Is "pressure relief" in my SleepyHead statistics the same as EPR/Flux?

[Beej]

...This time my machine has a modem sending off all my results every day, so "they" (respiratory therapists at my DME provider) will also see the changes to my settings, potentially reporting them to my doctor and insurance company. ...

The modem and WIFI features may have a way to turn them off.

[Sleeprider]

For the most part, your supplier is monitoring compliance. Rarely are they concerned with settings. However, if you change to APAP mode and keep your pressure the same, the only difference is that you can use A-Flex which is a much nicer pressure relief algorithm. Since this actually falls within the meaning of a "comfort setting" I don't see how anyone could object.

My machine is available to be monitored as well, but I have never been contacted about setting changes I have made. We're not talking about wild dial winging here. A pressure range of 10-12, or 11-11 is all we're talking about, other than changing A-flex. If it feels better, that's all you need to justify it.

[geekbearinggifts]

...This time my machine has a modem sending off all my results every day, so "they" (respiratory therapists at my DME provider) will also see the changes to my settings, potentially reporting them to my doctor and insurance company. ...

The modem and WIFI features may have a way to turn them off.

They do, but I want my compliance data available to my DME provider, doctor, and insurance company so I don't have to pay 100% of my equipment and supply costs.

For the most part, your supplier is monitoring compliance. Rarely are they concerned with settings. However, if you change to APAP mode and keep your pressure the same, the only difference is that you can use A-Flex which is a much nicer pressure relief algorithm. Since this actually falls within the meaning of a "comfort setting" I don't see how anyone could object.

My machine is available to be monitored as well, but I have never been contacted about setting changes I have made. We're not talking about wild dial winging here. A pressure range of 10-12, or 11-11 is all we're talking about, other than changing A-flex. If it feels better, that's all you need to justify it.

That seems quite reasonable to me! Thanks!

[OpalRose]

If you have an open relationship with your doctor, talk to him/her about switching to Apap mode, although there is nothing wrong with staying in cpap mode if your comfortable with that.

An advantage to apap mode, is that you can start with a slightly lower pressure. Sleeprider suggested a minimum of 10 and a max setting of 12. That makes sense as it is bracketed closely around your pressure of 11.

As far as insurance, they are looking at compliance, not settings.

Remember that EPR, which is what you used prior on a ResMed machine, is not the same as Flex on the DreamStation.
A setting of 3 Flex will not necessarily give you more exhale relief than a setting of 1. It is based on flow, or how hard you exhale. You might feel better using a setting of 2.

[Beej]

[quote='geekbearinggifts' pid='186340' dateline='1483123928']...This time my machine has a modem sending off all my results every day, so "they" (respiratory therapists at my DME provider) will also see the changes to my settings, potentially reporting them to my doctor and insurance company. ...

The modem and WIFI features may have a way to turn them off.

They do, but I want my compliance data available to my DME provider, doctor, and insurance company so I don't have to pay 100% of my equipment and supply costs.

That's why you take the chip in for your visits. Its all right there on the chip.

[geekbearinggifts]

If you have an open relationship with your doctor, talk to him/her about switching to Apap mode, although there is nothing wrong with staying in cpap mode if your comfortable with that.

An advantage to apap mode, is that you can start with a slightly lower pressure. Sleeprider suggested a minimum of 10 and a max setting of 12. That makes sense as it is bracketed closely around your pressure of 11.

As far as insurance, they are looking at compliance, not settings.

Remember that EPR, which is what you used prior on a ResMed machine, is not the same as Flex on the DreamStation.
A setting of 3 Flex will not necessarily give you more exhale relief than a setting of 1. It is based on flow, or how hard you exhale. You might feel better using a setting of 2.

Thanks again! I read elsewhere in the forum (and now can't find it) that the Flex setting actually determines how fast the transition is between the two pressures, and that 1 is fastest, and 3 slowest. I'm going to try setting Flex to 1 for a while and see if that makes a difference in how I feel.

[OpalRose]

Well, I don't know about fast or slow, but there is a slightly different feel between the Flex settings.

I do well on either Flex set at 1 or 2. Try 1 or 2 and see how you feel.

You can receive up to 2cm pressure relief, which is flow based, regardless whether you use 1,2 or 3.
• C-Flex – Provides pressure relief upon exhalation.
• A-Flex/C-Flex+ – Provides pressure relief taking place at the end of inhalation and at the start of exhalation.

[geekbearinggifts]

Had a noticeably easier time breathing out last night with the new settings, and saw a bigger difference in between the base pressure and EPAP on the graph. Yay! I don't think I have enough data to make any overall conclusions about efficacy and whether these will be the final settings, but I'm definitely more comfortable.

• Mode: Auto
  
• Opti-Start: off
  
• EZ-Start: off
  
• Auto-min pressure: 10
  
• Auto-max pressure or: 12
  
• CM-H2O pressure: N/A
  
• SmartRamp: off
  
• Ramp Time: 5 (ramp is enabled, but I'm not using it)
  
• Ramp start: 8 (ramp is enabled, but I'm not using it)
  
• Flex: A-flex
  
• Flex Setting: 1
  
• Tube type: 15

[OpalRose]

Comfort is important. Keep these settings for a few days and see how it goes.

[geekbearinggifts]

My AHI is great, but I've continued to increase my pressure in the hope that I can reduce my VS2 episodes. Unfortunately, the number just keeps going up instead (52 last night!). I've read up on VS2 some in the threads, and realize that we don't actually know what VS2 is, so I don't know whether I should be concerned or not. Regardless of pressure level, or whether I was using fixed pressure or APAP, my apnea is very well controlled. Since I started using the new machine and checking results with SleepyHead about a month ago, I've seen various combinations, and three nights with an AHI of zero, but usually have only one or two CAs, OAs, and/or Hs a night with an occasional RERA and one instance of periodic breathing. Should I reduce my minimum pressure back to 10 or 11 cm H2O, where I only had a handful of VS2s a night and didn't have any AHI concerns, either?

• Mode: Auto
  
• Auto-min pressure: 12
  
• Auto-max pressure: 20
  
• Flex: A-flex
  
• Flex Setting: 2
  
• Tube type: 15
  

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