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Should Everyone Use Bilevel instead of CPAP?
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- Опубликовано: 12 июл 2022
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Question answered about if everyone should use bilevel instead of CPAP. What do you think?
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He said it in the video but it bears repeating: All resmed 10 and 11 machines have Bi-PAP and ASV capability. All of them do. They just don’t install the software for it. The only difference between a cpap, auto set, bi-pap and ASV is the firmware on the machine. The hardware is 100% identical. They just slap a different logo on it and sometimes use a different color plastic. It’s dumb. I’m not opposed to charging for more advanced software…but if I have one of these machines I should be able to pay an upgrade fee rather than replace the whole thing. They could flash it remotely over the air if they wanted to.
Hey this is half true. The Aircurve Vauto and Autoset are the same. The ASV actually does have some extra controllers on it. I did the airbreak on my autoset and none of the ASV stuff actually works, but the bilevel stuff does.
@@jayhathaway4720 good to know that asv has some real hardware changes. That would make sense since I think part of what they're after with asv is controlling co2 levels. So maybe there's a sensor for that
@@jayhathaway4720 What about the ASV stuff didn't work for you? ASV seems to work fine on my Airbreak machine. Only differences I can see are you don't have control over Trigger, Cycle, or TiMin & Max with Airbreak!
@@zaciscool576 That's what I meant. Actually I learned that if you flash a firmware from an aircurve machine onto an autoset, you can get access to ti min and max etc. But I haven't been able to get my hands on the firmware.
@@jayhathaway4720you can take ASV firmware and flash it into a For Her just fine
Thanks for this Jason! I used to be on Auto Bipap for 3 years and I saw your past videos advising that Bilevel is better than auto. So as an experiment I changed my setting to Bilevel using my Oscar data over 3 years and tuned my Bilevel settings to my 95p ipap and 95p epap averages. My AHI has never been better with Bilevel and I wake up less!
Just started ASV therapy two weeks back - life changing after 2.5 decades of suffering - events are between 0.0 and 2.0 - (last overnight study was 72!
Why asv?
Same here. I have AHI usually less than 2.5 and feel great.
@@k6txh Also on ASV?
Bruh, v-com plus mouth tape and bleep is the holy grail. 100 score every night and 90-96 pillow sleep score. I’m a changed man. And I failed CPAP in 2019.
Yes. Everyone should be given the choice to experience it. Barry Krakow MD is right when he said fobbing everyone off with plain CPAP is inhumane in many cases.
You're asking the wrong question. It's not "should everyone be on bilevel or asv?"
The question is should everyone who needs them, have the same access to medical treatments?
Working your way through the barriers put in place by insurance companies forcing you to PROVE to them that you're x,y,z is the opposite of medicine. Give everyone a machine capable of automatic adjusting low and high pressure and let the doc (or the patient) turn on whatever features they want. Cpap mode, apap mode, bi mode or asv. Whatever works. Heck, there should probably even be hypothetical situations where someone might automatically convert from cpap to bipap or asv if the machine notices a lot of centrals. Not possible with current artificial pidgenholling of apnea sufferers.
Mechanically, these machines are identical and could easily offer all these features. One medical device to treat them all, and in the darkness, bind them!
Good point. The pharma industry and medical companies are not there to help people or "heal the world", but to make profit -- as we have experienced over all the years and also seen during the Covid time. So they are simply interesting to milk the people or insurance companies as much as possible. That is what the distinction between CPAP, Bilevel and ASV is used for. CPAP does not work for me -- I have tried that for a long time. EPR is making things worse. Now I will get a Bilevel machine although I am almost 100 % sure that this will not be the solution as well, because I am already on a very low pressure (5) and still getting centrals induced by the treatment.
I heard that ASV is the best machine for central apnea.
Definitely!
1:19 important nuance: It cycles from IPAP to EPAP when you stop actively inhaling. You don't have to immediately exhale.
thank you for this clarification 👍🏼
If your nose runs & feet stink, no worries, you are merely upside down..... just upright yourself.
I had bipap for my first machine. It was set up all wrong. I had tons of air in my belly and had category 5 shite storm sitting on my face at different time through out the night. Now I'm on cpap and doing much better.
BIPAP with the correct settings would have been even better probably
@@cebruthius I'm tuning mine in an effort to improve sleep. Dang dr left it wide open
@@keplix1 That happens all the time unfortunately
What do you think about people using Bilevel instead of CPAP? Thanks for watching!
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i've had cpap, auto cpap and bilevels bilevels are much more natural way to breathe. i'll never go back to cpap.
I was switched from ACPAP to ABilevel.. Thsnk God! Due to some other health issues as well the ACPAP was causing more issues. Got on bipap and my gawd was is soooo much better! I couldn’t go back to cpap
@@richardcranium5839 I stand with you 💯 %!!!
2:20 Thanks for being one of the good guys ❤
Interesting, I've had some issues with high co2 retention and my last split sleep study I was told I didn't meet the threshold to even do a titration. Seeing the doctor afterward, she noted the high co2 retention and sent me home with 6-15 pressure settings after having success with 6-8 (originally they had me using a 12-15 pressure. I still follow along with CPAP stuff, but I've totally given up on the whole racket they've set up that has such a low rate of success in finding solutions for patients.
Superb content. You teach us vital information.
I agree. My content is superb!!! 😉
You state that one can try Bilevel when central apneas occur. I can not see why that would help. In contrast - you once explained the EPR (on a Resmed machine) can increase the chance of central apneas. This is exactly what I have experienced. When I am not mistaken EPR can be seen as a sort of simple (up to 3 bar) bilevel option, right!? So why would Bilevel help with central apneas? What is the difference of a bilevel to an ASV machine -- especially in regards of trying to avoid CPAP introduced central apneas?
3:05 Actually (by applying PS) you're augmenting tidal volume. This has the effect of increasing CO2 blow off. With healthy lungs getting oxygen in is pretty easy. That's why people with hypercapnia can have full oxygen saturation. It's the CO2 blow off that requires the ventilatory effort. And PS adds its own ventilatory effort on top of your own ventilatory effort, with increased tidal volume as a result. This is how AVAPS/iVAPS works btw, it puts PS in a closed loop with tidal volume, increasing PS when tidal volume doesn't hit the target.
Thanks for the comment. What I'm unclear on (likely misunderstanding) is why bipap increases oxygenation vs CPAP. If CPAP is fixed at 10cm, and bipap is set to ipap = 10cm, epap = 6cm, wouldn't the patient receive more oxygen at a constant 10cm delivered by CPAP? Likewise, wouldn't the lack of epap require more exhalation effort than a bipap that drops the pressure on each exhale.
I ask because although my OSA is generally well treated with APAP of 7-11 and EPR of 3, I do see treatment emergent CA's and occasionally the waxing / waning pattern Jason discussed in the video during the CA clusters.
I've considered reducing the EPR on my Autoset from it's current level of 3cm, to see if that curtails some of the treatment emergent CA's, but I want to make sure I'm understanding the impact first.
@@longboarder543 That's my point. One cannot just say outright "bipap increases oxygenation as opposed to CPAP" you can only say that BiPAP will augment ventilation. EPAP and IPAP don't have anything to do directly with oxygenation. As long as there is air exchange (i.e. you are breathing) you will be oxygenated.
Waxing and waning can also have obstructive causes (back to back hypopneas or sub-hypopneas) so it is tricky with decreasing EPR since ResMed has set it up such that decreasing EPR will raise EPAP proportionally (EPR is subtracted from set pressure IPAP to become EPAP)
im a little confused, when a cpap allows you to exhale with no effort (like it senses you exhaling and allowing it to happen), isn't that the same as bipap then? I just got a new airsense 11 and my last one was some phillips cpap from 10 years ago, its incredible the difference in technology. That one you felt that pressure all the time, now its like you aren't even wearing a cpap except for the mask tied to your face of course.
How do you feel about placing patients on Bilevel or ASV without knowing their ejection fraction?? Or placing a patient on Bilevel with a low ejection fraction?
Thanks JAson, explained a lot in this video (for once) lol. Just kidding your thickness. But I did learn something. I'm on the Bi-pap and now I know a little bit more.
😂 Funny....because of the elements of truth. Thanks for watching!
I'm on BiPAP, have been for years. Honestly, I have no idea why I was moved from CPAP to BiPAP. It was never fully explained to me. I'm currently on a ResMed AirCurve 10. In 6 months I am eligible for a new machine. What machine is considered The Best? Should I stay with the same model machine? Or get something different? It's amazing how little my sleep doctor seems to know or inquire about my sleep. I just seem to learn as I go and my sleep keeps getting better.
I still don't get why the bipap isn't better. Exhaling is a different pressure than inhaling, so how is a machine that specifically targets these two different pressures not better....always... than one that doesn't?
Ty. Great video. Jason, can TREATED OSA possibly still cause a high rbc count?
so Bipap user here.
CPAP/APAP didn't work for me, as I ran into issues with the APAP pressures running away (trying to open airway but false reading rate limit) to the point that it would prevent breathing out at all. would wake me up and force me to rip off the mask to relieve the pressure then restart the machine.
Tried the mouthguard... Waste of 600+ dollars
Finally Got Bipap. Life Changing would never go back to sleeping without it.
I have to say I disagree with you, but not for the reasons you listed. Expiratory pressure relief is a setting on most cpap/apap devices (its worthwhileness is debatable but functionally its the same thing as Bipap but in reverse. As Bipap waits for you to breath in and keeps up the pressure vs Expiratory pressure relief is waiting for the signal you are breathing out. Functionally returning to a normal pressure on breathing in... here's my disagreement.. I think APAP/CPAP fails to address oxygenation at all, as its idea is just keep the airway open. And just does nothing if a CA happens.
I dont understand why a combination of the two cant be used. for people with minimal CA's but still have concerns for oxygenation where if the system detects a CA it gives a level of pressure support and if it detects a OA it gives a increase in base pressure? basically looking for a middle ground that looks at the entirety of possible situations.
Additionally Bipap has some nuance to it that it has a base line breaths per minute rate so if you stop breathing it will push a new breath every x(2 seconds) seconds (clinical setting is flexible) or it will detect a users breathing pattern by senses the pressure curve of the very start of a breath in, then provides the pressure support to inhalation pressure. some users may not need a massive pressure support like mine is 4 different which you feel but not much, I've seem as low as 1 or 2 cm of pressure support which most people wouldn't feel.
Personally I would say BIPAP for everyone but theres nuance to it, I honestly think its a better solution to start with than APAP / CPAP cause the titration study should be able to identify if all they need is pressure or if they need pressure support.
APAP of resvent ibreeze is better and softly regulate and managed your inhale and exhale rthym which is more comfortable than a continous blow.
Excellent comment. Thank you Spambot!!! [sarcasm]
Nice video Buddy thank-you ...A ? What would the price point be on data reading and dialing in with Oscar or SleepHQ
Are my ears playing tricks on me? Did i just hear 'Papper Jerks' Bahahahahahaha. Dude, you're looking sharp also! Sweet hair cut, shaved face but I'm glad you left the chest hair run wild and free 😜. Loving the great content dude. Keep it coming
What I think I’m REALLY hearing is that I need. YT channel for my chest hair. 😉
my favorite bromance on youtube
I tried bi-pap but I prefer cpap with pressure at 15. Yeah, you heard me.
When I replace my airsense 10 with a new cpap I'm going to play around with the 10 and see if I can install the bipap firmware on it. It's out there on the internet, the process is pretty well documented. I just wouldn't do it on my primary machine.
@@NotMyActualName_ if you find out how to do that, and you're able to do that, could you please post it cuz I'd be interested in knowing that? Thanks.
@@af1966 it's already been figured out. Look up airbreak firmware. It was a project for turning cpaps into ventilators during covid.
@@NotMyActualName_ okay, so the actual procedure is the same, including the required hardware and software on the PC? Instructions weren't all that clear to me.
@@nailbomb3 well. Not sure what procedure you found but if it's for an air sense 10 it's probably the same one. It's not the easiest thing in the world to do but if your comfortable disassembling electronics and flashing firmware it's doable
Hello all. I need help from someone. I’ve had my cpap for 4 years with about 3k hours on it. I take it off every night after 2 hours. I’ve had multiple mask, sleep studies, pressure changes, meds, etc. my insurance denied me for the inspire 3 times and I’m out of energy.
I’m willing to pay for help and I just need some guidance or advice.
Jason, sometimes, I will start my machine for the night, and lie down, but after 30-45 minutes, say, I need to shut off and get up for some reason. I have noticed that sometimes, the AHI for that short period is quite high, sometimes EVEN IF I HAVEN'T ACTUALLY FALLEN ASLEEP.
Here's one I'm thinking of especially -- 22 minutes and an AHI of 33.9, and my recall is that's one where I hadn't fallen asleep.
Any idea what would cause that? I haven't looked at the data yet on OSCAR.
Thanks
If you haven’t fallen asleep, it’s likely a bunch of false positives.
I am using an old DreamStation 1 BIPAP and need to replace it. When will they make a DreamStation 2 BIPAP?
Get a Resmed Bilevel…
*Quickie Question! Can a person become dependent on CPAP forever? What I mean is, does CPAP condition the body to need CPAP forever? I recall the brain (pons medulla?) has that secondary-type mechanism that senses extra CO2 that builds up and hence..encourages ONE TO BREATHE! But in a way.....aren't we (those of us on CPAP) kind of making that CO2 brain-backup-response go dormant by virtue of not using it because of longterm CPAP therapy? (Don't get me wrong...I know some of us need CPAP forever! ...but if one is hopeful in losing weight and perhaps wanting to ween themselves and get off CPAP...are we in a sense screwed by virtue of constant use? Gosh, that was a mouthful! sorry, Lefty. 😂* Hope this made sense? Oy. 🤓
Short answer: remove the obstruction, remove the need for PAP therapy.
Lanky Lefty, I have not used my CPAP for a few days due to a cold. But, during the night when I wake up for a bathrooom break, I use a pulse oximeter that measures my O2 saturation as between 95-97%. Does this mean that I get enough O2 without using the CPAP machine? Thanks.
No it was the oxygen saturation when you were awake instead of asleep. you need to measure your blood oxygen saturation during your sleep. Also unless you lose weight, your sleep apnea is very unlikely to resolve automatically. And it’s very likely that it gets worse over time as that’s the case for everybody.
Were you using an actual pulse ox? Or are you calling your fitbit a pulse oximeter?
A real pulse oximeter measures your O2 every couple of seconds and is far more accurate than the fitbit which is measured minutes apart.
Also, guy/gal above is right. Having a normal O2 while awake is normal. You need to look at a report that shows at least 1 whole sleep cycle, start to finish.
You need a device (there are some 02 rings) which read every second the whole night. The issue happens when you're asleep and stop breathing. When you're awake for a bathroom break, you're moving around and breathing then so that's why you're 95-97%.
The other thing is that you can have breathing issues without much of a drop in oxygen, or even any drop. So just because your oxygen levels are reasonable overnight doesn’t mean you should stop using your CPAP.
Hey Jason how are you? My name is Rick I am getting a CPAP machine I’m just wondering in your opinion I know you’re not a doctor do you think they can help with anxiety and stress those types of things if you get the proper sleep?
Hey Jason, is there any difference between CPAP and Bilevel on an Airsense 10 for the first 3 levels of EPR settings other than being able to be more granular in EPR steps, say instead of 1, 2, or 3 EPR being able to do 1.x or 2.x or 3.x EPAP?
On a VPAP or VAuto device you can customize trigger and cycle sensitivity settings and Ti_min and Ti_max. These are fixed on the Airsense with EPR. Dreamstation BiPAPs do it entirely differently, it continuously adapts with the AutoTrak algorithm with no manual settings. I prefer AutoTrak to be honest.
Thanks cebruthius_
@Stuart Crisp On the S9 you could have EPR with and without Easybreathe. On the Air10 it's always mandatory Easybreathe. The VPAP/VAuto also allows optional easybreathe. Personally I think Easybreathe is anything but, I strongly prefer BiFlex.
Hi Jason I want to ask you how to set the Resmed aircurve from bipap to cpap? is the cpap you mention similar to the mode Auto Cpap? or maybe can you make the psupport zero so that it's like an auto cpap mode? thankyou
Cpap stands for constant air pressure. Usually the bipap will have a cpap mode, but that mode will, again, be a constant air pressure mode.
Automatic mode is what the bipap is doing already, just with a bilevel pressure differential. Just narrow the differential from -5 to -3 and you're essentially in autopap territory.
I'm starting to wonder if i need bipap or asv. Im still having 2+ events most nights and i wake up at least once a night about 60% of the time. :/
You might have residual flow limitation. I use ASV, it takes care of my flow limitation
@@cebruthius someone just gave me a refurbed dsx900.
Paper jerks ? Lol, love it
I find it INFURIATING that people use the 'CPAP' when many of the times they mean 'APAP'. Maybe I am picky but I am new to half of your jargon and without local sleep techs available, getting your correct gear options sorted out is depressing. In Australia half the gear you speak of is unheard of 😔 by us commoners.
ASV Auto, for the win.
ASV is the bees knees
Bi-level + oxygen, Co2 retainer, O2 levels in 70's without
Why can you use tap water in Bipap and not in cpap?
Who told you that?!?!
You can use it in both... The only difference between bipap and cpap is the exhalation pressure. You can use tap water in any machine if you wash/rinse it out every day to avoid scale buildup.
@@jellybeansi Using tap water is not recommended! At one point I was using bottled water to prevent drying out from distilled. My sleep doctor told me not to do that and that the water can calcify in your lungs. Tap water has a lot of chemicals and can be considered hard water! Do not use tap water!
@@hertechprep Your doctor is a quack. Tap water cannot calcify in the lungs, you breathe in tap water from the shower all the time. That aside, whenever the water in the humidifer is heated, it turns into steam which leaves hard minerals behind in the reservoir anyways, it's the same process as distillation, it's just happening in the machine instead of somewhere else.
(A lot of cpap manufacturers explicitly say that tap water is perfectly safe too, fwiw.)