BiPAP or EPR Which is Best? Bilevel and Expiratory Pressure Relief

Let's talk about BiLEVEL or EPR. BiPAP or Expiratory Pressure Relief. Which one is best for you?
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[@Freecpapadvice]

I'd love to hear your thoughts! What do you think is best: EPR or Bilevel? Thank you for watching!!! Links: 1. Have a PAP Analysis with me at: axgsleepdiagnostics.com 2. As an Amazon Associate, I earn on Qualified Purchases: amzn.to/3drPax1 Video Sponsor: cpapsupplies.com/lefty Use my CPAPSupplies.com (affiliate link): bit.ly/38yPlXk February Discount...25% off AND 100 Loyalty Reward Points: LOVELANKY Don't forget discount code: LEFTY20 if all else fails! Check out my new Amazon Store: www.amazon.com/shop/thelankylefty27 (or....use my Amazon affiliate link every time you shop Amazon. Thanks!) Join this channel to get access to perks: kzbin.info/door/g_Rj5qrxlCo4OX6MMq08gQjoin

[@cebruthius]

1:02 How do you explain the EasyBreathe sharkfin being mandatory on ResMed's ASV units? There is no rise time on those machines. They are true bilevel units. That refutes your suggestion that you need "fast transitions" for "effectively opening the airway."

[@JoePhillips-b2s]

BIPAP! Hey Jason. My sleep has improved 100% with the last change to settings we made. Thanks a million.

[@CPAPfriend]

Pressure support seems to be able to deal with some portion of respiratory effort / resistance that further increases in pressure cannot, yet this is not widely understood in the industry. I've noticed the same outcome working with patients. Great video!

[@cebruthius]

1:08 PS of 5 cmH2O is very comfortable :D And bilevel definitely isn't intended for "speed of opening your airway." But augmentation of work of breathing, which leads to augmentation of tidal volume if the airway is sufficiently stabilized (with EPAP). In UARS it is very useful because a fully stabilized airway can still be narrow, so in that case the augmentation of WOB will resolve Flow Limitation.

[@semiephemeral9]

Tips on setting up a dsx900?.

[@RegularGunGuy]

BIPAP totally the way to go. Was having a hard time on cpap. BIPAP fixed it. Time to exhale.

[@Rschoe-j5b]

Yes. Switched! Needed to go higher per AXG and Jason to about 17 on CPAP to really knock my issues down. But, pressure, aero, and exhale was just too much Settled on about 13 on CPAP as it was about the best I could do for the last six months and my sleep Dr was like…. Your AHI is under 5 🎉 Bought an Aircurve VAuto and using it on “S” at 13 with PS 3 and OMG….. so much better Everything is just “better” Jason is correct; if you can get a BiLevel if you can so you have the “option” if you need it I just sucked it up and bought one on the clearance sales as they convert to newer model. Wasn’t gonna wait six months for insurance and the fight with my sleep Dr and insurance company. Just had my PMP write a script for a “new” machine as my old one was “broke” 😂 Thanks Jason! A lifesaver😢

[@ShayMaxx]

Got a sleep analysis with you this time last year and your brought to my attention potential UARS. Been back and fourth with ENT’s here in the UK about surgery and getting a BIPAP. NHS wouldn’t give me one so I got one literally 3 days ago. Night and day difference. Flow limit score crushed and day time fatigue already massively improved

[@kingsqueak2221]

Just want to say thanks for the OSCAR consult we did, it really filled in so many questions I had quickly. I highly recommend it for anyone cramming to understand what their data is saying.

[@jeffcoombes3598]

I'm supposedly on a bi-pap machine it helped resolve my aerophagia issues. And I don't notice the pressures during the nightlife I did on c-pap with c-pap if I woke up in the night the pressures would feel higher then they do now

[@gmrob552]

This video is very timely for me. I have been using a ResMed 10 for just over a year without much improvement. Thanks to the 02 ring reports, the sleep doc ordered a titration sleep study and lo and behold, I need a Bilevel machine. I pick it up tomorrow. I'm keeping my fingers crossed hoping it improves the quality of my sleep and my life.

[@dfrazier51]

I am in almost exactly the same situation. On CPAP my AHI was low and well controlled, but my oxygen levels dropped throughout the night to low levels. After an in-lab sleep study, my sleep doctor recommended Bi-Pap therapy instead of supplemental oxygen. I pick up my ResMed Bi-Pap next week. I hope it works, particularly because my cardiologist believes the low oxygen levels contributed to my AFIB issues. This video was very helpful to a newcomer to understand how Bi-Pap works and what it does.

[@mikeinpcola5543]

Can you share what the metrics were that they decided to switch you from cpap to bilevel? Was it O2, flow limitations, how you felt? Thanks.

[@dfrazier51]

Mine was related to low blood oxygen levels during sleep. My AHI averaged around 1.4, but my O2 would be below 85% for two hours over the course of the night. A sleep study was ordered to determine my need for supplemental oxygen, but apparently the oxygen level stabilized when the sleep tech switched over to BiPap during the test. The higher pressures available with BiPap were said to be the key. I am going to start out with inhale pressure of 25 I am told with a reduction on exhale of 4.

[@dalem04]

2:53 Hey, I think I've seen that chart before! (Every time I look at my sleep data using an APAP). BiPAP looks much better, although I have yet to quite get it dialled in.

[@peterh1282]

I have a Resmed 10 Vauto with Max IPAP 12 Min EPAP 11 and PS set at 1 and it does great. People have said that I should get an auto but this has worked well for me. Nicko also has an EPR sux video as well and comparisons between diff machines.

[@scowell]

vAuto *is* an auto-titrating machine, right? Aircurve 10 vAuto?

[@peterh1282]

Yeah, the AIrcurve 10 vauto @@scowell

[@scowell]

@@peterh1282 OK... if you open up the max IPAP it can motor up when it sees Flow Limitations... if you're already having low AHI why bother? You do have an auto machine.

[@genedong]

My sleep study at well known institution last month agreed with you that bilevel was indicated for me, but Medcare just denied coverage.

[@ASpectacular3777]

I was started on a Bi-Level. They did another Polysomnograph test overnight at NW and then ordered an ASV. Been on it 2.5 weeks. I hate it. Aerophagia is horrible. Using ResMed N30 which most nights 0Leaks. Was on BiPap for 2 years. Right before starting BiPap had normal Pulmonary Function Test. Been short of breath lately, had a Chest CT and I have Emphysema! I’ve never smoked! Ever! Did the BiLevel give me Emphysema from blowing so hard? And now on ASV I feel worse. :(. I think I’m going to stop therapy and see what happens. Scared to use the machine now.

[@travv88]

Hey have you looked into hyperbaric oxygen therapy as a way to help people with sleep apnea recover due to oxygen deprivation from this condition? Look into it. There is a bit of evidence that it might be effective for people with sleep apnea and it would be great if some of the big KZbinrs looked into it.

[@mikeinpcola5543]

Dude, this is 100% what I'm trying to have my sleep Dr look into at my next sleep test in 2 weeks. I KNOW therapy starts from the bottom up, as in quality of thousands of breaths, and then look at RERAs, and then hypopneas, and then apneas! So 2 questions if you will Jason, or lego man, have the time :)...did this patient noticeably feel better with the bilevel, and what is your recommendation on what bilevel to go with? I know resmed just came out with the 11 Aircurve Vauto, but what about Lowenstein Prismas? Thanks!

[@Crazy4mypets]

Question! Have you tried bongo rx, or what are your thoughts about it? I am prescribed 4 to 14 pressure so I have moderate apnea. I don't like the mask. I have purchased several, and I end up taking it off or it takes me 2 hours to relax but the moment I feel the pressure ramping up wakes me up and I can’t sleep until I take it off. I would like to try this bongo rx. Thanks 😊 PS Sorry about my English. It's my second language.

[@sirenmuscle]

Can you do a follow-up regarding the urology issue you were having. Like is flomax working, any dizziness from it, side effects of loss of drive, retrograde ejaculation, etc. Is the prostate still larger. Going through these issues along with uti's. By your feedback, you will be helping many out there. Thanks

[@Freecpapadvice]

I don't know about a video. So I was already on a very low dose of Cialis (apparently it makes the prostate "happy") and Flowmax. In combo they work well together. (just not for me). They found through the cystoscopy that my prostate was still huge even after cutting out caffeine. Finasteride was added and I've been on it for I think 3 weeks or a month now. I was worried about all the side effects that I had read about but have experienced nothing but positives. No dizziness, a return of drive, no retrograde. Assuming the prostate is shrinking. I personally think everyone is different. I'm going to ask about eliminating flomax and cialis at my next appointment.

[@sirenmuscle]

​@Freecpapadvice ty..I was going to tower urology by cedars in bh. Dr was like here's some flomax and Propecia. Take these and good luck. Even though I had a uti and prostate is not large. Then he walked out of the room. Not feeling the love there. I just don't want to be taking pills with side effects and the issue comes back after stopping. There has to be other natural remedies. Btw..you can do an ultra sound with a small probe in your rectum to measure the prostate exactly. No pain, way easier than a cystoscopy.

[@Freecpapadvice]

@@sirenmuscle I'm not going to pretend I understand Urology. Propecia is Finasteride. It's also called Proscar if used at higher doses specifically for enlarged prostate. I have to say that I was very uneasy starting Proscar because I read about all side effects. Same with Flomax. After speaking with my pharmacist she was very dismissive of most studies. She said that in the real world these side effects don't seem to track. From my experience after a brief period of time I would say this seems accurate, but time will tell. I have zero anxiety about going places now and no longer frantically search out the nearest restroom when going anywhere. Did you have a cystoscopy done or the butt probe? I TOTALLY would have opted for the butt probe.

[@sirenmuscle]

I have had both done. The 2nd cystocopy left me bleeding and freaked out.....the Dr was rough. The ultra sound is the way to go ..done twice . I'm going for a urinalysis and culture today at Tower to see if infected. Lately,I am seeing my urine dark orange which they say is dehydration, but I have been drinking lots of water...like a gallon day. This is just so frustrating and annoying. And the dr at Tower is off on Fridays..lol. I am not happy with him anyway..dr sacks. I just don't want to create more issues down the road with meds.

[@bob-ue8pl]

Flomax gives me retrograde ejaculation. Feeling the same, just no sperm!

[@cebruthius]

Personally I'm a fan of the Philips bilevel units, because the transition shape (confusingly called BiFlex) is a nice compromise between a "square wave" (Rise Time) and the slow EasyBreathe sharkfin. AutoTrak is also nice, no fiddling with Trigger and Cycle settings required.

[@davidpeterzell789]

Thanks for another great video. So I love traveling with my light and compact Resmed AirMini but it does nothing for my respiratory resistance issues. When I travel, should I dump the AirMini in favor of my bilevel machine (Reset AirCurve 10)? The AirCurve is clunky and heavy and takes up lots of space... but the therapy is better. I don't really feel the difference but I can see it in the data. Any thoughts about the tradeoff?

[@tristanmartin9087]

I finally ordered a bipap machine today. Should I keep it on bipap s and play around with the ipap epap? Or should I do auto and let it figure it out for me?

[@GuntherSnaps]

how do I approach getting a bipap?

[@scowell]

Depends on your insurance, or your willingness to pay. Or... your willingness to hack your AS10's firmware. You can ask your doctor for a dual cpap/bi-level titration session, they will always agree if it's been a while.

[@Rschoe-j5b]

You need to use buzzwords with the Dr. “can’t exhale, stomach hurts all the time for air, can’t breath and feel suffocating like I can’t get the air out, I think I’m just going to stop’ That gets you into the “problem with compliance” category and opens up the door for BiLevel 😉

[@beltycat5490]

Did you do a video on the AVEOtsd for OSA ?

[@elly535]

After 200+ night CPAP now trialing Lumis 150 VPAP ST (can't get VAuto here in Oz) 8 nights have tweaked settings myself but still sharp pointy breaths. So probably missing something but convinced I had - and still have - UARS as continue to feel tired in day. :-(

[@dalem04]

What is the difference between the VPAP and VAuto?

[@theleigharchie]

Going from apap to cpap made a huge improvement for me. No EPR. I would love to try a bipap but I don’t think I need one. I haven’t looked at my data in a long time but I’m getting under 1 event nightly, no leaks, and I’m feeling okay.

[@illt3ck]

What about efficacy of air delivery on the standard mode vs easy breathe? Is one more effective than the other?

[@scowell]

Curious to know whether EasyBreathe was turned on... when using vAuto mode it's on by default... in 'S' mode it's an option... without it the pressure really hits me too hard.

[@BrendaMalone]

very few people will be able to switch to Bi-Level because of Medicare and / or Insurance rejections.

[@NiWhomPing]

Agree

[@Ontheroadbrogymgo]

I really would like to see if my insurance would let me go in to see if I would qualify for BiPap. I’m currently on APAP.

[@Irishbearkrm]

What is the best bilevel machine to buy?

[@ghost-in-the-ciel]

I need BiPAP but it costs 3000 dollars for the same machine with an extra setting, so I guess I'll just die!

[@RebelRobot01]

I could be wrong, but I think it is only the ASV variant of Bipaps that are that expensive. I have seen the regular Bipaps go for about $1500. In fact, I got an email from one of the major online cpap retailers this week advertising the new Aircurve 11 (the new Bipap variant of the Airsense 11) for about $1200.

[@chalrd5452]

aircurve 10 vauto bi-level card to cloud on sale online for $949 out of NJ so no taxes. Not sure if I need it yet but for that price snagged one.

[@travv88]

Makes me think I might need a BiPAP.

[@michaelmarchei8539]

Love the epr on my prisma 20a. Poor mans bi level. Gives a 1CM bump on inhale

[@cebruthius]

Prisma has SoftPAP which is nothing like EPR.

[@ich8159]

I was at a pressure of 17 on CPAP (Airsense 10) and my AHI looked great, but my symptoms did not improve. It turned out that I had lots of oxygen drops. I was changed to a Bilevel (Resmed Lumis VPAP 150 ST) and put on 5 EPAP and 12 IPAP which was too low for me. I changed the settings to 10 EPAP and 20 IPAP, which feels great. My AHI is brilliant, but I am still having oxygen drops (less than before, though). Does anyone know what I need to do to bring my oxygen level up and prevent the drops?

[@ghost-in-the-ciel]

I'm not an expert, but 10 seems like a gigantic drop from 20 for your EPAP. Your airway may be collapsing too much on exhale. Try a higher EPAP maybe.

[@ich8159]

@@ghost-in-the-ciel Thank you! I will try that.

[@lloydwilson9411]

Wish I could get Bipap. I am stuck with CPAP. The place I goto downgraded me to CPAP and basically said I will like it. I don’t. I had bipap before but had to to a retest or whatever they call it. Fun times

[@scowell]

I'm having a dual titration coming up... both CPAP and bi-level... been 14 years! I tried to do a new sleep study... failed miserably... no way I'm going to sleep without massive Ambien, my original AHI diagnosis (100lbs and 14 years ago) was > 100. I notice that when I use EPR of 2 or 3 I get palate/uvula 'slapping'... like your face is slapped from the inside... is that palatal prolapse? The machine doesn't flag it but I do notice it only when using EPR... I'm hoping that bi-level won't do the same thing... I do appear to be well (self) titrated with lots of zero AHI nights at 15cm EPR1... but the flows look pretty chaotic and I do toss n turn, and in the morning I just want to go back for another two hours. I guess we'll know more after the titration... I consulted an ENT and without anything but a cursory look he told me 'tongue'. Maybe time for a DISE? Want those booby-shaped waveforms!

[@elly535]

Exact same!!! I love the way you described the palate /uvula 'slapping'. I experience a funny click like something shutting off- but never knew how to describe it.

[@elly535]

Also the rounded waveforms are what I'm chasing but both CPAP and Bilevel are ugly sharp pointed peaks

[@scowell]

@@elly535 That might be too *much* pressure... what are your settings?

[@stuartcrisp2027]

You have concluded that a BiLevel is better than a CPAP / APAP , agreed. You have concluded that IPAP = 15 and EPAP of 11 (PS = 4) is better than IPAP of 17 and EPAP of 14 (PS = 3, because your body only recocgnises pressure, not the name of the difference between two of them). The result shows this to be true for this user but does the AirCurve S use Easy-Breathe or not. So, was it because of the additional PS or because Rise Time was set (by default) to Min (approx. 150 ms, unless adjusted)? You mentioned the trampolining effect but attributed it entirely to PS. Is that really so? You can make valid comparisons of EPR and PS if both machines use Easy-Breathe. Even then, you should ideally first run with the same EPAP and IPAP to compare for similarity and difference between the machines before increasing PS to determine its effect. If the AirCurve S does not have Easy-Breathe, you MUST start with PS = EPR to understand the differences that are not related to PS, if you wish to make comparisons. I did that and found that CPAP with pressure = 9, EPR = 3 (EPAP = 6) and Easy-Breathe used is VERY different to S Mode with IPAP = 9, EPAP = 6 (PS = 3) and Rise Time = Min. For better or worse I was told, since I do not have an obstructive condition, that I could increase Rise Time (Ti Min has to be increased too). Yet even the maximum value of 900 ms for Rise Time is faster than Easy-Breathe (as seen on the mask pressure chart) and still quite different to experience but more comfortable than min.

[@cebruthius]

> You can make valid comparisons of EPR and PS if both machines use Easy-Breathe Exactly. Interestingly, there used to be a setting on S9 CPAP units to use EPR without EasyBreathe (i.e. linear rise time)

[@semiephemeral9]

@@cebruthius have to wonder if that was a FDA thing.

[@NiWhomPing]

In response to your question... in the product literature, Resmed states: "The comfort feature Easy-Breathe is available in S mode on the AirCurve 10 VAuto and AirCurve 10 S device." And Easy-Breathe can be disabled in S-mode if desired.

[@chalrd5452]

Could someone please tell me if the ResMed AirCurve 10 VAuto BiLevel card to cloud is a good machine? I am seeing it on sale for $949 online. I realize it does not have a cellar modem but is compatible with Oscar. After listening and learning from Lanky for the last 6 months I'm not worried about using the crap Myair app so I'm comfortable with no modem. Just curious if this is a true BIPAP machine. I only question it cause some ResMed Aircurve 10 VAutos say BIPAP this one says BiLevel. I'm thinking it is the same just worded different. Thanks for the help!!

[@cris_miko]

I bet Medicare won't cover bipap

[@NoNonsenseNan]

Insurance companies will not cover a Bi-level unless you produce a CPAP Tried & Failed to them first.

[@araydog]

EPR is fine but you will have to up pressure

[@semiephemeral9]

Bi-Level is much better choice too with people that COPD isn't it? Since they have expiratory flow limitation. The lower EPAP should make it easier for them to exhale? And decrease work of breathing. From lab titration protocols I've seen, most of them says "has COPD? try bi-level!"