore Analyzer, Pad-A-Cheek Guards (Work Great!)

Switching from BiPap to Auto??

Switching from BiPap to Auto??

Switching from BiPAP to Auto