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+--- Thread: For those that have switched from PAP to Bi-level... (/Thread-For-those-that-have-switched-from-PAP-to-Bi-level)
For those that have switched from PAP to Bi-level... - CPAPnerd - 01-22-2024
OK, I may or may not be needing/getting a new bilevel in coming 2-3-4 months to help improve my therapy, who knows. But I have often wanted to compare notes with those that have switched from C/A PAP to bilevel, so if you will please humor me and others in a similar situation, and share with us your responses to the following:
- What was the leading issue that made you switch to bi-level?
- What clinical metrics, if any, would you say improved? Lower AHI, less spikes in flowrate graph, less flow limits, etc?
- Lastly, based on your subjective perception of how you feel when you wake up and how you feel later in day, what letter grade would you have given your former PAP therapy, and what letter grade would you give your bi-level?
RE: For those that have switched from PAP to Bi-level... - PeaceLoveAndPizza - 01-22-2024
I’ll play…
1. flow limitations causing arousals not being handled by EPR 3.
2. AHI was 3-5, now < 1. FL’s no longer significant. Flow rate is smoother.
3. It took a few months, but I definitely feel more rested. Still some fine-tuning to go. I won’t grade as it is too subjective for my tastes. For many APAP is just fine. Some of us need more pressure support and trigger sensitivities.
I think it was SleepRider who suggested a while back that Bilevel should be the default machine as it can also be an APAP and CPAP. I think that the increased quantities needed should drop the price a bit and be better for the companies as they have fewer SKUs to manage. A scathingly brilliant and slightly balmy idea.
RE: For those that have switched from PAP to Bi-level... - WhyMe - 01-22-2024
Main issue - arousals related to flow limits, which were pretty much resolved by moving to bilevel.
Secondary, but related - I need a relatively high pressure (minimum of 15 ipap) to resolve OAs, and was having issues exhaling against that pressure. Bilevel provides more pressure relief than the regular APAP.
Both of those items are noticeable in Oscar, both in the flow rate chart (more rounded shape - no more flat tops on the chart) and in the flow limits chart.
Do I feel better? Sadly no, but that is due to other issues causing arousals, such as plms and pain. Breathing issues appear to be resolved, and I will be working with my doctors to deal with the other issues now that I have one issue under control.
RE: For those that have switched from PAP to Bi-level... - Sleeprider - 01-22-2024
(01-22-2024, 07:26 PM)PeaceLoveAndPizza Wrote: I think it was SleepRider who suggested a while back that Bilevel should be the default machine as it can also be an APAP and CPAP. I think that the increased quantities needed should drop the price a bit and be better for the companies as they have fewer SKUs to manage. A scathingly brilliant and slightly balmy idea.
I will add, that the hardware needed to provide bilevel is identical to the CPAP and the only difference is the firmware and profit margin. I love a balmy idea! Thanks.
RE: For those that have switched from PAP to Bi-level... - Sleeprider - 01-22-2024
My other thought on CPAP vs bilevel, is that the move from CPAP to bilevel is easier than you think. The medical mafia has convinced the public it has to be technical and difficult, involving studies and proof of medical necessity and other nonsense. The truth is, you need to move sleep specialists out of the path they obstruct, and understand your regular doctor, who presumably is more concerned with your overall health and better results, is the "treating physician". A certified "sleep doctor" is only required to sign off on a diagnostic test. MOST sleep doctors are not working to optimize your sleep disordered breathing therapy, but to optimize their billing with more tests and continued visits.
Transfer all SDB therapy and follow-up to your primary doctor. If your doctor agrees with you that your therapy can be improved with bilevel, he can prescribe it. If you have a legitimate concern for your therapy that bilevel could address, that is all you need. Sweep the professional obstructionists out of your path and you win. No law or standard exists that requires you prove bilevel will work, or that you take a test to prove it. A prescription lets you get the bilevel treatment, and discussions with your doctor that confirm the therapy is beneficial is the bottom line.
RE: For those that have switched from PAP to Bi-level... - CPAPnerd - 01-22-2024
Thanks Pizza! It appears that higher PS decreases FLs as well as helps round out flowrate graph. So all in all would probably be upgrade to the majority of PAP users.
Thanks for the reply and sharing your experience!
RE: For those that have switched from PAP to Bi-level... - CPAPnerd - 01-22-2024
(01-22-2024, 09:07 PM)Sleeprider Wrote: My other thought on CPAP vs bilevel, is that the move from CPAP to bilevel is easier than you think. The medical mafia has convinced the public it has to be technical and difficult, involving studies and proof of medical necessity and other nonsense. The truth is, you need to move sleep specialists out of the path they obstruct, and understand your regular doctor, who presumably is more concerned with your overall health and better results, is the "treating physician". A certified "sleep doctor" is only required to sign off on a diagnostic test. MOST sleep doctors are not working to optimize your sleep disordered breathing therapy, but to optimize their billing with more tests and continued visits.
Transfer all SDB therapy and follow-up to your primary doctor. If your doctor agrees with you that your therapy can be improved with bilevel, he can prescribe it. If you have a legitimate concern for your therapy that bilevel could address, that is all you need. Sweep the professional obstructionists out of your path and you win. No law or standard exists that requires you prove bilevel will work, or that you take a test to prove it. A prescription lets you get the bilevel treatment, and discussions with your doctor that confirm the therapy is beneficial is the bottom line.
Will definitely be talking to my primary. You are in the zone Sleeprider! Will offer update(s) as I get them.
RE: For those that have switched from PAP to Bi-level... - tbhausen - 01-23-2024
My "transition" occurred during my in-lab sleep study. If I understand correctly, the pressure required to stop my OA's was so high (18) that they switched to bilevel during the test to make exhalation more comfortable. So they prescribed BiPAP for me from the start.