Cpap vs. Bi-Pap

[RonWessels]

... 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.)

Not quite. PRS1 Flex settings lower the pressure at the detected start of the exhale, then restore the pressure at the detected end of the exhale. ResMed EPR settings lower the pressure at the detected start of the exhale, then restore the pressure at the detected start of the next inhale.

The difference is in the period between exhale and inhale, where ResMed machines are still at the lower pressure, but PRS1 machines are back at the treatment pressure.

This is difficult to confirm on PRS1 machines without an inline manometer. However, on ResMed machines, it is easy to confirm by closely examining the Mask Pressure graph.

[Sleepster]

Previously my air pressure was reduced to 7 because air was ending up bloatjng my stomach.

It's common to prescribe a BiPAP for that condition.

[pdeli]

Here's an interesting development (at least to me); I've noticed that over the past several weeks, my nasal mask is no longer a nuisance. In other words I seemed to have adapted to it and it has become part of my sleeping. I don't feel like taking it off when I'm awake (sometimes for several hours), and I don't take it off as soon as I wake up either. Sometimes when I wake up during the night, I feel my face to see if it is there.

How great is that? Plus AHI is now 0.40.

Also, the "fluttering" that I spoke of earlier seems to be gone as well. I suspect that I have adjusted to keeping my tongue up on the roof of my mouth up against my teeth and my mouth closed. In fact, it is in that position as I type this.

But I'm still very tired all day and I feel like I need more air, so I'm interested to see if my bi-pap trial next week will make any difference in that respect.

I've said this before, but this stuff is both complicated and very personalized.

Phil

..... Snip.....
Another point that I had neglected to mention here was that when I was first tested, my AHI was 30+ and now my 30 day average is .9. The Doc said that means that the C-Pap is working. And there's no need for further testing.

Be that as it may, none of that really matters because I'm still generally exhausted.

I was successful however, in setting up a 7 day Bi-Pap trial which will commence after Labor Day when we get back from a trip.

Oh yeah the "fluttering", the ....Snip....... So we'll see what if anything happens with the Bi-Pap test, and again I appreciate all of the feedback here.

Phil

[Sleepster]

How great is that? Plus AHI is now 0.40.

That's awesome. You'll definitely start noticing an improvement in the way you feel.

Why do you think you need a BiPAP?

[pdeli]

Hell, I don't really know. What I do know is that I feel like I don't get enough air at 7 cmh. I also know that when I exhale (while wearing the full face mask) I can feel the resistance, and if I yawn, I breath in my own air.

I kind of expected that there would be a scientific measure to determine settings, but it seems to be an "Ok, well try this" approach. I missed a great opportunity when I was up in WA last week, to try a friend's Bi-Pap. He's given up using it because it was too much work.

I also have a boating friend who was a respiratory therapist (now an RN) who said that based on our discussions, a Bi-Pap made sense. Now bear in mind that we're sitting out on a boat somewhere, with no data to look at, trying to make sense of my poorly explained issues. (For whatever reasons, I can't read my card on Sleepyhead anymore, so that was not helpful.)

Basically I think both my friend and the Doc (plus my badgering) went for the 7 day Bi-Pap trial because of the previously mentioned "fluttering". The Doc seems to be saying "Well you can try the Bi-Pap next week, but your AHI is way down, so everything is working well, so call me in 2020".

My response is "but I'm still exhausted!".

I'm very happy that I seem to have adjust to wearing the mask and the fluttering has stopped, plus I forgot to mention, the Alfalfa C-Pap Hair-in-the-air thing has also somehow gone away.

One question I have is can the B-Pap be a bad thing? Seems like it's more adjustable than the C-Pap.

God, my head is overfull with all this.

Phil

How great is that? Plus AHI is now 0.40.

That's awesome. You'll definitely start noticing an improvement in the way you feel.

Why do you think you need a BiPAP?

[Sleepster]

When I switched from a CPAP to a BiPAP my AHI shot up from under 5 to around 17. Lots of central apneas.

At 7 cm of pressure the EPR will get you down to 4 cm. That's the same thing a BiPAP will do for you.

If you feel you're not getting enough air at 7 cm when you're lying down, how can you feel ok during the day when you're walking around and breathing at 0 cm?

You've noticed that you're adapting well, that process will continue and soon you won't notice that 7 cm of pressure.

Remember the only reason we do the CPAP thing at night is so we can enjoy our lives during the day.

[vsheline]

... What I do know is that I feel like I don't get enough air at 7 cmh. I also know that when I exhale (while wearing the full face mask) I can feel the resistance, and if I yawn, I breath in my own air.
...
The Doc seems to be saying "Well you can try the Bi-Pap next week, but your AHI is way down, so everything is working well, so call me in 2020".

My response is "but I'm still exhausted!".

...

One question I have is can the B-Pap be a bad thing? Seems like it's more adjustable than the C-Pap.

Hi Phil,

I hope your doctor is not paying attention only to your great AHI, when you are complaining of still feeling exhausted.

It is possible that a bi-level unit would help reduce/eliminate your feelings of being exhausted. Bi-level therapy can help eliminate Respiratory Effort Related Arousals (RERAs), which can prevent some people from reaching deep restorative stage of sleep. RERAs can occur without raising the AHI, so the AHI may look fine but there may be many RERAs.

If you are not using A-Flex, using it would probably help you feel less resistance during exhale, at least during the early portion of exhale. I think most doctors and respiration therapists encourage patients to adjust the Flex setting to whatever setting (0-3) feels most comfortable.

Also, if it feels like you have to work a little too hard to inhale, this is often helped by raising the pressure a little. Your pressure is 7, and raising it to 8 or 9 may be more comfortable for you during inhale. And the larger the difference between the inhale pressure and the exhale pressure, the easier it will be to breath in and out, which is why bi-level units can eliminate RERAs.

You mention that SleepyHead is not working on your computer. If you can manage to find the problem then you would be able to see how well your treatment is working. (Perhaps you can post a question on the SleepyHead thread and receive ideas on how to troubleshoot the problem.)

Take care,
--- Vaughn