(08-11-2013 08:10 PM)pdeli Wrote: 1) I'm still exhausted (although I no longer need to pull over for a nap), 2) I often feel like I don't get enough air (Not gasping, but not enough), and 3) maybe 4 times a week, both my wife and I are awakened by a "fluttering" sound that I think comes from the back of my throat.
A friend who is a tech in a sleep lab told me that she thinks I need a Bi-pap (more expensive i guess than C-Pap) that would deal with at leasf #2 and 3 (and maybe #1).
Hi pdeli,welcome to the forum!
Your 7 cmH2O pressure is quite low. Is your machine running in CPAP mode, or Auto mode?
You may be more comfortable (easier to breath in) with a higher pressure, such as 9, especially if you feel at all like you have been needing to work to suck in enough air during inhale.
(08-11-2013 08:27 PM)PaulaO2 Wrote: I don't see how a bilevel PAP would help with #2. It would make it worse.
Actually, standard bilevel would probably help with #2, because, unlike standard CPAP or APAP machines which can only use EPR or C-Flex or A-Flex (which lower the pressure during exhale by up to 3 cmH2O), all bilevel machines have another setting which is called Pressure Support. Pressure Support boosts the pressure during inhale to make inhale easier.
(08-11-2013 08:27 PM)PaulaO2 Wrote: Bilevel can go more than 3 and are recommended for folks with higher pressures, cannot tolerate the pressures, or have a lung condition that prevents them from breathing out against even a 3 point drop. Going by the same inhale of 12, if the EPR is set to 5, your exhale would be 7.
Actually, in Respironics bilevel machines, the Flex is still limited to 3, but Pressure Support can be added to increase the pressure difference (between inhale versus exhale) to more than 3.
I've read conflicting descriptions of Bi-Flex. On some Respironics machines Bi-Flex is described as affecting (only) the smoothness versus abruptness of the transitions in Pressure Support. On others, it is described as being the same as C-Flex or A-Flex, which actually lower the pressure during exhale, but only during the first fraction of the exhale period. (ResMed EPR is different in this regard, because EPR lowers the pressure during the whole time we are exhaling, not just during the first second or so.)
The PRS1 BiPAP Auto clinician guide says it can use both Bi-Flex and Pressure Support at the same time, and the Flex setting only lowers the exhale pressure by up to 3 cmH2O during the first early portion of exhale, not during the whole time we are exhaling.
Pressure Support can raise the pressure (by up to 10) during the whole time we are inhaling.
So a bilevel example for the PRS1 BiPAP Auto would be, if the inhale pressure setting (IPAP) is 9 and the Flex setting is 2, and the PS setting is 4, then the pressure during exhale would drop to 7 but only during a short portion of the exhale time (returning to 9 for most of the exhale time), and the pressure during inhale would increase to 13 and stay there until the inhale time was finished.