Switching to Bi-Level - What to expect?

Hi!

My sleep doctor is switching me to a bi-level machine starting tomorrow. After reviewing my 2 sleep study stats, I did better when they tried the bi-level.

What should I expect? Will I notice much of a difference in the actual sleep experience??

I think I will be getting this machine...

https://www.cpap.com/productpage/S9-VPA ... chine.html

If you're not also switching to a significantly higher pressure I think you'll find the switch from the Autoset to VPAP will be very easy and will not feel significantly different. I made the same switch a year ago. The machine and menu operations are virtually identical so you'll already be very familiar with the new machine. I find the VPAP (mine is VPAP Auto) to be just a little easier to breathe with, something about how sensitively it follows my inhales and exhales. I think you'll be pleased.

Think of it as the inverse of CPAP + EPR.

With CPAP + EPR, you're mostly at the higher ("constant") pressure, with a slight dip at the beginning of each exhalation. (The dip is 1-3 cmH2O depending on your EPR/flex setting.)

With bi-level, you're mostly at the lower (EPAP) pressure until it detects you inhaling, at which point it switches to the higher (IPAP) pressure during your breath.

It's not exactly the inverse, since bi-level will be at IPAP throughout your inspiration, where as EPR is just a brief drop at the beginning of your expiration, but it's a reasonably intuitive approximation.

The biggest challenges you might encounter are:

1) It might occasionally mistakenly think you're inhaling when you swallow, depending on the kind of pressure changes your swallowing creates. (This happens to me maybe 5% of the time now; I just blow out a little after swallowing which convinces it that I'm no longer trying to inhale.)

2) It might make mask leaks a little different than before. Now the higher pressure will be the exception rather than the rule, which can make adjusting your mask a little trickier. If you're on non-auto you might be able to use the mask fit feature, but you probably won't use that every time you go to bed. Also, the leaks can interact with the breath detection, since a leak looks like inhaling (at first), so it bumps up to IPAP, which makes the leak worse, and then it ramps up trying to maintain IPAP.

But neither of these causes me much disturbance. It'll just feel a little different for the first few days.

kaiasgram wrote:If you're not also switching to a significantly higher pressure I think you'll find the switch from the Autoset to VPAP will be very easy and will not feel significantly different. I made the same switch a year ago. The machine and menu operations are virtually identical so you'll already be very familiar with the new machine. I find the VPAP (mine is VPAP Auto) to be just a little easier to breathe with, something about how sensitively it follows my inhales and exhales. I think you'll be pleased.

I had the same experience as Kaiasgram. No problem with the switch at all.

spmccord wrote:Hi!

My sleep doctor is switching me to a bi-level machine starting tomorrow. After reviewing my 2 sleep study stats, I did better when they tried the bi-level.

What should I expect? Will I notice much of a difference in the actual sleep experience??

I think I will be getting this machine...

https://www.cpap.com/productpage/S9-VPA ... chine.html

What will your new settings be and what are your current settings?

I will find out later this afternoon!

I use the mask fit every night. It's a good wY for me to know that I'm ready to sleep.

ems wrote:

kaiasgram wrote:If you're not also switching to a significantly higher pressure I think you'll find the switch from the Autoset to VPAP will be very easy and will not feel significantly different. I made the same switch a year ago. The machine and menu operations are virtually identical so you'll already be very familiar with the new machine. I find the VPAP (mine is VPAP Auto) to be just a little easier to breathe with, something about how sensitively it follows my inhales and exhales. I think you'll be pleased.

I had the same experience as Kaiasgram. No problem with the switch at all.

Ems, do you use any PS with your 6/9 setting or do you just use the S setting with no PS?

My CPAP setting was 14.

My Bi-level will be 17/13.

Did you use any EPR before? If so, what level?

If you were using EPR, I suspect your bi-level will feel like slightly more pressure. But given that this is the result of looking at your sleep study, the 13/17 is probably based on their measurements, so it's almost certainly worth starting there.

If you weren't using EPR, this will probably feel like less pressure except when you inhale.

I do have a question...

Does the machine respond to my breathing or does the machine try to dictate breathing to me??

I noticed more leaks last night with the Bi-level. I'll have to cinch up the straps tonight.

spmccord wrote:Does the machine respond to my breathing or does the machine try to dictate breathing to me??

Unless they've turned on a backup timer, it responds to you. It can, however, get a little confused and switch to IPAP before you're really ready, lag a little bit so that you feel like you're fighting it, or sometimes get completely confused and switch to IPAP when you swallow. Blowing out (like you're clearing water out of your nose) will usually convince it that you're not inhaling.

Eventually the two of you will get in sync with your breathing pattern.

I noticed more leaks last night with the Bi-level. I'll have to cinch up the straps tonight.

Make sure you're not having mouth leaks. Sometimes the change in pressure can overcome your usual resistance.

I noticed more leaks last night with the Bi-level. I'll have to cinch up the straps tonight.

i generally find tightening the straps makes for more leaks. Look at fit instead. It took me 3 months to get consistently under the large leak line, and I think the biggest contributing factors were 1) relaxing 2) not trying to over-engineer my solution with too many creams, straps, pAds, etc 3) washing my face with soap before masking up 4) finding the right mask for my face-there IS one that's just perfect for you, you just have to keep trying!

I wouldn't worry about the transition, at all, if I were you. For me bi-level CPAP was a lifesaver as I could not tolerate constant CPAP. But it might require some adjustment in the beginning. For example, during my titration study they tried bi-level and it didn't work. Probably because they had me sleeping supine (way too many wires and sensors) and I can't sleep on my back, and with the higher pressures of bi-level, and being the very first time on a CPAP machine, it was very hard on me. But after struggling with constant pressure for a week or two, my doctor prescribed a bi-level and it took immediately. Normally bi-level is meant to make it easier on the patient; if your doctor thinks you need bi-level, I think you definitely will benefit from it.

I should also point out that there are many adjustments on your new machine to help you customize it to your needs. My observations are from the S8 version of that machine, but I'm sure the S9 has those and probably more. For example, you can set the rate of pressure increase (from very gradual to an abrupt hit; I like the latter); the sensitivity to inhalation (from the machine requiring a significant inhalation effort to trigger, to immediately cranking up the pressure upon the slightest hint of pressure change in your airways; I like the latter); the minimum and maximum durations at IPAP level, and so on. I recommend you obtain a clinician's manual and study those.

Good luck!

McSleepy

Jeannh wrote:3) washing my face with soap before masking up

Just to reiterate the point that everybody's different and what works for one person might not work for you:

For me, if I wash my face before bed, my face is too dry and the mask liner leaks! I actually need a little moisture for the mask liner to get a good seal.