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[Pressure] Bipap on Tracheostomy
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me50 Offline

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Posts: 2,559
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Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

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Sex: Undisclosed
Location: USA

Post: #11
RE: Bipap on Tracheostomy
yep, I know what a vpap is as I use one. and yes, as I and Robysue and others suggested, a call to the doc is the best way to find out the answers the OP asked. I can see using a vpap, cpap, etc. for some medical conditions other than apnea. EDIT: I just don't understand how a vpap can be used with a trach and that is why I asked the OP how it works and how it works with no mask and with a humidifier. Just trying to learn something and to understand. That's all.
(This post was last modified: 03-19-2014 07:31 PM by me50.)
03-19-2014 05:04 PM
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luvkher Offline

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Posts: 4
Joined: Feb 2014

Machine: resmed
Mask Type: Not using mask
Mask Make & Model: none
Humidifier: h5i
CPAP Pressure: 5/11
CPAP Software: Not using software

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Sex: Male
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Post: #12
RE: Bipap on Tracheostomy
Thanks everyone for the replies,
To elaborate little bit more,
1. Bipap is indeed used with Trach, there is a valve which needs to be there between the hose and trach, this is for the expiration flow.
2. normally it works fine with a cuffed tracheostomy as then it creates a positive air pressure, in this case question is if it could work on uncuffed, as then the positive air pressure would be compromised due to high leak.
3. Indeed being used in the night to assit breathing and prevent apnea, The Mouth is usually open so the leak is higher due to this.
4. Vaughn, you are right, that resmed compensates the leakage with additional pressure and understood rightly that it is the "unintentional leak" which is what i wanted to prevent. this leakage is what is happening due to open mouth.
5. another issue noticed with this is that the lungs get dry due to high leak (Through the mouth) and hence increasing the need of nubulization. (despite the fact that the machine has a Heated Humidifier)

I will check with doc as well but here in city where we live, i doubt if there is much expertise available on the concept of query.

Thanks again and would still await if any comments based on my explanation above.
03-20-2014 02:32 PM
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PaulaO2 Offline
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Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #13
RE: Bipap on Tracheostomy
So you have central apnea events, too? Dang.

There are some good chin straps on the market that are rather comfortable and would probably work for you. If that's your primary source of leaks, one of those should stop them.

PaulaO2
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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.
03-20-2014 06:49 PM
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me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #14
RE: Bipap on Tracheostomy
(03-20-2014 02:32 PM)luvkher Wrote:  Thanks everyone for the replies,
To elaborate little bit more,
1. Bipap is indeed used with Trach, there is a valve which needs to be there between the hose and trach, this is for the expiration flow.
2. normally it works fine with a cuffed tracheostomy as then it creates a positive air pressure, in this case question is if it could work on uncuffed, as then the positive air pressure would be compromised due to high leak.
3. Indeed being used in the night to assit breathing and prevent apnea, The Mouth is usually open so the leak is higher due to this.
4. Vaughn, you are right, that resmed compensates the leakage with additional pressure and understood rightly that it is the "unintentional leak" which is what i wanted to prevent. this leakage is what is happening due to open mouth.
5. another issue noticed with this is that the lungs get dry due to high leak (Through the mouth) and hence increasing the need of nubulization. (despite the fact that the machine has a Heated Humidifier)

I will check with doc as well but here in city where we live, i doubt if there is much expertise available on the concept of query.

Thanks again and would still await if any comments based on my explanation above.

where is your doc that wrote the script for your machine? also, curious if the trach was put in for SA rather than using a cpap. hope you get the answers you are looking for. I agree with everyone that a doc is the best person to answer your questions.
03-20-2014 08:28 PM
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vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #15
RE: Bipap on Tracheostomy
(03-20-2014 02:32 PM)luvkher Wrote:  Thanks everyone for the replies,
To elaborate little bit more,
1. Bipap is indeed used with Trach, there is a valve which needs to be there between the hose and trach, this is for the expiration flow.
2. normally it works fine with a cuffed tracheostomy as then it creates a positive air pressure, in this case question is if it could work on uncuffed, as then the positive air pressure would be compromised due to high leak.
3. Indeed being used in the night to assit breathing and prevent apnea, The Mouth is usually open so the leak is higher due to this.
4. Vaughn, you are right, that resmed compensates the leakage with additional pressure and understood rightly that it is the "unintentional leak" which is what i wanted to prevent. this leakage is what is happening due to open mouth.
5. another issue noticed with this is that the lungs get dry due to high leak (Through the mouth) and hence increasing the need of nubulization. (despite the fact that the machine has a Heated Humidifier)

I will check with doc as well but here in city where we live, i doubt if there is much expertise available on the concept of query.

Thanks again and would still await if any comments based on my explanation above.


Hi luvkher,

As PaulaO2 said, a chin strap of some type is needed. As soon as the mouth and nasal leaking is stopped the airflow will drop low enough that the humidifier should be able to do its job and not use up all its water too quickly, even if you turn up the humidifier to better humidify the air. If Climate Control is set to Automatic, the air will be humidified the most when the temperature setting is adjusted to its max. (You should be using the Climateline heated hose, which allows the humidity to be turned up without allowing condensation in the tube.)

By the way, be sure to change your air filter often. I would recommend you use the ResMed hypoallergenic filters and replace the filter at least monthly. If you are independently wealthy, it may be ideal to change the filters weekly, since your nasal passages are not helping to filter the air.

ResMed recommends that the hose be disconnected from the machine and hung daily to air out and dry, and cleaned weekly and replaced occasionally, so bacteria and mold do not grow inside it.

What model VPAP do you have? If it is an S9 you can put a 1 GByte or 2 GByte physically-full-size SD memory card in it and can use free ResMed or SleepyHead software to see the time plots of Leak and Pressure for every minute of the night, to see whether the mouth leaking is so big that the machine is unable to maintain its target Pressure (not likely). And you can keep track of any apneas or hypopneas, see how long they last. And if it is an S9 model you can see a plot of the estimated Flow into and out of your lower trachea and lungs, to watch for periodic breathing or Cheyne-Stokes respiration, which may indicate a need for an Adaptive Servo Ventilator (ASV) class CPAP machine. If it is an S8, ask for the proprietary ResMed Smart Card and the proprietary ResMed Smart Card Reader (USB interface).

Again, it is important not to let unintentional Leak get too small. "Unintentional" Leak needs to be at least a little higher than zero, especially since your EPAP is only 4, which may be the lowest your machine can be adjusted to. (The lower the Pressure, the lower the intentional Leak, and the vent hole needs to allow adequate intentional Leak even when the pressure is minimum.)

If intentional Leak is too small (if your Leak Valve is closed off too much) you can die from suffocation. So don't mess with the Leak Value. Having said that, if after the mouth and nasal leaking is corrected the humidity is still too low and the ResMed plots of unintentional Leak still show a large or even a moderate amount of unintentional Leak (even when you know for sure that your mouth and nose are completely closed off), alert your doctor that you think the Leak Valve may be open too much.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 03-21-2014 03:59 AM by vsheline.)
03-21-2014 01:28 AM
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robysue Online
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Advisory Members

Posts: 1,233
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #16
RE: Bipap on Tracheostomy
(03-18-2014 02:43 PM)luvkher Wrote:  Hi
Can anyone guide on the BIPAP use with Tracheostomy.
?

...

The Leak value is 5/6

Question is , is it ok to have this high leak value ?, will there be any benefit with these high leak settings, i.e. normally if benefit with No leak to be rated at 100%, then with leak of 5/6, could it be 20% benefit
I am completely confused by what you are saying about the leaks.

Where are you getting the 5/6 number from? And what do you mean by 5/6? Are you saying the reported leak rate is usually between 5 and 6? If you are getting these numbers off the long version of the Sleep Quality report in the morning and your 95% unintentional leak rate is between 5 L/min and 6 L/min, that's actually a very low unintentional leak rate. Indeed, this level of unintentional leaking in a patient with an intact airway is considered excellent and has NO adverse effect on the efficacy of the therapy.

But if you mean something else by what you've written, then I have no idea what you are trying to convey.

(03-20-2014 02:32 PM)luvkher Wrote:  Thanks everyone for the replies,
To elaborate little bit more,
1. Bipap is indeed used with Trach, there is a valve which needs to be there between the hose and trach, this is for the expiration flow.
2. normally it works fine with a cuffed tracheostomy as then it creates a positive air pressure, in this case question is if it could work on uncuffed, as then the positive air pressure would be compromised due to high leak.
That's a question for the doc who wrote the script for the VPAP/BiPAP and/or the doc who did the trach.

Quote:3. Indeed being used in the night to assit breathing and prevent apnea, The Mouth is usually open so the leak is higher due to this.
What kind of apneas? OAs usually occur at a level higher in the upper airway than where a trach occurs. CAs are usually NOT treated with an ordinary VPAP; they're treated with a VPAP Adapt ASV unit, which is more expensive and has an algorithm for dealing with the central apneas.

And just how high is the leak rate? That's still not clear to me.

Quote:4. Vaughn, you are right, that resmed compensates the leakage with additional pressure and understood rightly that it is the "unintentional leak" which is what i wanted to prevent. this leakage is what is happening due to open mouth.
Again, can you tell us exactly where you're getting the leak rate numbers and exactly what they are? Your notation of "The Leak value is 5/6" does not make sense to me.

Quote:5. another issue noticed with this is that the lungs get dry due to high leak (Through the mouth) and hence increasing the need of nubulization. (despite the fact that the machine has a Heated Humidifier)
This is a problem that you need to discuss with the doc who prescribed the VPAP.

When a person with an intact airway uses a VPAP, the heated humidifier is really a comfort feature only---and it's purpose is to keep the nasal and oral passages from drying out. By the time the pressurized air enters the lungs, the sinuses and nasal mucosa in upper airway have had a chance to warm and humidify the air more or less normally and so the lungs themselves are not at risk of getting dried out.

But with the trach, the pressurized air is entering the lungs while bypassing most or all of the upper airway, and that is part of why PAP machines typically come with a warning that having a trach is a counterindication to using PAP.

Quote:I will check with doc as well but here in city where we live, i doubt if there is much expertise available on the concept of query.
If the doc who wrote the script for the VPAP cannot answer your questions, then quite frankly he should not have written the script.
(This post was last modified: 03-21-2014 08:40 AM by robysue.)
03-21-2014 02:32 AM
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vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #17
RE: Bipap on Tracheostomy
(03-20-2014 02:32 PM)luvkher Wrote:  4. Vaughn, you are right, that resmed compensates the leakage with additional pressure and understood rightly that it is the "unintentional leak" which is what i wanted to prevent. this leakage is what is happening due to open mouth.

Hi luvkher,

Actually, rather than compensating the leakage "with additional pressure", the machine compensates the leakage with additional airflow through the hose in order to maintain the "Mask Pressure" at the patient end of the hose unchanged (which is the pressure at the mask vent holes for intentional leak, or the pressure at your Leak Valve for intentional leak).

Assuming the extra airflow leaking through your nose and mouth is not absolutely huge, the machine is maintaining the pressure at the Leak Valve at 8/4. But there is an excessively high rate of airflow through the humidifier, using up the water too fast, even though the air is passing through the humidifier so quickly that it does not get adequately humidified.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
03-21-2014 03:53 AM
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