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Exhale Pressure
I am a new CPAP user. My machine is the Dream Station Auto. My setting is variable - from 4 to 20. I am told the machine automatically adjusts. The inhale is fine. However, I find it difficult to exhale (common problem I see here) I tried the Flex setting of 3 (max) but it made no difference. I saw in another post, that 4 cm is the minimum so the Flex setting has no effect. Is this so? Is there anything else I can do to make the exhale easier with this machine? It has CFlex & CFlex+ options. Thanks for your guidance!
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I'm not knowledgeable on the flex settings of the PR machines.

But, it is true that until your machine climbs above 4, you cannot get any exhale pressure relief.

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Your machine is set "wide open" which means that your doctor is using the machine to get a better idea of what pressure you need for treatment. 4 is very low and most people feel starved for air at that level. If/when you get your lower level increased then you will have more effect from the Flex setting.

A full face mask can also help with exhale pressure, if after that you still have issues you will be moved to a BiLevel machine.

Keep your doctor informed about problems you are having, they may move you along to BiLevel faster
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It would be helpful to know what pressures your machine is actually delivering, rather than the range, and at what point you find exhale difficult. I know you don't believe it now, but eventually, you will pull the mask away from your face to see if it is actually on. Things will get better. All of the auto CPAPs deliver 4.0 cmH2O as the mimimum pressure, so with EPR or flex, as long as your machine is at 4.0, there is no pressure change. As pressure increases, the Resmeds can deliver up to 3.0 cm pressure relief (i.e. 7.0/4.0), and the Respironics flex delivers up to 2-cm H2O but is flow based. In other words, if you have a strong exhale, the machine delivers as much as 2.0 cm reduced pressure, but if you have a less vigorous exhale, it will be less than 2 based on the force, or flow and may be near zero. The Respironics machines return to inhale ( full pressure) by the end of exhalation, usually well-before, while the Resmed maintains that low EPAP pressure until you begin the next inhale. This gives some people the feeling that Resmed follows your breathing, while Respironics seems to cut-off or lead your breathing.

Once your pressure rises above 4, you probably are having some pressure relief. It would be more noticable with a Resmed machine, but since this is a comfort issue, not much attention is given to it by the medical community. Be assured, it will get easier, and even disappear in time. Until then, good luck, and I'll be happy to try to answer any questions.
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Hi William2000,
WELCOME! to the forum.!
You should talk with your doc about the problems you are having with exhaling against pressure.

I wish you good luck with your CPAP therapy and getting adjusted to it.
Hang in there for more responses to your post.
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My understanding is -
in a true auto-adjusting CPAP machine, you still have to set the min-max pressure inside the clinical menu. Otherwise, the pressure is really really high (quite unpleasant) until the optimum max pressure is found by the CPAP.

According to my doctor, no body has a max pressure more than 13. So I set my Resmed Airsense 10 Autoset pressures at 4 - 11.4. It seems to give me good sleep.

Is my understanding wrong? Am I doing anything wrong?

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Htin, in an auto CPAP the default settings deliver a minimum pressure of 4.0, and the machine will increase pressure in response to apnea, hypopnea, flow limitations, snores and reductions in respiratory volume, according to a proprietary algorithm. Your Resmed autoset tends to respond with faster pressure increases than a Respironics auto, however the machine only raises pressure as far as necessary to alleviate the snores, flow limits etc. It is actually pretty rare for the machines to turn up pressure too far, but there are exceptions. It's actually more important to fine-tune the minimum pressure to prevent events, than it is to limit maximum pressure.

Your doctor is welcome to a broad opinion, that no one uses more than 13 cm pressure to effectively treat OSA, but you will find many on this forum that are living examples of someone that does require higher pressure, and it works for them, and is necessary. Some machines are designed to deliver as high of 25 cm pressure. Those high pressures are not commonly needed for the average OSA sufferer, but they are used by a few.

Whether you are doing something wrong, depends entirely on how effective you perceive your treatment to be, through the way you feel, and you could also take a look at your efficacy data and decide if it shows you are getting the sleep and kind of sleep you need. Your machine has data that may show you are well-treated, or it might offer a clue on what needs to change to improve. We can help you understand that data, and if something can be improved, share what we have learned works for us and others. Lots of knowledge and experience is here for you to tap into if you want. Good luck, and welcome.
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Welcome William2000!

One good method of getting accustomed to the pressure of cpap therapy is to use the system while watching TV, reading or some other activity that will take your mind off it. That will help overcome the anxiety that is often present when initially using the system while trying to get to sleep. It doesn't take many sessions like that to become comfortable with the pressure. I know that sounds impossible now but trust me, it happens to every one of us.


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