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Follow up after two months
#11
RE: Follow up after two months
There are a lot of suggestions for EPR here, and your Philips CPAP provides C-Flex which is not the same thing at all. EPR is a true bilevel approach to exhale pressure, while Flex is strictly a comfort supporting reduction in pressure during breathing transitions from inhale to exhale. With Flex, the pressure relief ends before exhale is complete, while with EPR the increase in pressure follows the start of inhale. I agree with the suggestions above that CA is not a problem here, and the usual approach with CPAP for H and OA are usually pressure increases. There is another option.

If you are uncomfortable with your therapy and are experiencing side-effects like aerophagia and marginal efficacy, then you can talk to your doctor about these issues and try to get a prescription for bilevel PAP therapy; preferably auto bilevel. With bilevel, you should be able to target an EPAP pressure to resolve OA events, then use pressure support to resolve the hypopnea. As long as it doesn't end up triggering CA, you will like it, and can usually achieve more comfortable therapy at lower pressures.
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#12
RE: Follow up after two months
Thank you very much for the quick replies.

I have tried and have used off and on the soft collar. It doesn't help much at all. As I research more, I'm wondering if using the c-flex or c-flex+ setting would help. It feels like my mouth will build with air then it will create enough to push through and let excess air out my mouth, which wakes me up. I'm not a mouth breather with the mask on. without the mask I most definitely am. I'm not sure whether to start with c-flex and what number, or c-flex+?

I'm relieved to hear that the numbers aren't bad. I've been quite concerned and may even schedule a follow-up sleep study. I don't want to if I can get my settings dialed in myself.

can you explain what EPR is?

I can't increase pressure because that makes things worse...very gassy and bloated. with this machine I switched from a nasal pillow swift FX, to a GoLife mask. The GoLife stays in place much better than the swift. However, I wonder if the mask is an issue. I don't seem to have issues with any leaks from my nose, just my mouth with the pressure build up.

I really do appreciate your help, and I was getting concerned that I blew it on this board. You all are such an amazing resource.

Have a blessed day.
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#13
RE: Follow up after two months
Yeah I blew it when I called it EPR. Still I would try using the C-flex Which is somewhat like EPR and try and get some relief from the bloating you said your having.

I'll let Sleeprider explain the differences.
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#14
RE: Follow up after two months
EPR (Exhale Pressure Relief) is used on Resmed CPAP machines to reduce pressure during exhale.  Unlike C-Flex, it is a true bilevel approach and offers up to 3-cm of pressure relief.  The chart below shows the mask pressure using EPR. Notice how the mask pressure follows patient breathing. With C-flex the pressure always rises to IPAP before exhale ends, so the pressure stays higher, longer, nearly the opposite of the mask pressure graph below.  The difference is that the Resmed EPR can be used as a therapeutic tool to reduce hypopnea and flow limitation, while C-Flex is strictly comfort.

[Image: attachment.php?aid=4258]
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#15
RE: Follow up after two months
I mistakenly referred to EPR as well, didn't meant to confuse.
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#16
RE: Follow up after two months
Thanks for the clarity. 

I do not have a ResMed machine and did not see any settings other than A-flex (if in Auto-CPAP mode), C-Flex or C-Flex+.

[Moderator note:  link to copyrighted Service Manual removed - if you would like the DreamStation Service Manual, please read THIS POST which gives you a link to our private Members-Only Files page... the same service manual can be found there]


I have now set up for tonight a 9.0 pressure with C-Flex+ level 1. Is that a good place to start at this point? I really want to have that mouth pressure issue resolved. I take very deep and long breaths.

Early on with this machine I was using a ramp setting and the 90% pressure was anywhere from 9.0-13. With that high pressure, as I mentioned earlier, I was very gassy. Someone suggested setting a fixed 9.0 and I have been with that for a couple months now. 

Whatever you all suggest, I will give it a shot and let you know.

Again, I really appreciate the replys.

C
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#17
RE: Follow up after two months
You are correct that the Philips machines offer CFlex in fixed CPAP and AFlex in auto CPAP. In my experience a setting of 1 is usually most comfortable, but feel free to experiment.
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#18
RE: Follow up after two months
Hello all,

So I have had two nights with C-Flex+ level 1 and two nights C-Flex+ level 2. I have really minimized the leak from my mouth, it seems. Not really any improvement in AHI though. The pressure was still set at 9.0, however my pressure numbers on the attached charts are around 7.5 and wobbly. probably due to the C-Flex setting. Why wouldn't my pressure be at 9.0? It is in the statistics section. 

Any suggestions from here to get that AHI any lower?

Thanks again.

C


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#19
RE: Follow up after two months
(06-26-2018, 08:10 AM)cbombzzz Wrote: The pressure was still set at 9.0, however my pressure numbers on the attached charts are around 7.5 and wobbly. probably due to the C-Flex setting. Why wouldn't my pressure be at 9.0? It is in the statistics section. 

If you look at the top of the Pressure graph you will see that along with the black border is a red line. The top value for the graph is 9.0. The lower green line is your exhale pressure.
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#20
RE: Follow up after two months
I have been having some better nights lately. My Dreamstation only allows up to a 30 day trial on auto setting then it reverts to fixed pressure. Why is that? Is it better to stay on a fixed pressure? I've had the machine set at 9.0-11.5 the last four nights and my 90% has been at 10 for three of those nights and one night was 10.3. I'm going to keep doing this for a few more nights. Would you suggest I change to fixed pressure of 10.0?

Thanks again.

C
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