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Bi-PAP vs. CPAP???

This area is for CPAP Mask and CPAP Machine Related Questions used in the treatment of Sleep Apnea.


Bi-PAP vs. CPAP???

Postby Sleepy Scott » Fri Nov 04, 2005 12:23 am

I've done enough reading of posts here to understand the difference between Bi-PAP and CPAP. I understand that the Bi-PAP has 2 stages which gives lower pressure to push against when exhaling and the CPAP is just a constant pressure. I have not "officially" been diagnosed as of yet (I have my first appointment with my PCP tomorrow morning), but I have all of the symptoms. What I want to know is if there are any situations with apnea in which the CPAP would work better than the Bi-PAP. I'm not sure if my insurance company will give me a choice in this matter, but I think knowing this will give me an edge in trying to convince them if they and I have a difference of opinion in the matter. It would seem to me that from the medical perspective only, the Bi-PAP would be a better choice all the way around, but I've been known to be wrong before.

I just figured I'd throw this out there and see what bounced back from it. It's been something I've been thinking about, and I want a more educated opinion on it.

Thanks,
Sleepy Scott

PS: Yes I really am sleepy!!!
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Postby Vicki » Fri Nov 04, 2005 2:59 am

Hi Scott!

The only thing I know for sure is that Bi-PAPs are usually ordered when the required pressure is high (like 14 cmH2O and above) and it becomes truly difficult to exhale against the higher pressure. Another option is a C-flex, if you get your instrument from Respironics and ResMed just came out with a version too, don't recall the name. It isn't a BiPAP but does assist exhalation by a quick drop and then resumption of pressure. As for me, I'm full pressure all the way baby. Let us know how it goes!

Vicki
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Vos Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.
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Postby Sleepy Scott » Fri Nov 04, 2005 5:33 am

I'm up right after what I believe has been an apnea arousal. You responded to my other string of messages, so you know this happens to me about every night. I may not be in the correct forum to say this, but I'm truly frustrated with this. I'm 33 years old and have probably suffered from this since I was a kid. I think this has been the cause of some deep depression and poor employment performance just because of the fact that I'm so exhausted all the time!

Ok, enough of the rant. Now, let's move on to talking about the other half of the title to this forum, masks. I have had a condition previously that required me to be on home oxygen therapy on an as-needed basis. I was prescribed 6 liters/minute via mask. As I said in the other thread, I didn't have any problems with claustrophobia. The reason I bring this back up is that I never had to sleep with the oxygen on. I'm not going to open up the can of worms about which mask do you prefer because I know that's too objective and based on personal preference. I know that they're probably going to give me a FF mask due to the fact that I am a serious mouth-breather. When I wake up, my mouth is as dry as a desert and tastes really funky. I don't mean to categorize, but please any of you that use a FF mask most of the time, please tell me how invasive the mask is and how heavy it feels. Did it feel like it took a really long time to get accustomed to it? I think I'm going to try to opt for a FF mask without the piece that rests on your forehead because I'm bothered by having something that close to me that's in my line-of-sight. I was on one of the many apnea DME sites and saw one with that design. I don't remember which site it was or what the brand was. Does anybody either have this one or know what it is?

My first appointment with my PCP is in T-minus less than 8 hours and counting. Needless to say, I'm starting to get excited! I will post later in the day to let you know how that went. I don't know if there is anything she can do other than listen to me rant about my problems and symptoms and then order a sleep study. I would think that she might do a pulmonary function test or something of that nature. Anyway, I really look forward to getting the ball rolling on this and eventually being able to sleep and actually be rested by it. I've been pulling my hair out trying to be patient for this. I'm past the point of being exhuberant, but I have to be careful not to make too much noise because my wife is asleep in the other room. I'm the king of going off on tangents... I guess my past study of trigonometry is starting to pay off. Those of you that know trig will get that joke!

Thanks for all your help and thanks in advance for this,
Really Sleepy Scott
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Re: Bi-PAP vs. CPAP???

Postby Daniel » Fri Nov 04, 2005 6:20 pm

Sleepy Scott wrote:I've done enough reading of posts here to understand the difference between Bi-PAP and CPAP. I understand that the Bi-PAP has 2 stages which gives lower pressure to push against when exhaling and the CPAP is just a constant pressure. I have not "officially" been diagnosed as of yet (I have my first appointment with my PCP tomorrow morning), but I have all of the symptoms. What I want to know is if there are any situations with apnea in which the CPAP would work better than the Bi-PAP. I'm not sure if my insurance company will give me a choice in this matter, but I think knowing this will give me an edge in trying to convince them if they and I have a difference of opinion in the matter. It would seem to me that from the medical perspective only, the Bi-PAP would be a better choice all the way around, but I've been known to be wrong before.

I just figured I'd throw this out there and see what bounced back from it. It's been something I've been thinking about, and I want a more educated opinion on it.

Thanks,
Sleepy Scott

PS: Yes I really am sleepy!!!


Hi Scott,

As I have said in the past.......forget about the machine for the present. Concentrate on your appointment and if a sleep study is required then concentrate on that.

Only when you have been diagnosed and require cpap, then concentrate on the MASK. The machine should come last, because if the mask ain't right, then no matter what machine you have you will have difficulties.

Moving on to Bi Level machines. Technically Bi Level PAP is a form of non invasive ventillation (not first line OSA treatment therapy) and is normally given to OSA sufferers who also have other problems such as COPD or CHF. Another suitable receipient is an OSA sufferer who requires a pressure setting above 20cms.............Now before a load of people start posting that they have a Bi Level machine and don't have other problems....that is the clinical/technical position. Some doctors in the US (not in Europe) prescribe Bi Level machines in the first instance......whether rightly or wrongly !!!

One other think with Bi Level machines..............they are bloody dear.

If it's a case that you want to consider other options......maybe you might look at APAP or cflex.

Let us know how you get on.

Kind regards,

Daniel
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Postby Vicki » Sat Nov 05, 2005 12:28 am

Hi Scott,

Don't worry about your rant, I'm the most tangentile person in the world so I followed you just fine!! What kind of interface are you using now? If you are using a nasal mask, a FF mask does not obscure your vision any more. Personally, I didn't find it to be a big deal at all.

There are several FF masks out there, the three most common ones are made by Fisher & Paykel, Respironics and ResMed.

Look forward to hearing from you!

Vicki
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Vos Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.
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Postby rested gal » Sat Nov 05, 2005 3:49 am

Scott, you have a good sense of humor which will stand you in good stead during the search for what Daniel rightly categorizes as the single most important item to concentrate on...the mask.

Don't rule out ones with the forehead pad. Trigonomically speaking..lol (those who've seen me struggle with the simplest math issues are laughing!)...the adjustment thingy on the vertical bar that supports the forehead pad is a very useful element for getting the right "tilt" of mask to face. With some masks (I've tried a bunch of 'em - some just for the "fun" of trying something new) the tilt adjustment ends up working well without even causing the forehead pad to touch the forehead at all...go figure!

At first glance (no pun intended) we'd all prefer nothing up there in front of our eyes. Actually, we'd prefer not wearing any kind of mask at all, but...oh well. Presumably the mask is going to be used when sleeping, not when up and about all that much, so it really doesn't matter a whole lot whether there's a vertical bar up front. It doesn't block vision so much that a person can't unhook the hose and toddle off to the bathroom with mask still in place.

The most important thing is getting a mask that is comfortable, as leakproof as possible without having to cinch the straps down tightly, and that suits you - vertical bar and forehead pad, or not. If you absolutely have to breathe through your mouth at night due to a nasal obstruction, then, yes... a full face mask (covers just nose and mouth, not the entire face) may very well be what you'll need.

The ResMed Ultra Mirage FF (full face) is my personal favorite in a full face mask. I used to wear it all the time until I decided to tape my lips shut to prevent mouth air leaking and mouth breathing. Then I could wear much more comfortable masks such as nasal pillows interfaces. The full face mask is stored in my stash of masks, brought out now only if I have a cold or congestion that makes mouth breathing more comfortable.

Try as many masks as the DME will let you try. And try them in as many of your own sleeping positions as possible. If you are going to be fitted at the DME's office (durable medical equipment -- home health care equipment provider), take along your own pillow and blanket. Mask fittings done sitting up do not simulate the way gravity changes the position of muscles, tendons and skin (and yes, pockets of fat) of the face when you lie down. A mask that feels quite nice and isn't leaking while you're sitting up, can change into the mask from H*** when you lie down. Some masks lose their seal when you start tossing and turning, have a pillow pushing against the side of the mask, etc.

If they don't have a bed or couch you can lie down on, cast dignity to the wind, spread your blanket on the floor and lie down right there in front of God and everybody. Get them to hook a cpap machine using your prescribed pressure to the mask. Test drive the mask thoroughly, as long as you can, right there. Have the person assisting you hold the hose up overhead, out of your way, as if you were a fish on the end of a slack line...for easy tossing and turning under it without getting tangled up in the hose. Because that's going to be the best way to manage the air hose at home too - hanging it up on the headboard or wall. Keeps the weight of the airhose from tugging at your mask when you turn, or hose getting under you.

Simulating your sleeping position is especially important if you have the misfortune of not getting with a DME that will let you try masks at home and swap over and over again until you find the right one for you in your own sleeping environment. The better DMEs will do that. But some are going to let you swap just once. Worse, some have a policy of: "Open the package, it's yours." You may have just one or two shots at selecting the mask you want, so don't let them rush you. Ignore comments such as, "This is our most popular." Or "We never get complaints about this one." Or "That's a good fit for you (while you're sitting up!)" That might simply be the mask they make their most profit on and push the hardest regardless of whether it really suits people at home in REAL sleeping conditions.

Be sure to jot down the size (including every word about the cushion size...like "Medium Standard" or "Medium Shallow") even for masks that you reject during the fitting. Make notes about the rejects too. You never know when you might decide to try a reject in the future, so it will be handy to have a note that said "x mask pressed too hard on bridge of nose". As you learn more and more about masks, you might find that "x mask" comes in other cushion shapes that the DME didn't have, or didn't offer to switch out for you to try. A brand/model you might not like during a fitting might be just the mask that suits you someday down the line, with a different cushion.

Of course, you can always do what many of us end up doing, if your DME doesn't let you keep trying masks at home and bringing back the ones that don't work out.... you can start looking at the many, many masks at online cpap supply stores (see where those voluminous notes about the sizes you try on and reject will come in handy?) and guesstimate what mask and what size will work ... spend money out of pocket for what you want to try. No prescription is needed to buy masks (or any cpap accessories like a heated humidifier) from online stores. Buying a machine from an online store is the only thing that needs a prescription. You'll see the same masks that you saw at the local DME priced at one-half or one-third the price. Supposedly, the "extra service" of personal fitting of a mask by the DME is one of the reasons for higher prices, but if they fit you with a mask that doesn't work and they say, "Sorry, you have to wait three months (or 6 months) before your insurance lets you have another mask..... well.

Hey, Christmas is coming. Make it easy for relatives to shop for you. Put a few masks on your list! LOL!!

Long post, I know. But it can be a very long night if you're fighting a mask that leaks and bores a hole into the bridge of your nose all night. Try as many masks as you can, while you can. Good luck! :-)
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Postby Sleepy Scott » Sat Nov 05, 2005 6:37 am

rested gal,

I hope after while, I can switch my username to rested guy!!! Thank you so much for your post. I don't mind reading an essay when it's going to benefit me. You gave me a lot to remember. I hope my diminished mental capacity doesn't make me forget any of it. It's funny that a lot of times in the past, I've spoken of my diminished mental capacity and made it out to be a joke, never knowing that I have a medical condition that actually causes it. You'd need a knife to cut that irony. Trust me, if you try to look at this world we live in right here in 2005 without a sense of humor, you'd be put in a straight jacket!

I might have to print your post and staple it to my forehead when I'm going to visit my DME. I guess I have somewhat of an advantage there. I have previously been prescribed oxygen for use at home and for the most part, at least during that experience, they seemed like they knew what they were talking about. I know that there's a big difference between ordering oxygen and getting CPAP or Bi-PAP set up. I will absolutely not leave the DME until I have a machine and mask that fits and stays sealed in normal sleeping positions. What's the use of therapy if the seal breaks? I really don't want to spin my wheels on this. I want to take care of it. I should have nipped this in the bud long before now. I believe I've been suffering from this most of my life (33 years), but never knew that being exhausted all the time, depressed, and waking up several times a night wasn't anything out of the ordinary. It's a powerful thing when reality nails you right between the eyes.

I feel that I owe this forum a lot already, even though I haven't been formally diagnosed yet. Everybody's kind words and encouragement have been the gentle kick in the butt I need to persevere and get this taken care of. I can only hope that after I've gotten into my treatment, my experiences will be able to help others as much as all of yours has benefitted me. Thanks again and again and again!!!

Sleepy Scott
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Postby Sleepy Scott » Sat Nov 05, 2005 6:48 am

Vicky and Daniel,

I didn't catch your posts until after I read rested gal and posted a reply to her. I actually haven't been diagnosed yet. I haven't seen my PCP yet. Right now I'm posting to probe for as much information as I can and try to be informed throughout the whole process. One thing I can say is that my symptoms are exactly what the brochure that you, Vicky, posted to me on one of my other threads. I initially had my PCP appointment scheduled for yesterday, but I had a problem with past bills that they refused to see me. I have an appointment with a different doc Wednesday. I'm chomping at the bit to get this taken care of because my sanity is slipping away.

Anyhow, thank you both and everybody for the advice and encouragement. It means immensely more than you know.

Hopefully Not Sleepy Scott For Long
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Postby Marlene » Sat Nov 05, 2005 9:56 pm

Rested Gal, how do you tape your lips shut? What kind of take do you use? I'm going to try that, as my lips started flapping last night, even with a good chin strap! Thanks for your helpful post.
Marlene W.
Started with face mask, had skin problems with silicone, tried many tried many types of masks, methods to avoid skin problems, currently using $25 ?disposable? vinyl nasal mask, with no skin problems. CPAP set at 17.
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Postby rested gal » Sun Nov 06, 2005 3:18 am

Hi Marlene,

I used Johnson & Johnson waterproof adhesive tape. The one inch wide size.

Cut two strips about 5 inches long. Turn down a bit of the end of each strip, to stick the end to itself. Those make handy "grab tabs" making it easier to remove the strips in the morning, or to lift a corner if you need to cough during the night. Be sure the face is washed and completely dry. Tape won't stick well to oily or damp skin.

Place one strip horizontally over your lips, corner to corner. Should be long enough to extend well past the corners of your mouth. It helps to turn your lips inward while applying the tape. Place that first strip just a tad high. Put the other strip on the same way, but a little lower so that the two strips overlap each other. The lips can work a single strip loose too easily. That's why I use two slightly overlapping strips -- to make a really big patch over the entire mouth.

After both strips are in place, you don't have to keep your lips pursed inward any more. Jaw can relax and tape keeps mouth closed. Main thing is, the big patch of tape dams the air from escaping as lip puffs.

Sometimes, with mouth taped, if air escapes into the mouth, your cheeks will puff out like a chipmunk. It takes practice, but is easy once you get the hang of it, to kind of suck the air back out of your cheeks (as if sucking a straw) and work the air back with your tongue to let the air get whisked back the right way. Work the cheek air backwards when that happens....don't swallow the excess air.

Also try to keep the tip of your tongue pressed against the hard palate and front teeth. Getting the tongue to form a seal within your mouth will help prevent the mouth from filling with air from inside and ballooning your cheeks.
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Postby Marlene » Sun Nov 06, 2005 6:46 pm

Thanks for the good help!
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air no longer escaping through mouth, Hy-Tape

Postby Marlene » Mon Nov 07, 2005 12:06 pm

Just one more quick thank you, Rested Gal! I had my best sleep last night in a long time, and am going to try to go without a nap today. The tabs made me feel safer, and the tape comes off just fine with oil or water.

I have some Hy-Tape (with zinc oxide) on hand. It removes comfortably and claims less skin damage. It also claims to stick to wet or oily skin, but I haven't tried that!.
Thanks again,
Marlene
Started with face mask, had skin problems with silicone, tried many tried many types of masks, methods to avoid skin problems, currently using $25 ?disposable? vinyl nasal mask, with no skin problems. CPAP set at 17.
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Postby NoDoz » Tue Nov 15, 2005 5:18 pm

I just talked again with my resmed nurse and now that most of the costs is paid for she wants me to refer stuff to my ENT doctor. Based on what I told her and my complaints, she thinks I should look at the bi-pap. So the answer to your question is probably your going to have to try to cpap first and then move up to the bi-pap. I assume that means you can bend over so they can pry more money out of your wallet.

I think that they could have done a better assessment and this is what I wanted to pass on, they seem to be in a big hurry to recommend the cpap and all your problems just vanish mode. If they would have looked at my history - choking accident, ex-smoker, someone who sleeps on his side, hates humidified air, etc, they should have known that the cpap was not going to work and saved me a lot of grief.

Since you don't have the equipment yet be sure to ask a lot of questions - why the cpap versus the bipap? What about weight, side, tummy, back sleeping. Can I try the equipment and return it in so many days. NOte: I have three friends that gave there's up after a month or so and the thing sits in closet.
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Postby BARBCCRN » Tue Nov 15, 2005 6:08 pm

8-) 8-) -I'M A NEW KID ON THE BLOCK-SO I CAN TOTALLY RELATE TO SLEEPY SCOTT!!!!!!
HAVE HAD 2 SLEEP STUDIES. AFTER 2ND-THE NIGHT I WAS PUT ON CPAP I WOKE UP FEELING WIDE AWAKE-THE 1ST TIME IN YEARS. I'M GETTING MY EQUIPMENT NEXT WEEK-IN THE MEANTIME I STILL GET REALLY TIRED THROUGHOUT THE DAY... BUT AT LEAST I NOW KNOW THE REASON. HOPE EVERYTHING WENT WELL AND SCOTT WILL BE SLEEPY-NOT MUCH LONGER :lol: :lol:
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