AboutDave Walsh RRT Expertise Registered Respiratory Therapist and Licensed Respiratory Care Practitioner (IL). Thirty-five years in the field of Respiratory Care with the last twenty-five years spent concentrating in the area of sleep disordered breathing. Established the first hospital based compact multiphysiologic recording program for the diagnosis and treatment of obstructive sleep apnea syndrome (OSAS). I`ve been fortunate to have the opportunity over the past fifteen years to travel across the country and train fellow heath care practitioners in the scoring and analysis of compact sleep apnea studies.
Experience I'm proud to have built a comprehensive sleep disorders center in Chicago during the '80s and to then go on and build the first hospital based compact multiphysiologic recording program in the country. I now operate DRW&Associates Inc, providing sleep disorders case management services to the community along with both attended sleep studies in sleep labs along with unattended sleep studies done in the home.
Expert: Dave Walsh RRT Date: 6/28/2008 Subject: cpap vs bipap in nmd
Question QUESTION: I have written before about having hypoventilation at night due to an underlying mitochondrial myopathy. I had a sleep titration study and was placed on a cpap instead of a bipap. I did question the tech about this as literature I have read has said bipap not cpap should be used in persons with nmd and respiratory muscle weakness ( as I have).He said they have to start out on the cpap 1st.I actually slept 6 hrs with the cpap . I was very proud of myself. :-)
I received a call yesterday from the home health co. who will be setting my machine up. They said my dr had ordered a cpap machine. I already have a bipap machine that I had gotten 3 yrs ago but had difficulty tolerating(no sleep study or titration with that- just pressures picked by a former dr). I explained this to them but they said I would have to purchase this cpap machine.
My question is : I am really uncomfortable with getting the cpap if this potentially could make things worse for me in the long run.Am I making too much of the cpap vs bipap issue? I have put 2 calls into my dr ( who is a sleep specialist) but have had no response as of yet.
I am not sure what to do at this point. Can you help me?
Thanks.
ANSWER: Linda:
No, I don't think you are making too much of this issue. In fact I applaud your enthusiasm in insuring you remain an informed health care consumer. If if were me, I would take a bit of time to print off whatever literature I find on the internet that supports my stance and forward it to my doc.
In the long run, if you have PPO insurance you may have to fire your current doc and find one who is more receptive to your needs and willing to consider alternative approaches to the problem. In any event, I hope you stick to your guns!
---------- FOLLOW-UP ----------
QUESTION: My dr called me this evening. I went over my concerns with him. He said my hypoventilation was mild and the cpap would not hurt at this time. He said I could have problems in the future and need bipap at that time.I don't know how reassured I feel in that even though my osa is mild at this point, I certaintly don't want to worsen the weakness over time. He said he set my settings at 7 since on the titration study, they started at 5 and went up to 8.He said it totally corrected the hypopneas.
As far as the machine, he said he had ordered an "easy breathe" machine from resmed. My bipap machine is 3 yrs old. He said it was up to me if I wanted to get the new one.
I think I would just feel better if I was on the bipap and not cpap- just from what I have read from neuromuscular specialists. He said as the hypoventilation grows more severe, that is when the cpap vs bipap becomes the issue.
Any thoughts?
Thanks.
Answer Linda:
Well, at least you are being given a choice. As for me, I consider CPAP and BiPAP to be benign forms of therapy with no significant risk. So why wait until you develop worsening symptoms? Example: a reasonable diet is a good thing for a person to adopt and especially when he or she thinks they may have a propensity to gain weight, so why wait until you put on pounds before following such a reasonable diet?
That's about all I can offer you at this time. I hope our exchanges have been of help in some way. Be well!
