For those have tried BiPap and CPAP/APAP - Did anyone not prefer the BiPap?

[Jamesdg89]

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Hi there,

As the thread title says, I am wondering:

Of those of you who have tried BiPap and CPAP/APAP, did anyone actually prefer the CPAP or APAP. I understand some try to argue that the BiPap is only for special cases, however after struggling to exhale with my new APAP (Tried AFlex and Cflex at 3) I would disagree. After doing a decent amount of research on various CPAP forums I have never seen anyone who switched to BiPap say they went back to or preferred their CPAP/APAP.

If anyone has any additional thoughts or opinions on this debate, I would be interested to hear. At this point, I am struggling to understand why doctors are so hestistant to prescribe a BiPap machine that can led to more natural breathing and sleeping. They seem to think this is a luxury some patients don't need. Insurance pays for these machines and medical costs in the US are out of control, how did these machines become the area where doctors want to limit the quality of care customers have access to? If my insurance covered a car, I would prefer to get the Lexua or the Honda. 

Thanks for any help you can provide on my understanding of this issue

[SarcasticDave94]

With my very high CA to OA ratio, I did not like the BiPAP from Respironics at all. It made my CA even worse, as the style of pressure variations on these BPAP/BiPAP machines is very different than an ASV like I have currently. I have medical necessity requirements that eliminate CPAP and BPAP.

Some other types of symptoms will become worse with BPAP, so it is really not for everyone. There is a bit of a cost difference between CPAP to BPAP, and it does need to be factored in. If everyone were getting a BPAP, expect there to be a price adjustment to insurance premiums, etc. Someone will have to pay for this. Following your car analogy: If you eliminate the cars that cost $15-20 K, and the new starting price is $30-40 K, some will not afford the car purchase.

The majority of apnea patients still only need a CPAP. Call the healthcare method a headache or madness, but it does make sense to a degree. The patient uses CPAP and the results are either he can or cannot benefit from the device or has need of more specialized machines.

Again, most can do well with CPAP/APAP. Less NEED/medical necessity exists for BPAP or VAuto. Even less need for ST/ST-A/ASV. And again, even less need the NIV ventilator. Insurance rightfully requires medical necessity to prove the reason for a higher priced machine. It's not always the doctor that's withholding treatment you think you need. Insurance holds the doctor accountable to prove you need it.

[70sSanO]

The problem with your research is that if people were successful on CPAP/APAP they would never needed to go to BiPAP. That is the sequence, it is never BiPAP to CPAP/APAP.

I’m not saying that BiPAP does not provide more comfort, but if a person is running a pressure of 10 or less it might not even be a consideration with or without EPR up to 3.

I ran CPAP/APAP at 10 for years without EPR, which was good since I had centrals. Bit the next person might have an issue.

John

[Jamesdg89]

OK - thanks so much for your detailed response and sharing your experience. Glad to hear that others are having luck with APAPs and CPAPs. 

Somehow before your response, all I had read about were people metaphorcomparing BiPap pressure support to power steering and talking about how much time they had felt they wasted on CPAP and APAP and I wasn't sure what to think. 

Perhaps my troubles with asthma maybe making the APAP extra uncomfortable. My exhale pressure and power seems to be very limited by APAP machine and mask. It feels like I am trying to breathe out of a straw.

[sheepless]

if you post some oscar charts you'll get some opinions about why you're having trouble breathing with your current machine & whether bilevel would be better or not.

[slowriter]

There's no conceivable argument for CPAP being better than bilevel, because the latter effectively offers a superset of therapy settings to the former. As in, you can setup a bilevel to behave exactly like a CPAP.

And given that natural breathing itself involves a pressure differential between inhale and exhale, pressure support in a bilevel most closely fits with how we breath.

I think any hesitation on the part of doctors is purely a function of the dysfunctions of how we finance medical care (though they may come up with other justifications).

[SarcasticDave94]

Really on an individual treatment level, the devil's in the details. Asthma must be factored in when deciding what's medically necessary for YOUR treatment. Despite the medical world painting apnea treatment as one type for all, we know different. If they were right, why did the manufacturers need to create machines nobody needed?

Your having asthma likely means the vanilla CPAP/APAP or possibly even a BPAP could be unsuitable. Remember, almost every single aspect of your health picture counts when deciding the best apnea therapy. Things like do you suffer from GERD, asthma, COPD, complex apnea, etc. matter and must be on the table in the discussion on deciding the best machine for you.

[Sleeprider]

I used CPAP (Respironics M Series Auto and PRS1 Auto for 8 years before switching to Bilevel. I bought a used PRS1 BiPAP Auto and after a year got my current Aircurve 10 Vauto. Each machine was an advancement in comfort however I have always had very good efficacy.

I think many doctors prefer to write scripts for CPAP because it’s easier. Insurance originally denied my bilevel and the appeal process required a few rounds of justification from my doctor. He is not a sleep specialist and was very accommodating. I think the specialists are just conditioned not to bother when CPAP is good enough.

[70sSanO]

I’m on ASV, which is not exactly a pure Bilevel since it triggers the breath. But even with an EPAP that is quite comfortable, if I could go back to the few years of APAP that were at a 6-9 range and get the same results, I’d do it in a flash.

Low pressure is low pressure. No matter how anyone looks at it, going from an EPAP of 7 to and IPAP of 15 or more is probably a bit disruptive. It is a different world from sailing along at 7 or 8 all night long.

John

[holden4th]

I went from APAP to BiPAP after doing quite a bit of research. What I wanted was more flexibility with both inhale and exhale and while an APAP gave me some of that, BiPAP gave me a lot more. Like Sleeprider I went from a Respironics 760 BiPAP to the Resmed Aircurve V10 auto which is the best machine I've ever used. It wasn't without its issues though and initially I thought I'd made a mistake.

The PR760 has some unique settings you can make between IPAP and EPAP as you can adjust the amount of EPR pressure in both directions. A rise in IPAP does not necessarily mean a rise in EPAP with the Respironic. The Aircurve system means that if you set the EPR to a certain figure then that is the gap, no matter what pressure the machine goes up to. Let's say it's fixed at 4.0. If your IPAP goes up to 17, then your EPAP will be 13 which is not always ideal.

The issue is how both machines tackle hypopneas and OAs. The Philips machine tends to let these events come on to you before progressively dealing with them. It's a softly, softly approach and while this might work for those who are easily aroused from sleep, it didn't work that well for me. Resmed's let's take the bull by the horns approach means that any event is quickly dealt with a quick and somewhat aggressive approach. This worked well for me as I am a sound sleeper.

The Aircurve has two settings that really need to be set properly to get the best from the machine. They have two settings which control when the machine decides that you have finished inhaling and now need to go into exhale mode. The main one is Ti min/max which assumes that you inhale for a certain length of time then you exhale. The default settings didn't work for me and it switched to exhale before I had finished breathing in so I increased the inhale time (Ti max).

Now to make sure that the machine would go into exhale mode when it should I set the trigger to very high. So as soon as I started to exhale, the high setting recognised it instantly and the machine was now responding to my breathing patterns. Even if the Ti max was too long, the very high trigger setting counteracted it.

Once I had done this I was beginning to enjoy a very comfortable nights sleep and this is the secret of BiPAP - the comfort.

Do I need BiPAP - No. Does it provide better therapy - YES! Could I tolerate APAP if I needed to, yes.