Optimizing aPap settings

[MisterY]

I'm using a Respironics Dreamstation since may 2017 but I'm still struggling to get good results. One problem is that I don't get any support from a knowledgeable doctor. I have read a lot of info on this forum the last couple of months and I'm impressed with the level of knowledge.

I started with a pressure of 5 and quickly changed it to auto 5-10. After a while I changed it back to a fixed setting because I had many problems with higher pressures which caused awakenings and some centrals. After a couple of months my body adapted to the xpap and when I reached the (fixed) pressure of 9 my ahi got below 5 on some nights. Because I'm still tired and my ahi's are mostly between 3 and 7 I was hoping for some advice on how to optimize the xpap settings.

These are my questions:
- What changes can I make to improve the therapy.
- Would aflex or cflex help and which settings would help considering the need of a minimum pressure of 9 to get the ahi below 5.

Here's the screenshot of last night (scored a reasonable 3.37 without much snoring):
[img]h ttps://i.imgur.com/ZQ7GG0G.png[/img]

[Walla Walla]

Look at your sleepyhead charts and see what the 95% pressure is at then set your minimum pressure to 2cm below that. Look at your max pressure and set 2cm above that. If you use C-flex you might want to bump the minimum pressure up 1 cm more for that. I would't use A flex.

[MisterY]

Thank you for your quick reply.

If I'm right the difference between cflex and aflex is the following:
- aflex: pressure relief at the end of inspiration and start of expiration
- cflex: pressure relief at the end of expiration

Is the advice to use cflex based on experience of users or is it based on some research?

[Walla Walla]

Aflex reduces the pressure both on inhale and exhale. Cflex reduces the pressure just on exhale. Most people use cflex as it makes it easier to breath out.

I'm not sure way anyone would use Aflex. It amounts to just dropping your pressure 1cm all around. You don't need flex to do that.

[ajack]

You also need the leaks fixed. It looks like you may also be mouthbreathing. The forum can help there, some need to move to a mask that also covers the mouth.

[trish6hundred]

Hi MisterY,
WELCOME! to the forum.!
Good luck with CPAP therapy, hang in there for more responses to your post.

[MisterY]

How can you tell the mouth-breathing. Is that the flat top in the leak rate.

I know that when the pressure gets higher I'm having some trouble with a dry mouth. I would think that it's also a matter of getting used to that higher pressure. However I will have look at a chin strap or even a cervical collar.

[Walla Walla]

Yes the flat top on the increased leaks is a dead giveaway for mouth leaks.

[Sleeprider]

You have brought your therapy a long way, and I think you have found a pretty effective pressure range. Your residual events are mostly hypopnea, with some obstructive apnea, and you have some flow limitations.  Flex only provides up to 2-cm of pressure relief, and it is proportional to expiratory flow.  Try using Cflex at 2 and see how it feels.  You can experiment with Aflex, but I was not a fan of it when I used Philips machines.  Your pressure range seems fine, and I would reserve judgement on any changes until after seeing how you respond to Flex. 

With results like this, I think you would like bilevel which is more comfortable and can be effective in specifically addressing hypopnea with pressure support.  Although the pressure difference of something like Flex is very limited, it may help here. If you continue to feel tired and have events near 5 AHI, it might be worth talking to your doctor about BiPAP/VPAP. We can talk more about it if things don't improve, meanwhile good luck, and great job on the chart.

[MisterY]

Last night I switched the apap to cflex mode 2 and it was horrible. I woke up at 5am with an ahi of almost 10. After that i switched back to cflex mode 1 because I need a good night sleep.

My question is, what is the difference between cflex mode 1 and 2?



Note: I did limit the high pressure to 13 because 15 will cause lots of centrals. I'm not used to it (yet).