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Got titration results - a bit confused
#1
Hello all,

The review doc recommends nasal CPAP therapy with CFLEX at 7cm/H2O. My sleep doctor said we'll go with the review doc's recommendation and see how it goes. I was hoping to get an S9 Autoset for Her, but not sure if that machine would fit the diagnosis. Need to wait until July 1 to deal with the machine issue since my insurance will change to Medicare then. Could someone explain the "CFLEX" please? Thanks for any advice!
"Freedom is the oxygen of the soul."
Moshe Dayan
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#2
(06-20-2015, 09:46 AM)kingskid Wrote: Hello all,

The review doc recommends nasal CPAP therapy with CFLEX at 7cm/H2O. My sleep doctor said we'll go with the review doc's recommendation and see how it goes. I was hoping to get an S9 Autoset for Her, but not sure if that machine would fit the diagnosis. Need to wait until July 1 to deal with the machine issue since my insurance will change to Medicare then. Could someone explain the "CFLEX" please? Thanks for any advice!

kingskid, I pasted the explanation from the Apnea Board Wiki. Good luck with everything

C-Flex is a Philips-Respironics brand-specific term for CPAP Exhalation pressure relief.
According to the Philips-Respironics website: "C-Flex pressure relief technology makes sleep therapy more comfortable by reducing pressure at the beginning of exhalation and returning to therapeutic pressure just before inhalation. The level of pressure relief varies based on the patient’s expiratory flow and which of the three C-Flex settings has been selected." [1]
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#3
First, the S9 autoset and the S9 autoset for Her are the same machine with a different paint job. It is the Airsense where the autoset and the For Her model are different functionally.

The S9 has the same feature as the Resperonics Remstar's do. If you want an S9, insist upon it. The pressure relief provided is the same (just a different marketing word) and marked 1, 2 and 3. YOU are paying for the machine (you pay premiums to your insurance company). Just remind them that you are the one paying over $1000 for a machine - you want the brand you want.

If you actually want the Airsense, just tell them that manufacture of the S9 has discontinued now (although parts will be available for 7 years according to DocWils).

The advantage of the S9 is that it is not an integrated model, which I think is a hassle for some folks.
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#4
(06-20-2015, 10:39 AM)JerryLeeK9 Wrote:
(06-20-2015, 09:46 AM)kingskid Wrote: Hello all,

The review doc recommends nasal CPAP therapy with CFLEX at 7cm/H2O. My sleep doctor said we'll go with the review doc's recommendation and see how it goes. I was hoping to get an S9 Autoset for Her, but not sure if that machine would fit the diagnosis. Need to wait until July 1 to deal with the machine issue since my insurance will change to Medicare then. Could someone explain the "CFLEX" please? Thanks for any advice!

kingskid, I pasted the explanation from the Apnea Board Wiki. Good luck with everything
--------
Thanks, JerryLeek9. I should have checked the Wiki area.

C-Flex is a Philips-Respironics brand-specific term for CPAP Exhalation pressure relief.
According to the Philips-Respironics website: "C-Flex pressure relief technology makes sleep therapy more comfortable by reducing pressure at the beginning of exhalation and returning to therapeutic pressure just before inhalation. The level of pressure relief varies based on the patient’s expiratory flow and which of the three C-Flex settings has been selected." [1]

"Freedom is the oxygen of the soul."
Moshe Dayan
Post Reply Post Reply
#5
(06-20-2015, 11:27 AM)Mosquitobait Wrote: First, the S9 autoset and the S9 autoset for Her are the same machine with a different paint job. It is the Airsense where the autoset and the For Her model are different functionally.

The S9 has the same feature as the Resperonics Remstar's do. If you want an S9, insist upon it. The pressure relief provided is the same (just a different marketing word) and marked 1, 2 and 3. YOU are paying for the machine (you pay premiums to your insurance company). Just remind them that you are the one paying over $1000 for a machine - you want the brand you want.

If you actually want the Airsense, just tell them that manufacture of the S9 has discontinued now (although parts will be available for 7 years according to DocWils).

The advantage of the S9 is that it is not an integrated model, which I think is a hassle for some folks.

---------
Thanks, Mosquitobait. I've been interested in the S9 because I didn't want the humidifier integrated, nor did I want the wireless modem. Hope the S9 is still available and as long as it'll provide CFLEX at 7cm/H2O, there shouldn't be a problem getting it. If it isn't available, I wonder if the AirSense for Her would provide what I need? I assume the AirSense allows for straight CPAP. Need to do some more research. BTW, who determines the 1, 2 or 3 pressure relief?
"Freedom is the oxygen of the soul."
Moshe Dayan
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#6
(06-20-2015, 09:46 AM)kingskid Wrote: Hello all,

The review doc recommends nasal CPAP therapy with CFLEX at 7cm/H2O. My sleep doctor said we'll go with the review doc's recommendation and see how it goes. I was hoping to get an S9 Autoset for Her, but not sure if that machine would fit the diagnosis. Need to wait until July 1 to deal with the machine issue since my insurance will change to Medicare then. Could someone explain the "CFLEX" please? Thanks for any advice!

'Review doc' is a document and not a doctor? I got confused at first reading your post.

7cm, if your optimum pressure, is relatively low. You may not need to use any CFLEX at all. I believe that with most machines CFLEX/RESFLEX/AFLEX may be a user comfort setting so perhaps script doctor just wanted that function enabled thus leaving the choice with you.

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#7
(06-20-2015, 12:19 PM)tedburnsIII Wrote:
(06-20-2015, 09:46 AM)kingskid Wrote: Hello all,

The review doc recommends nasal CPAP therapy with CFLEX at 7cm/H2O. My sleep doctor said we'll go with the review doc's recommendation and see how it goes. I was hoping to get an S9 Autoset for Her, but not sure if that machine would fit the diagnosis. Need to wait until July 1 to deal with the machine issue since my insurance will change to Medicare then. Could someone explain the "CFLEX" please? Thanks for any advice!

'Review doc' is a document and not a doctor? I got confused at first reading your post.

7cm, if your optimum pressure, is relatively low. You may not need to use any CFLEX at all. I believe that with most machines CFLEX/RESFLEX/AFLEX may be a user comfort setting so perhaps script doctor just wanted that function enabled thus leaving the choice with you.

------------

Thanks, TedBurns. Review "doctor" from the facility I used. I guess I will just have to get a machine and see how things go.
"Freedom is the oxygen of the soul."
Moshe Dayan
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#8
I have no actual idea, but I think if a xPAP machine has pressure relief, it is very likely going to be an APAP anyway.

It is fine to start with what is recommended, but I would argue to the sleep doc that having just a straight CPAP sort of paints you into a corner, and since this is the beginning for you and we don't know quite yet if APAP would be a better prescription down the road, what makes the most sense is to get an APAP and brick it to 7 cm, for right now. That seems like logic that any sleep doc you would be willing to continue seeing should agree with.

The data is extensive from a sleep test, but it is also a tiny snapshot of a condition that varies dynamically with sleep stage, position, the bed you are sleeping in, and even age and current respiratory conditions, which change if you get a cold. The data from using an APAP in your own bed over time is not as detailed, but it is a much larger sample of what is really going on, and helps modify the therapy in a positive direction. So it may have as much or even more value than the PSG.

A CPAP can't provide this level of data, and can't adjust automatically to give you the best pressure at any given moment. Instead, it bases an average pressure on that PSG snapshot, and is only modified if the doc parses your data and makes a change. It's like a broken clock. A broken clock is only right twice a day, and a CPAP may not be right much of each night. Close, but then this is not horseshoes, its your health. And a doc making changes with CPAP data is like throwing a dart; all he knows is that the AHI isn't where it should be. APAP data will tell the doc why the AHI is not optimal. The doc wants the best data, right? Then prescribing an APAP should be a no brainer for them.

So, fight for APAP. Be a squeaky wheel if you have to. If there is any whisper of RERA in your PSG, fight for the Airsense or a Respironics model that addresses that (the S9 doesn't). Actually, they all address that, but the S9 does not flag that data.

One other thing different about the "For Her" series is that the included mask for the other machine is in sizes S, M, and L. In the "For Her" series, the sizes are XS, S, and M. If you have a little button nose, maybe "For Her" makes sense. If you have a nice normal beautiful Roman nose, maybe not so much. The smaller sizes of the NPs will cause more Venturi turbulence and be harder to breathe through for many people at a given pressure.

And get SleepyHead or compatible software, and keep coming back here.
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#9
(06-20-2015, 04:25 PM)TyroneShoes Wrote: I have no actual idea, but I think if a xPAP machine has pressure relief, it is very likely going to be an APAP anyway.

It is fine to start with what is recommended, but I would argue to the sleep doc that having just a straight CPAP sort of paints you into a corner, and since this is the beginning for you and we don't know quite yet if APAP would be a better prescription down the road, what makes the most sense is to get an APAP and brick it to 7 cm, for right now. That seems like logic that any sleep doc you would be willing to continue seeing should agree with.

The data is extensive from a sleep test, but it is also a tiny snapshot of a condition that varies dynamically with sleep stage, position, the bed you are sleeping in, and even age and current respiratory conditions, which change if you get a cold. The data from using an APAP in your own bed over time is not as detailed, but it is a much larger sample of what is really going on, and helps modify the therapy in a positive direction. So it may have as much or even more value than the PSG.

A CPAP can't provide this level of data, and can't adjust automatically to give you the best pressure at any given moment. Instead, it bases an average pressure on that PSG snapshot, and is only modified if the doc parses your data and makes a change. It's like a broken clock. A broken clock is only right twice a day, and a CPAP may not be right much of each night. Close, but then this is not horseshoes, its your health. And a doc making changes with CPAP data is like throwing a dart; all he knows is that the AHI isn't where it should be. APAP data will tell the doc why the AHI is not optimal. The doc wants the best data, right? Then prescribing an APAP should be a no brainer for them.

So, fight for APAP. Be a squeaky wheel if you have to. If there is any whisper of RERA in your PSG, fight for the Airsense or a Respironics model that addresses that (the S9 doesn't). Actually, they all address that, but the S9 does not flag that data.

One other thing different about the "For Her" series is that the included mask for the other machine is in sizes S, M, and L. In the "For Her" series, the sizes are XS, S, and M. If you have a little button nose, maybe "For Her" makes sense. If you have a nice normal beautiful Roman nose, maybe not so much. The smaller sizes of the NPs will cause more Venturi turbulence and be harder to breathe through for many people at a given pressure.

And get SleepyHead or compatible software, and keep coming back here.

Thanks Tyroneshoes! You just answered the most important question I had whether I could use an autoset for straight cpap. I thought it should be okay if the setting is set at what the doctor recommended of 7cm/H2O. I definitely do want the flexibility of an APAP for the reasons you mentioned to accommodate any future changes. For some reason,the RERA was zero during both my sleep and titration tests. Not sure of the significance of the RERA....need to look it up. I did download the SleepyHead software from this site. From all accounts, it provides a lot of great feedback. I definitely will stay plugged into this site!
"Freedom is the oxygen of the soul."
Moshe Dayan
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#10
Any PRS1 machine (data capable or a brick) have CFlex and PRS1 Auto have AFlex as well
Only model 560 is true APAP, make sure the friendly doctor write it on the script and add "dispense as written"
Very easy to pull wool over your eyes and dispense a brick while you're not looking

[Image: PR-model-1.jpg]
[Image: PR-model-2.jpg]

Respironcis Cflex is not exactly like ResMed EPR, EPR provide better relief and closer to bi-level pressure support effect but does not goes any higher than 3 (difference between inhale and exhale)

As for Airsense 10 integrated humidifier, you can use A10 without engaging the humidifier and also there is a side cover for the A10 goes in the same slot as the water chamber (to be used instead of the water chamber), nice and neat

You can turn on "airplane mode" and that turn off the wireless

[Image: ResMed-AirSense-10.png]
[should say "AutoSet, AutoSet for Her, Elite or CPAP"]

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