VPAP and BiPAP - when?

I'm a Finn and I've been trying to help my countrymen (and women) in these issues.
I've learned a lot here, and I think I'm quite familiar with CPAPs and APAPs, but
now, I think, it would be time to find out about VPAPs and BiPAPs.

How do they work, and in what kind of situations VPAP/BiPAP is the right choice.
What's the idea in VPAP/BiPAP.

Does anyone know good pointers where to start?

turbosnore wrote:I'm a Finn and I've been trying to help my countrymen (and women) in these issues.
I've learned a lot here, and I think I'm quite familiar with CPAPs and APAPs, but
now, I think, it would be time to find out about VPAPs and BiPAPs.

How do they work, and in what kind of situations VPAP/BiPAP is the right choice.
What's the idea in VPAP/BiPAP.

Does anyone know good pointers where to start?

wiki/index.php/BiPAP

Thanks.
I didn't see the index-link until now when I knew to look for it.

BiPAP is a certain Respironics' VPAP, although BiPAP is also used as a synonym vor VPAP?

So basically it's about responsiveness - whan APAP adjusts according to time over several breaths, VPAP adjusts
also within each breathing cycle - or rather parts of it taking into account the breathing cycle period.

Synchros are then better equipped VPAPs?

Now, any idea about machine adjustments and measurements terminology?

There is a big DME-equivalent in Finland that has a rule to make bad settings.
Their rule says that all APAPs are set to 4-20 cm H2O, and if it doesn't help the patient, the
CPAP-(APAP-)treatment is not suitable for that patient!
It was the leading doctor that told me so.

Hi Turbosnore,
Just keep reading and studying. It's a complicated subject and takes awhile to get a handle on it.

Clearly you have a ways to go and while most people here will bend over backward to help a cpap user in trouble, you are just satisfying your own curiosity. And your thread title doesn't even make sense.

I think what you may be confusing is avaps. I don't know what vpap is...so I think you got that confused.

avaps is a volume control system designed for people who tend to retain CO2. It's a Philips Respironics thing and stands for: Average Volume Assured Pressure Support.

It is usually incorporated into a BiPap machine.

BiPap, if you read the link that LSAT gave you, is a bilevel machine that provides a lower pressure for exhale. They are a more expensive machine and used with people who have problems with cpap.

Google is your friend...use it. So now you have your homework assignment...happy reading and keep warm with winter on your heels (or probably already there)
Cheers,
Jamis

ResMed has a VPAP https://www.cpap.com/productpage/S9-VPA ... chine.html

I use a Resmed VPAP. I did the trials with a APAP and a CPAP with a AHI of 42. They helped some but my outstanding AHI was still around 12. Most of my outstanding were centrals. It was determined I needed a VPAP. I trialed it and it worked. My AHI went to 4 or below. When I purchased my new Resmed S9 VPAP ASV my AHI is mostly under 1 every day.

turbosnore wrote:Thanks.
I didn't see the index-link until now when I knew to look for it.

BiPAP is a certain Respironics' VPAP, although BiPAP is also used as a synonym vor VPAP?

Right. "BiPAP" is Respironics trademark name for their "bilevel" machines... the Philips Respironics System One BiPAP Pro, for example.
"VPAP" is ResMed's trademark name for their "bilevel" machines... the ResMed S9 VPAP, for example.

And yes, the word "bipap" is often used generically for any manufacturers' bilevel machine (including ResMed's "VPAP") even though "BiPAP" is actually Respironics' trademark name. Kind of like the way "kleenex" is often used to refer to any brand of facial tissue, even though "Kleenex" is actually a brand name. And "chapstick" is often used to refer to any brand of lip balm, even though "Chapstick" is a brand name.

A basic bilevel machine (Respironics' "BiPAP" or ResMed's "VPAP") uses two separate pressures. One pressure (called "IPAP") for breathing in. And a lower pressure (called "EPAP") for breathing out. With a plain bilevel machine those two inhale/exhale pressures never vary. Example: If IPAP is set at 14, and EPAP is set at 10, the machine will blow 14 every time the person breathes in, and will blow 10 every time the person breathes out. Just those two pressures, in and out, all night long.
A bilevel machine can also be set to work exactly like a plain CPAP machine if you set the EPAP and IPAP pressure at the same number (like 10 for EPAP and 10 for IPAP.)

There is another type of bilevel machine that can "autotitrate" (vary the two pressures for inhaling and exhaling) while still using two separate pressures for breathing in and out.
Examples: Philips Respironics System One BiPAP Auto and ResMed S9 VPAP Auto.
Those are "bilevel auto" machines....sometimes generically called "bipap auto" machines. Bilevel auto machines can be used in plain bilevel mode, or they can be used in "bilevel auto" mode. When used in "bilevel auto" mode, you set a range of pressures -- the "minimum EPAP" pressure setting, and the "maximum IPAP" pressure setting (much like setting the "range" of pressures for an autopap machine) so that the machine can vary the two pressures as needed throughout the night.
And just like with a plain bilevel machine, the bilevel auto machine can also be set to work exactly like a plain CPAP machine, by setting it for "bilevel" mode (instead of "bilevel auto" mode) and setting IPAP/EPAP for the same number (like EPAP 10, IPAP 10.)

There are some bilevel machines that come with yet an additional mode of operation ("T" for "timed back up rate") but I won't go into that. Most people prescribed "bilevel" (or "bipap") get the ones I described above, and don't need "timed" capability. Bilevel machines with "timed back up rate" turned on (or with the rate set too high) can be annoying if the person doesn't really NEED "timed back up breaths."

Bilevel (or bilevel auto) machines, when set right, are probably more comfortable for many people than plain CPAP.
EPAP (or "min EPAP") is the most important pressure to "set right" on a bilevel machine, imho:

Some discussions about EPAP setting on a bilevel machine (and min EPAP on the BiPAP Auto.)

November 2007 - EPAP is for more than just comfort exhaling.
viewtopic.php?p=227068#p227068

December 2007 - my understanding of how a bipap titration is done.
viewtopic.php?p=231786#p231786

May 2008 - discussion with RonS about importance of EPAP setting.
viewtopic.php?p=265020#p265020

September 2007 - discusson with JLFitzfamily about EPAP 4
viewtopic.php?p=211222#p211222

February 2009 - a topic that contains jnk's excellent explanation about the very different ways Respironics' BiPAP Auto and ResMed's VPAP Auto handle the "pressure support" (PS) setting when those machines are being used in "bilevel auto" mode:
viewtopic.php?p=376749#p376749

Thanks!

Things are getting clear bit by bit...

@Jamis: This time Google was not my friend - I went through about 10 pages of links and found nothing else but
adverticements. I wonder if my catch would have been better if I searched for "bilevel" instead of "BiPAP".

@RG:
"There are some bilevel machines that come with yet an additional mode of operation ("T" for "timed back up rate") but I won't go into that."

About this I found something, I think it was about timed "ticle" to start a new breathing cycle, if inhalation doesn't seem to
start in due time.

I think I got enough info to understand the discussion here.
Thanks again.

Turbosnore wrote: Things are getting clear bit by bit...

Hey Turbo,
Sorry if my post on vpaps was confusing to you. I had never heard of them.

Focus on the basics at this point. Each manufacturer has their own little acronyms that can be perplexing. Like Respironics uses the phrase flex for their exhalation relief and Resmed calls it EPR but pretty much the same thing.

Oh and on your comment about the Doc who prescribes an apap with wide open pressures to everyone. Well that doesn't just happen in Finland. My Doc did that too. That is usually what's called a titration setting to determine what pressures you might need. Then they should be tightened down.
Hope your cpap is going well too,
Jamis

jamiswolf wrote:

Turbosnore wrote: Things are getting clear bit by bit...

Hey Turbo,
Sorry if my post on vpaps was confusing to you. I had never heard of them.

Focus on the basics at this point. Each manufacturer has their own little acronyms that can be perplexing. Like Respironics uses the phrase flex for their exhalation relief and Resmed calls it EPR but pretty much the same thing.

Oh and on your comment about the Doc who prescribes an apap with wide open pressures to everyone. Well that doesn't just happen in Finland. My Doc did that too. That is usually what's called a titration setting to determine what pressures you might need. Then they should be tightened down.
Hope your cpap is going well too,
Jamis

Don't worry, I'm not that easily confused. I've been hanging around these pages since 2008.
The thing is: in one place in Finland, the sleep doctor that sets the rules has ordered that for everyone the settings
4 to 20 must be done, and if it's not helping, the machine is taken away "because this form of treatment doesn't fit
the patient". Then the patient is left on his/her own.

The worse thing is, that she knows that with those settings the pressure typically doesn't increase fast enough to treat the apneas. And she still demands those settings.

Turbosnore wrote: The worse thing is, that she knows that with those settings the pressure typically doesn't increase fast enough to treat the apneas. And she still demands those settings.

Auto machines don't operate at the speed of light xapping apneas on an individual basis. They rise more slowly until most apneas are prevented. The wide open settings are rather standard for titration and many Docs just leave their patients at those pressures. I'm not saying it's perfect but it doesn't indicate neglegent therapy.

As far as your feelings about that Doctors understanding and intent, I personally doubt that she is intentionally undermining treatment so that her apnea patients get no therapy. Why would she do that?
I think it's much more likely that she just doesn't understand xpap therapy.
Jamis

>Why would she do that?
That's exactly what I'm wondering...

And yes, she intentionally leaves the patients to suffer.

She herself answered me when I asked if she knew that APAP is really a self adjusting CPAP (adjusts the CONSTANT pressure),
and she replied that she knew, and that with those settings the pressure doesn't raise fast enough for many patients.