APAP with A-flex vs BiPAP

AdmiralCougar wrote:

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

dsm wrote: Christy,

If you get an SpO2 machine, pls PM me if you want any opinions / interpretations of the data. I have a couple of these machines & have taken lots of nights data & have much of it online. It takes a while to figure out what it is really telling you.

Good luck with this

DSM

Will Do

Rested Gal,

Did some further research for you on Auto patents and pulled up this

http://lewiston.mit.edu/sleep/autopatent.pdf

In looking at the patent Abstract the key point they make is (in the 1st sentence.

(57) ABSTRACT

"A pressure support system and method of treating disordered breathing that optimizes the pressure delivered to the patient to treat the disordered breathing while minimizing the delivered pressure for patient comfort".

What I see yet again is that the Auto design seeks to improve the patient's comfort and the means it does this introduced a whole lot of side benefits of which I am happy both you and I have covered.

Cheers

DSM

You are getting lots of great advice here! I have a couple of things to add. Your doctor MAY have prescribed bipap because without the extreme pressure relief, you may have experienced central apneas during your titration. The only way to know that is to get a copy of the sleep study.

With pressures that high I would look into GERD, silent GERD and how big your tonsils and adenoids are.

I was on bipap scrip 16/12 and found out I had silent GERD (which means you have reflux when you sleep, but not necessarily any symptoms of heartburn during the day--my only symptom was a persistent wad of goo at the base of my throat that I constantly tried to swallow and clear my throat against). I started treating it with Prilosec OTC and on my bipap auto my titration went down to something like 14/11.

Then I had my tonsils out approx 3 weeks ago and my pressure is currently running at about 11/7. That is a big jump from 16/12--especially in comfort! I expect my throat to heal a bit more and for that to maybe get even better. This is all with a very good AHI of course.

I hope the input helps. If you have trouble adjusting to your pressure at first DO NOT GIVE UP! With time it will get easier.

With an auto you can set it at a range of pressures slightly lower than your scrip so that maybe you will be able to spend a large portion of the night at a lowere pressure and only have it go up to the max when necessary. You won't want to run it at 4-20 because it would take too long to take care of an event. But you might try 14-20 or something like that.

It is well documented in the scientific literature that patients on autos are more likely to be compliant due to the increase in comfort. You deserve it.

jen

[quote="socknitster"]You are getting lots of great advice here! I have a couple of things to add. Your doctor MAY have prescribed bipap because without the extreme pressure relief, you may have experienced central apneas during your titration. The only way to know that is to get a copy of the sleep study.

With pressures that high I would look into GERD, silent GERD and how big your tonsils and adenoids are.

I was on bipap scrip 16/12 and found out I had silent GERD (which means you have reflux when you sleep, but not necessarily any symptoms of heartburn during the day--my only symptom was a persistent wad of goo at the base of my throat that I constantly tried to swallow and clear my throat against). I started treating it with Prilosec OTC and on my bipap auto my titration went down to something like 14/11.

Then I had my tonsils out approx 3 weeks ago and my pressure is currently running at about 11/7. That is a big jump from 16/12--especially in comfort! I expect my throat to heal a bit more and for that to maybe get even better. This is all with a very good AHI of course.

I hope the input helps. If you have trouble adjusting to your pressure at first DO NOT GIVE UP! With time it will get easier.

With an auto you can set it at a range of pressures slightly lower than your scrip so that maybe you will be able to spend a large portion of the night at a lowere pressure and only have it go up to the max when necessary. You won't want to run it at 4-20 because it would take too long to take care of an event. But you might try 14-20 or something like that.

It is well documented in the scientific literature that patients on autos are more likely to be compliant due to the increase in comfort. You deserve it.

jen

socknitster wrote:
With pressures that high I would look into GERD, silent GERD and how big your tonsils and adenoids are.

I was on bipap scrip 16/12 and found out I had silent GERD (which means you have reflux when you sleep, but not necessarily any symptoms of heartburn during the day--my only symptom was a persistent wad of goo at the base of my throat that I constantly tried to swallow and clear my throat against). I started treating it with Prilosec OTC and on my bipap auto my titration went down to something like 14/11.

That is a pretty good improvement from just the tonsils. They must not have touched your Uvula or soft palate?

That "goo" or flem you speak of at the base of the tongue, that can also be from Post Nasal Drip, thick clear mucus from the sinus cavity draining down into your throat, it coats the vocal cords like superglue and causes the same dysfunction as stomach contents coating them from GERD.

From that link rooster had posted a while back, they only injected saline solution below the UES and it caused a contraction of the UES.

It would be interesting to see what your AHI did back at your old pressure, I bet it would go up along with the pressure.

While it has been known to destroy sleep architecture, a decongestent like Claritin-D may dry things up where that post nasal drip subsides.

You can check for it in a mirror with a flashlight and a spoon, push down on the base of the tongue with the spoon, you see that clear sticky mucus you might want to ask your doctor about it. The decongestant dries out the sinuses and stops the Post Nasal Drip, but that is even controversial.

A regular saline Rhino rinse would also help with that where a decongestant wouldn't be needed.

Jen, thanks for your advice!

Actually this all started with a dry cough that turned out to be caused by GERD. Prilosec once a day stopped the cough but it returned and a second Prilosec had little effect so my GP sent me to an ENT. The ENT did a laryngoscopy (sp?) that showed swollen vocal cords and confirmed the GERD diagnosis.

The ENT also commented on the small size of my mouth and the scar tissue from a tonsillectomy that further reduced the already small airway. He is the one who sent me for the sleep studies. When I asked about surgery to remove the scar tissue he said that it would likely return after any surgery.

I plan on asking for a copy of the sleep studies when we return from our trip at the end of September. The ENT told me that the first study, without CPAP, showed severe OSA with 70 events per hour and an oxygen saturation of 78% down from a baseline of 90. I haven't heard anything about central apneas during titration which is one of the reasons I want a copy of both studies.

Thanks for your input, and you are right about the advice. The input on this thread has been awesome!

Susan

Susan,

I too had been plagued with dry coughs for a long time. Evey cold would linger for months (or so I thought.)

DSM,

I had 3 different doctors exclaim when they saw them that they couldn't believe no one had taken them out before. They were huge. Sometimes they touched each other or the uvula and made me gag--an ongoing disgusting sensation, believe me.

If you have sinus issues, I would address them, certainly. If they tell you your tonsils are large I would strongly consider having them out. I've had three surgeries in three years: impacted (sideways) wisdom teeth, septoplasty/turbinatectopy/adenoidectomy, and tonsilectomy as the third. You should know that NO GOOD DOCTOR will do the tonsils and the rest at once--that would be the worst torture imaginable. I would rank the surgeries from ease of recovery (easiest to hardest) 1 septoplasty etc.
2.wisdom teeth 3. (worst) tonsils. So, make sure it is necessary to do it before you do it, but if you need it--the two weeks of recovery are worth it! (Pain vs benefits)

See if they will combine procedures (esophogoscopy) at the same time as something else so you don't have to be put under unnecessarily.

Snoredog,

You are right! I woudn't let them touch anything else except the tonsils. And they did the esophogoscopy at the same time. After 6 weeks on prilosec and 2 weeks on pepsid (and never having had heartburn!) there was still damage evident in my esophogus from the silent GERD.

My ENT said that this persistent and thick mucous glob that you feel like swallowing all the time or clearing your throat against is almost always silent GERD. Your body is trying to protect the esophogus from the acid that isn't supposed to be there! The goo is actually around your LES.

Another interesting point. I used to have a very "radio" voice. I used to do a lot of theater and some singing and had a lot of vocal control. Since treating the gerd AND having tonsils out I finally am getting that vocal control back and sounding like a radio announcer again (when I want to). More recently I sounded like I had been smoking six packs a day for about 10 years. I might go into radio after the kids are in school. Who knows.

Regarding AHI at old pressure. I got good ahi's at old pressures (before the auto I have no idea, of course). And you are right--the higher the pressure over my scrip of 16, the higher my ahi. It is documented in my sleep study.

Jen