I'm still studying all this, haven't got a prescription yet, but I know I have some central apneas. As I understand it, BiPap machines are aimed at this--is that right? I see they're more expensive, but is there anything else special to know about BiPap machines? Do they work OK with the same masks as are used with CPAP? Maybe I'm jumping the gun a bit...
centrals and BiPap machines
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BIPAP
I recently started therapy with a Respironics Auto BIPAP with BiFlex.
However, I don't have a central apnea problem, so I am not familiar with those issues.
One advantage for the BIPAP is that the lowered exhale pressure makes it easier to breathe. This is more important for people who use higher pressures. (It probably matters more for new users, also. My sister manages a consistent pressure of 20 cm on a CPAP, and she even stopped using the RAMP after a while.) I think the dual pressure feature is important for me, because my claustrophobia kicks in when I think I cannot breathe.
This machine can be used as BIPAP or CPAP or APAP. It takes a smart card so you can monitor your results with the software. The only disadvantage that I can see is the price.
BIPAPa work with the same masks, although some masks are reported to work better than others. Of course, if you read this board for very long, you will see that mask problems and solutions vary considerably between different individuals anyway.
I have seen only a couple of Auto BIPAP users on this forum, possibly because my own machine is pretty recent, and as I understand it, the older BIPAPs were not Automatics.
Moogy
However, I don't have a central apnea problem, so I am not familiar with those issues.
One advantage for the BIPAP is that the lowered exhale pressure makes it easier to breathe. This is more important for people who use higher pressures. (It probably matters more for new users, also. My sister manages a consistent pressure of 20 cm on a CPAP, and she even stopped using the RAMP after a while.) I think the dual pressure feature is important for me, because my claustrophobia kicks in when I think I cannot breathe.
This machine can be used as BIPAP or CPAP or APAP. It takes a smart card so you can monitor your results with the software. The only disadvantage that I can see is the price.
BIPAPa work with the same masks, although some masks are reported to work better than others. Of course, if you read this board for very long, you will see that mask problems and solutions vary considerably between different individuals anyway.
I have seen only a couple of Auto BIPAP users on this forum, possibly because my own machine is pretty recent, and as I understand it, the older BIPAPs were not Automatics.
Moogy
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Interested Party
Actually BiLevels without T (timed) feature are likely to be no better at overcoming centrals than a std CPAP or AUTO.
If the central is a slow decline then no breathing, no BiLevel (without T control), Cpap or Apap can force a person to start breathing again. Only the person can & will do that.
But before getting into this in any great depth, you would need to explain what you mean by 'central' and, what type of central, and then we can establish common ground for working out what might work best.
A BiLevel on its own does some things very well in that they help alleviate a number of issues relating to breathing out. These are primarily
1) the difficulty of breathing out against pressure and
2) the constant frustration of mask leaks.
But 1 & 2 vary greatly between people and depending on what pressure one's machine is set to.
Breathing out on xPAP therapy is a constant source of xPAP problems
these include:
- the effort (varying with cms),
- the ability of the chosen mask to cope with the higher pressure that occurs when an xpap tries to pump air in while the user tries to breath out (for the moment lets ignore the pressure reduction from the mask leak holes),
- the user's output breath must be greater in pressure than what the machine is pumping in. Consider someone on 16cms, their output breath must 1st stop the input flow of 16cms, then go higher to allow their breath to exit. All this takes place in our little nasal mask or large f/f mask. The theoretical pressure is going to be titration cms (e.g.16) + x cms which will vary depending on how hard one breathes out. It is no surprise that the slightest distortion of a mask causes those annoying 'squeaks' & leaks.
- The side effects for 'mouth breathers' is the constant search for some way to seal one's mouth as it is very disconcerting to be woken by a hurricane whistling out one's mouth in the middle of the night.
- Our partners suffer significantly from the side effects of breathing out against pressure. This can be the noises as well as the air blasts etc:.
- BiLevels try to solve the problem and do a great job of it but in turn can and do introduce other types of problems. It is fair to say that the problems they introduce tend to be a lot less than the problem they solve. These new problems relate to rate of breathing, the effects of switching from Input (IPAP) to output (EPAP). Most modern machines do well at alleviating these new problems but the cost is in the price of these machines.
- In the past here, people have claimed that BiLevels are only for special breathing disorders. Anyone who seriously holds to such a view has become blind to the reasons why that used to be true. The only reason being that BiLevels used to cost a small fortune and thus one had to have a very complex medical disorder to justify one. But, now they are getting closer to the cost of standard machines. In fact all top brands now offer 'exhalation relief' mechanisms that generally mimic BiLevel functionality. The ultimate 'exhalation relief' is a BiLevel.
- Getting back to centrals and using a BiLevel. There are some types of central that can be effectively resolved with 'Timed' control. This is the setting on an ST Bilevel that allows setting the time a breath takes, or the number of breaths per minute etc:. If the machine detects a zero or very low flow for the Timed period, it can flick from EPAP (Exhale) to Inhale (IPAP) & because these two settings are going to be several cms apart, the effect is to fire a puff of air into the user & that generally triggers a breathing response. No other type of xPAP other than expensive hospital ventilators can do that. BiLevels with ST tend to be very expensive still but are not needed by the majority of xPAP users.
If the central is a slow decline then no breathing, no BiLevel (without T control), Cpap or Apap can force a person to start breathing again. Only the person can & will do that.
But before getting into this in any great depth, you would need to explain what you mean by 'central' and, what type of central, and then we can establish common ground for working out what might work best.
A BiLevel on its own does some things very well in that they help alleviate a number of issues relating to breathing out. These are primarily
1) the difficulty of breathing out against pressure and
2) the constant frustration of mask leaks.
But 1 & 2 vary greatly between people and depending on what pressure one's machine is set to.
Breathing out on xPAP therapy is a constant source of xPAP problems
these include:
- the effort (varying with cms),
- the ability of the chosen mask to cope with the higher pressure that occurs when an xpap tries to pump air in while the user tries to breath out (for the moment lets ignore the pressure reduction from the mask leak holes),
- the user's output breath must be greater in pressure than what the machine is pumping in. Consider someone on 16cms, their output breath must 1st stop the input flow of 16cms, then go higher to allow their breath to exit. All this takes place in our little nasal mask or large f/f mask. The theoretical pressure is going to be titration cms (e.g.16) + x cms which will vary depending on how hard one breathes out. It is no surprise that the slightest distortion of a mask causes those annoying 'squeaks' & leaks.
- The side effects for 'mouth breathers' is the constant search for some way to seal one's mouth as it is very disconcerting to be woken by a hurricane whistling out one's mouth in the middle of the night.
- Our partners suffer significantly from the side effects of breathing out against pressure. This can be the noises as well as the air blasts etc:.
- BiLevels try to solve the problem and do a great job of it but in turn can and do introduce other types of problems. It is fair to say that the problems they introduce tend to be a lot less than the problem they solve. These new problems relate to rate of breathing, the effects of switching from Input (IPAP) to output (EPAP). Most modern machines do well at alleviating these new problems but the cost is in the price of these machines.
- In the past here, people have claimed that BiLevels are only for special breathing disorders. Anyone who seriously holds to such a view has become blind to the reasons why that used to be true. The only reason being that BiLevels used to cost a small fortune and thus one had to have a very complex medical disorder to justify one. But, now they are getting closer to the cost of standard machines. In fact all top brands now offer 'exhalation relief' mechanisms that generally mimic BiLevel functionality. The ultimate 'exhalation relief' is a BiLevel.
- Getting back to centrals and using a BiLevel. There are some types of central that can be effectively resolved with 'Timed' control. This is the setting on an ST Bilevel that allows setting the time a breath takes, or the number of breaths per minute etc:. If the machine detects a zero or very low flow for the Timed period, it can flick from EPAP (Exhale) to Inhale (IPAP) & because these two settings are going to be several cms apart, the effect is to fire a puff of air into the user & that generally triggers a breathing response. No other type of xPAP other than expensive hospital ventilators can do that. BiLevels with ST tend to be very expensive still but are not needed by the majority of xPAP users.
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rested gal
- Posts: 12880
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
Thank you for the explanation
I am a fairly new BiPap S/T user, and I have never seen such a clear explanation about the differences in the machines. I have central apnea, and my IPAP is 14, EPAP 4, and backup rate 8. I know that the timed response works. When I first got the machine, I was in such bad shape, the timed response seems to have been the primary function, and I got used to the rhythmic breathing. Now, at least when I am falling to sleep, I am breathing spontaneously.
_________________
| Mask: FlexiFit HC432 Full Face CPAP Mask with Headgear |
| Additional Comments: Started bipap Nov. 2005 |
Central Sleep Apnea
Wow, thanks to all of you for help in understanding this! As I said, I'm probably jumping the gun, since I don't even have a full diagnosis yet. All I know at this point from the sleep study is that I'm 50% obstructive and 50% centrals. Next week I talk with my PCP and will know more. but these explanations have helped me greatly to know what to ask. If there are particular other questions I should ask in order to understand this better, I would appreciate any thoughts. I'm pretty sure I have that Cheyne-Stokes respiration pattern, but only because it sounds like what my wife observed--no doctor has formally told me that. My mother also I think had it, but it was undiagnosed. She lived to 90, but did suffer a major stroke. I guess if we make it to 90, that's pretty good!
6 posts
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