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One month in, trying to improve
#11
RE: One month in, trying to improve
Wdarner, I notice in the periodic breathing that there is a slight bump in flow at the end of expiration and before inspiration begins.  In my experience this sometimes happens as a result of the Philips Respironics Flex (comfort setting).  Could you check what your machine is set at (A-Flex or C-Flex) and the number (1-3).  If you are set to a Flex setting of 3, let's try reducing that to 2 or 1.
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#12
RE: One month in, trying to improve
I agree - reducing flex or turning it off completely might help with the central apnea.
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#13
RE: One month in, trying to improve
(03-29-2020, 07:52 AM)Sleeprider Wrote: Wdarner, I notice in the periodic breathing that there is a slight bump in flow at the end of expiration and before inspiration begins.  In my experience this sometimes happens as a result of the Philips Respironics Flex (comfort setting).  Could you check what your machine is set at (A-Flex or C-Flex) and the number (1-3).  If you are set to a Flex setting of 3, let's try reducing that to 2 or 1.

Funny, I was just reading about this in another thread on CSR here. I have been recently set on 2, I just reduced it to 1 and I'll see what happens tonight. To go further and set it to 0 if needed, does that require just turning Flex off? Is that advisable? Thanks
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#14
RE: One month in, trying to improve
Some people do better without the Flex. I used it when I had Philips machines, but I'll be honest in that I don't like the way it works. With the Resmed exhale pressure relief (EPR) he pressure follows the user's spontaneous inhale and exhale as well as flow rate. In contrast, Flex anticipate when the user will start to inhale and increases pressure ahead of that, sometimes so far ahead that exhale gets cut-off. With some people the sync is pretty bad, and that is mostly what I was seeing in your charts. While many members here get good results and are comfortable with the Philips machines, it is remarkable how many solve all their problems by switching to Resmed. Most health care professionals will say they are the same, but I have seen hundreds of anecdotal results that say it's not.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#15
RE: One month in, trying to improve
(03-29-2020, 08:41 AM)Sleeprider Wrote: Some people do better without the Flex.  I used it when I had Philips machines, but I'll be honest in that I don't like the way it works. With the Resmed exhale pressure relief (EPR) he pressure follows the user's spontaneous inhale and exhale as well as flow rate.  In contrast, Flex anticipate when the user will start to inhale and increases pressure ahead of that, sometimes so far ahead that exhale gets cut-off.  With some people the sync is pretty bad, and that is mostly what I was seeing in your charts.  While many members here get good results and are comfortable with the Philips machines, it is remarkable how many solve all their problems by switching to Resmed. Most health care professionals will say they are the same, but I have seen hundreds of anecdotal results that say it's not.

Interesting. I think I'll turn it off completely tonight and see what happens.

Not sure what would be involved in switching to Resmed. The Medical Supply my doctor referred me to only carries the Phillips machines. I assume I have the right as the patient to request a different company if changing to a different brand is warranted.
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#16
RE: One month in, trying to improve
As an experiment, I turned off Flex completely and went back to bed this morning for an hour or so to see what would happen. It just added data onto to last night's chart.  The results were very interesting. I am attaching a zoomed in look at the hour I slept. No CAs or PB at all and brought my overall AHI down. What it DID introduce was 3 events of RERAs, which I have never seen before. I assume this is a byproduct of turning FLEX off? Anyone have thoughts on this? I'll give it a try again tonight for a full night and see if the trend continues.
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#17
RE: One month in, trying to improve
I would reserve judgement until seeing the new settings for a full night. RERA is flagged when the machine detects increasing flow limitation that ends with a larger volume of air (recovery breathing) indicating an arousal. You have to get zoomed into about a 2-minute view and follow the respiratory volume to the RERA to really appreciate what is happening.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#18
RE: One month in, trying to improve
Reporting back, two nights ago I tried to turn Flex off, but could not get to sleep, I guess due to the pressure change on the exhale. So after an hour I went back to A Flex set to 1. I had an AHI of 6.8, 16 CAs, 2 OAs, and 29 Hyps.

Last night, I was determined to turn Flex off, so I reduced my Min setting from 7.0 to 6.5, and was able to get to sleep OK. The result: AHI of 8.1, 3 CAs, but 14 OAs and 32 Hyps. There was only one small area of PB. I tried to attach the files but apparently I have reached my max data limit and it's not allowed.

So as you said might happen, turning off Flex helps reduce the CAs at the expense of increased OAs. So I'm not sure what to do here. I can't seem to get my AHI down to 5 regardless. I'm thinking of going back to a Flex setting of 1 and settling back to that for a few nights. It definitely makes my breathing a little easier.

Any thoughts of trying C Flex instead of A Flex? I'm not sure what the difference is except that I think C Flex is their older algorithm. 

As always, any input appreciated!
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#19
RE: One month in, trying to improve
Two different things need to balance. Turning off Flex did not cause the OA, it was the reduction in pressure. Pressure is needed for obstruction, and the pressure changes of Flex need to be reduced for CA. It all points to complex apnea, and the ideal solution is going to be using CPAP mode at a pressure that prevents most OA, but the sacrifice is comfort due to the lack of Flex. Single pressure rather than auto pressure will produce the best results, but again may not be as comfortable. It's possible in time you might change therapy approach to something that can treat both CA and OA, but for a while you are probably going to be stuck getting used to this, especially with the SARS-COV2 at its peak.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#20
RE: One month in, trying to improve
(03-31-2020, 08:10 AM)Sleeprider Wrote: Two different things need to balance. Turning off Flex did not cause the OA, it was the reduction in pressure.  Pressure is needed for obstruction, and the pressure changes of Flex need to be reduced for CA.  It all points to complex apnea, and the ideal solution is going to  be using CPAP mode at a pressure that prevents most OA, but the sacrifice is comfort due to the lack of Flex.  Single pressure rather than auto pressure will produce the best results, but again may not be as comfortable.  It's possible in time you might change therapy approach to something that can treat both CA and OA, but for a while you are probably going to be stuck getting used to this, especially with the SARS-COV2 at its peak.

Thanks. so based on that, I probably need to keep Flex off to control the CAs but up my lower limit of my Auto setting? I have been running that at 7.0, then down to 6.5 yesterday. My 90% pressure has been between 8.0 and 9.0. So maybe up the lower pressure back up to 7.0 or even 7.5 and try that?
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