Pressure 13 & up - Bi-PAP Needed?

I'm looking for input from other forum members who set either set their x-PAP to 13 or above or have an A-PAP with a minimum pressure of 13 or above. Do you need Bi-PAP or is C-PAP or A-PAP ok for you?

The reason I'm asking is because I'm having some problems with leaks with my min set to 13. I'm trying to revolve that. I recently got a new UMFF. The first night I put it on to try it out, adjusted it to fit my face, and tried the leak test on the ResMed S8 Vantage that I'm currently using. I couldn't keep the mask on my face. Many leaks - I felt like something was being forced down my throat and I needed to cough/gag - just had to get the mask off. Then last night I decided to try again, at my regular pressure setting. I put the mask on, hooked up the hose, lied down in bed as I would when I go to sleep and turned on my machine. During inhalation, everything was fine. During exhalation, I had leaks. I think I would have to fasten the mask really TIGHT to prevent the leaks on exhalation. Would Bi-PAP possibly solve this problem? I looked at the price of Bi-PAPS on cpap.com and I would REALLY like to be able to stick to A-PAP, but not if Bi-PAP is better for me.

Would like to hear from others with similar pressure settings. What type of machine do you use? What type of mask and set-up works best to prevent leaks?

I have an appointment with ENT tomorrow morning and I would like to get a script for my permanent machine (though it I need more trial time to get things right, I understand and will tolerate that).

Appreciate any input!

I was titrated at 18, and use a Remstar M APAP with AFLEX, set from 16 to 20. I use the Swift LT nasal pillows mostly. It took a couple of nights for my nose to be used to the pressure, but now I hardly notice it. My leaks are under control. My average AHI is around 1.0

I have a Liberty FF mask to use when I have a cold - I've only had to use it once. I do have to have it very tight to seal around the mouth, but I do have a mustache and beard that probably doesn't help. I definately feel it "puff" on exhale, even with the AFLEX on maximum.

I use a 7/11 bipap, close to what you are talking about (at least on the inhale) with the mask listed below. It took me a while to figure out how to use the mask without leaks

What makes you think using a bipap in place of a cpap will change the leak? It might not leak on the lower exhale pressure, but my guess is if the mask leaks at 13 in cpap, it will leak at 13 in bipap

I think you need to concentrate on the mask (using it better or replacing it)


--G

For your pressure a APAP or CPAP are fine, I am at 15 CM and do fine. Bi-PAPs are for higher pressure, and of for people that can't take normal XPAP treatment well,after all the more costly the better. Not really, I think a lot of people reason that way, The more settings the harder to get it correct.

It's more important to get data recording and the software to tweak your treatment. Jim

A leak at 13 on apap will still be the same leak at 13 on bipap ... This appears to be a leak problem, not a machine problem ...

Thanks all! I was REALLY hoping I didn't need a Bi-PAP. You've made me feel better. I can play with the pressure and try various leak remedies!

For me a bipap made all the difference and helped to reduce my leaks bc when you exhale the pressure is no longer increasing above what you set it at. It feels so much more normal, like I have nothing on at all.

I would say if you are having trouble with straight cpap at your pressure to try either a bipap or an Aflex at the very least. See if you can get doc or DME to trial them if doc won't script it.

I can only say a bipap is the ultimate in exhale relief.

Good Luck,
GumbyCT

One widely used protocol for use by the tech during a titration study says: "If there are continued obstructive respiratory events at 15 cm H2O of CPAP during the titration study, the patient may be switched to BPAP." But that same protocol states that if a patient is "uncomfortable or intolerant of high pressures on CPAP, the patient may be tried on BPAP."--http://www.apneasupport.org/viewtopic.php?t=16738

GumbyCT wrote:For me a bipap made all the difference and helped to reduce my leaks bc when you exhale the pressure is no longer increasing above what you set it at. It feels so much more normal, like I have nothing on at all.

I would say if you are having trouble with straight cpap at your pressure to try either a bipap or an Aflex at the very least. See if you can get doc or DME to trial them if doc won't script it.

I can only say a bipap is the ultimate in exhale relief.

Good Luck,
GumbyCT

Thanks for your input. I will keep your comments in mind. Before going to a more expensive BiPAP, I would really like to get the ResMed S8 Autoset II on a trial basis to see if Easy-Breathe makes any difference. I doubt however that my DME has an Autoset II available on a trial basis. I also doubt my current DME has Respironics as my current machine is ResMed and he's in a small town. I'm willing to bet he carries only ResMed PAP products.

jnk wrote:One widely used protocol for use by the tech during a titration study says: "If there are continued obstructive respiratory events at 15 cm H2O of CPAP during the titration study, the patient may be switched to BPAP." But that same protocol states that if a patient is "uncomfortable or intolerant of high pressures on CPAP, the patient may be tried on BPAP."--http://www.apneasupport.org/viewtopic.php?t=16738

My titration pressure in the sleep study was 14, so I'm borderline. Since I've been on Auto PAP at home, my 95th percentile pressure is 17.6. This might explain the leaks I have trouble eliminating. My leak line is pretty good early when I first go to bed, but it usually goes "wacky" sometime during the night. I don't move in my sleep. I wake in the same position that I went to sleep in, so I think higher pressure is likely the culprit for increased leaks.

I'll keep all this in mind and see what my ENT recommends in the morning. I wish I had a clear cut answer, but it looks like I'm borderline in need of Bi-PAP (would like to avoid the extra expense thnough if I can). I don't know how insurance will handle it. Are Bi-PAPs coded under the same insurance code as straight C-PAP (just like A-PAP and full data machines)?

I just reread your original post again ... I have a couple of questions ...

1. You mentioned the problem is on exhale ... I am not familiar with the Resmeds, but would EPR take care of that? Is it adjustable? If so, what is it set at?

2. If your titration was at 14, maybe the upper limit on your auto is set too high at 17? Can the high end be lowered? Of course, I don't know how you are ending up at 17 so am just grasping at straws lol ...

Michael

Bilevel is a different code.

Peaktagger wrote:I just reread your original post again ... I have a couple of questions ...

1. You mentioned the problem is on exhale ... I am not familiar with the Resmeds, but would EPR take care of that? Is it adjustable? If so, what is it set at?

2. If your titration was at 14, maybe the upper limit on your auto is set too high at 17? Can the high end be lowered? Of course, I don't know how you are ending up at 17 so am just grasping at straws lol ...

Michael

My ENT didn't include a min or max limit on my script for auto pap. My DME set it from 6 - 20. I've increased the min, but so far, I have not decreased the max. That is certainly something I can try.

EPR is available on the Vantage that I have now, but only in straight C-PAP mode. I haven't tried straight C-PAP mode mostly because I don't want it to appear in my reports and perhaps my ENT see that I do better on straight C-PAP, so he refuses to give me a scpript for a permanent A-PAP. I will try straight C-PAP only AFTER I get a script for A-PAP in my grimy little hands

The Autoset II has EPR in C-PAP mode, but it also has "Easy-Breathe" which I think applies in both modes.

There are so many things I can try and I know I have to be patient as it will take time to try them all and optimize my treatment. I sure appreciate ALL input from everyone here!

As you were titrated at 14, and have your high end set at 20, I'd suggest dropping your high end to maybe 15. The machine may be chasing snores or pressure induced events. So maybe a range of 13-15 might be better? I'm thinking that will help leaks as well as lower your AHI, assuming the titration at 14 is an accurate number.

Why has the low end been bumped from 6 to 13? Not that that is a bad idea