[Diagnosis] Reasons to BPAP, over CPAP

[WakeUpTime]

...I tested the PR and the ResMed, each for seven days. I abandoned the ResMed after one night. I reported to the Sleep Doc that, while I had no understanding of what was actually happening or what was wrong since I was either asleep or half asleep, but there was a real problem with the ResMed. I couldn't figure out why one would work well while the other was so problematic. Phil

PR & ResMed's proprietary breathing algorithms set them apart I suppose. I'm sure they will be constantly tweaking those algorithms. It's a darn shame that we can't get firmware updates after investigating thousands of dollars in their technologies. Maybe they'll announce "new advanced versions" every 3 years and expect us to all "upgrade".

Another part of my so-called sleep tests was that they were at home, and so of course no one could make any adjustments during the night. Oh and plus I got minimal sleep during the test periods. Phil

A big advantage of clinic sleep studies, and the added cost, is that pressure setting tweaking (titration). However, you're a lot like me, if you didn't sleep well at home, you wouldn't sleep for more than an hour in the lab! They say "I slept for 6 hours" but I told them that they might want to qualify their version of "sleep". A relative, in the medical profession, said that an "awake brain but paralyzed body (or deliberate frozen for the sleep study)" is not uncommon.

Someone should invent a sleep clinic that lets you test many different machines and many different masks. They should also design a much better way to get you to sleep, other than hooking up 25 electrodes and saying "TIME TO SLEEP!"

[robysue]

PR & ResMed's proprietary breathing algorithms set them apart I suppose. I'm sure they will be constantly tweaking those algorithms. It's a darn shame that we can't get firmware updates after investigating thousands of dollars in their technologies. Maybe they'll announce "new advanced versions" every 3 years and expect us to all "upgrade".

The algorithms for when and how the pressure is increased back to IPAP and down to EPAP are indeed subtly different. For most people, the difference is so slight that they probably can't really tell them apart.

But for some people the small differences are critically important. And for these sensitive people, which is "more comfortable" really depends on the particular person. There are some people who strongly prefer the Resmed algorithm and there are others who strongly prefer the PR algorithm. The shame is that it's very rare for someone to have a chance to use both machines at the same setting in their own home for several nights to figure out which works more smoothly for them.

In addition to the subtle differences in how the machines switch between IPAP and EPAP on every breath, there are also some pretty big differences in how the bi-level AUTO algorithms work. One of the significant differences in the AUTO algorithms is that the PR System One BiPAP Auto can increase or decrease the IPAP and EPAP independently of each other; the Resmed S9 VPAP Auto increases and decreases IPAP and EPAP together. The net result of these differences is that on the PR System One, IPAP - EPAP is not constant and on the Resmed S9, IPAP - EPAP is constant. For some people this difference in the way the Auto algorithms work makes a big difference in comfort, for others it makes no difference at all. And again, which method is more comfortable really depends on the person.

For me: The fact that my BiPAP can increase the IPAP without increasing the EPAP is critically important in helping me keep the aerophagia at bay, which increases my comfort.

But for others, that's yet another thing that can vary all night long, and the varying PS can be annoying and irritating to some individuals. And these folks would probably be much more comfortable with a Resmed VPAP Auto.

[me50]

and one thing that is also not good about sleep studies in the lab is that some of them have you be there at 10 PM, takes an hour to hook you up and get all the paperwork done, find a mask, etc. I don't think 5-6 hours is enough time for a titration let alone when they are monitoring a person without any machine to see if they have SA and then do the titration in the same night. I think that rushed feeling on top of sleeping in a strange place doesn't help and may even cause or add to the anxiety of the whole situation. jmho

[WakeUpTime]

In addition to the subtle differences in how the machines switch between IPAP and EPAP on every breath, there are also some pretty big differences in how the bi-level AUTO algorithms work. One of the significant differences in the AUTO algorithms is that the PR System One BiPAP Auto can increase or decrease the IPAP and EPAP independently of each other; the Resmed S9 VPAP Auto increases and decreases IPAP and EPAP together. The net result of these differences is that on the PR System One, IPAP - EPAP is not constant and on the Resmed S9, IPAP - EPAP is constant. For some people this difference in the way the Auto algorithms work makes a big difference in comfort, for others it makes no difference at all. And again, which method is more comfortable really depends on the person.

You ever think about writing a CPAP guide? (Not kidding.) A little kindle (or perhaps not so little) book with your experience would become a pretty popular book -- especially for new CPAP-ers. Your comments seem heavily researched and extremely practical. (Wow.)

and one thing that is also not good about sleep studies in the lab is that some of them have you be there at 10 PM, takes an hour to hook you up and get all the paperwork done, find a mask, etc. I don't think 5-6 hours is enough time for a titration let alone when they are monitoring a person without any machine to see if they have SA and then do the titration in the same night. I think that rushed feeling on top of sleeping in a strange place doesn't help and may even cause or add to the anxiety of the whole situation. jmho

The expense must be HUGE for the sleep clinic. YET, they all really miss-the-boat on that "sleep comfort" and "simulating a patient's real typical sleep". I wonder about the accuracy of their results given that mismatch. But of course, we take what we can get; and thank goodness for their existence. (Next patient please, now SLEEP!)

[Johnny Chowder]

In addition to the subtle differences in how the machines switch between IPAP and EPAP on every breath, there are also some pretty big differences in how the bi-level AUTO algorithms work. One of the significant differences in the AUTO algorithms is that the PR System One BiPAP Auto can increase or decrease the IPAP and EPAP independently of each other; the Resmed S9 VPAP Auto increases and decreases IPAP and EPAP together. The net result of these differences is that on the PR System One, IPAP - EPAP is not constant and on the Resmed S9, IPAP - EPAP is constant. For some people this difference in the way the Auto algorithms work makes a big difference in comfort, for others it makes no difference at all. And again, which method is more comfortable really depends on the person.

For me: The fact that my BiPAP can increase the IPAP without increasing the EPAP is critically important in helping me keep the aerophagia at bay, which increases my comfort.

This was the biggest factor in why I chose The PRS1 Auto BiPAP over the Resmed Auto VPAP.

But for others, that's yet another thing that can vary all night long, and the varying PS can be annoying and irritating to some individuals. And these folks would probably be much more comfortable with a Resmed VPAP Auto.

Is it possible to set the PS on the Respironics unit to a fixed number so IPAP - EPAP is constant? Just wondering if it can be set to behave like the Resmed VPAP if one were so inclined.

---

You ever think about writing a CPAP guide? (Not kidding.) A little kindle (or perhaps not so little) book with your experience would become a pretty popular book -- especially for new CPAP-ers. Your comments seem heavily researched and extremely practical. (Wow.)

I'd buy it!

[robysue]

Is it possible to set the PS on the Respironics unit to a fixed number so IPAP - EPAP is constant? Just wondering if it can be set to behave like the Resmed VPAP if one were so inclined.

On the newer System One Series 60 machines, yes, you can set min PS = max PS, and that will force the machine to increase/decrease the IPAP and EPAP at the same time.

On the older System One Series 50 machines like mine, that's not possible unless one is content with a PS = 2 because there is no min PS setting; the min PS = 2 and cannot be changed on the older Series 50 machines.

[vsheline]

What I'm really curious about (BPAP users, please weigh-in) why wouldn't one want the IPAP/EPAP spread to be GREATER, therefore causing as much exhaust air to get out of the body??? I.e. What is the downside of a much lower EPAP (exhaust air) number?

If the PS (Pressure Support, the difference between IPAP and EPAP) is too large, as well as being hard to get accustomed to, or causing more mask leaks, or (in some people) causing more Central Apneas, it can also cause our Oxigen level to get too high, leading to more "free radicals" and serious health issues like lowering the effectiveness of prescribed medicines or causing cardiovascular damage like atherosclerosis. In the first half of the twentieth century, millions of premature babies who were kept in incubators with high Oxigen concentrations became permanently blind, because too much O2 caused abnormal growth of the blood vessels in their eyes.

For me, if my minimum PS is set to 6 my O2 levels (SpO2) tend to be between 96 to 98 or higher most of the night, which is probably too high for good long-term health.

I've read that a good target range for SpO2 is 94 to 96, or a little lower. For me, I stay in that range pretty much all night when my minimum PS is set a little lower than 5. Others may do fine with no PS at all, and someone else who has lung damage from chemical exposure in their work environment or from smoking, or who has anemia, may need PS to be 7 or 8 or higher to keep their SpO2 above 90 most of the time.

I recommend wearing a Pulse Oximeter occasionally, to keep tabs on our O2 levels.

Take care,
--- Vaughn

[Johnny Chowder]

I recommend wearing a Pulse Oximeter occasionally, to keep tabs on our O2 levels.

Take care,
--- Vaughn

Good advice, I think I'm going to pick up a CMS-50F this week.

[me50]

In addition to the subtle differences in how the machines switch between IPAP and EPAP on every breath, there are also some pretty big differences in how the bi-level AUTO algorithms work. One of the significant differences in the AUTO algorithms is that the PR System One BiPAP Auto can increase or decrease the IPAP and EPAP independently of each other; the Resmed S9 VPAP Auto increases and decreases IPAP and EPAP together. The net result of these differences is that on the PR System One, IPAP - EPAP is not constant and on the Resmed S9, IPAP - EPAP is constant. For some people this difference in the way the Auto algorithms work makes a big difference in comfort, for others it makes no difference at all. And again, which method is more comfortable really depends on the person.

You ever think about writing a CPAP guide? (Not kidding.) A little kindle (or perhaps not so little) book with your experience would become a pretty popular book -- especially for new CPAP-ers. Your comments seem heavily researched and extremely practical. (Wow.)

and one thing that is also not good about sleep studies in the lab is that some of them have you be there at 10 PM, takes an hour to hook you up and get all the paperwork done, find a mask, etc. I don't think 5-6 hours is enough time for a titration let alone when they are monitoring a person without any machine to see if they have SA and then do the titration in the same night. I think that rushed feeling on top of sleeping in a strange place doesn't help and may even cause or add to the anxiety of the whole situation. jmho

The expense must be HUGE for the sleep clinic. YET, they all really miss-the-boat on that "sleep comfort" and "simulating a patient's real typical sleep". I wonder about the accuracy of their results given that mismatch. But of course, we take what we can get; and thank goodness for their existence. (Next patient please, now SLEEP!)

because a person scores the sleep study, there is always a possibility that it is scored wrong. It all depends on how knowledgeable the person is and how dedicated the person is.

If a DME can do the things they do, unethical things in my book, then what is to say that a sleep lab doesn't do the same thing. What agency monitors the sleep lab and the person scoring the titration? I had a sleep study last October and again last November. While I know that sleep varies each night, the tests were so different in the results that it makes me wonder. Not all people that score these things are competent and not all of the sleep labs (or DME's, Sleep doc's) are ethical.