Difference between BiPap and CPAP

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


Difference between BiPap and CPAP

Postby the brewer's wife » Wed Jun 29, 2011 7:57 am

My husband's doctor has changed his machine from a CPAP to a BiPAP. I haven't been able to go to the past few appts, and I can't go with hubby to the DME to get his new BiPAP. Can anyone explain to me why one machine would be preferrable over the other and in what situations? Searches on this site gave me limited info. I hate to be "that wife" but I'm thinking of scheduling an appt with the ENT/sleep doc for myself so I can get the info and ask some questions. Thanks!
the brewer's wife
 
Posts: 65
Joined: Tue Apr 20, 2010 2:43 pm
Machine: BiPAP
Mask: Quatro FX
Humidifier: Yes
Year Diagnosed: 2009

Re: Difference between BiPap and CPAP

Postby Daniel » Wed Jun 29, 2011 8:23 am

the brewer's wife wrote:My husband's doctor has changed his machine from a CPAP to a BiPAP. I haven't been able to go to the past few appts, and I can't go with hubby to the DME to get his new BiPAP. Can anyone explain to me why one machine would be preferrable over the other and in what situations? Searches on this site gave me limited info. I hate to be "that wife" but I'm thinking of scheduling an appt with the ENT/sleep doc for myself so I can get the info and ask some questions. Thanks!


BiPAP (Philips Respironics brand name), is BiLevel therapy. ResMed use the name VPAP or ASV.
Bilevel machines are effectively Non Invasive Ventilation (NIV), as distinct from Positive Airway Pressure.
Machine is similar in size and appearance to CPAP. Same mask can be used.
Latest models can include an 'Auto' feature.
BiLevel machines are considerably dearer than CPAP machines.

BiLevel involves two pressure settings (IPAP/EPAP)....one for inhalation and one for exhalation.

Reasons for the change could be:
1. Inability to handle CPAP, specifically a problem with exhalation and the need to reduce the exhalation pressure significantly (usually in excess of 4/5 cmsH2O).
2. Another respiratory condition in addition to Sleep Apnoea (typically asthma, COPD)....or a cardiac condition such as CHF (Congestive Heart Failure). BiLevel is NOT a first line treatment for Sleep Apnoea.
3. Pressure requirement in excess of 20 CmsH2O......CPAP machines usually max out at 20 CmsH2O. BiLevel machines can deliver pressure up to 35, depending on manufacturer. IMHO, anyone requiring a pressure above 17 should look towards BiLevel for comfort.

Good idea to talk to the specialist......there has to be a solid reason for proposing the change.

Daniel.
Daniel
 
Posts: 6006
Joined: Sat Jun 25, 2005 5:49 am
Location: Ireland
Machine: Philips Respironics System One Auto
Mask: ResMed Micro Nasal Mask
Humidifier: No
Year Diagnosed: 1993

Postby CrohnieToo » Wed Jun 29, 2011 9:40 am

One qualifier: in the US the ENT/sleep doctor can NOT discuss your husband's situation w/you w/o the explicit permission of your husband, either by his presence at the appointment or by his written permission.
ResScan 3.10 - Resmed S8 ResLink & oximeter
ConTec CMS-50D+ oximeter - Philips EverFlo 5L Oxygen Concentrator
PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2.14.0
User avatar
CrohnieToo
 
Posts: 7943
Joined: Mon Mar 20, 2006 9:18 pm
Location: Mid-Michigan
Machine: Resmed S8 VPAP Auto
Mask: Resmed Quattro FX Small
Humidifier: Resmed H3i
Year Diagnosed: 2006

Postby Bons » Wed Jun 29, 2011 10:30 am

Don't let Daniel's post scare you: it doesn't have to be a MAJOR problem for proposing the change. It could be that he is having pressure-induced central apnea events; that would be resolved by the bipap, so it's not a change in his medical condition, just a problem that needs addressing. :-D

Whereas CPAP sets a single pressure above the ambient pressure, BiPAP sets two pressures above the ambient, a higher (IPAP) and a lower (EPAP), e.g., 10/5 cm H2O (see pressure curve, below). In BiPAP the higher pressure is experienced on inspiration and the lower pressure on expiration. Note that both pressures are always above ambient.

In the NON-ACUTE SETTING, BiPAP has 3 main uses:

1) For obstructive sleep apnea (OSA) that does not respond to CPAP. Either there is patient intolerance to the fixed pressure, or the patient just needs two levels of pressure to eliminate the apneas. In these situations BiPAP is often effective.

2) BiPAP is generally more effective than CPAP in central sleep apnea (e.g., Cheyne-Stokes breathing).

3) BiPAP is sometimes used for patients with chronic hypercapnia, for augmentation of oxygenation and ventilation during sleep. Examples include patients with neuromuscular impairment (post-polio syndrome; amyotrophic lateral sclerosis).
PR bipap auto sv advanced
Fisher and Paykel flexifit 431
Bons
 
Posts: 572
Joined: Fri Sep 03, 2010 1:11 pm
Location: Pennsylvania
Mask: fx for her nasal mask

Difference between BiPAP & CPAP

Postby the brewer's wife » Wed Jun 29, 2011 3:15 pm

Thanks guys! This is a huge help. Yep Crohnie, I've hit that HIPPA Hippo before. We've learned to take care of that problem right up front! I think this confirms my need to talk to the doc myself to see what changed after the surgery, or perhaps what became evident. Hubby's SA is quite severe; his apenea went from 92/hour prior to surgery to 70/hour after. A great improvement but still quite severe. I really need copies of his studies because I want to know more about the O2, etc.

Wish us luck with a new therapy. Hubby already has his mind set against it, but is only trying this because I'm such a PIA and I want to keep him around! Thanks again!
the brewer's wife
 
Posts: 65
Joined: Tue Apr 20, 2010 2:43 pm
Machine: BiPAP
Mask: Quatro FX
Humidifier: Yes
Year Diagnosed: 2009

Postby Bons » Wed Jun 29, 2011 3:35 pm

Tell him (the truth) that many people find the bipap's different pressures for inhaling and exhaling a much more natural and comfortable way to breathe.
PR bipap auto sv advanced
Fisher and Paykel flexifit 431
Bons
 
Posts: 572
Joined: Fri Sep 03, 2010 1:11 pm
Location: Pennsylvania
Mask: fx for her nasal mask

Postby Daniel » Wed Jun 29, 2011 4:39 pm

Bons wrote:Tell him (the truth) that many people find the bipap's different pressures for inhaling and exhaling a much more natural and comfortable way to breathe.


I think you are missing the point of CPAP.......positive airway pressure, to splint the airway open while you breathe naturally using your own effort.....this is natural and comfortable.

On the other hand, BiLevel (BiPAP, VPAP, ASV etc) is Non Invasive Ventilation......this type of device encourages or instigates breathing.......certainly not natural and for all those who find it comfortable, there have been reports on the forum of people who find it uncomfortable as they find that the 'machine' instigates breathing and they have to synchronise to its tempo.......although, thankfully the newer devices often have an auto function that helps considerably.

I believe that this is the 'whole truth'..... ;-)

Daniel.
Daniel
 
Posts: 6006
Joined: Sat Jun 25, 2005 5:49 am
Location: Ireland
Machine: Philips Respironics System One Auto
Mask: ResMed Micro Nasal Mask
Humidifier: No
Year Diagnosed: 1993

Differences in machines

Postby the brewer's wife » Thu Jun 30, 2011 7:09 am

Last night was the first night with the new machine. Geez but that thing is quiet! I could still hear the crickets out the open window. Hubby even heard the cat meowing to get in. We didn't get much sleep though. Me because I wanted to see how he reacted to it, and him because he was anxious. I know his brain was churning, but his legs were twitching/moving like mad. He was even moving his toes! I am 100% certain this is an anxiety issue, and he was trying to keep himself awake. When he did his last sleep study the doc said he had restless leg syndrome and tried to prescribe meds. With my confirmation, hubby assured him this was not the case and he has no other symptoms. The doc couldn't understand because his legs were cranking all night. Now we know! His mask did not leak, but he did swallow a lot of air hence a gas issue this morning. He needs to learn to not sleep on his back which would help him keep his mouth shut. I think he would also fall asleep faster and quite possibly stay asleep longer. As much as he said he didn't sleep, he sure was in a better mood this morning. Even cracked a few jokes/puns. Thanks again guys for all your help. You've made me feel better, and I hope I can translate that to being more supportive for him.
the brewer's wife
 
Posts: 65
Joined: Tue Apr 20, 2010 2:43 pm
Machine: BiPAP
Mask: Quatro FX
Humidifier: Yes
Year Diagnosed: 2009

Re:

Postby robysue » Tue Jul 26, 2011 4:14 pm

Daniel wrote:
Bons wrote:Tell him (the truth) that many people find the bipap's different pressures for inhaling and exhaling a much more natural and comfortable way to breathe.


I think you are missing the point of CPAP.......positive airway pressure, to splint the airway open while you breathe naturally using your own effort.....this is natural and comfortable.

On the other hand, BiLevel (BiPAP, VPAP, ASV etc) is Non Invasive Ventilation......this type of device encourages or instigates breathing.......certainly not natural and for all those who find it comfortable, there have been reports on the forum of people who find it uncomfortable as they find that the 'machine' instigates breathing and they have to synchronise to its tempo.......although, thankfully the newer devices often have an auto function that helps considerably.

I believe that this is the 'whole truth'..... ;-)
Daniel,

Your "whole truth" is a misleading misstatement of the facts. Without the T part of the S/T-settings, a bi-level machine cannot "encourage or instigate breathing." That's why the plain PR System One BiPAPs and Resmed VPAPs are NOT non-invasive ventilators---they have no T setting.

In truth, both the Resmed S9 VPAP and the PR System One BiPAP are nothing more than CPAPs with two distinct pressure settings---IPAP for inhale and EPAP for exhale. Think of the S9 VPAP as a Resmed S9 Elite with a super, duper EPR system that can be set to numbers as high as 8 or 10cm if warranted. And the System One BiPAP can be thought of as a System One CPAP with a super, duper form of C-Flex+: a Flex system that doesn't just temporarily reduce the pressure by a (non-fixed) amount for the first half of the exhale, but rather reduces the pressure substantially and for the entire exhalation part of the breath.

Now, it is true that not everybody finds breathing with a bi-level much more natural and comfortable than breathing with a CPAP. And some of these folks complain that the machine is not in sync with their breathing---the problem here is that the machine is not detecting the pattern and timing of the start of the inhales in the same way the patient perceives them. Same kind of thing happens when some folks say that Flex or EPR makes them feel rushed.

And some of us definitely DO find breathing with a bi-level much more comfortable than breathing against a single pressure or even a single pressure with exhalation relief of some sort. For myself, I fought with the S9 APAP in both CPAP and APAP mode for 3 1/2 months and it NEVER felt comfortable to breath with, let alone "natural". And that was regardless of which EPR setting I used and over three different prescribed pressure settings. But as soon as I switched to my PR System One BiPAP, breathing started to feel much more comfortable and much more natural---it is so much easier to exhale and I don't feel rushed to breath in again like I did with the S9. And it's because there are TWO pressure settings and the pressure stays at EPAP as long I want to continue exhaling.

And these plain-jane bi-level and auto bi-level machines (PR S1 BiPAP and Resmed S9 VPAP) are often prescribed to patients with plain old OSA and no other breathing conditions---often simply because the patient is deeply uncomfortable and cannot tolerate the way a CPAP/APAP feels or because of serious aerophagia problems that are not alleviated with mask changes and pressure changes.

But the BiPAP S/T, VPAP S/T, and the ASV machines are a whole 'nother can of worms so to speak. These machines can indeed function as non invasive ventilators. And if the back up breathing rate is not set correctly, people can be very, very uncomfortable on them when the T-settings are triggering breaths that are not in sync with the patient's own breathing. But it's important to note that these machines are NOT the basic bi-level PAP and auto bi-level PAP machines. They require special prescriptions and they are NOT routinely used to treat plain-jane OSA with no other breathing issues.
current settings Min EPAP = 4, Max IPAP = 8 and Rise time = 3

8/1/2010 sleep study results:
AHI = 3.9 [AHI = (#OA +#CA + #H w/desat) per hour]
RDI = 23.4 [RDI = (#OA +CA + #H w/desat + #H w/arousal) per hour]
Dx: Moderate OSA
User avatar
robysue
 
Posts: 1330
Joined: Tue Aug 24, 2010 6:47 pm
Location: Buffalo, NY
Machine: PR System One BiPAP Auto
Mask: Swift FX for Her
Humidifier: System One Heated Humidif
Year Diagnosed: 2010

Re: Difference between BiPap and CPAP

Postby gwyn » Mon Aug 01, 2011 6:09 pm

I'm a newbie (one week with CPAP) and have been searching and googling my problem with not being able to exhale normally and never falling asleep while fighting to exhale for hours. In the 6 total nights with a CPAP machine, using two different masks (Easy Life nasal mask, and the Opti Life nalas pillows), I've only fallen asleep for a total of 40 minutes out of 5 hours of trying, 1 hour out of 4 hours of trying, zero hours out of 3 hours of trying with the Easy Life nasal mask, and two nights with the nasal pillows for a total of 2 one-hour naps out of 5 hours trying and one 30 minute doze during 3 hours of trying.

I found this forum because of people mentioning the difficulty exhaling. How much of this is due to me being new and how much of this is physical and I should start asking for a B-PAP or VPAP machine? (And by the way, I was told I was getting a ResMed S8 Elite II, but when I got to the centery, they gave me a RemStar Plus C-flex. I've called them several times since reading these forums and they said they won't change it because it meets the prescription intent. I'm not a happy camper!)

So....Any tips on how hard I should push on getting a BiPAP machine? My life is sooooo much worse now that I'm on this machine than before it. I can't concentrate and my sleep deprivation level is dangerously high. I can't make social plans and I just want to curl up in a ball and shut out the world. I was so looking forwar do the CPAP IMPROVING my life....not making it unbearable! Any help or tips would be greatly appreciated. The nasal pillows definitely helped with the claustrophobia and allow me to watch TV while tying to relax and get sleepy and quit thinking about my breathing, but it hasn't helped the craving to open my mouth and take a deep breath, and it hasn't helped to make exhaling feel "normal" in any way.
gwyn
 
Posts: 2
Joined: Mon Aug 01, 2011 12:10 pm
Machine: Respironics Remstar Plus C-flex
Mask: easy life
Humidifier: Yes Remstar System One
Year Diagnosed: 2011

Re: Difference between BiPap and CPAP

Postby Daniel » Mon Aug 01, 2011 7:40 pm

gwyn wrote:I'm a newbie (one week with CPAP) and have been searching and googling my problem with not being able to exhale normally and never falling asleep while fighting to exhale for hours. In the 6 total nights with a CPAP machine, using two different masks (Easy Life nasal mask, and the Opti Life nalas pillows), I've only fallen asleep for a total of 40 minutes out of 5 hours of trying, 1 hour out of 4 hours of trying, zero hours out of 3 hours of trying with the Easy Life nasal mask, and two nights with the nasal pillows for a total of 2 one-hour naps out of 5 hours trying and one 30 minute doze during 3 hours of trying.

I found this forum because of people mentioning the difficulty exhaling. How much of this is due to me being new and how much of this is physical and I should start asking for a B-PAP or VPAP machine? (And by the way, I was told I was getting a ResMed S8 Elite II, but when I got to the centery, they gave me a RemStar Plus C-flex. I've called them several times since reading these forums and they said they won't change it because it meets the prescription intent. I'm not a happy camper!)

So....Any tips on how hard I should push on getting a BiPAP machine? My life is sooooo much worse now that I'm on this machine than before it. I can't concentrate and my sleep deprivation level is dangerously high. I can't make social plans and I just want to curl up in a ball and shut out the world. I was so looking forwar do the CPAP IMPROVING my life....not making it unbearable! Any help or tips would be greatly appreciated. The nasal pillows definitely helped with the claustrophobia and allow me to watch TV while tying to relax and get sleepy and quit thinking about my breathing, but it hasn't helped the craving to open my mouth and take a deep breath, and it hasn't helped to make exhaling feel "normal" in any way.


I replied to a similar post, from you, on another section of the forum, see link below:

http://www.apneasupport.org/cpap-machine-information-what-to-look-for-t10164-105.html

Asking similar questions on different sections of the forum is confusing and frustrating for those responding. It is also quite likely to annoy responders sufficiently, that they might not bother helping.

I appreciate your frustration......but don't frustrate others.

Daniel.
Daniel
 
Posts: 6006
Joined: Sat Jun 25, 2005 5:49 am
Location: Ireland
Machine: Philips Respironics System One Auto
Mask: ResMed Micro Nasal Mask
Humidifier: No
Year Diagnosed: 1993

Re: Difference between BiPap and CPAP

Postby Bons » Tue Aug 02, 2011 9:29 am

Gwyn,
You need to have another sleep study and be titrated for bipap. Insurance companies authorize bipap after cpap has been found to be inappropriate treatment.
Do you have the c-flex setting turned on? If you your pap is set at a fairly high pressure, putting the c-flex at three reduces the pressure enough to let most people breathe more comfortably. This is a comfort setting, not a treatment setting, so you should be able to adjust the pressure setting by yourself. If it is locked, ask the DME person to unlock it for you.
Also, are you using the ramp feature on the machine? That starts you out at a lower pressure that slowly builds up over up to 45 minutes, so that you can fall asleep at lower pressure. This is also a setting that you can adjust yourself.
You may also ask to try one more mask. The Inova Hybrid is a mask that has both pillows and a mouth mask. With that you can still read with it on, and also breathe through your mouth.
And frustrate us all you want - just remember what posts you've made so you can check all of the topics you've asked questions on so you can find the answers (then you may not need to ask multiple times).
Good luck - this can drive you nuts at first. I am approaching my first anniversary and went through cpap to bipap to asv in four months. I can finally say that it is now helping me.
PR bipap auto sv advanced
Fisher and Paykel flexifit 431
Bons
 
Posts: 572
Joined: Fri Sep 03, 2010 1:11 pm
Location: Pennsylvania
Mask: fx for her nasal mask

Re: Difference between BiPap and CPAP

Postby mountainnancy » Mon Aug 15, 2011 2:19 pm

I switched from a cpap to a bipap because I was uncomfortable and therefore my hours of sleep were low. Depending on the mask, I have also had aerophagia on the cpap (11 with flex) I love the bipap. It allows me to relax during the exhalation and its much quieter. The new mask mirage fx is great too. It is more comfortable than earlier masks although i wish i didn't have to wear it either. But I'm getting better sleep. And I love how i feel after a good night's sleep on my bipap. I'm stronger and more with it.

Nancy
Bipap (about 10/5). 25 apneas untreated.
mountainnancy
 
Posts: 2
Joined: Wed Aug 10, 2011 7:06 am
Machine: Respironics BIPAP
Humidifier: yes
Year Diagnosed: 2007



  • Site Supporter

Return to CPAP Mask, Machine, & Monitoring Treatment Questions

Who is online

Users browsing this forum: Yahoo [Bot] and 1 guest