C-Flex Vs. Bi-PAP

I just watched a video from another post here showing CPAP and atleast BIPAP referenced. My machine has C-Flex with 3 settings (1,2 and 3). How many settings does a BIPAP have? Is the C-Flex feature just a limited version of the same. How does it differ?

I've noticed that at 13 my machine is really too high for me on the exhale and I've gone to a 2. 3 seems even better than that. I can stand 1 at times but overall 2 seems more comfortable.

My only worry is that I'm losing effectiveness by going to a setting to low on the exhale. If that's not possible, then it would be nice to know. Then 2 or 3 comes down completely to comfort and if that's all it really means then I'll pick the number I think is most comfortable overall. Having even 3 settings seems confusing to me so I can't imagine the need for 10 or 20. But I'm assuming the goal is "just right". Not too much, not too little.

If 3 is more comfortable than 2 is that ok? And doesn't a "C-Flex" feature effectively give this CPAP....BIPAP status. Or am I off track?

You should run your cflex on what is comfortable for you. There is nothing wrong with running it on 3.

A BiPap has and inhale of one pressure, and an exhale of another. The exhale pressure is probably stronger than a 3 on cflex.

Your pressure is close to what I would consider borderline between a cflex and BiPap. I would think someone with a pressure of 15 might be a candidate for BiPap - if they have trouble exhaling. Plus, high pressure causes many to swallow air, thereby getting painful bloating and gas in the mornings.

That makes alot of sense from the video I saw earlier on this website. So, C-Flex really is Bi-PAP junior then? Hmmmm. I'm going to accept that I'm over-thinking this and just go with the flow but I just don't want to make the wrong decision and BUY the wrong unit.

So, C-Flex really is Bi-PAP junior then? Hmmmm.

Actually that is not really true. C-flex pressure relief is based on the pressure you exhale with and the C-flex setting (3 being the greatest relief and 1 being the least relief). In a Bi-PAP the minimum differential pressure is 4 cms from what I understand. That means that if my pressure is 15 cms my pressure at exhale will be 11 cms. I would consider the Resmed units with EPR to be a closer fit to a BiPAP than I would a Respironics unit with C-flex.

Actually C-Flex is for comfort, and Bi-PAP are prescribed for a reason. The Bi-PAP can be set to provide two distinct pressures for treatment. Inhale pressure can be set for what you need to keep the airway open and exhale can be set for any pressure and timing that's needed by the patent. Bi-PAP is a much more controlled machine. Bi-PAP's are a stronger machine that can support the higher pressure requirements of some patients (25-30 cm)

A Bi-PAP can be set for lower exhale pressure and that makes helps to prevent air getting in the intestines for some. It seems that more Bi-PAPs are being bought because more people want the highest end units they can get, instead of just a machine they can live with, at twice the price that's something to think about. We all can't afford Hummer's. Jim

Another consideration to think about with BiPAP, is that BiPAP has a different billing code, so if your physician is willing to prescribe a BiPAP, then the DME gets paid a lot more. Getting a BiPAP is generally hassle-free, at least compared to trying to pry an APAP loose from your DME. Also, if considering a BiPAP, then the Respironics BiPAP-auto is a machine you ought to be considering. It combines the best features of an APAP into a BiPAP machine, yet is priced to compete with other Bi-level machines. I've not seen that anyone has reported a problem getting a BiPAP-auto through their local DME.

I've got a BiPAP-auto, and consider it an excellent machine. No one has posted anything negative about it, at least that I've seen.

Regards,
Bill

C-flex relief is a very brief, momentary drop in pressure and doesn't last through the entire exhalation. It is not a distinct pressure drop of 1cm per setting. The degree to which the pressure will drop is based on how hard you exhale and the setting combined.

Bi-level pressure relief lasts longer; all the way through the entire exhalation. The degree to which the pressure will drop is not affected by how hard you exhale and gives a distinct, specific pressure drop in cms. to the level you've preset on your machine.

You know something? It would seem they would prescribe based on how severe your apnea is. It doesn't seem logical that severe apnea could be treated by the most basic unit. And yet you have people out there with mild apnea on a bi-pap or apap (much more common if they can buy it themselves, which I someday might.)

My good luck streak ended last night. My wife is noticing me letting air out of my mouth and even I could feel/hear it while I was still awake. This is WITH the chin strap. Also, I woke up twice and the mask was up on my forehead so apparently I pulled it off during the night. Obviously, I can't tie the mask to my head. Or maybe some of you can? Anyway, obviously taping is an option for the chin strap. What I want to avoid is getting a mask that has far less effectiveness and increased leakage problems. Right now, I get no leaks that I'm aware of. That's a big plus I'm guessing.

It's funny. I'd wake up to find the mask off and get made for about 2 seconds wondering who took it off me. I tend to get miffed when things are not the way I left them when I return. LOL!

Any suggestions?

Have you tried tape? It works great for many people and allows you the luxury of using any type of mask you want. If it's something you're comfortable trying, here's a link to a previous 2 page discussion:

Mouth Tape

.

Actually, the severity of apnea is measured by the type and quantity of episodes a person experiences and not the pressure required to treat the episodes. Some people may have many episodes but can be treated at a lower pressure. Others may have lesser episodes but require a higher pressure. Still others may have different types of events that require different treatment. Also, some people just don't respond well to a fixed pressure.

The main goal is to get something that is right for you regardless of the type of machine, pressure, etc. If you are comfortable and compliant then you have half the battle already won.

Bottom line is you should get as much information as you can then talk to your doc about what the best treatment is for YOU.

Anonymous wrote:Have you tried tape? It works great for many people and allows you the luxury of using any type of mask you want. If it's something you're comfortable trying, here's a link to a previous 2 page discussion:

Mouth Tape

.

I'm allergic to the tape. I had to put it on during a recent hernia surgery and the after effects are still present 6 months later. I guess i'm VERY allergic to it.

Rastaman wrote:I'm allergic to the tape. I had to put it on during a recent hernia surgery and the after effects are still present 6 months later. I guess i'm VERY allergic to it.

I'd suggest you might try the Poligrip strips. I've been using them for maybe two weeks now, and find that they improve therapy for me. No way I was gonna use tape. The strips are no muss, no fuss. At most, about 60 seconds to wipe off a little residual stickiness with a wash cloth. Many mornings not even that is needed.

Regards,
Bill

kevder wrote:Actually, the severity of apnea is measured by the type and quantity of episodes a person experiences and not the pressure required to treat the episodes. Some people may have many episodes but can be treated at a lower pressure. Others may have lesser episodes but require a higher pressure. Still others may have different types of events that require different treatment. Also, some people just don't respond well to a fixed pressure.

The main goal is to get something that is right for you regardless of the type of machine, pressure, etc. If you are comfortable and compliant then you have half the battle already won.

Bottom line is you should get as much information as you can then talk to your doc about what the best treatment is for YOU.

That make sense. I just wish the results were discussed in a little more detail. I really have no idea what level or severity my apneas were. And I've already talked to someone from the sleep center once about it. He went into basic detail about how many per hour. But he didn't go into why I have a 13 setting. He didn't tell me why CPAP is preferred over say an APAP or BIPAP, specifically for ME.

In the meantime my wife is checking on a couple of things for me. First, to see if I HAVE to go through the sleep center for my machine or can I get it from cpap.com and then what I'm covered up to. At $1890 (only $600 paid by my insurance!) I doubt I'll go to the trouble to ever have a sleep study done again unless I have to do it to get the proper machine.

Then I'm going to call the "Yes" man at the sleep center and find out exactly what happened during my study. With all the stuff on I know I wasn't sleep normally. I'm a back and side sleeper. I sleep on both sides and on my back. I doubt I could do all that with all the wires and machine on. And if I did do that, how did those apneas different from the ones on my back? Is one continuous pressure covering me? Is there a chance I have fluctuating needs? I already know the answer to this last one. Since my needs were assessed based on 1 single night, how is the CPAP machine that I have now (with absolutely no software) going to keep me up on whether or not my pressure setting is right for me? To my knowledge my unit doesn't keep any info beyond compliance info.

Demand a copy of your sleep study. You're entitled to it.

Prescribing a CPAP for garden-variety OSA is standard procedure. It seems only in-the-know docs prescribe the APAPs. BPAPs are generally prescribed if you have certain health issues:

Conditions Frequently Treated with Bilevel Devices &/or NPPV
Now, physicians typically use bilevel therapy to treat a broad range of conditions, including some conditions that require 24-hour ventilatory support.
o Respiratory muscle dysfunction (CO2 >45 mm Hg)
o previous poliomyelitis
o muscular dystrophies
o myopathies
o Neurological disorders (CO2 >45 mm Hg)
o neuropathies
o bilateral diaphragmatic paralysis
o spinal cord injury
o brainstem lesions
o primary alveolar hypoventilation
o Chest wall deformity (CO2 >45 mm Hg)
o scoliosis
o thoracoplasty
o Upper airway disorders
o severe OSA
o obesity hypoventilation
o Lung disease (CO2 >52 mm Hg)
o COPD
o cystic fibrosis
o bronchiectasis
o Acute respiratory failure (CO2 >52 mm Hg)
o hypercapnic respiratory failure
o hypoxemic respiratory failure

Bilevel therapy is not typically prescribed for OSA patients; however, OSA patients who require high treatment pressures, OSA patients that can not tolerate exhaling against the set pressure of CPAP or OSA patients that have another respiratory condition like underlying lung disease (COPD) may be candidates for bilevel therapy.

Rastaman wrote:Then I'm going to call the "Yes" man at the sleep center and find out exactly what happened during my study. With all the stuff on I know I wasn't sleep normally. I'm a back and side sleeper. I sleep on both sides and on my back. I doubt I could do all that with all the wires and machine on. And if I did do that, how did those apneas different from the ones on my back? Is one continuous pressure covering me? Is there a chance I have fluctuating needs? I already know the answer to this last one. Since my needs were assessed based on 1 single night, how is the CPAP machine that I have now (with absolutely no software) going to keep me up on whether or not my pressure setting is right for me? To my knowledge my unit doesn't keep any info beyond compliance info.

Welcome to "taking-charge-of-your-own-therapy" club, Rastaman. Your sleep center won't do it. Your doc won't do it. Your DME for sure ain't gonna do it.

In truth it's ridiculous that we ever thought they would. But our health "professionals" have controlled information very tightly for years, and for years have spouted mantras like "xxx only your doctor knows". How stupid is that, really?

Apnea is not simple, it's not neat, and the health professionals, in all candor, have a terrible track record of diagnosing and treating it. If you want good therapy, the burden falls fully on you to make it happen. I decided that meant monitoring and adjusting things myself. I have not one regret about doing that. I recommend it highly. This is not rocket science.

Regards,
Bill