TURNED EPR OFF!

[DaveL]

I find Lanky Lefty interesting.

First of all, he understands more about sleep comfort than most sleep techs.
Second, he's used equipment. Most have never done so.

And he has a mind of his own.

So I'm glad to see this video. But I appreciate all the knowledge shared here so much more.

[ChinaMan]

While I agree with LeftyLankey on Flex "being more trouble than it's worth" or "super-dumb", I strongly disagree that EPR is the same animal. We have effectively reduced flow limitations and hypopnea with the use of EPR, and of course in many cases improved comfort.  While the super-dumb Flex is often poorly times and makes matters worse, EPR is a true bilevel limited to 3-cm and follows the user's breathing, rather than predicts it.  

I respect what is being attempted in this video, but the settings need to be considered on a case by case bases, and if you have worked with knowledgeable people on EPR to reduce flow limits or hypopnea, chances are you will make a mistake by accepting this one answer for all approach in this simplified video.  LeftyLanky is also very familiar with bilevel, and that is what an Autoset does in a limited way.  We know some people will develop CA events or discomfort with ERP, so individual consideration of its use is important. That said, I think more people benefit from EPR than are disadvantaged by it.  If it works for you, you probably already know it.  Flex on the other hand predicts trigger and cycle on a Philips CPAP and is often poorly times or results in inadequate support of the airway.  This problem is compounded by the slow or non-response of a Philips Auto to flow limitation.

Bottom line, if you are setting up a machine for the first time, this is a great video.  If you have worked with EPR and Flex and know what works for you for comfort and efficacy, this video is mostly targeted at making new users familiar with CPAP controls.

you mean I should turn my Dreamstation AFlex and CFlex off?

[Gideon]

While I agree with LeftyLankey on Flex "being more trouble than it's worth" or "super-dumb", I strongly disagree that EPR is the same animal. We have effectively reduced flow limitations and hypopnea with the use of EPR, and of course in many cases improved comfort.  While the super-dumb Flex is often poorly times and makes matters worse, EPR is a true bilevel limited to 3-cm and follows the user's breathing, rather than predicts it.  

I respect what is being attempted in this video, but the settings need to be considered on a case by case bases, and if you have worked with knowledgeable people on EPR to reduce flow limits or hypopnea, chances are you will make a mistake by accepting this one answer for all approach in this simplified video.  LeftyLanky is also very familiar with bilevel, and that is what an Autoset does in a limited way.  We know some people will develop CA events or discomfort with ERP, so individual consideration of its use is important. That said, I think more people benefit from EPR than are disadvantaged by it.  If it works for you, you probably already know it.  Flex on the other hand predicts trigger and cycle on a Philips CPAP and is often poorly times or results in inadequate support of the airway.  This problem is compounded by the slow or non-response of a Philips Auto to flow limitation.

Bottom line, if you are setting up a machine for the first time, this is a great video.  If you have worked with EPR and Flex and know what works for you for comfort and efficacy, this video is mostly targeted at making new users familiar with CPAP controls.

Withour reviewing your daily charts I canmake no recommendations either way.  Po them and we can give you an opinion.
you mean I should turn my Dreamstation AFlex and CFlex off?

[Sleeprider]

Aflex and Cflex are usually better at a setting of 1 or 2, than at a setting of 3. With Flex, it is mainly a guess as to what to do. The first question you should ask when setting Flex is, am I comfortable? If yes, don't change it, if you are uncomfortable try alternative settings or off and choose the best.

[ragtopcircus]

I find breathing to be most natural on AFlex/CFlex+ 2 - WHEN my nose is clear. I reduced it to 1 while I was figuring out some mask and positional issues. Now I’m at the other extreme, using 3 because of frequent flow limitations in my nose. I recognize that EPR might be better, but Flex is what I have right now, and it does help even if it isn’t ideal. Before going to 3, I was exhausted from trying to somehow force more air into my lungs because I hadn’t been able to exhale enough on the previous cycle.

[vroomvroom]

Based on this post, as well as the other one touting reduction or elimination of EPR, I set mine from 3 to 2 a couple nights ago. I don't think I am noticing a difference, except that exhaling is just a tad bit more "natural" feeling in that I am not feeling over exertion when exhaling if that makes any sense. I can't tell if this is accurate or some sort of placebo feeling.

I should probably have someone just pick a number for me (off, 1, 2, or 3) and set it, without my knowledge, and then me seeing I can tell the difference.

I will try a setting of 1 tonight, and see how it goes.