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Obstruction on Exhallation
just a note that the machine can also be put in CPAP mode, so there is no relief at all. then you would get 7 cm inhale and 7 exhale, 8 cm inhale and 8 exhale, etc. I would not do this until there was serious dissatisfaction with the machine as currently functioning. QAL
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My airway is frankly obstructing at beginning of exhale, like a tiny reverse snore. That is what keeps me from drifting off. I don't know if that is what you are referring to as "that uncomfortable feeling". 

Is the "relaxing of exhale pressure" something that the machine does regardless of Flex or only with Flex turned on? 

Also, I guess I didn't really understand the concept of the ramp button.  I will have to read more.
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the relaxation of pressure occurs regardless of Aflex setting, even if Aflex is off.

there are two settings that affect exhale pressure reduction. flex and whether APAP or CPAP is chosen.

I am looking again at both posted charts to see if we can find out what the exhale pressure is that will take away the resistance.

ok, my best guess - hope you can follow. we are going to be talking about the exhale pressure primarily.
1. exhale pressure must be above 5.5 to have relatively resistance free exhales.
2. starting with 7.5 (but exhale is 5.5) was not pleasant, and you still noticed it.
3. FLEX reduces exhale in addition to the standard 2 cm drop for exhale (APAP mode).

Ditch the flex. -AND-
Ditch the APAP 2cm drop. [by setting the PAP mode to 'CPAP'] -AND-
minimum (inhale and exhale) set to 6cm
maximum (inhale and exhale) set to 9cm [remember old setting was max of 12 inhale which was 10 max exhale] [we'll do 9 for comfort, til lungs are not complaining]

try to sleep for a while. if you can sleep well, then just ride this for a few nights.
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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(05-02-2017, 11:02 AM)eLPete Wrote: I have a new problem, greatly exacerbated with switch from ResMed S9 Auto to DreamStation Auto.  At the beginning of exhalation, it feels like I have airway collapse.  It idoes not prevent me from exhaling, ultimately, but it is enough to keep me from falling asleep.  It probably occurs as I start to drift/fall asleep.  It happened occasionally with prior machine, and I overcame it by intentionally taking shallower more relaxed breaths for a bit.  That doesn't work with new machine.  I had pressures set at 7.5 - 12, as per some suggestions yesterday on previous post.  I changed the Flex settings, then tried dropping the lower pressure setting to 4, all to no avail.  I'm really out of my depth here.  Is this the sort of thing that BiPap is used for? This is going to kill my sleeping.

On top of this, my wife said I was snoring through the mask this morning.  Top pressure not high enough?  Here is my data from last night..........

Anybody have any ideas??

sounds like min pressure not enough to keep it open
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That is really helpful to know.  I had no idea. 

Now I have reread the section of the manual on the "Ramp Feature". There are 2 modes for the ramp.  I gather you are referring to the "SmartRamp" mode, which will maintain the initial pressure setting for the ramp period, unless higher pressure is required.  Here's hoping.
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-deleted- Eat-popcorn
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my machine does not adjust any pressure for this, I doubt your machine will either.

this is what I would do.
turn off the ramp, you will get use to the treatment pressure of 8cm quickly enough. I'm running 15 as a minimum pressure.
see if your current minimum treatment pressure of 8cm fixes it. if it doesn't raise it to 9cm

a rough way of doing it is to lay on your back and try to snore/tissue closes back of throat, on the out breath. see what happens., if it's ok at 8cm you have your solution.
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Many CPAP and Auto CPAP machines have the capability to reduce exhale pressure. The resmed machines can reduce pressure by 3 cm, and the lower EPAP does not increase until a spontaneous inhale is initiate; then IPAP pressure increases proportional to the inhalation effort. If a hypopnea or flow limit is in progress, the IPAP never reaches the set CPAP pressure. If an apnea is in progress the machine remains in EPAP pressure. This identical to the function of bilevel PAP therapy, with the limit of 3 cm pressure support.

In Bilevel titrations, it is the EPAP pressure that must prevent occlusion of the airway. Once EPAP establishes a patent airway, IPAP can be adjusted to mitigate hypopnea, flow limits and snoring. When a person is titrated on CPAP, then goes home and employs EPR or Flex, they are dropping the EPAP pressure, sometimes below the level where the airway remains patent. This causes apnea during exhale. The answer is to either increase minimum CPAP pressure to a level where Minimum Pressure - EPR is greater than the pressure needed to hold the airway open; or to reduce EPR so that the pressure reduction does not occur. Either strategy will work.
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(05-02-2017, 06:27 PM)eLPete Wrote: That is really helpful to know.  I had no idea. 

Now I have reread the section of the manual on the "Ramp Feature". There are 2 modes for the ramp.  I gather you are referring to the "SmartRamp" mode, which will maintain the initial pressure setting for the ramp period, unless higher pressure is required.  Here's hoping.

When using SmartRamp with an auto machine, your ramp starting pressure is used as the auto minimum pressure during the ramp period and your auto max for the ramp period is set to your normal auto minimum. The machine will auto adjust using the new, lower pressure range to respond to events. Your normal pressure range takes over when the ramp period ends.
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eLPete, which flex setting are you using, AFlex or CFlex? The reason I ask is if you are using AFlex that will give a momentary pressure relieve as you are finishing you inhalation and could be the cause of allowing your airway to collapse. I would suggest switching to CFlex and try it at a setting of 1. This will still give you a little bit of comfort as you begin your exhalation. If you find you can tolerate your pressures without any relief that would be even better to turn flex of completely. Like others have suggested I would definitely raise your minimum pressure to at least 6.5. At your current setting of 4 you are probably not getting enough pressure to breath normally.
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