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CPAP or BiPAP?
What's the difference between a CPAP and a BiPap machine? I have a BiPap.
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Replies to This Discussion
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Permalink Reply by Gil Ben-Dov on
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JNK - Thanks for the very detailed answer. You hit the nail on the head in described how our algorithm works regarding EPR.
CPAP is not recommended for CSA - If anyone is interested in a more detailed description of ResMed bilevel devices and the disease states they are approved for, I just posted a response within this forum that is pretty thorough, http://www.sleepguide.com/forum/topics/resmed-s9-bilevel-machines?x....
Gil Ben-Dov
VP Social Media Strategy
j n k said:Somnonaut,
Your opinion on EPR is correct for describing what a Philips-Respironics machine does (with varieties of "Flex") but NOT for what a ResMed machine does with ResMed's EPR.
EPR on a ResMed (unlike "Flex" on a Philips-Respironics machine) actually lowers therapeutic pressure during the entire exhalation, unless EPR gets suspended during an event.
That illustrates why it is good to keep in mind the differences between the brands when discussing things like EPR and PS.
On a ResMed auto-bilevel, for example, the difference between IPAP and EPAP (PS) is set specifically and never varies--the IPAP and EPAP change together, in tandem, but the distance between the two stays the same. On a Philips-Respironics auto-bilevel (which they call BiPAP Auto), the PS varies between a hardwired minimum and a set maximum PS. VERY different approach, since the brands have very different algorithms. That is one reason that if one brand doesn't respond well treating a patient, there may be reasons to try the other brand.
For CSA, my opinion is that plain CPAP is now usually considered better than bilevel for most, that if CPAP doesn't help things sufficiently within a few months, ASV is then tried. That is merely my understanding as a patient. I am not a medical professional of any sort.
ResMed calls bilevels VPAPs, and the ones designed to treat OSA (not the ventilators) can have a PS as high as 10, I believe. But if I recall, setting PS over 8 cm can affect the reliability of the data. Four cm is the standard PS for bilevel for treating OSA, according to the AASM. ResMeds can be locked into 4 cm PS in auto-bilevel mode; Respironics cannot, although they can be set with a range limited to 4 cm maximum PS.
If Sheila is using a Philips-Respironcs, and the IPAP is "running away," the doc-RT team may choose to limit PS by setting the maximum PS to 4 cm. That would be one thing to try, anyway.
Hope that clarifies more than muddies.
Feel free to ask more questions of any sort, Sheila.
Somnonaut said:Gil Ben-Dov,
The Pressure Support (PS) is not truly changed therapeutically using EPR. So why do you mention that CPAP can have +-3cm/H20? CPAP has very low tolerance for pressure swings, that is why it is called Continuous. EPR only alters the pressure for a short duration during exhalation, to create the perception of breathing out against lower pressure, but the actual pressure within the airway does return (within the 100msec or so window of "pressure relief") to the Rx pressure (within the manufacturer machine tolerances.) So, I would not include EPR in describing CPAP except as a comfort feature. I would not describe CPAP as allowing a swing of 3 cm/H20 in a patient's Rx either.
Just my opinion.
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The odd thing about the BiPAP is that I didn't have any apneas at all during titration - just lots of hypopneas and oxygen desaturations. With the BiPAP the apneas started, with more centrals than obstructives. Very strange, I think.
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Permalink Reply by Somnonaut on
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Maybe you should have them update their information and I am pretty sure the FDA would like to know that the Resmed CPAP machines are not "CPAP".
http://www.resmed.com/us/assets/html/device_epr/epr.html?nc=patients
"When the patient exhales, the S8 device detects the beginning of exhalation and reduces motor speed to drop pressure."
And since the PAP therapy is controlled by the critical airway pressure at the end of exhalation, this little game of decreased pressure is quickly put back up to therapeutic pressure as the exhalation continues/ends, such that at the end of exhalation the pressure is at the Rx pressure, not the EPR level.
I stand by my statement, with using the machine and the way it has been explained to me over the years, and the logic of the airway. Logically you can't have a Rx pressure and expect a lower pressure to do the trick.
Beginning to no longer trust Resmed devices. And there is no therapeutic benefit to using EPR as was recently published.
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Permalink Reply by RockRpsgt on
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Wasn't EPR considered to be for pt comfort rather than treatment? I mean if someone needed EPR for therapy purposes then you would go Bpap. Right?
EPR changes the therapy for sure. If it is not used during the titration and then applied at home the resulting pressure will be insufficeint.
As for Resmed this is the most response I have seen from them since leaving Indy. Colorado has horrible Resmed Reps. We can't even get ours on the phone. HintHint
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Just because a definition of "bilevel" has some semantics of 4cm PS attached to it, does not change the definition of what CPAP is.
Maybe there is a new IBPAP (in-betweenPAP) /snark
I do agree it is/was sneaky. It also makes a lot of clinicans look like schmucks.
Maybe this is the straw that gets Peter Farrell fired. Yeah, I won't hold my breath.
And BTW, I haven't touched a Respironics device in over ten years,so I am not confusing the two. I have been a Resmed shop since the 90's. EPR has always been described as only dropping within a short window of exhalation. I tried it on myself, I wear CPAP. That is the way it worked. It was sensible during exhalation, and measurable. And there are othes complaining of increased AHI readings with increasing EPR. http://www.cpaptalk.com/viewtopic.php?p=457007
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Where did you get this?
"it is usually the pressure at inhalation that eliminates hypopneas and the pressure at exhalation that eliminates apneas."
ANd when you say "average"
"That's why average pressure is often lower for a patient when titrated for bilevel."
What average of ins and ex, hi and low of PS?
The S8 Series II, using EPR, is not CPAP. Period. EPR should not only be OFF by default, it should not be showing to the patient by default and clinicans should be properly educated as to this quasi-PAP. There ya go 'QPAP". QuasiPAP. I knew we could get a new term out of this.
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I'm confused, is the beginning of expiration at vertical line #1 or #2?
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Permalink Reply by Mary Z on
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In the series of videos by Dr. Rapoport at the Manhatten A.W.A.K.E. meeting last year I believe he stated apnea/hypopneas were found during inspiration. The airway should be open on exhalation. Though the Provent device which provides positive pressure during exhalation works for some.
There is always more research to be done.
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Mary,
Apnea and Hypopnea may be "found" during inhalation but the point where the airway occludes has always been taught to be at the end of expiration. Now maybe they (the CPAP device manufacturers) have refined these events more clearly, and have kept said research proprietary for business purposes, I do not know. But, in the field it is that the airway closes at the end of expiration, not yet inspiration. You would (on recording) see the "events" during the inspiratory phase, but the actual closing occurred before inspiration.
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Permalink Reply by Mary Callahan on
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I also have been diagnosed with MILD sleep apnea and have been told due to my small mouth and large tongue and so many RERAs and Arousals that I also have UARS, although the doc said he didn't think the UARS was a problem and that there is controversy that it even exists. I just wish for a night he knew what it felt like to try and sleep and wake up feeling like crap. I use an APAP set between 7 & 9 with an EPR of 3. Don't know if it should be changed.
All I know is that everywhere I read that people who have mild sleep apnea don't do as well on the machines as those with moderate or severe. It seems when the ones who have the moderate and severe are treated they feel wonderful compared to how they felt ahead of time. But those who are mild, it really doesn't seem to work as well. We have a lot more struggles to feel well using the machines. I know mine is complicated with life-long insomnia -- I am such a light sleeper, every little thing keeps me awake.
I wish you success. Just don't give up. Sooner or later it could fall into place.
Danny Heller said:Banyon, I was diagnosed with "mild" sleep apnea (but in no way is my misery level "mild"!) and UARS, which is the more significant fact here, because it is what causes the bulk of my arousals. I don't have access to the machine data, but I know my pressure settings are 9cm for inhalation and 5 cm for exhalation. I am using a nasal pillows mask (Swift FX, I believe). I couldn't stand a nasal mask - it chewed my face up and made it impossible to sleep on either side.
Mary, thanks for the tip. Glad to hear my problem is not unique.
Sheila, thanks for your info. Are you being helped by BiPAP?
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I have extreme OSAH, my uncorrected AHI was 63 during a sleep study done about a year ago.
I'm now on my third machine, and I can agree with some of the others who have replied that Respironics and ResMed have very different ESR correction. I found the ESR correction on the Respironics machine to be 'OK', but the ESR on my ResMed S9 was annoying, woke me up in the middle of the night, and resulted in poorer correction. The machine is dream, however, with ESR turned off, and does a much better job of correcting both my apneas and hypopneas. My typical AHI when on the machine now is around 1, and often as low as 0.1-0.2. It no longer wakes me up, and I prefer the machine without the initial ramp as well. The heated hose has eliminated the buildup of water that I used to get with the humidifier attached to my Respironics unit, which was another source of poor correction and getting woken up needlessly.
Work with your specialist to either get your machine adjusted to fit your needs, or change machines and/or headgear. My experience (after over 10 years of CPAP machines) is that once I got used to it, using *fewer* automatic features actually worked better. Some of the features (like ESR) made it easier getting used to a new machine, but. like training wheels on a bike, they held me back later on. Other people find ESR comfortable and necessary. My current combination of ResMed S9/integrated humidifier/heated hose/Breeze nosepillow headgear took me a while to arrive at, but my sleep quality has improved immensely compared to other combinations that I've tried.
And since I'm on sleep meds as well , I *never* sleep without it, and I always use it for the entire night. You should be able to do this too, with lots of persistence at getting the right gear, adjusted correctly - but it can take time and patience to get there, and your needs (and the gear) may change over time.
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