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APAP Discussion
#41
Today the Doc replied and wants me to set an appointment to come in for discussion/re-set. (another $35 co-pay)

In answer to your previous question, I got into the Bi-Pap machine through constantly bugging the boys and girls at the sleep lab for some improvement in my treatment.

My sense of "reality" is that if someone would sit down with with me and say "Ok, here are your results. This means such and such, this means so an so, so we think that this approach will work best for you." If that were to happen, I would have a much, much, higher level of confidence that someone is actually personally looking at ALL of the data rather than just looking at certain extremes.

Instead what I get is some variation of "Here you go, and come in for this class and we'll show you how to put the mask on. Also, here's some brochures that you can read."

Again, they're all very nice people, but they are really jammed.

So now I have a 12/30 appointment and we'll see how that goes. The sleep therapist prints out the results, takes them into the Doc, and we go from there.

Phil

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#42
The sleep doc and techs get paid the same for peeking at compliance and saying all's well as they would if they actually took an interest and tried to help.

robysue has presented more and better information in this thread than you'll be able to squeeze out of a sleep doc or tech in 100 paid visits...

It would be ideal for sleep docs to do what you described, but won't happen until more people start demanding it rather than just wanting to take the doc's word for it and plug along. Until that happens, they'll do whatever they can to get you out the door and on your way home so they can get back to the long line of patients happy to pay for a pat on the head for compliance and a false sense of security thinking they are being well looked after.

Whoops, I accidentally let this turn into a rant...

Oh-jeez
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#43
(12-16-2013, 01:24 PM)pdeli Wrote: In answer to your previous question, I got into the Bi-Pap machine through constantly bugging the boys and girls at the sleep lab for some improvement in my treatment.

What improvements were you looking for?

Quote:Instead what I get is some variation of "Here you go, and come in for this class and we'll show you how to put the mask on. Also, here's some brochures that you can read."

Well, we're here to try and fill that gap.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#44
I was having several issues including air in my stomach and little improvement in energy. There were several other things that I don't recall at this point, but when I asked about the BiPap, the Doc set up a test. I tested both ResMed and Respironics, and for some reason the ResMed was uncomfortable. I also found that the higher IPAP was too much pressure for exhaling and subsequently resulted in stomach air.

I also had some guidance from a friend who was a respiratory therapist awhile back, and although she was a bit outdated in terms of equipment, she was somewhat helpful.

It seems that every time I figure out part of this puzzle, another layer of mystery shows up.

Phil
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#45
A BiPAP is commonly prescribed for patients with aerophagia. I'm one of them.

I started at 13 cm of CPAP, but then switched after two weeks to BiPAP at 13/8. Because of an elevated CA index they lowered the pressure first to 11/8 then 10/7. Since then I've tweaked things and find that 12.5/11.0 is the maximum I can handle without inducing lots of air-swallowing, although it's never been as bad as those first three or four weeks.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#46
That may be part or all of why I have chest pain and I never thought I swallowed air but I never really had the most common symptoms of OSA. Will see what the CT angiogram that I have tomorrow shows.
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#47
I'm realizing now that although much of what read here is very enlightening, it is also often confusing and complicated because it is disjointed in a sense. In other words, the pieces don't always fit together. The isolated, unconnected comments, and the variety of similar terms and acronyms, which often aren't particularly memorable (at least for me) leave me spinning. Things often seem rather abstract.

Although I'm very grateful for what I've learned here and to all who have contributed to this forum and taken the time to answer all of my questions, I'm still quite confused.

- I'm now wondering if I made a mistake pushing for the Bi-Pap to replace the C-pap. In looking at my C-Pap data, I see that my "pressure" on a given day went from a base of 7 to as high as 11.

The machine is a Respironics System One 560P, RemStar Auto with A-Flex. Mode: APAP 7-13cmH20.

My question is, what is the distinction between the application and results of this machine vs. the Bi-Pap with its 6 IPAP and 16 EPAP ??????

Phil
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#48
(12-17-2013, 05:37 PM)pdeli Wrote: - I'm now wondering if I made a mistake pushing for the Bi-Pap to replace the C-pap. In looking at my C-Pap data, I see that my "pressure" on a given day went from a base of 7 to as high as 11.
Maybe, maybe not. The thing is: With the BiPAP, you can always switch it to straight CPAP mode if you prefer. Or with the 560, you can make it act just like a System One APAP by doing nothing more than setting min PS = 0 and max PS = 0. That small change in settings is all it takes to make the machine use the same pressure on both inhalation and exhalation like your CPAP. And in this setting, you can just use the Bi-Flex setting to mimic whatever A-Flex setting you used to have.

In other words, the System One BiPAP is a more flexible machine than the System One APAP. You can make the BiPAP mimic the APAP, but you can't make the APAP act like a BiPAP.

Quote:The machine is a Respironics System One 560P, RemStar Auto with A-Flex. Mode: APAP 7-13cmH20.

My question is, what is the distinction between the application and results of this machine vs. the Bi-Pap with its 6 IPAP and 16 EPAP ??????
From a previous post, we've determined that your BiPAP's settings are:
  • min EPAP = 6
    max IPAP = 16
    min PS = 0
    max PS = 10

Your old APAP was set with
  • min pressure = 7
    max pressure = 13

The short answer to your question
The biggest difference between the APAP and the BiPAP is that on the APAP when you are exhaling, the pressure is the same as when you were inhaling, while on the BiPAP there are two pressures---one for inhalation (the IPAP) and one for exhalation (the EPAP). And these two pressures do not have to equal each other.

In your case, on the APAP, the starting pressure for the night is 7 = min pressure setting. And any time you turn the machine off and back on, the pressure is reset to 7cm. And on each and every breath through the night,
  • 7 <= current pressure <= 13
The pressure will adjust through the night, but on any given breath, the pressure on the inhalation will be the same as the pressure on the exhalation. (Flex will provide a small, variable decrease in pressure at the start of the exhalation, but by the time the exhalation is complete, the pressure will be back up to what it was during the inhalation.)

On the BiPAP with your BiPAP settings, the starting pressures for the night are:
  • starting EPAP = 6 = min EPAP
  • starting IPAP = 6 min EPAP + min PS
And any time you turn the machine off and back on, the pressures are reset EPAP = 6 and IPAP = 6. And on each and every breath through the night,
  • min EPAP + min PS = 6 <= IPAP <= 16 = max IPAP
    min EPAP = 6 <= EPAP <= 16 = max IPAP - min PS
  • min PS = 0 <= IPAP - EPAP <= 10 = max PS
The biggest difference between the BiPAP and the APAP is that on the BiPAP, the IPAP does NOT have to equal the EPAP on every single breath, and with your settings, it is possible for IPAP = 16 and EPAP = 6 since max PS = 10 = 16 - 6.

The way the BiPAP works is this: When you are inhaling, the machine increases the pressure to the current IPAP pressure; as soon as your exhalation starts, the pressure is decreased to the EPAP pressure, which can be quite a bit less than the IPAP. The cycle of increasing the pressure at the start of each inhalation and decreasing it a the start of each exhalation continues for each and every breath you take whenever your IPAP > EPAP. The BiPAP Auto algorithm is very similar to the APAP's Auto algorithm and it allows both the IPAP and EPAP pressures to change during the night. But in the BiPAP Auto algorithm, sometimes the machine will only increase the IPAP pressure in response to events; sometimes it will only increase the EPAP; and sometimes it will increase both the IPAP and EPAP pressures.


The point of having two different pressures on a BiPAP is that for many people, the switch between IPAP on inhalation and EPAP on exhalation (when IPAP > EPAP) makes breathing against the positive air pressure seem more natural. The drop to EPAP during the entire exhalation also makes it easier for some people to exhale against the pressure. (The pressure relief provided by Flex does not last for the full exhalation.) And in general the average pressure level the body has to deal with is lower because roughly half the night, you're exhaling at EPAP. And this can reduce the tendency to swallow air, which reduces aerophagia. For people who have a tendency to develop pressure induced CAs, the fact that EPAP can be much lower than IPAP can help reduce (sometimes even eliminate) the problem of pressure induced CAs.

A longer, more complete answer to your question: What is the distinction between the application and results of the APAP vs. the Bi-Pap Auto? requires some understanding of how each of these two machines respond to obstructive apneas, hypopneas, flow limitations, RERAs, and snoring. I'll save that for another post.


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#49
(12-16-2013, 06:39 PM)pdeli Wrote: when I asked about the BiPap, the Doc set up a test. I tested both ResMed and Respironics, and for some reason the ResMed was uncomfortable. I also found that the higher IPAP was too much pressure for exhaling and subsequently resulted in stomach air.
Unlike the PR System One BiPAP Autos, the Resmed VPAP Auto (bilevel) machines do not allow the IPAP and EPAP to vary independently of each other; the two pressures are always increased and decreased together. And there's a setting called the PS (pressure support) setting on the Resmed VPAP that determines what the IPAP will be. On a Resmed VPAP, on every breath you take:
  • IPAP = EPAP + PS
And my guess is that the PS on the trial machine was set to 3 or 4 cm while your min EPAP was still set to 6cm. And that would mean that the starting IPAP on the Resmed bilevel was probably something like 9 or 10cm.

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#50
(12-17-2013, 05:37 PM)pdeli Wrote: - I'm now wondering if I made a mistake pushing for the Bi-Pap to replace the C-pap.

Not at all. You've got a good machine that can be set in straight CPAP mode if need be, so stop worrying.

You don't need to understand the answers to all your questions right now. There's plenty of time for you to learn all that stuff later. The first thing you need to do is adapt to using the machine. Monitor both your leak rate and your AHI to make sure they are both at acceptable levels. Don't make changes to the pressure settings on your machine for at least 30 days unless you are having problems and you can't get your doctor and equipment provider to prescribe the needed changes. And even after the 30 days are up don't make any adjustments unless you understand what you're doing.

Sleep apnea has a huge negative effect on our cognitive abilities, but the good news is that CPAP therapy reverses it.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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