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

[geekbearinggifts]

I'm brand-new this week to the Apnea Board, SleepyHead, and (after 10 years with a ResMed S8 Elite and Mirage Swift/Mirage Swift II mask) a Philips Respironics DreamStation Auto CPAP (in CPAP mode) and a ResMed AirFit P10 mask. I asked for and received the clinician's manual for my machine here (thank you very much!) and have been familiarizing myself with it and the SleepyHead software.

After my last sleep study and before I got the new equipment I was advised to raise my pressure from 10 cm H20 to 11 cm H20, which I did. Didn't have any problem with that with the old machine, but I'm still a bit uncomfortable a the beginning of sleep sessions with the new machine. I have the ramp option available but haven't been using it because I wasn't with the old machine. Sometimes it feels like I'm not getting enough air at the beginning of every sleep session, but mostly I feel like I'm fighting to exhale fully early in the sleep session. I was using EPR on max with my ResMed machine, so I made sure the new one has Flux at set maximum (3), but when I look at the "Statistics" view on SleepyHead is says "Pressure Relief" is "None." Am I comparing apples to oranges, or am I actually not getting expiratory relief, and could that be why I feel uncomfortable? My AHI with the DreamStation is .22-.23, so I have nothing to complain about on that score.

Thanks for being here! Wish I'd found the board years ago!

[OpalRose]

Hi geekbearinggifts,
The pressure relief on Phillips DreamStation is called AFlex.
It does not work the same as ResMed machines where you get an exhale preasure relief according to the setting of 1,2 or 3.

Flex settings also have settings of 1,2 or 3, but the most exhale relief pressure you will get from it is 2cm regardless of setting and it is flow based.

• A-Flex/C-Flex+ – Provides pressure relief taking place at the end of inhalation and at the start of exhalation.

The thing to do is try the different settings and see which one feels best.

You should be able to see on #SleepyHead on the pressure graph two lines. The second line would show the drop in pressure relief.

Your AHI is excellent. Now its just a matter of getting your comfort settings to your liking.

[Sleeprider]

Could you summarize the following settings?

Mode
Opti-Start
EZ-Start
Auto-min pressure
Auto-max pressure or
CM-H2O pressure
SmartRamp
Ramp Time
Ramp start
Flex (none, C-flex, A-flex)
Tube type (15, 15H, 22)

[Beej]

Ramp Time - how much time it takes to get from a specified starting pressure to the minimum set therapy pressure.

Have you downloaded the manual for your machine? It should explain some of the settings.

Have you read over the wiki at the top of this page? It describes some of the basics of sleep and sleep apnea.

[geekbearinggifts]

Could you summarize the following settings?

• Mode: CPAP;
  
• Opti-Start: N/A since in CPAP mode, not Auto-CPAP mode;
  
• EZ-Start: Off (I'm a long-time CPAP user and need it to get to sleep/stay asleep, so it would be silly to start off at less than my prescribed setting);
  
• Auto-min pressure: N/A since in CPAP mode, not Auto-CPAP mode;
  
• Auto-max pressure: N/A since in CPAP mode, not Auto-CPAP mode;
  
• CM-H2O pressure: 11 cm H20;
  
• SmartRamp: Off;
  
• Ramp Time: I have set it to 5 min, but haven't been using it because I'm a long-time CPAP user and hadn't used ramp for years with my old machine;
  
• Ramp start: I have set it to 8 cm H20, but haven't been using it because I'm a long-time CPAP user and hadn't used ramp for years with my old machine;
  
• Flex (none, C-flex, A-flex): C-Flex 3 (A-Flex is only available in Auto-CPAP mode)
  
• Tube type (15, 15H, 22): 15, non-heated.
  

[Sleeprider]

Geek, thanks for the settings. I think we could try something if you're game. These settings should not significantly affect your therapy, but might make things 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 start: off
Flex: A-flex
Flex Setting: 3
Tube type: 15

This puts you in auto mode which will record additional data like flow limitations that are not recorded in CPAP mode. The minimum of 10 is your former setting, and the maximum of 12 is just to see if the machine thinks you'd benefit from a higher pressure. I'm going to suggest A-flex at 1 because it can make breathing transitions smoother and more comfortable in both inhale and exhale. These are pretty minimal changes, and it's up to you to evaluate whether it is better or worse. You could go to APAP mode and use a minimum pressure of 11 and maximum pressure of 11 if you want to hold pressure the same, but have the advantage of A-Flex and flow limitations and RERA recording.

[geekbearinggifts]

Hi geekbearinggifts,
The pressure relief on Phillips DreamStation is called AFlex.
It does not work the same as ResMed machines where you get an exhale preasure relief according to the setting of 1,2 or 3.

Flex settings also have settings of 1,2 or 3, but the most exhale relief pressure you will get from it is 2cm regardless of setting and it is flow based.

• A-Flex/C-Flex+ – Provides pressure relief taking place at the end of inhalation and at the start of exhalation.

The thing to do is try the different settings and see which one feels best.

You should be able to see on SleepyHead on the pressure graph two lines. The second line would show the drop in pressure relief.

Your AHI is excellent. Now its just a matter of getting your comfort settings to your liking.

Thanks! My machine is an APAP model, but currently set to CPAP mode, so C-Flex is the setting available in that mode. Checking the pressure graph, it looks like I'm currently averaging less than 1 cm H20 relief at C-Flex 3. Better than nothing!

[geekbearinggifts]

Ramp Time - how much time it takes to get from a specified starting pressure to the minimum set therapy pressure.

Have you downloaded the manual for your machine? It should explain some of the settings.

Have you read over the wiki at the top of this page? It describes some of the basics of sleep and sleep apnea.

Thank you for your reply. I know what ramp time is, but I don't use ramp anymore as I have been using CPAP for years and don't need it. My question was about expiratory relief and the fact that SleepyHead says Pressure Relief is "None" despite setting C-Flex to 3 on my machine.

As I mentioned in my original post, I do have the clinician's manual. I checked there first when making sure expiratory relief was set to maximum, but I had a question about pressure relief in SleepyHead stats. OpalRose' info about the two pressure lines in the SleepyHead graphs helped.

I have a pretty good understanding of sleep issues, including apnea/hypopnea and treatment with CPAP, which I've been using for 10+ years. I have not had a chance to read through the Wiki except the part specific to SleepyHead, since that is the part which is new to me. I also searched the boards for some terms which are different between the machines and masks I have used and am now using.

[Sleeprider]

In case you missed it while replying to others, I think auto mode can provide a better level of comfort. Pressure levels can be the same, or allowed to move a bit.

Geek, thanks for the settings. I think we could try something if you're game. These settings should not significantly affect your therapy, but might make things 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 start: off
Flex: A-flex
Flex Setting: 3
Tube type: 15

This puts you in auto mode which will record additional data like flow limitations that are not recorded in CPAP mode. The minimum of 10 is your former setting, and the maximum of 12 is just to see if the machine thinks you'd benefit from a higher pressure. I'm going to suggest A-flex at 1 because it can make breathing transitions smoother and more comfortable in both inhale and exhale. These are pretty minimal changes, and it's up to you to evaluate whether it is better or worse. You could go to APAP mode and use a minimum pressure of 11 and maximum pressure of 11 if you want to hold pressure the same, but have the advantage of A-Flex and flow limitations and RERA recording.

[geekbearinggifts]

Geek, thanks for the settings. I think we could try something if you're game. These settings should not significantly affect your therapy, but might make things 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 start: off
Flex: A-flex
Flex Setting: 3
Tube type: 15

This puts you in auto mode which will record additional data like flow limitations that are not recorded in CPAP mode. The minimum of 10 is your former setting, and the maximum of 12 is just to see if the machine thinks you'd benefit from a higher pressure. I'm going to suggest A-flex at 1 because it can make breathing transitions smoother and more comfortable in both inhale and exhale. These are pretty minimal changes, and it's up to you to evaluate whether it is better or worse. You could go to APAP mode and use a minimum pressure of 11 and maximum pressure of 11 if you want to hold pressure the same, but have the advantage of A-Flex and flow limitations and RERA recording.

These settings seem reasonable to me. I have to admit, though, I'm fighting emotionally with myself about changing from CPAP to APAP because I know someone's monitoring my usage this time. The first time I got a CPAP machine my insurance changed less than a month later and I had to change doctors because of the insurance, so no one was even checking on my usage. I had to buy a clinician's manual to set expiratory relief because the original DME provider didn't turn it on. 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. I suppose they are looking more for usage time than the actual settings, though, so I doubt they'd squawk. What do you think?