Whats the differences in BIPAP, XPAP, APAP, CFLEX

sapphireskye · Post by **sapphireskye** » Tue Dec 27, 2005 3:08 am

I am just curious. What are the differences in the types of machines and features on them like the Autopap? What is C-FLex- that is what I have. What is an XPAP? and what does a BiPAP do? Just trivia

Thanks
Chelle

neversleeps · Post by **neversleeps** » Tue Dec 27, 2005 9:03 am

Use the CPAPopedia (click on the blue book at the top of this page) and/or click on the links automatically provided at the bottom of your post (appearing in blue).

XPAP is just a shorthand way of describing any kind of PAP machine without specifying which one.

C-Flex is a feature offered on some Respironics XPAP machines which you can adjust to provide relief upon exhalation. If you click on the link in your post, it will bring you to the brochure explaining it.

BiPAP is often used as the generic term for a Bilevel machine, but really BiPAP is a Respironics trademarked acronym for their particular Bilevel machine. When you're in the CPAPopedia, click on Bi-Level Machine for the definition:

A Bi-Level machine is a positive airway device that can be set to two distinct pressure settings. The inhalation setting, (IPAP), is adjusted to relieve snore and hypopnea. The exhalation pressure, (EPAP), is adjusted to relieve apnea.

Bi-Level devices are commonly used when a patient cannot tolerate the pressure of a CPAP. Used for this purpose, the Bi-level machines are set to run in Spontaneous Mode. Spontaneous referring to the presence of respiratory drive.

A Bi-Level set to run in Timed Mode, are used for patient’s with a host of medical issues, including Central Apnea, ALS, and many forms of COPD. The timed Bi-Level will initiate a breath, when respiratory drive is not present.

Guest · Post by **Guest** » Tue Dec 27, 2005 12:34 pm

The machine section of the cpap.com FAQ covers this well too

https://www.cpap.com/cpap-faq/Machines.html#FGID-2

sapphireskye · Post by **sapphireskye** » Tue Dec 27, 2005 12:35 pm

Thank you for the info, I appreciate the help.
Blessings
Chelle

rested gal · Post by **rested gal** » Tue Dec 27, 2005 12:58 pm

Excellent explanations, neversleeps!

Chelle, to round it out, here are some more things you might come across:

As neversleeps said, BiPAP is Respironics trademark name for its bi-level machine.

ResMed's trademark name for its bi-level machine is VPAP -- as in VPAP III.

Puritan Bennett's bi-level machine is the Knightstar -- as in Knightstar 330.

There are also special bi-level ST (spontaneous/timed) machines that can be set for a timed backup rate. May be helpful for treating pure Central Sleep Apnea -- much less common than Obstructive Sleep Apnea.

C-Flex, as neversleeps explained, is Respironics' trademark name for its exhalation pressure relief feature on their cpap and autopap machines.

Respironics also offers Bi-Flex in their bi-level machines as an optional bit of more relief you can set to drop the already lower exhalation pressure a bit more temporarily, right at the beginning of exhalation. Kind of like icing on the cake.

EPR is ResMed's exhalation relief feature on its new S8 models.

When using an autopap, Respironics' C-Flex is available in any operating mode, even in auto mode.

ResMed's EPR is available only when operating its S8 Vantage autopap in cpap mode. ResMed's EPR cannot be used in auto mode.
Edit in 2009: The newest ResMed autopap (S8 Autoset II) can now use EPR in auto mode.

C-Flex (Respironics) and EPR (ResMed) both have the same goal - pressure reduction for easier exhaling. However, the two manufacturers went about designing their respective exhalation pressure reduction features very different ways.

EPR is can be set for an exact number of cm's of pressure drop - 1, 2, or 3 cms.

The amount of drop C-Flex can give is very dependent on the force of a person's exhalation. The prescribed pressure will come back in before the exhalation is finished, so the user will be back up at the prescribed pressure before the next inhalation takes place.

Edit May 23, 2007 to add a new feature Respironics is putting in some of their M series REMstar Autopaps:

Respironics M Series REMstar Auto with A-Flex. Yes, "A-Flex" instead of their current "C-Flex." As I understand it, A-Flex will allow the autopap to still deliver C-Flex style drop in pressure at the beginning of each exhalation, and will also round out the transition to the regular pressure that comes back in before you begin to inhale, making it all feel smoother. Probably works somewhat like Bi-Flex does in bi-level machines to "soften" the beginning and end of inhaling. The Auto with A-Flex has both C-Flex and A-Flex in it, but you can't use both at the same time. A-Flex is available only in auto mode. C-Flex is available in both cpap or auto mode.

Edit Nov. 14, 2009 to add a new feature Respironics is putting in the Philips Respironics System One machines -- "C-Flex + " :
As best I can tell from the descriptions, C-Flex + probably works in the PR System One machine the way Bi-Flex does in a BiPAP, or like A-Flex does in the M series Auto -- softening/smoothing pressure transitions. Both C-Flex + and the older C-Flex are exhalation pressure relief features that let the regular pressure back in before the exhalation is finished. C-Flex + may feel a bit smoother while it is doing that.

More machines of interest:

Autotitrating Bilevel machines -- can be used just as a bilevel or can be set to autotitrate while operating as a bilevel. In autotitrating bilevel mode they vary EPAP and IPAP as needed.
Respironics BiPAP Auto
ResMed VPAP Auto

Adaptive Servo Ventilators (ASV) are primarily for treatment of central apneas and normalizing Cheyne-Stokes respiration associated with Congestive Heart Failure. Also probably the best machines for treating "CSDB" (Complex Sleep Disordered Breathing -- CompSAS -- complex sleep apnea syndrome.)
Respironics BiPAP Auto SV
ResMed VPAP Adapt SV

Patrick A · Post by **Patrick A** » Tue Jun 26, 2007 9:51 am

I don't believe that this feature is available in M-series Auto Yet in a Bipap machine

Respironics M Series REMstar Auto with A-Flex. Yes, "A-Flex" instead of their current "C-Flex." As I understand it, A-Flex will allow the autopap to still deliver C-Flex style drop in pressure at the beginning of each exhalation, and will also round out the transition to the regular pressure that comes back in before you begin to inhale, making it all feel smoother. Probably works somewhat like Bi-Flex does in bi-level machines to "soften" the beginning and end of inhaling.

At least they didn't say so when I ordered my new machine yesterday. It is available in the non-Bipap machines

Nazareth · Post by **Nazareth** » Tue Jun 26, 2007 10:13 am

OK here's a question for the experts- My doctor had originally ordered a Synchrony Bipap S/T machine, but my DME only had the Respironis Bipap S/T. She told me that the two machiens did exactly the same thing, and when I questioned her a bit abotu hte difference,s, trying to understand, she got a little defensive and repeated that there was noc difference between the two, and I ended up with the Bipap S/T machine because they didn't have a Synchrony Bipap S/T machine on hand- My Docs perscription was for the Synchrony Bipap S/T, not hte Bipap S/T.

Is there a difference? I know the bipap S/T is supposed to self adjust to my breathing pattern, but it's doing a kind of lousy job, and seems to be a very mechanical adjustment, and I'm finding I have to fight to try to keep up with the constant rate changes that the machine is throwing at me (for instance, it will Ipap for 1.5 seconds, then hte next Ipap will be 2-2.5 seconds, then the next will be 4 seconds, then it goes to 2-2.5 seconds, then back up to 4 seconds on next Ipap, then down to 1.5 seconds- it just seems VERY erratic and mechanical) It seems to me that a synchrony S/T might be a more natural process that follows my natural breathing rate changes in a more gentle, natural method rather than a more rigid mechanical machine oriented rate switch?

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, DME

rested gal · Post by **rested gal** » Tue Jun 26, 2007 1:19 pm

Nazareth, I used a borrowed timed back up rate S/T machine in timed mode for a couple of weeks. Not because I needed it, but just for the "fun" of trying out what various timed backup rates felt like. (I didn't like "timed"...but, as I say, I don't need that.)

So, I'm not an expert by any means about those kinds of machines. My guess, and it's purely a guess, is that the Respironics BiPAP S/T the DME RT girl gave you will deliver the same kind of treatment as the Respironics Synchrony S/T model. I think the Synchrony is the machine used in a lot of sleep labs during cpap and bi-level titrations. It can be controlled remotely to titrate for straight cpap, or to titrate for bi-level, or to titrate for bi-level with timed backup rate. I don't know if the BiPAP S/T can be controlled remotely in the sleep lab, but perhaps so. If not, then that's probably the main difference between the Synchrony S/T and the BiPAP S/T. Again, my guess is that as a treatment machine, they'd both work the same and feel the same. But I don't know that for sure.

The poster nicknamed christinequilts would know. She used a Synchrony BiPAP with timed backup rate for several years before she switched to the Adapt SV machine.

The "fighting" and out-of-synch times you describe with you and your machine would be true with any S/T machine, I believe...if the backup breaths rate is set too high for you. Pesonally, if I had to have an S/T machine, I'd rely very heavily on Christine for advice and suggestions. Probably more so than I would on a doctor, and RT, or other DME employee. As in the excellent information she's been providing in your threads:

viewtopic.php?t=21162
Jun 16, 2007 subject: BiPap S/T cycles too quick

viewtopic.php?t=21310
Jun 22, 2007 subject: BiPap S/T Settings Question

P.S. I still get a chuckle thinking about your tongue-in-cheek humorous comment (in a different thread) -- "Why would cleaning the buttons change the pressure?"

oceanpearl · Post by **oceanpearl** » Tue Jun 26, 2007 1:47 pm

If it is a Flex machine I would suggest trying another Flex setting. That worked for me.

Nazareth · Post by **Nazareth** » Tue Jun 26, 2007 9:27 pm

Thanks RestedGal- Yeah- I took her advice and set the BPM's to 12 instead of 14, and it seems a little better- setting it to 10 seems optimum, although I still fight it a little bit- but it is better at that 10 setting, but I don't want to push it, so I compromised and have it at 12 for now

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Whats the differences in BIPAP, XPAP, APAP, CFLEX

Whats the differences in BIPAP, XPAP, APAP, CFLEX

Thank you neversleeps