RE: Pressure Relief Features (JCSM article)
(09-05-2022, 02:24 PM)StratCat48 Wrote: My DS2 only has 'Flex' 1,2,3 settings. Has the P-Flex and A-Flex been an addition to the DS2 with a recent firmware/software update? My current version is V1.0.3.3690.
I have 1.0.6.4326
In the user menu, you can only select flex level (if the flex system is enabled).
In the provider menu, you can select flex type (off, flex, p-flex).
Thats all in auto mode, Im not sure what appears in cpap mode.
RE: Pressure Relief Features (JCSM article)
Gideon;
I believe the article's point was that for Obstructive
Apneas which occur at the end of expiration, then EPR=3 is incorrect for that type of patient. Otherwise, it's a positive.
The takeaway from this forum should be EPR=3 is indicated mainly for Hypopneas and Flow limitations. So people should not be confused on that point!
TheResMed AirSense 11 algorithm presents us with a "Black Box"containing an obsolete software program that needs improvements that are scientifically and commercially available. Whether ResMed will ever invest in a non-inferiority study to “cheaply” do this is a hope to keep..... They did this with Autoset for Her, so I am keeping the faith.
RE: Pressure Relief Features (JCSM article)
SleepyHenry, both Gideon and I are aware of the importance of positive end expiratory pressure for both obstructive AHI and proper oxygenation in some patients. When we coach users to use EPR, we mitigate the lower EPAP by titrating for a high minimum pressure as indicated necessary by the data. EPR or Flex is not the cause of the apnea, it is the failure to choompensate for its use with the other available settings. It's interesting that individual response to expiratory pressure relief varies widely with some needing the higher pressure, while others seem to do fine with the lower EPAP. Another observation we have made is that most individuals with a prescribed pressure can better optimize their therapy through changes in settings, including the use of EPR. It's remarkable that the sleep profession thinks 1 to 2-hours of low event rates at a particular pressure represents a good titration, when little regard is given to lower level events like flow limitation, RERA and patient comfort. It would be an interesting poll to ask how many members of this forum actually retain the prescribed settings they received.
RE: Pressure Relief Features (JCSM article)
Agree: If the poll response is not higher than 50% it is not the fault of the forum. It's us Apnea sufferers relying on inertia and procrastination.
PSG is everyone's"Gold Standard" but it is not a research instrument. Its too expensive and labor-intensive. So why are we not using the APAP results more??? Sleep Docs don't have the time to follow patients adequately, and that was even before Covid-19. Don't expect help here.
I was a Respironic costumer until the recall. I studied Flex and arrived at the decision it was at best a comfort gimmick and should not be in the same paragraph as EPR that really works.
As you guys know, the between-individuals pressure response varies significantly between patients...even of the same age, sex and BMI..Not so much for the intra- individual pressure difference. (The PALM Scale phenotype explanation for Upper Airway collapsability). IMHO emphasizing subject differences as you have been doing is great for us apnea sufferers. (Avoiding jargon is always a challenge).
These are my thoughts on your post above. Hope they do not confuse the issue?
So, in summary:Red, Gideon,SleepRider, Opal Rose, Sarcastic Dave and all you guys continue the very helpful advice you provide. As an Apnea sufferer, please accept my thanks!
