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Got titration results - a bit confused
#11
(06-20-2015, 05:49 PM)zonk Wrote: 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"]

Thanks, Zonk for all this good info. Would any of the machines you mentioned be about equal? Would I want a machine with higher than 3 for the difference between inhale and exhale for a possible change later on?
"Freedom is the oxygen of the soul."
Moshe Dayan
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#12
Do not underestimate the value of straight CPAP. The recommended pressure should cover you for all sleep positions and scenarios, and has the benefit of a constant pressure, adequate oxy sats, and perhaps less desats than on Auto. I had significantly more desats while on APAP than CPAP. I know this due to my extensive overnight pulse oximeter testing.

I've been on APAP for 90% of the time, and currently feel that straight CPAP pressure may be better (for me) due to numerous factors, including that I seem to sleep better and longer, and feel better on it.
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#13
If your real pressure requirement turns out to be 7 than EPR or AFLEX CFLEX of 3 would bring you down to a pressure of 4.
4 is the lowest pressure any of the machines being discussed can provide. So no you wouldn't benefit from a more advanced machine that offers more pressure relief than 3 CM H2O.
If my doc had prescribed a straight pressure of 7, I would have immediately changed it to 6-9 so the machine could report back to me what I actually need of a period of a week or 2.
Making changes is easy enough with help from here and most docs don't even seem to pay attention to the data other than compliance. I already know if I used the machine and for how long. I don't need the doc to tell me that. What I need to know if the therapy is effective and if not what I can do to improve it.
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#14
(06-20-2015, 08:47 PM)bwexler Wrote: If your real pressure requirement turns out to be 7 than EPR or AFLEX CFLEX of 3 would bring you down to a pressure of 4.
4 is the lowest pressure any of the machines being discussed can provide. So no you wouldn't benefit from a more advanced machine that offers more pressure relief than 3 CM H2O.
If my doc had prescribed a straight pressure of 7, I would have immediately changed it to 6-9 so the machine could report back to me what I actually need of a period of a week or 2.
Making changes is easy enough with help from here and most docs don't even seem to pay attention to the data other than compliance. I already know if I used the machine and for how long. I don't need the doc to tell me that. What I need to know if the therapy is effective and if not what I can do to improve it.

Am I wrong in assuming that with CFLEX of '3', above, that exhalation pressure would be reduced to 4 cm but inhalation pressure would remain at 7 cm?

In my case, and as an aside, the feature is set at a RESLEX of '3' currently. My set pressure is 11.5 cm and last night's average pressure was 11.5cm with P95 of 11.0 cm. I'm not sure that I understand average pressure as greater than P95 . I thought it should be the other way around (accustomed to that when machine was set in Auto mode) but at least my average pressure is apparently not reduced by 3 cm due to the RESLEX feature.

[Image: 6-19-2015%20CPAP%20niTE%2011pt5_zpsma8x0a73.png]

I had set RESLEX at '3' as I was suffering from a bad URI/lung infection for weeks. I am feeling better now and will go down to '2', then '1', and so on.

User Manual for my machine states in part re RESLEX feature: "This setting allows you to adjust the level of air pressure relief that you feel when you exhale during therapy...Use the + and - keys to increase or decrease the pressure relief provided on exhalation" [emphasis added].

Reply appreciated!

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#15
(06-20-2015, 08:32 PM)tedburnsIII Wrote: Do not underestimate the value of straight CPAP. The recommended pressure should cover you for all sleep positions and scenarios, and has the benefit of a constant pressure, adequate oxy sats, and perhaps less desats than on Auto. I had significantly more desats while on APAP than CPAP. I know this due to my extensive overnight pulse oximeter testing.

I've been on APAP for 90% of the time, and currently feel that straight CPAP pressure may be better (for me) due to numerous factors, including that I seem to sleep better and longer, and feel better on it.

-----------

Yes, I've read that from some others who have done really well on straight CPAP. As long as I'll be able to do that on the S9 autoset, that would provide a level of comfort knowing the machine could also be used for APAP, should the need arise. So much to learn, and so many variables!
"Freedom is the oxygen of the soul."
Moshe Dayan
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#16
(06-20-2015, 08:47 PM)bwexler Wrote: If your real pressure requirement turns out to be 7 than EPR or AFLEX CFLEX of 3 would bring you down to a pressure of 4.
4 is the lowest pressure any of the machines being discussed can provide. So no you wouldn't benefit from a more advanced machine that offers more pressure relief than 3 CM H2O.
If my doc had prescribed a straight pressure of 7, I would have immediately changed it to 6-9 so the machine could report back to me what I actually need of a period of a week or 2.
Making changes is easy enough with help from here and most docs don't even seem to pay attention to the data other than compliance. I already know if I used the machine and for how long. I don't need the doc to tell me that. What I need to know if the therapy is effective and if not what I can do to improve it.
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Oh, so that's what CFLEX 3 means. I don't know if an S9 autoset is a more advanced machine, or if it is just APAP capable and would work fine in the CPAP mode, as long as it works for me. I'd feel absolutely lost if I didn't have access to this site....you all are so well-informed!
"Freedom is the oxygen of the soul."
Moshe Dayan
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#17
My understanding of an APAP machine is that it can always be set to a straight CPAP setting. The opposite is not true if your machine is a CPAP.

In general, one might be better off with an APAP machine to have that choice. Some prefer Auto function and later might prefer straight CPAP, or vice-versa. A wide APAP setting, e.g. 6-15cm, might better assure initial Compliance requisites than a straight setting of say, 12cm.

Your recommended optimal pressure, if it conforms to the Clinical Guidelines, will assure RDI of <5 with adequate 02 sats in REM while supine.

I'm no physician, but if the optimal lab titration pressure is 10cm, then that would be your recommended starting pressure at straight CPAP. If going APAP, you might want to have the lower end of your pressure slightly lower than 10cm, assuming adequate 02 sats/desats, because at minimum 8 for example, the machine will likely average out at 8-10cm, all things being equal.

The upper end would permit more latitude because the machine does not go that high, say upper setting of 15cm, unless necessary. So sufficient lower pressure is usually more important.
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#18
(06-20-2015, 10:53 PM)tedburnsIII Wrote: My understanding of an APAP machine is that it can always be set to a straight CPAP setting. The opposite is not true if your machine is a CPAP.
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Yes, that is my understanding also, and I will make getting an APAP a priority. My sleep doctor already warned me that all the DME they use are bad and that I may have to fight for what I want. Oh well, I can do that!Wink
"Freedom is the oxygen of the soul."
Moshe Dayan
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#19
(06-20-2015, 06:17 PM)kingskid Wrote: Thanks, Zonk for all this good info. Would any of the machines you mentioned be about equal? Would I want a machine with higher than 3 for the difference between inhale and exhale for a possible change later on?
Most of us with just old plain obstructive apnea, would not need anything more than CPAP/APAP. I like APAP because offer two modes of therapy, cost few dollars more, and like having two machines in one
Insurance does not care, they pay by billing code 0601 which is the same for a brick or top end machine

The rest of the machines designed to treat people on higher pressure requirement or/and complex/central apnea

Exhale pressure relief is called comfort feature, the doctor can prescribe it, but only you can say whether you like it or not, same with humidity
Everyone is different, for some can offer some relief but not everyone need or use it

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#20
To be straight, if you are getting a Phillips Respironics PRS System One, capable of CFLEX, then you should not accept anything other than Model 560!

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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