APAP with A-flex vs BiPAP

All I have to add is this... Being a M Series BiPAP Auto with Bi-Flex user that has a min EPAP=13 and Max IPAP=25 I can say that I am glad that the machine doesn't stay at a set cm difference between Inhalation and Exhalation because sometimes I actual hit 25cm and I'd hate to have to exhale at 21 which was the 4 cm difference I had originally been prescribed when I was at 20/16, instead I'm usual hardly ever going above 19 which is my 90% EPAP so far. So why should my EPAP be pulled up when it is already taking care of the events it's meant to take care of when the IPAP adjust to take care of its own events if it doesn't have to. So there are definite merits to having a min separation and a max separation instead of a fixed separation. Plus I have gotten great relief from my Aerophagia which I was getting from being on straight BiPAP.

But as DSM suggests I'm probably in the great minority with my pressure needs.

Christy

[quote="AdmiralCougar"]All I have to add is this... Being a M Series BiPAP Auto with Bi-Flex user that has a min EPAP=13 and Max IPAP=25 I can say that I am glad that the machine doesn't stay at a set cm difference between Inhalation and Exhalation because sometimes I actual hit 25cm and I'd hate to have to exhale at 21 which was the 4 cm difference I had originally been prescribed when I was at 20/16, instead I'm usual hardly ever going above 19 which is my 90% EPAP so far. So why should my EPAP be pulled up when it is already taking care of the events it's meant to take care of when the IPAP adjust to take care of its own events if it doesn't have to. So there are definite merits to having a min separation and a max separation instead of a fixed separation. Plus I have gotten great relief from my Aerophagia which I was getting from being on straight BiPAP.

But as DSM suggests I'm probably in the great minority with my pressure needs.

Christy

Currently I am using a loaner that only provides CPAP and a full face mask. Even with it set at 13 I have been swallowing air. I wake up feeling bloated, but more rested than I have in a long time.

Is there any chance that this will improve with a BiPAP Auto with Bi-Flex set at 20 IPAP & 15 EPAP? I guess I'm hoping that the "Auto" part will allow me to use a lower pressure for both inhale and exhale while I sleep on my side, which is what I usually do.

Susan

[quote="Perchancetodream"]Currently I am using a loaner that only provides CPAP and a full face mask. Even with it set at 13 I have been swallowing air. I wake up feeling bloated, but more rested than I have in a long time.

Is there any chance that this will improve with a BiPAP Auto with Bi-Flex set at 20 IPAP & 15 EPAP? I guess I'm hoping that the "Auto" part will allow me to use a lower pressure for both inhale and exhale while I sleep on my side, which is what I usually do.

Susan

Thanks, DSM.

The gap doesn't matter to me, it is just what the doctor prescribed after the sleep study. My experience with the loaner has suggested to me that I don't always require such high pressures.

Susan

AdmiralCougar wrote:All I have to add is this... Being a M Series BiPAP Auto with Bi-Flex user that has a min EPAP=13 and Max IPAP=25 I can say that I am glad that the machine doesn't stay at a set cm difference between Inhalation and Exhalation because sometimes I actual hit 25cm and I'd hate to have to exhale at 21 which was the 4 cm difference I had originally been prescribed when I was at 20/16, instead I'm usual hardly ever going above 19 which is my 90% EPAP so far. So why should my EPAP be pulled up when it is already taking care of the events it's meant to take care of when the IPAP adjust to take care of its own events if it doesn't have to. So there are definite merits to having a min separation and a max separation instead of a fixed separation. Plus I have gotten great relief from my Aerophagia which I was getting from being on straight BiPAP.

But as DSM suggests I'm probably in the great minority with my pressure needs.

Christy

actually, with your settings at 25/13, your machine in the auto mode can go all the way to 25/23. Much of why it stays pegged up at 25 at times can be do to physical requirements related to a high BMI and how particular settings are set on the machine.

IPAP takes care of your Hypopnea and FL's.
EPAP takes care of your Apnea and snoring.

Two separate pressures to address two different events. While Bilevel itself offers exhale relief how "smooth" that transition is can be improved up with features designed to smooth over those transitions.

If you are using your BiPap Auto with the BiFlex feature enabled, try disabling that, then you'll have a Resmed Malibu. It would be interesting to hear your actual experience and difference in doing that. There is a reason they were able to obtain US and foreign patents on those features.

I see absolutely no logic in the Malibu having fixed pressure offsets in its auto mode. I suspect it is like EPR in the Vantage, it doesn't work in the Auto mode or they do a similar method of disabling that feature whenever the machine encounters a series of SDB events.



With your machine, your IPAP/EPAP can never drift farther apart than 8.0 cm. The minimum is 2 cm hard coded by the machine. When you understand how the machine responds to events seen and how those parameters play together you'll find that machine you have hard to beat. The Resmed Malibu is trying to play catch-up just like they did with EPR that no one uses.

Check around here and other boards, there are at least a dozen people using that machine, the Malibu has been out for months, I doubt you will be see many jumping ship for it.

and the point to the above post, is if you are using a pressure of 25/13 and it is pegging at the maximum set IPAP of 25, that is due to they way the machine is set up. Most likely cause is PS is too high.

While having a PS at maximum of 8 may "seem" to offer more relief it is really a two-headed snake. If you shortened the PS setting down to 6 or 4 then the events that are driving up IPAP to 25 would also have to pull up EPAP along with it using only a 4 or 6 cm spread, like a rope tied between them.

While you may think you won't have a the "exhale" relief offered by a higher PS setting, the result should be a lower IPAP. So instead of IPAP pegging at 25 and EPAP dangling 8 cm lower as the IPAP triggering events increase in frequency EPAP would pull up to eliminate those events normally taken care of by IPAP pressure. The result is the splinting effects CPAP offers from its single pressure, but with exhale relief.

Everyone is different but if the reasons for which machine are based upon tolerance of said pressure, my feeling is if pressure requirement is:

Pressure >14/15cm = Bipap Auto is a better fit
Pressure <14 = Auto such as AFlex is a better fit.

My opinion: AFlex will soon replace the need to market and sell both a CFlex and AFlex machine and you will see CFlex only models go by the wayside. If they cold just fix a few of the annoyances like bright BLUE LED's, lousy humidifier and give us some reporting software they would dominate this market.

My experience using AFlex at a pressure of 10 cm you don't even know you are using the machine it is that comfortable. That means I use it longer, less sleep interruptions, more comfort. In fact I struggled the first few nights getting used to AFlex going from a CFlex machine as I felt I was struggling for air. All the while increasing the Auto:Min up and watching AHI drop and leak numbers plummet.

I don't know what they are doing with that machine to lower leak rates but it appears to be working in my case anyway.

cindyh wrote:

rested gal wrote:That machine is, first and foremost, a "bipap" machine and requires a bipap (bi-level prescription.) It is not an autopap, even though it does have the auto-titrating feature that can be turned on so that the IPAP / EPAP pressures can vary independently of each other, as needed throughout the night.

Rested Gal,
HI I dont understand how it isn't an auto pap?? I was going to post this question today anyway, asking if bi flex was the same as the aflex and cflex used on the auto cpap.. i am confused on the auto part though?

As I understand it, C-Flex, Bi-Flex, and A-Flex are comfort features. They are not "types of machines."

Both A-Flex and Bi-Flex use "C-Flex" for the relief all three (A, B, and C) give at the beginning of EXHALATION. C-Flex acts only on exhaling.

A-Flex and Bi-Flex take the comfort of C-Flex a step farther by smoothing out the transition from exhale to inhale. They make the switches back and forth feel softer when a person breathes in and out, in and out, in and out...throughout the entire respiratory cycle instead of just at the beginning of exhaling the way C-Flex does.

From all accounts that I've read, A-Flex is very similar to Bi-Flex. Essentially the same thing.

The term "A-Flex" is used when talking about that comfort feature in an auto-titrating cpap machine.

The term Bi-Flex is used when talking about that comfort feature in a bi-level machine.


The reason the BiPAP Auto is not an "autopap" is because the BiPAP Auto cannot be used in just auto-titrating mode. It will always operate as a bi-level machine, whether you have auto-titration turned on or off.

Actually there are only two categories of "cpap" machines where Medicare and insurance are concerned, as far as I know.

CPAP (includes cpap machines which can auto-titrate -- autopaps)

and

BI-LEVEL (includes bi-level machines which can auto-titrate -- bipap auto)

An autopap is a CPAP machine that can have auto-titration turned on or off. We use the term "autopap" as a shorthand way of referring to a CPAP machine that is capable of auto-titration. The autopap can operate in auto-titrating mode, or in plain cpap mode.

The bipap auto is a BI-LEVEL machine that can never operate in "just auto-titrating" mode.

It can never operate "only as an autopap." It will always be operating as a bi-level machine with two pressure settings -- IPAP (inhale) and EPAP (exhale) -- whether you turn its auto-titration mode on also, or not... and whether you turn on its bi-flex comfort feature or not.

AdmiralCougar wrote:Being a M Series BiPAP Auto with Bi-Flex user that has a min EPAP=13 and Max IPAP=25 I can say that I am glad that the machine doesn't stay at a set cm difference between Inhalation and Exhalation because sometimes I actual hit 25cm and I'd hate to have to exhale at 21 which was the 4 cm difference I had originally been prescribed when I was at 20/16, instead I'm usual hardly ever going above 19 which is my 90% EPAP so far. So why should my EPAP be pulled up when it is already taking care of the events it's meant to take care of when the IPAP adjust to take care of its own events

Well said, Christy. I agree. I'm not at anything like the high pressures you were prescribed, nor do I even need to use the BiPAP Auto. I could get perfectly good treatment on straight cpap at 10, with no exhalation relief of any kind.

I use the BiPAP Auto with Bi-Flex because I'm big into "comfort", and I found that machine to be extremely comfortable. Like you, I don't want my nice steady EPAP pulled up unnecessarily when IPAP goes up to do its thing independently.

Rested Gal wrote: An autopap is a CPAP machine that can have auto-titration turned on or off. We use the term "autopap" as a shorthand way of referring to a CPAP machine that is capable of auto-titration. The autopap can operate in auto-titrating mode, or in plain cpap mode.

The bipap auto is a BI-LEVEL machine that can never operate in "just auto-titrating" mode.

It can never operate "only as an autopap." It will always be operating as a bi-level machine with two pressure settings -- IPAP (inhale) and EPAP (exhale) -- whether you turn its auto-titration mode on also, or not... and whether you turn on its bi-flex comfort feature or not.

BIPAP is a Respironics term, BILEVEL is what every other manufacturer uses to describe their BiPAP machine offering seperate IPAP/EPAP pressures.

I think in the Respironics machine that mode is disabling of the BiFlex feature.

BiFLex as I understand it means 2 like a Bi-plane with two wings, it offers relief on both inhale and beginning of exhale. I think the reference to BiFlex being associated with the Bilevel version and Cflex being associated with the CPAP version and now AFlex being associated with the CPAP Auto was an after thought on their part.

BiFlex was the first comfort feature they came out with and the one that holds the main patent. CFlex actually came from the BiFlex technology. When they perfected that digital autotrak technology they were able to expand it to other machines.

And I agree there isn't much (if any) difference between BiFlex and AFlex when you compare the two charts on how they show it works. My guess is that 2 cm PS built-in to the AFlex machine also came from the Bipap Auto's finding.

Great features, I wouldn't use one with out it, tried with my 420e because of better reports but my aerophagia always drove me back to Cflex now AFlex.

Further 0.2 cents worth on the topics of C-Flex, Bi-Flex and A-Flex.


These additions to the Respironics machines are extensions to the auto-trak algorithms.

C-Flex is the basic facility for Cpaps & Autos and it offers a small burst of pressure relief when the user starts to breath out. The goal is to take the edge off the act of completing a breathe in cycle and starting a breathe-out cycle against the current pressure. C-Flex offers 3 settings that vary the amount of this relief. It is very short but is of great help to people who do find the breathe-out part a problem.

A-Flex offers exactly the same exhale relief as C-Flex right down to the 3 settings but then adds a new component that is not adjustable. The new component is an inhale adjustment of pressure that more naturally follows how typical users breath in. As mentioned, this component does not adjust its level when the A-Flex settings are changed from 1 to 2 or to 3.

Bi-Flex is not really like A-Flex. A-Flex is not an adaptation built around two pressures, BiFlex is.

A-Flex operates around the current delivered pressure of the Auto. Bi-Flex makes its adjustments 1st to the breath-in (Ipap) pressure and an adjustment to the breath-out pressure (Epap). A-Flex doesn't make any change of adjustment to the A-Flex breath-in pressure when settings 1 to 3 are altered, these setting changes only change the breath-out pressure. On Bi-Flex the settings 1, 2 & 3 change both Ipap & Epap pressures.

The Bi-Flex and A-Flex features are really an answer to how Respironics exploits the auto-trak algorithm. Other brands achieve somewhat similar results but they go about it differently because of their own approach to leak vs breathing detection. It is a tad disingenuous to trumpet the C-Flex and Bi-Flex features as special pluses. The truth is it was the only way Respironics could add a working relief adjustment without messing up how auto-trak monitors the difference between leaks and breathing.

Puritan Bennett and Resmed both use internal leak rate tables to determine what is leak and what isn't and that approach is (providing the user has a mask that matches one of the tables closely) the best method of all of tracking breathing. Both those brands (in regard to BiLevel machines) offer a wide range of sensitivity adjustments to the Ipap - Epap - Ipap transitions than Respironics Bipaps do, so Respironics added Bi-Flex as its way of offering an effective transition relief. Again it is disingenuous to trumpet that to be something it isn't. These brands all match each other pretty well in the area of Ipap / Epap transition relief.

C-Flex was an innovation that made straight CPAP better for many people. EPR is another innovation that does the same but goes more into the realm of BiLevel operation in that its levels determine how many CMS of pressure get applied.

A-Flex is an innovation and I am quite confident a lot of people will like it.


DSM

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, Puritan Bennett, C-FLEX, CPAP, auto

dsm wrote:I remain convinced the primary purpose of the Auto was to develop a machine that would help reduce the burdens of therapy that people were experiencing using straight cpap therapy.

I remain equally convinced the primary purpose the auto-titrating cpap was developed was to do exactly what its name says -- be a machine that could perform a "titration." I think it was designed to do that primarily outside the sleep lab...at home.

dsm wrote:You commented "The purpose of an autopap, or at least why they were developed in the first place, as I understand it, is to find a pressure that takes care of preventing apneas/hypopneas at least 90% of the time".

Yes, I did write that.

dsm wrote:Let us look at this statement from United States Patent 5645053 - The Patent Issued on July 8, 1997 (Healthdyne).

Ok. Let's look at it.

dsm wrote:"OSA therapy is implemented by a device which automatically re-evaluates an applied pressure and continually searches for a minimum pressure required to adequately distend a patient's pharyngeal airway . For example, this optimal level varies with body position and stage of sleep throughout the night. In addition, this level varies depending upon the patient's body weight and whether or not alcohol or sleeping medicine has been ingested. "

I have highlighted the critical point "minimum pressure required to adequately distend a patient's pharyngeal airway".

Well, I'd have highlighted a few more of the words that preceded that phrase, because it[sure sounds to me like an attempt to develop a machine to do essentially the same thing that goes on during a sleep lab titration:

a device which automatically re-evaluates an applied pressure and continually searches for a minimum pressure required to adequately distend a patient's pharyngeal airway

Sounds like a diagnostic device to perform automatic titrations to me, because....

In the sleep lab, the sleep tech re-evaluates an applied pressure and continually searches for the minimum pressure required to adequately distend a patient's pharyngeal airway.

Looks to me as if the autopap's developers were trying to invent a machine that could do the same thing -- do an "automatic" titration -- outside the sleep lab, in an unattended setting, like at home.

dsm wrote:I do not believe that Autos were invented wholly to perform titration which is more or less what your words imply.

I'm not just implying that. I didn't say "wholly". I said "primarily." But yes, I do believe that was the primary reason autopaps were invented.

I also think that back then AND to this day that's the primary way the manufacturers and their reps market autopaps to the doctors and DMEs...as temporary data gathering machines for titration at home. Either to get more information for eventually setting a single pressure if the titration night in the sleep lab did not go well, or to use in situations where a person absolutely cannot go to the sleep lab for a fully attended titration. In any case, a machine to be used as a tool for a couple of weeks or a month, then taken away and the person put on straight cpap after the trial period with the autopap machine is over.

dsm wrote:The patent application shown doesn't take the position you have.

Really? You and I certainly do read it differently.

dsm wrote:Doing titration is a side benefit of Auto machines

Main purpose in why they were developed, imho. The side benefit, in my opinion, is that autopaps do suit quite a few people to use as their full time treatment machine.

dsm wrote:I would agree that is why most clinics now use Autos to do titrations.

I'm not sure with whom you're "agreeing" since I didn't say that. I doubt that "most" clinics are using autopaps in the lab to do titrations. I'd think (and hope!) most sleep clinics are having experienced sleep techs using a bi-level machine like the Synchrony to do regular cpap titrations and bi-level titrations.

dsm wrote:The main purpose was only ever to improve therapy and compliance. So I believe Autos were invented along with just about all other types of xPAP machines, to improve the therapy experience for users and to improve CPAP compliance. Titration benefits were a plus.

LOL, well, I'm about finished beating this dead horse. One last time, my opinion is that the main purpose for inventing autopaps was as a diagnostic tool pure and simple. To perform titrations in the home when titration could not be achieved in the sleep lab.

dsm wrote:It may be that we are in agreement but coming at the matter from different angles.

No, I don't think we are in agreement at all about why we think the autopap was developed in the first place.

dsm wrote:One aspect your comments fails to address is any complications arising from constantly changing the pressure from the machine to a user during the night. I believe the jury is out on if this is a downside of an Auto machine. There are certainly many many experienced people who have commented here on cpaptalk how after some months they gave up running their Autos in Auto mode. I fit into that category.

I thought you and I were talking about why we thought autopaps were invented.

dsm wrote: Varying the pressure on top of providing relief through dual pressure is pure overkill for the average person and more of a sales gimmick that a practical benefit.

A "sales gimmick" in your opinion.

A very comfortable experience for quite a few who have the bipap auto.

Being comfortable while using whatever equipment suits a person best can have very practical treatment benefits, imho.

Straight cpap with no exhalation relief can very well be what suits many people best.

rested gal wrote:

dsm wrote:I remain convinced the primary purpose of the Auto was to develop a machine that would help reduce the burdens of therapy that people were experiencing using straight cpap therapy.

I remain equally convinced the primary purpose the auto-titrating cpap was developed was to do exactly what its name says -- be a machine that could perform a "titration." I think it was designed to do that primarily outside the sleep lab...at home.

dsm wrote:You commented "The purpose of an autopap, or at least why they were developed in the first place, as I understand it, is to find a pressure that takes care of preventing apneas/hypopneas at least 90% of the time".

Yes, I did write that.

dsm wrote:Let us look at this statement from United States Patent 5645053 - The Patent Issued on July 8, 1997 (Healthdyne).

Ok. Let's look at it.

dsm wrote:"OSA therapy is implemented by a device which automatically re-evaluates an applied pressure and continually searches for a minimum pressure required to adequately distend a patient's pharyngeal airway . For example, this optimal level varies with body position and stage of sleep throughout the night. In addition, this level varies depending upon the patient's body weight and whether or not alcohol or sleeping medicine has been ingested. "

I have highlighted the critical point "minimum pressure required to adequately distend a patient's pharyngeal airway".

Well, I'd have highlighted a few more of the words that preceded that phrase, because it[sure sounds to me like an attempt to develop a machine to do essentially the same thing that goes on during a sleep lab titration:

a device which automatically re-evaluates an applied pressure and continually searches for a minimum pressure required to adequately distend a patient's pharyngeal airway

Sounds like a diagnostic device to perform automatic titrations to me, because....

In the sleep lab, the sleep tech re-evaluates an applied pressure and continually searches for the minimum pressure required to adequately distend a patient's pharyngeal airway.

Looks to me as if the autopap's developers were trying to invent a machine that could do the same thing -- do an "automatic" titration -- outside the sleep lab, in an unattended setting, like at home.

dsm wrote:I do not believe that Autos were invented wholly to perform titration which is more or less what your words imply.

I'm not just implying that. I didn't say "wholly". I said "primarily." But yes, I do believe that was the primary reason autopaps were invented.

I also think that back then AND to this day that's the primary way the manufacturers and their reps market autopaps to the doctors and DMEs...as temporary data gathering machines for titration at home. Either to get more information for eventually setting a single pressure if the titration night in the sleep lab did not go well, or to use in situations where a person absolutely cannot go to the sleep lab for a fully attended titration. In any case, a machine to be used as a tool for a couple of weeks or a month, then taken away and the person put on straight cpap after the trial period with the autopap machine is over.

dsm wrote:The patent application shown doesn't take the position you have.

Really? You and I certainly do read it differently.

dsm wrote:Doing titration is a side benefit of Auto machines

Main purpose in why they were developed, imho. The side benefit, in my opinion, is that autopaps do suit quite a few people to use as their full time treatment machine.

dsm wrote:I would agree that is why most clinics now use Autos to do titrations.

I'm not sure with whom you're "agreeing" since I didn't say that. I doubt that "most" clinics are using autopaps in the lab to do titrations. I'd think (and hope!) most sleep clinics are having experienced sleep techs using a bi-level machine like the Synchrony to do regular cpap titrations and bi-level titrations.

dsm wrote:The main purpose was only ever to improve therapy and compliance. So I believe Autos were invented along with just about all other types of xPAP machines, to improve the therapy experience for users and to improve CPAP compliance. Titration benefits were a plus.

LOL, well, I'm about finished beating this dead horse. One last time, my opinion is that the main purpose for inventing autopaps was as a diagnostic tool pure and simple. To perform titrations in the home when titration could not be achieved in the sleep lab.

dsm wrote:It may be that we are in agreement but coming at the matter from different angles.

No, I don't think we are in agreement at all about why we think the autopap was developed in the first place.

dsm wrote:One aspect your comments fails to address is any complications arising from constantly changing the pressure from the machine to a user during the night. I believe the jury is out on if this is a downside of an Auto machine. There are certainly many many experienced people who have commented here on cpaptalk how after some months they gave up running their Autos in Auto mode. I fit into that category.

I thought you and I were talking about why we thought autopaps were invented.

dsm wrote: Varying the pressure on top of providing relief through dual pressure is pure overkill for the average person and more of a sales gimmick that a practical benefit.

A "sales gimmick" in your opinion.

A very comfortable experience for quite a few who have the bipap auto.

Being comfortable while using whatever equipment suits a person best can have very practical treatment benefits, imho.

Straight cpap with no exhalation relief can very well be what suits many people best.

Rested Gal,

If people can afford all the bells and whistles even if they don't need them, then yes go for it

As for why they invented Autopaps we will just have to agree to disagree on what the primary motivation was unless you can dig up a patent description that matches more closely what you said. You may be right, I am sure with your great researching skills you can find it.

Cheers

DSM

PS is Bi-Flex the same as A-Flex ?

dsm wrote:

AdmiralCougar wrote:All I have to add is this... Being a M Series BiPAP Auto with Bi-Flex user that has a min EPAP=13 and Max IPAP=25 I can say that I am glad that the machine doesn't stay at a set cm difference between Inhalation and Exhalation because sometimes I actual hit 25cm and I'd hate to have to exhale at 21 which was the 4 cm difference I had originally been prescribed when I was at 20/16, instead I'm usual hardly ever going above 19 which is my 90% EPAP so far. So why should my EPAP be pulled up when it is already taking care of the events it's meant to take care of when the IPAP adjust to take care of its own events if it doesn't have to. So there are definite merits to having a min separation and a max separation instead of a fixed separation. Plus I have gotten great relief from my Aerophagia which I was getting from being on straight BiPAP.

But as DSM suggests I'm probably in the great minority with my pressure needs.

Christy

Christy,

You have a good point for when all the features can help. I feel for you having to cope with +20 CMS pressures. I struggled at 15 & am a fit person.

At 15 & 15+ CMS I was always grappling with mask problems & aerophagia. I am sure the critical point does vary for each person & adding the GERD condition complicates it a lot.

I ran my BiLevel for 6 months with Ipap at 15 & Epap at 8, then I got a BiLevel that recorded AHI & it showed me as having an AHI of 50-60 each night. I thought I was getting by ok - but by tuning those two settings (to Ipap 13 & Epap 10) I got the AHI back down to 3-5 & then experienced a great improvement in overall health & well being.

There really are so many variables that play a role in the actual outcome & the willingness to meet compliance.

DSM

Before the tech and my Dr decided to go to Auto my AHI was around 40-50 and I was doing ok a little better than I had been before xPAP (Sleep study recorded an AHI of 150), but I definitely wasn't feeling as good as I am now though I'm still no where near 100%. After 7 days on Auto my 7 day average AHI = 1.6 Plus I have the added benefit of no more Aerophagia.

I even felt good enough to be up and dancing to the radio this morning, must of looked really silly if anyone would of watched but I was having a good morning. Energy didn't last incredibly long but I'll take that little improvement as a sign of what's to come. I have to go in to get an Oximeter on the 6th and the Tech plans on checking out my data so we'll see if he'll suggest tightening my range then.

/hijack

Christy

Perchancetodream wrote:Currently I am using a loaner that only provides CPAP and a full face mask. Even with it set at 13 I have been swallowing air. I wake up feeling bloated, but more rested than I have in a long time.

Is there any chance that this will improve with a BiPAP Auto with Bi-Flex set at 20 IPAP & 15 EPAP? I guess I'm hoping that the "Auto" part will allow me to use a lower pressure for both inhale and exhale while I sleep on my side, which is what I usually do.

Susan

Susan, I'm no doctor, but if it were me and I were using a loaner straight cpap set at 13 and was feeling more rested, albeit bloated, and...if I had been prescribed regular bi-level 20 IPAP / 15 EPAP... I would set the BiPAP Auto with Bi-Flex this way:

Auto-titrating bi-level mode (called AbFLE in non M-series BiPAP Autos)
Min EPAP 10
Max IPAP 20
Max Press Sup 8 (called "PS" in non M-series BiPAP Autos)
Bi-Flex 3

I'd want to use the Encore Pro software to see how things went with those settings, or if I didn't have the software, I'd want the DME to do a download within the first five days of using the machine. I'd want to see the Full Report from the machine -- not just a "Summary" or "Trend" report.

With the EPAP set at 10, the BiPAP Auto will start out using 10 for exhaling and 12 for inhaling. It will always start out using 2 cms more IPAP than whatever the EPAP is set for.

The machine will adjust the EPAP pressure to handle apneas. The IPAP pressure will adjust to try to prevent/deal with hypopneas, flow limitations, and residual snores.

There's a very good chance that since you sleep mostly on your side, you'll get good treatment at less IPAP/EPAP pressures that the machine will find for you throughout the night. That good scenario is most likely to happen if your bi-level titration in the sleep lab was with you sleeping mostly on your back -- "supine" but you sleep mostly on your side at home.

Good luck!!