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Auto CPAP vs. Auto BiPAP
#1
My sleep study recommends using pressure of 18/12 (with non-auto BiPAP) or 14 (with non-auto CPAP). I am considering purchasing a PR System One auto machine but do not know enough about auto machines to decide whether to buy an auto CPAP or an auto BiPAP. Just on the face of it, it would seem that an if an auto CPAP really adjusts to your needs, whatever your needs, this would make the auto BiPAP unnecessary. What can an auto BiPAP do that an auto CPAP cannot do?
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#2
(06-02-2013, 02:21 PM)Apnea 1 Wrote: My sleep study recommends using pressure of 18/12 (with non-auto BiPAP) or 14 (with non-auto CPAP).

That's pretty strange. What does the doctor say?

If a CPAP pressure of 14 is high enough to prevent obstructive apneas, then I don't understand why they'd recommend a pressure of 18 with a BiPAP. Likely there's more going on here with your symptoms than simple obstructive sleep apnea.

To answer your question, a BiPAP will lower the pressure, in your case, to 12 when you stop inhaling, making it easier for you to exhale against the machine's pressure.

A BiPAP can also be placed in CPAP mode, so if you can afford the extra cost a BiPAP may be the way to go.
Sleepster
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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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#3
(06-02-2013, 02:21 PM)Apnea 1 Wrote: My sleep study recommends using pressure of 18/12 (with non-auto BiPAP) or 14 (with non-auto CPAP). I am considering purchasing a PR System One auto machine but do not know enough about auto machines to decide whether to buy an auto CPAP or an auto BiPAP. Just on the face of it, it would seem that an if an auto CPAP really adjusts to your needs, whatever your needs, this would make the auto BiPAP unnecessary. What can an auto BiPAP do that an auto CPAP cannot do?

I would echo what Sleepster said. Auto-BiPAPs generally go up to 25 cmH2O of pressure, while standard auto-CPAPs and straight CPAPs go only up to 20. If your titrated pressure is actually 18, it's a good bet that eventually at some point, your pressure needs might actually go above 20, in which case a standard CPAP or Auto-CPAP would not deliver sufficient pressures.

It is confusing as to why the sleep center folks think you might be okay with standard CPAP set at 14, but they give a BiPAP inhalation pressure of 18... that's just strange, as it seems to indicate they might be willing to allow you to use CPAP with less than the optimum titrated pressure of 18. I suspect that the person recommending such a thing believes you have difficulty breathing out against a pressure higher than 12 or so, and therefore does not recommend going with a higher standard CPAP pressure of 14 with C-Flex set at 2-3, bringing your exhalation pressure down to a more tolerable 11-12. (the inhalation/exhalation pressure difference on most standard CPAPs is only 3 cmH20 using the Flex or EPR technology, meaning on those machines, you can only lower the exhalation pressure by 3, max).

In this scenario, it would look to me like auto-BiPAP would be your best bet. You get maximum flexibility on exhale pressures, higher level pressure options (up to 25 cmH2O if needed in the future) and the machine auto-adjusts to meet your needs during the night.

I'd probably recommend an auto-BiPAP for nearly all OSA patients who have higher pressure needs, as it offers the most options for treatment all around. Of course, price is usually a big factor, as they're more expensive than standard CPAP or auto-CPAP. But if you have good insurance with no huge co-pays, the auto-BiPAP is a no-brainer in my book... get one if you can... you can always use it in straight CPAP mode (non-auto mode) if need be, but have a lot more treatment options available to you in the future.

Coffee
SuperSleeper
Apnea Board Administrator
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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#4
Hi Apnea 1,
WELCOME! to the forum.!
What has been said so far. A BiPAP sounds like it will be the best thing for you to get if you can swing it.
Best of luck to you with your decision.
trish6hundred
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#5
(06-02-2013, 03:08 PM)Sleepster Wrote:
(06-02-2013, 02:21 PM)Apnea 1 Wrote: My sleep study recommends using pressure of 18/12 (with non-auto BiPAP) or 14 (with non-auto CPAP).

That's pretty strange. What does the doctor say?

If a CPAP pressure of 14 is high enough to prevent obstructive apneas, then I don't understand why they'd recommend a pressure of 18 with a BiPAP. Likely there's more going on here with your symptoms than simple obstructive sleep apnea.

To answer your question, a BiPAP will lower the pressure, in your case, to 12 when you stop inhaling, making it easier for you to exhale against the machine's pressure.

A BiPAP can also be placed in CPAP mode, so if you can afford the extra cost a BiPAP may be the way to go.

I thought that was strange also. I asked the doctor about it and the doctor said no, it is not strange. The doctor said that, in the sleep study, they switched me to CPAP of 14 for a period of time and this proved as effective as the BiPAP pressure of 18/12. Then we went on to other things. But I still think it is strange and would like to understand it better.

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#6
(06-02-2013, 05:01 PM)trish6hundred Wrote: Hi Apnea 1,
WELCOME! to the forum.!
What has been said so far. A BiPAP sounds like it will be the best thing for you to get if you can swing it.
Best of luck to you with your decision.

Thank you! This is a great forum! It has already done a lot, a huge lot, for me.

Right now, I am thinking of getting the auto BiPAP. Can't swing it with the people who supply my needs so I will probably buy it myself.

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#7
(06-02-2013, 03:08 PM)Sleepster Wrote:
(06-02-2013, 02:21 PM)Apnea 1 Wrote: My sleep study recommends using pressure of 18/12 (with non-auto BiPAP) or 14 (with non-auto CPAP).

To answer your question, a BiPAP will lower the pressure, in your case, to 12 when you stop inhaling, making it easier for you to exhale against the machine's pressure.

What would the auto CPAP do here? I had imagined that it would go down to whatever pressure it could go down to without producing an apnea. If it works this way, it would seem to be fine. But I really don't understand how the auto CPAP works.

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#8
Quote:I would echo what Sleepster said. Auto-BiPAPs generally go up to 25 cmH2O of pressure, while standard auto-CPAPs and straight CPAPs go only up to 20. If your titrated pressure is actually 18, it's a good bet that eventually at some point, your pressure needs might actually go above 20, in which case a standard CPAP or Auto-CPAP would not deliver sufficient pressures.

It is confusing as to why the sleep center folks think you might be okay with standard CPAP set at 14, but they give a BiPAP inhalation pressure of 18... that's just strange, as it seems to indicate they might be willing to allow you to use CPAP with less than the optimum titrated pressure of 18. I suspect that the person recommending such a thing believes you have difficulty breathing out against a pressure higher than 12 or so, and therefore does not recommend going with a higher standard CPAP pressure of 14 with C-Flex set at 2-3, bringing your exhalation pressure down to a more tolerable 11-12. (the inhalation/exhalation pressure difference on most standard CPAPs is only 3 cmH20 using the Flex or EPR technology, meaning on those machines, you can only lower the exhalation pressure by 3, max).

In this scenario, it would look to me like auto-BiPAP would be your best bet. You get maximum flexibility on exhale pressures, higher level pressure options (up to 25 cmH2O if needed in the future) and the machine auto-adjusts to meet your needs during the night.

I'd probably recommend an auto-BiPAP for nearly all OSA patients who have higher pressure needs, as it offers the most options for treatment all around. Of course, price is usually a big factor, as they're more expensive than standard CPAP or auto-CPAP. But if you have good insurance with no huge co-pays, the auto-BiPAP is a no-brainer in my book... get one if you can... you can always use it in straight CPAP mode (non-auto mode) if need be, but have a lot more treatment options available to you in the future.

Coffee

Thanks. Food for thought. I need to reread and think about your reply. I will probably get the auto BiPAP. Pay for it myself. What settings should I consider (max IPAP, min EPAP, max PS)? What flex settings should I consider?

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#9
The difference between a bilevel PAP and a regular PAP is the exhale relief. Regular PAPs can only go down 3 points (or raise 3 if inhale based). Meaning if your treatment pressure (the inhale) is 14, then the exhale can be no lower than 11. Except with bilevel PAP, it can go more than 3. This is why bilevels are usually used for patients with other lung issues which makes breathing out against the flow difficult. They get their treatment pressure but their exhale can be much lower.

And, to be honest, your doctor is odd. The pressure setting of 18/12 is different than 14. If you got low AHI with a setting of 14, why on earth would he think a pressure of 18 with bilevel be the same? Maybe he confuses the term "bilevel" with "auto"? That would make more sense.

Whatever you get, you want one that is data capable so you can view the data and monitor your treatment. Most bilevels do this, which is good.

A PRS1 that is both auto and BiPAP probably then has both A-Flex and Bi-Flex. The x-Flex is their term for exhale relief. ResMed's uses the term EPR.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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#10
(06-02-2013, 06:28 PM)Apnea 1 Wrote: What settings should I consider (max IPAP, min EPAP, max PS)? What flex settings should I consider?

If you go the auto-BiPAP route, go with what settings the sleep lab suggests - at least at first. Use it at those levels for at least two weeks, and use software to monitor your treatment during those two weeks. If you have low enough AHI and your comfort levels are sufficient, then just leave it at the settings they suggest. If not, then come back here and post your data in the forums and we can help you tweak the settings to provide lower AHI and more comfort (by changing IPAP, EPAP and pressure support, etc.).

Keep in mind that it's always best to keep your sleep doctor in the loop on any pressure or other settings you decide to change - you're paying for their professional advice, so it's best to at least consider their thoughts into any changes, since they know more about your personal health situation than we do here on the forums.

Coffee

SuperSleeper
Apnea Board Administrator
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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