Why a vent rather than a Bi-Pap?

Remember that you can go on a ventilator without having a tracheostomy. Karen Roth in Texas uses a ventilator and nasal mask to take over her breathing at night. She asked her pulmonary therapist, Richard Hodgkins some important questions that could save you from going on a vent requiring a tracheostomy if your doctor will read and heed. She writes: I recently had a visit with Richard Hodgkins, my breathing therapist (Richard custom-makes masks for patients who use Bi-Pap machines and vents to assist breathing). He has been with me since 1987 when I first was diagnosed as having breathing problems. At that time Richard was head pulmonary therapist at Dallas Rehab Center, where I happened to be a patient after being told the news.
Q: Why wasn't I put on a Bi-Pap unit after being told that I needed assistance in breathing?
A: Because your muscles around the lungs were too weak for a Bi-Pap to do any good. You were past a Bi-Pap. The next thing to try was a portable vent with a nasal mask...no invasive measures. I used light, comfortable custom nasal masks I made myself and they were working.
Q: When is a Bi-Pap unit effective in patients with CMT?
A: Bi-Pap is effective only in patients who have good chest wall mobility, and takes less pressure to achieve an effective volume.
Q: How does one know that he is not on the right breathing device?
A: If he has to keep changing the numbers on his machine (higher) and, if he still feels tired the next day. The Bi-Pap can only do so much. That is when the vent comes to the rescue. Patients who are on the Bi-Pap will find that they are having to assist the machine to breathe. This tires and stresses the muscles, thus weakening the patient.
Q: Where can a patient obtain a comfortable, good sealing nasal mask if he can't find someone like Richard who makes them?
A: Respironics makes a mask called the Golden Seal, that is new and effective. I put one on my ALS patient today. He's doing well. Also the Ultra Mirage made by RES-MED, is supposed to be comfortable and gets a good seal.
Q: Why are so many patients put on Bi-Pap and not even tried on a vent?
A: It has been the thinking for years that vents were used as "the last straw." A patient using a vent was automatically trached. Doctors didn't want to be bothered to even try non-invasive means, such as the nasal masks. When I was at Dallas Rehab, our doctors wanted to stay away from trachs. With the vent and a good sealing mask, our patients did well.
RICHARD'S CONCLUSION:
For people who are on Bi-Pap, be sure to set it so the machine will do ALL the breathing for you. If you can't get this effect, then you are beyond the machine's capabilities to assist you. In Karen's case, as I stated, her muscles were too weak for a Bi-Pap to do her any good. The machine just did not have the settings. The vent was the unit for her, and with a nasal non-invasive mask. If she weakens a little through the years, the vent is capable of still helping her, and yes, without the invasive means.