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Ms.OwLMooN
Unread post  Post subject: CPAP or BIPAP? What Issues Make Doctors Decide?  |  Posted: Sat Dec 23, 2017 9:45 am

Joined: Mon Dec 28, 2015 3:09 am
Posts: 69
Location: New Jersey
PAP Mask: Resmed Air Fit F20
PAP Machine: Resmed AirCurve 10 VAuto
Humidifier: HumidAir Heated Humidifier
Pressure Setting: Low - 12 High - 25

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What do doctors see on sleep reports that determines whether a patient needs CPAP or BIPAP?


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Pugsy
Unread post  Post subject: Re: CPAP or BIPAP? What Issues Make Doctors Decide?  |  Posted: Sat Dec 23, 2017 9:56 am

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 511
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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Pressure needs (like over 20 cm).

Or simply comfort issues at any pressure. Bilevel allows for a greater difference between inhale and exhale and it's that difference that offers us the greater comfort.

Or in the case of those specialty bilevel machines for special problems...a special problem like centrals.

Some bilevel machines are nothing more than a cpap/apap machine with greater ability to make that difference between inhale and exhale bigger than what a person can get with using whatever exhale relief their cpap/apap has available.

Some bilevels are very complicated with a lot more than just exhale relief being offered.


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Ms.OwLMooN
Unread post  Post subject: Re: CPAP or BIPAP? What Issues Make Doctors Decide?  |  Posted: Sat Dec 23, 2017 11:53 am

Joined: Mon Dec 28, 2015 3:09 am
Posts: 69
Location: New Jersey
PAP Mask: Resmed Air Fit F20
PAP Machine: Resmed AirCurve 10 VAuto
Humidifier: HumidAir Heated Humidifier
Pressure Setting: Low - 12 High - 25

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Pugsy wrote:
Pressure needs (like over 20 cm).

Or simply comfort issues at any pressure. Bilevel allows for a greater difference between inhale and exhale and it's that difference that offers us the greater comfort.

Or in the case of those specialty bilevel machines for special problems...a special problem like centrals.

Some bilevel machines are nothing more than a cpap/apap machine with greater ability to make that difference between inhale and exhale bigger than what a person can get with using whatever exhale relief their cpap/apap has available.

Some bilevels are very complicated with a lot more than just exhale relief being offered.


Wow, it sounds very complicated.

In my opinion with what I've read here in this forum and issues that I'm struggling with I feel that I might need Auto Bipap? But of course I know that my doctor has to decide this.

I just don't know if the problems that I'm having are enough to convince my doctor that I might need BIPAP.

I see my doctor next month and I do want to ask her If she will order another sleep study for me and see what happens after that.


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Pugsy
Unread post  Post subject: Re: CPAP or BIPAP? What Issues Make Doctors Decide?  |  Posted: Sat Dec 23, 2017 7:38 pm

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 511
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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Unless you have something special going on (like centrals) if you would need a bilevel machine it would most likely be what I call a "plain" bilevel machine which is nothing more than a cpap/apap machine that can go higher than 20 cm or has the greater difference between inhale and exhale (it's called pressure support) than we can get using the exhale relief feature.

Your exhale relief feature offered on your machine is called EPR and it can be set to 1, 2 or 3 cm and it makes your machine a bilevel machine of sorts.
Example...if you were using EPR of 3...that would make your machine act like a bilevel machine and with your current minimum pressure of 16 cm your EPAP would be 13 and IPAP would be 16 and if you went to 20 (your machine max) for IPAP then your EPAP would be 17.

So if you aren't using EPR at 3...you might give it a try and see how you do in terms of exhale comfort.
It's going to function like a bilevel machine would function if PS was set to 3.
Now a real bilevel machine would let you use 4 PS or even 5 PS.
But using EPR at 3 will give you some idea of how a bilevel feels.

A real bilevel wouldn't be limited to 20 cm...the max is 25..so if you need more than 20 cm pressure to keep the airway open then bilevel is the way to go.

I know you are having problems but I am not current with all your problems or what they are. If it is exhale issues...bilevel might help. If it is aerophagia issues (air in the belly) bilevel might help.

Have you tried EPR at 3?


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Ms.OwLMooN
Unread post  Post subject: Re: CPAP or BIPAP? What Issues Make Doctors Decide?  |  Posted: Wed Jan 24, 2018 7:25 pm

Joined: Mon Dec 28, 2015 3:09 am
Posts: 69
Location: New Jersey
PAP Mask: Resmed Air Fit F20
PAP Machine: Resmed AirCurve 10 VAuto
Humidifier: HumidAir Heated Humidifier
Pressure Setting: Low - 12 High - 25

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Pugsy wrote:
Unless you have something special going on (like centrals) if you would need a bilevel machine it would most likely be what I call a "plain" bilevel machine which is nothing more than a cpap/apap machine that can go higher than 20 cm or has the greater difference between inhale and exhale (it's called pressure support) than we can get using the exhale relief feature.

Your exhale relief feature offered on your machine is called EPR and it can be set to 1, 2 or 3 cm and it makes your machine a bilevel machine of sorts.
Example...if you were using EPR of 3...that would make your machine act like a bilevel machine and with your current minimum pressure of 16 cm your EPAP would be 13 and IPAP would be 16 and if you went to 20 (your machine max) for IPAP then your EPAP would be 17.

So if you aren't using EPR at 3...you might give it a try and see how you do in terms of exhale comfort.
It's going to function like a bilevel machine would function if PS was set to 3.
Now a real bilevel machine would let you use 4 PS or even 5 PS.
But using EPR at 3 will give you some idea of how a bilevel feels.

A real bilevel wouldn't be limited to 20 cm...the max is 25..so if you need more than 20 cm pressure to keep the airway open then bilevel is the way to go.

I know you are having problems but I am not current with all your problems or what they are. If it is exhale issues...bilevel might help. If it is aerophagia issues (air in the belly) bilevel might help.

Have you tried EPR at 3?



Yes, and I'm not comfortable breathing at 3 either.

I was also told by CPAP.com that my Resmed APAP does not have any Bilevel features if that's what you mean?

But I just saw my doctor the other day and I told her about my breathing issues and she did prescribe VPAP.

She also told me I should try to find a full face mask with fixed vent holes to eliminate the problem I'm having with the F20.

Would happen to have any recommendations for a full face mask with the fixed vent holes that can hold up to high air pressures?


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Pugsy
Unread post  Post subject: Re: CPAP or BIPAP? What Issues Make Doctors Decide?  |  Posted: Wed Jan 24, 2018 10:28 pm

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 511
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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EPR at 3 feels pretty much exactly like a real bilevel with PS of 3...I know because I have tried/owned both. Using EPR does indeed create a pressure support situation. I think the person you talked to a cpap.com didn't understand how EPR works.

I have no idea what "fixed vent holes" are...I didn't know that there were any that moved around with any mask unless she is talking about the ones that have the vent holes more on the mask and not the adapter that might swivel.
Sorry...the only FFM I have even minimal experience with is the Amara View. I don't like FFMs so I haven't bothered learning much about them enough to recommend one over an other.


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Ms.OwLMooN
Unread post  Post subject: Re: CPAP or BIPAP? What Issues Make Doctors Decide?  |  Posted: Thu Jan 25, 2018 7:12 pm

Joined: Mon Dec 28, 2015 3:09 am
Posts: 69
Location: New Jersey
PAP Mask: Resmed Air Fit F20
PAP Machine: Resmed AirCurve 10 VAuto
Humidifier: HumidAir Heated Humidifier
Pressure Setting: Low - 12 High - 25

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Pugsy wrote:
Unless you have something special going on (like centrals) if you would need a bilevel machine it would most likely be what I call a "plain" bilevel machine which is nothing more than a cpap/apap machine that can go higher than 20 cm or has the greater difference between inhale and exhale (it's called pressure support) than we can get using the exhale relief feature.

Your exhale relief feature offered on your machine is called EPR and it can be set to 1, 2 or 3 cm and it makes your machine a bilevel machine of sorts.
Example...if you were using EPR of 3...that would make your machine act like a bilevel machine and with your current minimum pressure of 16 cm your EPAP would be 13 and IPAP would be 16 and if you went to 20 (your machine max) for IPAP then your EPAP would be 17.

So if you aren't using EPR at 3...you might give it a try and see how you do in terms of exhale comfort.
It's going to function like a bilevel machine would function if PS was set to 3.
Now a real bilevel machine would let you use 4 PS or even 5 PS.
But using EPR at 3 will give you some idea of how a bilevel feels.

A real bilevel wouldn't be limited to 20 cm...the max is 25..so if you need more than 20 cm pressure to keep the airway open then bilevel is the way to go.

I know you are having problems but I am not current with all your problems or what they are. If it is exhale issues...bilevel might help. If it is aerophagia issues (air in the belly) bilevel might help.

Have you tried EPR at 3?



So are you saying that vpap is basically just for centrals?


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diamaunt
Unread post  Post subject: Re: CPAP or BIPAP? What Issues Make Doctors Decide?  |  Posted: Thu Jan 25, 2018 7:55 pm
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Joined: Wed Mar 02, 2016 2:26 am
Posts: 1590
Location: Dallas(ish)
PAP Mask: Resmed P10
PAP Machine: Resmed S9 vpap auto
Pressure Setting: 18/13-25/19

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Ms.OwLMooN wrote:
So are you saying that vpap is basically just for centrals?

No.

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cindyY
Unread post  Post subject: Re: CPAP or BIPAP? What Issues Make Doctors Decide?  |  Posted: Thu Jan 25, 2018 10:20 pm

Joined: Sun Apr 23, 2017 8:34 pm
Posts: 410
Location: Southern California
PAP Mask: AirFit P10, Swift FX, Swift FX Nano, Eson2
PAP Machine: Resmed AirCurve 10 VAuto in S mode
Humidifier: Integrated set to 5 @ 81F; ClimateLineAir heated hose
Pressure Setting: IPAP 19 EPAP 15

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Ms.OwLMooN wrote:

So are you saying that vpap is basically just for centrals?


I use bilevel because I had real trouble exhaling against the CPAP. It took them most of my split-night study to figure out that I needed bilevel, but once they did it made a world of difference. I'm not sure exactly why I had such trouble, I don't have COPD, which I've heard is one reason why people may need bilevel. I did suffer with recurring bronchitis in my late teens, so maybe I have some damage to my lungs due to that. Or maybe I'd be able to handle regular CPAP now that I've adjusted well to my high pressures, I don't know. I do know that I am well rested, only have rare bouts of aerophagia, and my numbers are consistently under 2, and usually under 1. Mostly I have OAs, I get the occasional central when falling asleep or waking up, but that is not why I need the bilevel machine. My PS is 4, which is only 1 higher than I would be able to get with EPR, but apparently it makes a big difference and I am grateful to have it.


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Ms.OwLMooN
Unread post  Post subject: Re: CPAP or BIPAP? What Issues Make Doctors Decide?  |  Posted: Mon Jan 29, 2018 11:44 am

Joined: Mon Dec 28, 2015 3:09 am
Posts: 69
Location: New Jersey
PAP Mask: Resmed Air Fit F20
PAP Machine: Resmed AirCurve 10 VAuto
Humidifier: HumidAir Heated Humidifier
Pressure Setting: Low - 12 High - 25

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Ms.OwLMooN wrote:
Pugsy wrote:
Unless you have something special going on (like centrals) if you would need a bilevel machine it would most likely be what I call a "plain" bilevel machine which is nothing more than a cpap/apap machine that can go higher than 20 cm or has the greater difference between inhale and exhale (it's called pressure support) than we can get using the exhale relief feature.

Your exhale relief feature offered on your machine is called EPR and it can be set to 1, 2 or 3 cm and it makes your machine a bilevel machine of sorts.
Example...if you were using EPR of 3...that would make your machine act like a bilevel machine and with your current minimum pressure of 16 cm your EPAP would be 13 and IPAP would be 16 and if you went to 20 (your machine max) for IPAP then your EPAP would be 17.

So if you aren't using EPR at 3...you might give it a try and see how you do in terms of exhale comfort.
It's going to function like a bilevel machine would function if PS was set to 3.
Now a real bilevel machine would let you use 4 PS or even 5 PS.
But using EPR at 3 will give you some idea of how a bilevel feels.

A real bilevel wouldn't be limited to 20 cm...the max is 25..so if you need more than 20 cm pressure to keep the airway open then bilevel is the way to go.

I know you are having problems but I am not current with all your problems or what they are. If it is exhale issues...bilevel might help. If it is aerophagia issues (air in the belly) bilevel might help.

Have you tried EPR at 3?



So are you saying that vpap is basically just for centrals?


Sorry for all the questions to me it's pretty confusing but I'm trying to understand.

I made a mistake though.

My doctor actually prescribed auto bilevel and not vpap.

I'm feeling a little insecure about her choice because she didn't really go by readings, simply just that I was having problems with exhale relief with my auto CPAP and I'm wondering if the auto bilevel will be enough to help me or if vpap would have been the way to go?

I just don't want to be stuck with a machine that's not going to help.


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Pugsy
Unread post  Post subject: Re: CPAP or BIPAP? What Issues Make Doctors Decide?  |  Posted: Mon Jan 29, 2018 12:05 pm

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 511
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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VPap is nothing more than the ResMed marketing term for their now discontinued models of bilevel pressure machines.
There was a VPAP that was bilevel that wouldn't auto adjust and a VPAP that would auto adjust...they were both bilevel machines.

ResMed used the term VPAP in model name...now they changed to AirCurve 10 and the bilevel model that will auto adjust is now called VAuto. They kept the "V" part of VPAP.

Respironics uses the term "BiPap" for their bilevel machines.

VPAP and BiPAP...just brand marketing terms.

Now...the confusing part...some bilevels are designed to specifically treat centrals but there are bilevels that can't treat centrals and instead they just offer more options for exhale relief....like for your situation.
Not all bilevels will effectively deal with centrals...but they will all effectively help with exhaling issues.

The "auto" part of the "auto bilevel"...all that means is that it can auto adjust the pressures based on what the machine senses might need to be done.
There are bilevel models that can't auto adjust.

If looking at a ResMed bilevel model that will auto adjust..probably the AirCurve 10 VAuto as it is the newest model but the S9 VPAP Auto would do the job too. The AirCurve 10 VAuto simply replaced the older S9 VPAP Auto.


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