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Went ahead and bought a BiPAP. Why is it better for UARS? - Printable Version

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Went ahead and bought a BiPAP. Why is it better for UARS? - CentralApneaUser909 - 02-04-2021

I have UARS and tried a Phillip's Respironics APAP for about a week. I felt some benefit... dreams more vivid and felt a bit more rested. But my main symptom of waking up throughout the night was persistent (usually wake up multiple times). 

I found that my flow limitations still persisted and that even at higher minimum pressures of 14, I still had them.

So I read that BiPAP can be better for UARS and found a cheap used Resmed s9 fixed BIPAP with humifidier. I bought it and am awaiting its arrival. 

Can someone explain why BiPAP is better for UARS than CPAP? My understanding is that the exhale relief is what makes it better for FLs as exhaling becomes easier. Usually I do struggle a bit to exhale against the CPAP pressures tbh.


RE: Went ahead and bought a BiPAP. Why is it better for UARS? - Sleeprider - 02-04-2021

A bilevel machine has separate inhale and exhale pressure settings. The difference between IPAP and EPAP is called pressure support (IPAP-EPAP=PS). With your Dreamstation, you got a single pressure, but with bilevel, the perceived pressure, is much lower when there is a difference or contrast between the inhale and exhale pressure. Pressure support helps to off-load some of the effort of inspiration, form your abdominal and chest muscles used to expand the diaphragm, to the machine's pressure. Then the lower exhale pressure makes it easier to exhale. Pretty simple, but you're about to find out.

With bilevel you can use a lower EPAP pressure and overcome any airway resistance by letting the pressure support do its work, then exhale will feel very easy. EPAP is used to prevent obstructive apnea and can be relatively low. Since you never posted a single chart with your CPAP or even included your pressure settings in your profile, I have nothing more to add on what your settings should be.


RE: Went ahead and bought a BiPAP. Why is it better for UARS? - CentralApneaUser909 - 02-04-2021

(02-04-2021, 08:52 PM)Sleeprider Wrote: A bilevel machine has separate inhale and exhale pressure settings. The difference between IPAP and EPAP is called pressure support (IPAP-EPAP=PS).  With your Dreamstation, you got a single pressure, but with bilevel, the perceived pressure, is much lower when there is a difference or contrast between the inhale and exhale pressure.  Pressure support helps to off-load some of the effort of inspiration, form your abdominal and chest muscles used to expand the diaphragm, to the machine's pressure. Then the lower exhale pressure makes it easier to exhale. Pretty simple, but you're about to find out.  

With bilevel you can use a lower EPAP pressure and overcome any airway resistance by letting the pressure support do its work, then exhale will feel very easy.  EPAP is used to prevent obstructive apnea and can be relatively low.  Since you never posted a single chart with your CPAP  or even included your pressure settings in your profile, I have nothing more to add on what your settings should be.

I'll post the charts tomorow if I can.

I can tell you what my pressures were though. For the first 2 days, I had at 4 min and 20 max. The 3rd day it was 6 min and 20 max..the 4th day I upped it to 8 min and 20 max. The 5th day I upped to 12 min and 20 max and the 6th day I uppsed to 14 min and 20 max. FLs persisted.


RE: Went ahead and bought a BiPAP. Why is it better for UARS? - Sleeprider - 02-04-2021

We use EPAP to treat OA, and pressure support for flow limits. You want to set EPAP min to what ever pressure resulted in treatment of OA events, then we will just start at PS 4 for the flow limits and go from there. Sounds like you go a S9 VPAP - S machine. If no OA at x.00 pressure, then set IPAP to x.00 + 4.0.


RE: Went ahead and bought a BiPAP. Why is it better for UARS? - CentralApneaUser909 - 02-04-2021

(02-04-2021, 09:14 PM)Sleeprider Wrote: We use EPAP to treat OA, and pressure support for flow limits. You want to set EPAP min to what ever pressure resulted in treatment of OA events, then we will just start at PS 4 for the flow limits and go from there.  Sounds like you go a S9 VPAP - S machine. If no OA at x.00 pressure, then set IPAP to x.00 + 4.0.

Going from how I felt anecdotally off the top of my head, I felt better at min pressure 10/11.

I am excited for BiPAP because I DID feel a benefit from APAP, but the EPAP just wasn't good enough at higher pressures for obvious reasons. 

Going by what you've seen from members here, do you think BiPAP usually do a good job at treating FLs in the majority people with UARS ? I really hope it isn't the case that I have to get an ASV.


RE: Went ahead and bought a BiPAP. Why is it better for UARS? - Sleeprider - 02-04-2021

When you get your machine, reset all the user data and settings to default, then set it to VPAP S mode, with EPAP 8.0, IPAP 12.0 and be sure the comfort feature Easybreathe is on. We can go from there. Get a copy of the clinical manual so you understand how to access settings and what is available. https://www.apneaboard.com/adjust-cpap-pressure/change-cpap-pressure-settings-adjusting-your-machine-with-a-clinician-setup-manual


RE: Went ahead and bought a BiPAP. Why is it better for UARS? - CentralApneaUser909 - 02-04-2021

(02-04-2021, 09:27 PM)Sleeprider Wrote: When you get your machine, reset all the user data and settings to default, then set it to VPAP S mode, with EPAP 8.0, IPAP 12.0 and be sure the comfort feature Easybreathe is on.  We can go from there.  Get a copy of the clinical manual so you understand how to access settings and what is available. https://www.apneaboard.com/adjust-cpap-pressure/change-cpap-pressure-settings-adjusting-your-machine-with-a-clinician-setup-manual

Thanks, I'll be sure to do this. What is easybreathe and the benefit of it?