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is exhalation relief really necessary?
Hello everyone. I've been on APAP for almost a month; first a Respironics System One, then an F&P Icon and now a Resmed Autoset. I am probably going to switch back to the F&P Icon as the Respironics and Resmed machines have that awful whine. I understand that a lot of people don't hear it or aren't bothered by it, but it drives me crazy.

However, the problem with the F&P Icon is that there is no exhalation relief. And without it, I wake up several times per night with my mouth open and air rushing out. I'm hoping that in time this will resolve itself. Does anyone have any experience with that? My leak and AHI stats are fine.

I do realize that I can't see my own data charts with the F&P Icon, but I am willing to sacrifice that in order to not have to listen to the whine. However, I am concerned that I am compromising my therapy by having no exhalation relief and the consequent mouth leaking.

Any thoughts?
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I doubt you are compromising anything. I have the Respironics and I can't stand the A Flex. It does not seem to fit my breathing and made me feel like I needed air. So No, and I am fine without it. I think it is just a preference.
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EPR is a comfort feature, some swear by it and others swear at it
I don,t use it, find it annoying ... everyone is different

As for mouth leaks, chinstraps helps keeps mouth closed and minimize mouth leaks

Try fit the mask at 95% percentile pressure

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The exhale relief probably is not related to your mouth opening when you do not have it.

Like Zonk said, some people hate it, others love it. There's a trend slowly growing where sleep docs are not having them turned on for their patients because they feel it effects the AHI. I did a small experiment and for me, it was the opposite.

One solution to the whine is to put the device in a cabinet. Leave room for air, of course.
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I have a window A/C and dehumidifier in the room and I can't hear my ResMed S9 at all. (It does have a soft whistle though)
Never used Exhale relief so I don't miss it. Smile

A white noise generator or small fan will drown out most modern CPAPs. Wink

Right now having used your machine only a month. I would strongly suggest hanging on to the machine that collects nightly data, otherwise you'll have more headaches down the road getting different masks sorted out and varous other issues. Even worse: No one here will be able to help you without being able to see the data you collect. Wink
IE: I have one mask that is nice and comfly but it leaks like a sieve. I would have never known it was a bad leaker and why I was having other problems without that leak data collected the previous night.

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

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(05-13-2013, 04:42 PM)megan_charles Wrote: I am probably going to switch back to the F&P Icon as the Respironics and Resmed machines have that awful whine. I understand that a lot of people don't hear it or aren't bothered by it, but it drives me crazy.

It might not be an option available to you, but I'll mention it anyway.

I think the S9 VPAP Auto (a bi-level machine) has an upgraded blower unit which would not exhibit the whistle which some hear from the standard CPAP and APAP S9 units.

ResMed says the S9 VPAP Auto is their optimal machine for treating simple obstructive Sleep Apnea (not central, nor mixed obstructive plus central).

I would suppose the Philips Respironics BiPAP (bi-level) machines would also have upgraded blower units compared to their standard CPAP or APAP models.

I suggest you ask to trial a bi-level machine, explaining that the fully data-capable standard units are too noisy for you to sleep with. Perhaps your hearing is extraordinarily sensitive to that particular frequency range. If the bi-level units do not make the same objectionable noise as the standard machines, then perhaps you could arrange to pay the difference or something.

I just think that giving up the ability to track your progress using a fully data-capable machine is a course which should be avoided if at all possible.

Good luck,
--- Vaughn

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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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Exhale relief/EPR/Flex is definitely NOT just a comfort feature for all.

For most people it is a comfort feature, but it can have an effect on AHI for some people. Exhale relief is sort of a lower level of bilevel/BiPAP, which is definitely necessary for some people.

However, most people will probably do about as well without it.
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The exhale relief is for people who tend to swallow a lot of air due to the pressure, but many don't need it, in some it can even lead to (anecdotally) central sleep apnoea events, but most who use it find relief and do not have increased CSA events. It is completely unnecessary in the treatment regime itself, and is simply there as a comfort feature. In most Phiilips machines it is not automatically freely available, but a demo mode, and you have to mess with the technician's settings to make it permanent.

I doubt the exhale relief or anything like it would cause you to open your mouth, that is from other problems. If anything, since it reduces the back pressure on the outflow, it would lead to the mouth remaining closed. I suspect this is more a normal habit of yours that needs to be retrained. Some use a chin strap to help keep the mouth closed, others, like me, have never had need of it. I agree about having a machine that gathers a lot of data at the outset of your therapy, to see how the therapy is working out. I disagree about putting the machine in a cupboard - it requires a great deal of air and a cupboard has too limited an amount of air for that - however, it is relatively easy to "blimp"* a CPAP, so long as you leave the air intake free and unobstructed. The bulk of the noise isn't the compressor so much as the sound of the air being expelled into the humidifier chamber, which acts like an echo chamber. Wrapping a blanket around it and the beginning of the hose outlet can do the trick, wrapping the entire machine is not recommended because you risk impeding the air intake and also raising the temperature of the mechanics, but careful blimping is possible even then.

*blimp is a term from motion picture technology and refers to ways of wrapping motion picture cameras to muffle the noise of the motors, necessary for filming with sound. Later cameras came "auto-blimped" and modern digital cameras do not need it, so it is a term that is now dying out in that industry.
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I couldn't live without it, it gets a bit annoying but its very comfortable most of the time
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Thanks for your replies everyone.
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