is BiPAP just for relief? or other therapeutic value?

Exceuse my ignorance but what is the value of BiPAP over regualr APAP? is it just for relief on high pressure or does it have more therapeutic purposes? is it just a matter of patient comfort and patient choice?

Some people cannot breathe out against the pressure they need for inhaling.
They may get central apneas, or hypopneas as a result.
They may have their sleep disrupted, because they can't exale comfortably

How can you separate therapy and comfort under those conditions?

O.

ozij
May I ask you, can this problem be detected while awake or it might happen only during sleep?
in other words, if I feel OK with my pressure while awake, can it be too much for me during sleep? (my pressure 15-17)


Thanks

I can't tell you about your specific condition.
But if you're at 15-17 every night, and you don't feel too happy with your therapy, I suggest you talk to you doctor about a Bi-Level machine. I believe 15 is the limit at which insurance companies start agreeing to giving people a BiLevel (ie BIPAP) machines.

It's worth a try.

o.

I was initally precribed a BiPAP because they said I was intolerant of constant pressure during the sleep study. My pressures were rather low... 10/6.

It wasn't the pressures I was intolerant of, though. It was the mask they took all of about 5 seconds to set me up with and never bothered to come back and check on through the night. I was told by my doctor that they had to torture me through the night as a demonstration to the insurance company that I was CPAP intolerant.

Anyhow - In the first couple months of using the machine I found the BiPAP modulation distracting and during the past 3-4 weeks I've mutinied against my doctor and taken control of my own settings and am finding I do best with a more constant setting - around 10/10 or 10.5/10. If I'm up around 12-13, I start finding it hard to exhale, so maybe if I was up in the 14-15+ range, I'd have to have a BiPAP. So I'm essentially using my BiPAP/APAP as a CPAP...

I'm on Bi-PAP. The reasons for my Bi-PAP are different (Cheyne-Stokes respirations), but like you, I had a really tough time sleeping through the pressure changes. I'm almost finished with month #4 of sleep therapy. It's still far from ideal. I don't think it ever will be ideal since it's not natural to sleep with a mask on, but I've gotten somewhat adjusted to sleeping through the pressure changes. Mine range from 10 to 20. You can eventually get used to the therapy. I've actually awakened and had to put my hand up to the exhaust port to be sure that the machine was still running and blowing air. I didn't realize it until I thought about it later, but that seemed to mean that I was getting used to having a mask on and air being blown at me.

Best wishes,
Tony

Some thoughts on Bilevel vs straight pressure.

As Ozij has pointed out, a big issue is when therapy pressure needs to be at or around the 15 CMs mark
as this is typically where mask management troubles start to become bothersome. Mask leaks and noises
contribute significantly to people abandoning cpap therapy. At 15 CMs of fixed pressure, it can be a
struggle to breathe out smoothly and the combined cpap + breathing out pressure can contribute to the
mask seal on the mask getting breached resulting in leaks and just as often that causes noise that can
wake the user.

By having the 2 pressures, it can be much easier to manage the mask.

Two pressures also contribute to the reduction in the effort needed to breathe. As you can
imagine, it takes a lot more effort to breathe out against say 14 CMs than it does 11 CMs. In
fact they are the 2 pressures I have set my bilevel to operate at. I am one who really enjoys the
advantages of having the 2 pressures.

#2 Just wanted to add the obvious info that if someone has COPD or some other lung impairment
and is on cpap, it is obviously very much easier for them to breathe out against a lowered pressure
as provided by a Bilevel. In fact in the early 2000s Bilevels were mainly offered to people with
breathing complications as the early models were *very* expensive compared to what they cost
today.


Good luck

DSM

I use a bi-level machine at 17/23 cm H2O. If exhaling against high pressure is so difficult, then how can I manage at 17? True, it is better than 23, but it is still high. I have no problem exhaling against 17 cm H2O. The changes in pressure don't bother me either. Another example of how people react differently to their therapy.

mhurley3 wrote:I use a bi-level machine at 17/23 cm H2O. If exhaling against high pressure is so difficult, then how can I manage at 17? True, it is better than 23, but it is still high. I have no problem exhaling against 17 cm H2O. The changes in pressure don't bother me either. Another example of how people react differently to their therapy.

Trud. Additionally, for many people, it's the BPAP's inhale/exhale difference that makes exhalation easier - normal exhalation in human beings is passive, you don't need your muscles for that if you're healthy. With the BIPAP dropping it's pressure 6 cms in your case, you actually get to experience some passive exhalation, since there less relative pressure in your lungs / chest for you to work against.

dsm -- having never experinced those pressures, I forgot all about leak management being easier...

O.

my concern is, can I feel OK with my pressure while I am awake, but when I sleep and my breathing efforts slow down, the same pressure that was once tolerable becomes intolerable , as a result I develop some hypopnea or apnea just from the high exhaling pressure that becomes unbeatable with the sleeping breathing efforts?

can this scenario happen?
and isn't A flex at 3 means decreasing the exhale pressure 3 cmH2O ?

williamco wrote:my concern is, can I feel OK with my pressure while I am awake, but when I sleep and my breathing efforts slow down, the same pressure that was once tolerable becomes intolerable , as a result I develop some hypopnea or apnea just from the high exhaling pressure that becomes unbeatable with the sleeping breathing efforts?
can this scenario happen?

Well, are you or are you not getting more hypopneas and apneas at higher pressures?

Have you ever tried tracking your data at constant pressures - as was suggested to you 3 weeks ago, on more than one thread you started?

Myself

Brenda (bdp522)

Den (Wulfman)and jules

Last thing on that thread, you showed a 3.5 hours chart and were told that's not enough time to base anything on. Have you gathered better data since? Do you think anyone here can help you understand that new data?

Many people were trying very hard to help you on the previous threads - but if you tried their advice you never came back to share the data with them.

You seem to prefer driving yourself crazy with hypothetical scenarios, instead of doing some patient, consistent testing of the facts.

Hypothetical scenarios are not going to get you better therapy, because you will never know which on many possible scenarios is happening in your case - a great way of ensuring catastrophic thinking, and remaining eternally concerned by what might happen.

and isn't A flex at 3 means decreasing the exhale pressure 3 cmH2O ?

Not at all.

My emphasis in color.
http://aflex.respironics.com/

A-Flex Pressure Relief Technology
A-Flex is designed to work with our clinically proven auto CPAP algorithm to improve
comfort even more by matching pressure delivery to the patient’s entire breathing
cycle. Like C-Flex, A-Flex provides flow-based pressure relief at the beginning of exhalation.

O.

It's not for comfort in my case. After trying for over a month to get my AHI down to acceptable levels with CPAP and APAP I finally had my second (full titration) sleep study last night.

As I had found more pressure was better (20 worked the best), but still wasn't enough to get my AHI down when sleeping on my back.

Once the sleep tech put the machine in BiPAP mode a pressure setting of 20/15 did the trick -- even on my back!

I don't mind the pressure at all, in fact I can't even feel a setting of 20 inhale or exhale after minute or two.

Somehow the pressure differential is necessary for my treatment. Without it my AHI is unacceptable.

ozij: yes, I tried the suggestions and it didn't work. I don't understand why you are edgy at me but

the recommendation was to try back at pressure 10 cmH2O and work my way up after 1-2 week on each pressure set
however when I lowered my pressure from 15 to 13, trying to see if I can take the suggested 10, my AHI went up from 5.8 to 9.8. there was no point of heading down further I think

the other recommendation was to change from AUTO to CPAP mode, which I did for a week and the AHI went up to the area of 10

now, if my case is like MGoBlue that he needed pressure relief on exhale for his treatment to work, then removing any pressure relief like changing from A flex to C flex in CPAP mode (which I had to do if I switch to CPAP according to the recommendation) , will worsen my case which it seemed that this what had happen. this is why I think my case is more similar to MGoBlue and that is why I started this thread

there are other possiblity than what you had recommended in the last thread, although I worked on yours.

your last post, you said to ask my doctor, well if every one would have success with his doctor, no one would have been here. as a matter of fact any question on this forum can be answered by "ask your doctor"

you are closing the discussion just because I didn't report to you back on your suggestion. now I did so, would you allow me to persue these other possibility without getting edgy at me??

Thanks

It seems to me the experienced and helpful ozij is being understandably direct in helping you to keep your focus on a systematic, methodical way of thinking about the most important aspects of your treatment. I can understand how directness can sometimes sound like "edge." But if you listen to ozij for the deeper points of the overall process she is laying out for you, instead of allowing yourself to get too distracted with other possibilities, you may find you get where you are going more quickly and successfully. At least, that is what I have seen happen on this board over and over again in reading her posts to those who have had similar issues with their therapy.

then removing any pressure relief like changing from A flex to C flex in CPAP mode (which I had to do if I switch to CPAP according to the recommendation) , will worsen my case which it seemed that this what had happen. this is why I think my case is more similar to MGoBlue and that is why I started this thread

C-Flex is there to give you pressure relief in CPAP mode. You have 3 levels of relief with C-Flex. So when you moved to CPAP, which pressure did you try it at? What was your C-Flex set to?

ozij wrote:But if you're at 15-17 every night, and you don't feel too happy with your therapy, I suggest you talk to you doctor about a Bi-Level machine. I believe 15 is the limit at which insurance companies start agreeing to giving people a BiLevel (ie BIPAP) machines

This was said as a very practical suggestion I was not suggesting a theoretical discussion with your doc., nor was I suggesting you ask him for info. None of us on the forum can recommend a BIPAP in a way that anyone in insurance will listen to. Your doctor can. If you talk about it with your doctor he may help, just because 15 is high - and people at your pressure levels often get BIPAP when they complain to their doctors about how they feel. You will need a doctor's Rx for a BIPAP. Unless you plan to get one from craigslist or some such source. A CPAP Rx will not let you buy a BIPAP, even though it will let you buy an APAP.

You asked if it was possible for you to "develop some hypopnea or apnea just from the high exhaling pressure that becomes unbeatable with the sleeping breathing efforts".

I responded with: "Well, are you or are you not getting more hypopneas and apneas at higher pressures? "

Having read your reply, I still have no idea if you get more hypopneas when you set the machine at higher fixed pressures.


Here's a suggestion:

Create a table. The columns should be:
Date Pressure Time_Used C-Flex AHI
Don't include nap data - that gives unreliable AHI -- meaninglessly high.

Choose a minimal fixed pressure you think is right for you. Set C-Flex at whatever strength it feels comfortable.
Record your AHI every day for a week at that pressure.
Raise your pressure 0.5.
Record your AHI every day for a week at that pressure.
Raise your pressure 0.5.
Record your AHI for a week.

Analyse your data: look for trends.

Use the forum members as a sounding board to check the validity of the conclusions you arrive at from you data. You'll have to share the data in order to do that.
O.