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Advice Needed - New DreamStation Auto and A-flex settings
#1
Advice Needed - New DreamStation Auto and A-flex settings
I was diagnosed with obstructive sleep apnea through a 1-night take-home sleep test, which detected 30.5 events/hour I was told.  My insurance would not cover an in-person sleep study (no idea why, because I have great insurance), however it did cover purchase of an APAP w/heated humidifier.  I was told "everybody's insurance does not cover a heated hose," allegedly but I don't know if I even care about the hose being heated.  I decided to purchase the Philips Respironics DreamStation Auto (it came with heated humidifier).

It's only been my 3rd night, but my stats show the following for last night:  5.9 AHI, 100% mask fit, Min Pressure 4.0, Max Pressure 20.0, 90% Pressure 12.5cm, Device Mode AutoCPAPwithAFlex, Ramp On.  My ramp is set at 4.0 with a time of 5 minutes.  My A-flex setting does not have an "off" option that I can see, and I've had it set at 3.

My understanding is that A-flex provides "relief upon exhalation?"  Can somebody point to any hard data or studies on A-flex in terms of it's safety, benefits, and risks?  I don't care at all about the A-flex in terms of comfort, because I'm pretty sure I'll sleep regardless.  Is it healthier to have that "relief" upon exhalation?  Does it help prevent me from developing breathing issues or reduce the risk of developing complications or developing central apneas?  Is it safer or is therapy more effective with it turned to "off?"  Or are there downsides to this both medically and physically?

Also, does the DreamStation APAP let you know if you have central apneas developing, either on the screen of the device or in the DreamMapper app?

Also, I am male, age 31, 5' 9", 185 lbs.  Based on my research, I stated I wanted to buy and try AmaraView mask. Both my mouth and nose are average for somebody like me.  The lady who set me up with my APAP at the medical supply company was insistent I needed a size "small" mask.  That just didn't sound right, because I wear medium everything:  Medium shirts, Medium shorts, etc etc.  Am I using the wrong size mask?  I have a pretty average sized nose and mouth.

Best Regards, and thanks everyone for your help!!!
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#2
RE: Advice Needed - New DreamStation Auto and A-flex settings
For the best possible advice, if you download Sleepyhead (free) and post your organized charts, you will provide some much needed detail about how often and what type of apnea you are experiencing. Follow the links in my signature to download Sleepyhead and help with organizing your charts properly.

A-Flex is a comfort setting and you should be able to turn it off in the clinicians manual. See CPAP setup manuals in the link bar above to get the Clinicians manual.

Dreammapper describes central apnea as clear apnea.

As far as mask sizing, everyone is unique. I suggest you read the mask primer in the wiki section for helpful information on that subject.

Welcome to Apnea Board!
Jesse


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#3
RE: Advice Needed - New DreamStation Auto and A-flex settings
Welcome

Heated hose: someone fibbed. If prescribed, most insurances will cover it.

Amara View mask: I've got one in medium, but my F20 AirFit is small. Different masks fit differently and each of our faces are unique. BTW see my avatar; small mask? Yup. Small dimensions are more right than medium for me.

A-Flex is a comfort setting. Use it or don't, it's up to you. There are times when it could modify one's therapy effectiveness. I'm thinking, if right, certain times where central apnea can be triggered via pressure swings. Regardless, as mentioned, get Sleepyhead and post data. Gurus can assist if needed to optimize your settings.

lots-o-coffee
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Advice Needed - New DreamStation Auto and A-flex settings
(03-25-2018, 01:19 PM)SarcasticDave94 Wrote: Heated hose: someone fibbed. If prescribed, most insurances will cover it.

How will heated hose help me, I'm curious?  I got very dry mouth at night even with humidity on maximum.  Cold air sounds more comfortable for some reason so I don't get overheated and sweaty at night.

(03-25-2018, 01:19 PM)SarcasticDave94 Wrote: Amara View mask: I've got one in medium, but my F20 AirFit is small. Different masks fit differently and each of our faces are unique. BTW see my avatar; small mask? Yup. Small dimensions are more right then medium for me.

If I request a medium size instead tomorrow, do I have to give the small back for it to be covered by insurance?  I just got all my equipment on 3 days ago. I want to try both at night to compare for leaks.


(03-25-2018, 01:19 PM)SarcasticDave94 Wrote: A-Flex is a comfort setting. Use it or don't, it's up to you. There are times when it could modify one's therapy effectiveness. I'm thinking, if right, certain times where central apnea can be triggered via pressure swings. Regardless, as mentioned, get Sleepyhead and post data. Gurus can assist if needed to optimize your settings.

Why does my DreamStation only allow me to rotate the A-flex setting from 1, 2, to 3 without an "Off" option?  Is that were the "off" option would normally show up?  Did the doctor block this?  If you guys suggest I turn it off, I don't want to have to hack the machine though to turn it off.

I believe I saw a post on here where having A-flex off actually lowered their AHI quite a bit.  Is this true?  I just want to do whatever is healthiest and most effective, because I don't care about the comfort aspect of A-flex, only the health aspects.



Thanks again!
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#5
RE: Advice Needed - New DreamStation Auto and A-flex settings
A heated hose will help with rainout if that becomes a problem.  If you have dry mouth with humidity on maximum, it's more than likely you are mouth breathing.

Check with your DME, but I would try both masks to see what fits better, then return one before 30 days is up, as your insurance will only pay for one.

As Dave said, Flex is a comfort setting.  It works differently than ResMed's EPR.  You can receive up to 2cm pressure relief on exhaling.  On my machine, my options are settings 1, 2, 3. If you want to turn off, go to Clinicians menu, then under Flex Options choose AFlex, CFlex, or OFF.

AFlex has nothing to do with lowering AHI, nor has any health aspect to using it. It is strictly for comfort.  Some folk may see a rise in Clear Airway events when using EPR or Flex, and if so, we advise to turn down or not use it.
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Advice Needed - New DreamStation Auto and A-flex settings
I agree with OpalRose. FWIW a heated hose could assist in comfort in some circumstances by allowing higher humidity settings if you want or need it via diminishing rain-out. Is it required? No. I have it and love it's help in my comfort. Return policy is strictly up to the DME where you purchased the mask. I'm glad to assist if there's clarification that I can offer. Just ask. Happy Sunday.

lots-o-coffee
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Advice Needed - New DreamStation Auto and A-flex settings
(03-25-2018, 12:40 PM)dk2011 Wrote: I was diagnosed with obstructive sleep apnea through a 1-night take-home sleep test, which detected 30.5 events/hour I was told.  My insurance would not cover an in-person sleep study (no idea why, because I have great insurance), however it did cover purchase of an APAP w/heated humidifier.  I was told "everybody's insurance does not cover a heated hose," allegedly but I don't know if I even care about the hose being heated.  I decided to purchase the Philips Respironics DreamStation Auto (it came with heated humidifier).

It's only been my 3rd night, but my stats show the following for last night:  5.9 AHI, 100% mask fit, Min Pressure 4.0, Max Pressure 20.0, 90% Pressure 12.5cm, Device Mode AutoCPAPwithAFlex, Ramp On.  My ramp is set at 4.0 with a time of 5 minutes.  My A-flex setting does not have an "off" option that I can see, and I've had it set at 3.

My understanding is that A-flex provides "relief upon exhalation?"  Can somebody point to any hard data or studies on A-flex in terms of it's safety, benefits, and risks?  I don't care at all about the A-flex in terms of comfort, because I'm pretty sure I'll sleep regardless.  Is it healthier to have that "relief" upon exhalation?  Does it help prevent me from developing breathing issues or reduce the risk of developing complications or developing central apneas?  Is it safer or is therapy more effective with it turned to "off?"  Or are there downsides to this both medically and physically?

Also, does the DreamStation APAP let you know if you have central apneas developing, either on the screen of the device or in the DreamMapper app?

Also, I am male, age 31, 5' 9", 185 lbs.  Based on my research, I stated I wanted to buy and try AmaraView mask.  Both my mouth and nose are average for somebody like me.  The lady who set me up with my APAP at the medical supply company was insistent I needed a size "small" mask.  That just didn't sound right, because I wear medium everything:  Medium shirts, Medium shorts, etc etc.  Am I using the wrong size mask?  I have a pretty average sized nose and mouth.

Best Regards, and thanks everyone for your help!!!

You are using the default wide-open settings of 4-20 pressure on a Dreamstation Auto CPAP. The problem with that is that the minimum pressure is much too low, and you are even using ramp, which is useless when the machine starts at 4-cm anyway.

Auto CPAP machines have a minimum pressure of 4.0, and the minimum pressure of Ramp is 4.0.  So this redundancy is just unnecessary.  Most people do not experience enough therapeutic benefit at a minimum pressure of 4.0 and a minimum pressure of 6.0 would at least be comfortable in providing enough air to breathe.  I can tell you that increasing your minimum pressure between 6.0 and 8.0 will immediately cut your AHI at least in half.

Download #Sleepyhead software and post a chart, and we can probably put your AHI to less than 2.0 consistently.  The ideal CPAP setting is high enough to prevent most events, but avoids large pressure swings which are disruptive to sleep.  Good luck with your therapy, and for best comfort or results, increase your minimum pressure, get #Sleepyhead, and we can help you with the rest.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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