Posted by Marco Polo on November 26, 2007 at 17:23:50:

In Reply to: Re: Increased Pressure to 18 cm posted by StevieB on November 21, 2007 at 04:14:57:

Steve,

It's good to see that you are in good care.

Your questions are good and the first 2 I have to admit, I cannot help much with them. I have not had any experience with the discomfort in the lung area and chest. These symptoms are not uncommon for OSA patients starting therapy though.

My experience with bloating is not much to speak of--a couple days and a couple good belches in the morning took care of my instances. Again, this is not uncommon and there are others who have written about this in this and other forums.

I would suggest a search for both questions in this forum and you'll probably find an answer that helps.

#3 is a fun question. To give you some of my background, I started with a CPAP, went to BiPAP w/BiFlex, then to APAP all within 4 years. I'm not sure if you're familiar with the different devices and their TYPICAL uses so I'll give a brief synopsis.

CPAP - One straight pressure during therapy. Variances include C-Flex and EPR which reduce the pressure on exhale according to algorithms that allegedly similate "normal" breathing patterns. The reduction in pressure on exhale is typically 1-3 cm based on user preference or Doctor's prescription.

BiPAP - 2 different pressures (Inhale set higher than Exhale). The machine swings between the two pressures on a straight line. Variance includes Bi-Flex which is based more on the algorithm. Instead of a straight drop in pressure ove rthe length of the exhale to the prescribed lower setting, the algorithm assimilates a breathing function/curve to the lower pressure. According to ResMed's website, EPR only works in the CPAP mode.

BiPAP has been typically prescribed for patients with UARS (Upper Airway Resistance Syndrome). That's basically people who have a difficult time breathing against the incoming pressure. It seems to be a more common practice now-a-days that BiPAPs are being automatically prescribed for patients whose pressures are 14 or higher. My doctor is doing this. He won't even prescibe CPAP with pressures 14 or higher unless the patient makes a specific request.

APAP - Theoretically, a device that is prescribed a range of pressures to work within--to give only the pressure needed to eliminate the apnea/hypopnea event and then return to the lowest pressure within a reasonable amount of time. Basically it provides the pressure needed to keep the event from happening (pre-emptive) based upon algorithms and breathing patterns, OR once an event has happened, it provides enough pressure to keep another event from happening (reactionary). This is NOT on a breath-by-breath basis rather it is more typically associated with changes in sleeping positions and their breathing patterns.

I mentioned "pre-emptive" vs. "reactionary". The debate still remains in certain circles as to whether or not APAPs are pre-emptive in keeping an event from happening at all or reactionary in that once an event has happened it reacts to disallow more events. Studies are being conducted; findings are being made and thigns are not very settled yet. Arguments on forums fly concerning this issue.

I am not familiar with A-Flex. I surmize from Respironics' website that it is the same as C-Flex, but "rides" with the pressure changes. I could be wrong on this issue, but that is my perception of their info.

If you already knew that--sorry. If you disagree with any off it or have questions, chime in.

Now...BiPAP vs. APAP? They both have their pros and cons. Here's my experience and you can extrapolate from it what you need.

With BiPAP I found out what the hooplah was on the matter of pressure relief on exhale. I didn't realize that I needed it, but it helped my sleeping tremendously. I have a BiPAP as my backup machine.

The APAP came in when I finally had insurance for the first time in years. I had the BiPAP as the standard backup in case APAP din't work for me. Initially me doctor didn't like APAPs, but I gave him a good reason to try it--especially since insurance was picking up the tab.

In MY case, + or - 5 lbs. of weight = 1 cm change in pressure. He knew this from our consults over the years. Rather than going to his office on a rather monthly basis to get the pressure changed by his CRT, I reasoned that "with the weight change, the pressure would change to what I needed and your CRT wouldn't need to see me very much anymore."

A second reason that I gave him was that according to my last PSG titration, I needed as high as a 15 and as low as an 8. He prescribed a 12 for CPAP bcoz that was the most efficient of 4 optimal pressures I could have been prescribed. The 15 was too high bcoz central apneas kicked in hard at that pressure for me. I reasoned that if the lower range pressure is set to the prescribed 12 and the upper limit is set to 16, I will always have the pressure I need at a 12 and if I need a 15, the machine can adjust for the time that I need the 15. He said "let's try it."

My history thus far: 95% of my sleep time is spent at a pressure that is less than 1 cm over minimum--usually a 12.6 or 12.8. My AHI is consistently a 2.5-3.8. And this has been for almost a year now. So my Doctor is a very happy man! I'm a happy camper!

I highly recommend APAP if you can use it and it suits your treatment needs.

BiPAP is a more rigid treatment style, and APAP is a rather flexible treatment style IMHO.

Now in the last question you've introduced Central/Complex/Mixed apneas. This is definitely a more complex matter. From my understanding in talking with my doctor, CRT, Sleep Tech, and in reading forums, central apneas whether in mixed/complex apnea or alone are only treatable with medication. The obstructive part of mixed/complex apnea is treatable with XPAP therapy.

You MAY be better served with a BiPAP if you have mixed/complex sleep apnea. That's something to definitely talk with your doctor about.

Anyhow, Hope this helps! Sleep Well and Prosper!

Marco Polo

Follow Ups:

• Re: Increased Pressure to 18 cm StevieB 16:29 12/17/07 (0)

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