Last night I had my CPAP study and I noticed the machine the hospital used was labeled as a BiPap, not a CPAP.  

What is the difference between a BiPap/Bilevel machine and a CPAP machine?

Can you be tested on a BiPap and be prescribed a CPAP?  Are the readings cross-applicable?

Would a BiPap machine work similarly to the Respironics CPAP with C-Flex?

If you get a machine with a humidifier, can the humidity levels be adjusted?

Re masks:

When you got fitted did you try it sitting up and laying down?  (I noticed the mask fit shifted after I got into bed.)

If you are a mouth breather do you automatically get a full mask?  (I noticed the full mask kept my mouth closed, which is different than what I'm used to -- not worse, just different.)

pickles wrote:

Last night I had my CPAP study and I noticed the machine the hospital used was labeled as a BiPap, not a CPAP.  

What is the difference between a BiPap/Bilevel machine and a CPAP machine?

Can you be tested on a BiPap and be prescribed a CPAP?  Are the readings cross-applicable?

Would a BiPap machine work similarly to the Respironics CPAP with C-Flex?

If you get a machine with a humidifier, can the humidity levels be adjusted?

Re masks:

When you got fitted did you try it sitting up and laying down?  (I noticed the mask fit shifted after I got into bed.)

If you are a mouth breather do you automatically get a full mask?  (I noticed the full mask kept my mouth closed, which is different than what I'm used to -- not worse, just different.)

Hi Pickles,

BiPap (Bi Level PAP) is a form of non invasive ventilation, and is not usually first line PAP therapy. In the case of using it for a titration study you may find that there are a few additions to the machine not normally on the standard. Different sleep clinics use different machines for titration.

Bi Level machines work on 2 settings as distinct from 1 setting on standard cpap. On Bi Level you have a higher pressure for inhalation (for correct pressure) and a lower pressure for exhalation. They are particularly popular for use with high pressures and some are calibrated to deliver pressure above the 20cms level (cpap is only calibrated to 20cms). Bi Level, as a form of non invasive ventilation is normally prescribed to patients with CHF (Congestive Heart Failure), COPD (Chronic Obstructive Pulmonory Disease) or other respiratory problem.

I believe you can be titrated on a number of different machines.

I think people are starting to equate the c flex as the poor mans Bi Level. I'm not sure of the exact workings of c flex, but from what I hear the second generation of these machines may well replace Bi Level.

Heated humidifiers can be adjusted up or down, whether stand alone or built in.

When getting fitted, try every conceivable position as the masks are not returnable. It is the most important aspect of complying with cpap.

If you are a natural mouth breather it is probably best to look for the full face mask. I doubt you will be offered one.
Remember all masks are interchangeable with the different machines, so ResMed works with Respironics etc. If you go down the route of c flex or auto adjusting you may need to check as the type of mask being used must be programmed into the machine to allow for leaks, fitting etc. Some masks may not be suitable.

Daniel.

Hello Pickles!
Yeah, there's a lot of options out there.  To continue on these points, just about all sleep labs use BiPAP machines because they have the options available to give either mode when necessary.  A CPAP machine, on the other hand, cannot do BiPAP.  Respironics machines do C-Flex.  Therefore, a Respironics Synchrony BiPAP can do all three modes.  It works thus:
You are prescribed a CPAP pressure, and this is the pressure that will hold your airway open, say 10 cmH2O.  If you wanted to use BiPAP, this "CPAP" becomes synonymous with EPAP, or the pressure you exhale against.  You would then be given a little "boost" on inhalation, or IPAP, say 15 cmH2O, so your settings would be 15/10 in this BiPAP case.
C-Flex is like BiPAP in reverse.  Let's say you're back on 10 cmH2O of CPAP.  You would inhale using 10 cmH2O, but when you go to exhale, the pressure would drop a bit, to say 7 cmH2O, to allow you to exhale agianst a lesser resistance.  OSA does not occur during exhalation, only inhalation, so that's how you can get away with that.
Now, it's a subtle point, but at the moment immediately prior to inhalation, you need to be at your prescribed pressure, and that's why these modes are not completely interchangeable.
sleepydave



Last edited by sleepydave on Sun Aug 14, 2005 6:10 pm; edited 2 times in total

With a CPAP, is the pressure at a constant level on both inhale and exhale?  (It seems that would make it hard to exhale.)  

If so, is it most advantagous to get a BiPap or CPAP with C-Flex over a CPAP machine?  Is the CPAP with C-Flex the new BiPAP?

I want to have as much information as possible before I get a machine (assuming I'll be prescribed one).  I don't want end up with something that I won't use.

pickles wrote:

With a CPAP, is the pressure at a constant level on both inhale and exhale?  (It seems that would make it hard to exhale.)  

If so, is it most advantagous to get a BiPap or CPAP with C-Flex over a CPAP machine?  Is the CPAP with C-Flex the new BiPAP?

I want to have as much information as possible before I get a machine (assuming I'll be prescribed one).  I don't want end up with something that I won't use.

Hi Pickles,

Firstly, as I mentioned before Bi Level PAP is a type of non invasive ventilation and is normally prescribed for people with other respiratory or cardiac problems such as COPD or CHF. It is also prescribed where pressure in excess of 20cms is required. On this side of the pond it is not first line therapy, however in the US it appears to be prescribed as a cpap type machine more readily. The other thing is they are quite expensive.

CPAP, by its very nature is positive air at a predetermined pressure, one pressure only. Unless you have some other respiratory problem you should be able to exhale against the pressure, unless of course the pressure is quite high, in which case your sleep doc should explain things to you and advise you on a machine.

Respironics, with c flex is an advanced cpap machine, with an advanced price.

May I suggest that you walk before you run. It is good to know what is out there, but get the diagnosis and titration first and then decide. Try not to anticipate what will and won't work. The most important part of 'any PAP' is the interface, whether it be nasal or full face mask or nasal pillows or indeed an oracle type oral interface. If the mask aint right you can have any machine you want, with bells, whistles, computer chips, online downloads etc and it still won't work.

Concentrate on the mask. Look around and put the cpap supplier through the hoops on the mask end of things.

Daniel

sleepydave wrote:

Hello Pickles!
Yeah, there's a lot of options out there.  To continue on these points, just about all sleep labs use BiPAP machines because they have the options available to give either mode when necessary.  A CPAP machine, on the other hand, cannot do BiPAP.  Respironics machines do C-Flex.  Therefore, a Respironics Virtuoso BiPAP can do all three modes.  It works thus:
Tou are prescibed a pressure CPAP, this is the pressure that will hold your airway open, say 10 cmH2O.  If you wanted to use BiPAP, this is also the equivalent of EPAP, or the pressure you exhale against.  You would then be given a little "boost" on inhalation, or IPAP, say 15 cmH2O, so your settings would be 15/10 in this BiPAP case.
C-Flex is like BiPAP in reverse.  Let's say you're back on 10 cmH2O of CPAP.  You would inhale using 10 cmH2O, but when you go to exhale, the pressure would drop a bit, to say 7 cmH2O, to allow you to exhale agianst a lesser resistance.  OSA does not occur during exhalation, only inhalation, so that's how you can get away with that.
Now, it's a subtle point, but at the moment immediately prior to inhalation, you need to be at your prescribed pressure, and that's why these modes are not complettely interchangeable.
sleepydave

Mine does ... the soft palate on exhale, rises to close off the sinus...


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Quote:

The most important part of 'any PAP' is the interface, whether it be nasal or full face mask or nasal pillows or indeed an oracle type oral interface. If the mask aint right you can have any machine you want, with bells, whistles, computer chips, online downloads etc and it still won't work.

Concentrate on the mask. Look around and put the cpap supplier through the hoops on the mask end of things.

Amen to what Daniel said!  A mask that suits you as comfortably as possible is the real key to good treatment, imho....and to being able to stick with the treatment.

Hello Picles!
Actually, the C-Flex option is only a little bit more than the equivalent Respironics machine without it, and the DME companies down here cover C-Flex machines without additional patient cost.  It might be prudent to investigate that option now, because it may not be possible to change out machines without additional out-of-pocket expense once you use the non-C-Flex unit and decide you want to have that option.
BTW, you also asked about humidifiers in your original post, and you might want to consider that now as well.  Some machines have an intergrated (built-in) humidifier which offers some convenience.  Those machines, however, do not offer C-Flex, so you'll have to decide that beforehand as well.  Say, what's your pressure, anyway?  If it's low, you might not need the pressure-enhancing options, and could concentrate a little more on the humidification system.  Good luck.
sleepydave