A flex vs C flex vs C flex plus

[delfinparis]

I'm embarrassed to admit, after a year of using my Philips Respironics PR System One REMStar 60 Series Auto CPAP Machine with Humidifier...

but I truly don't know the difference between a-flex, c-flex, and c-flex plus. I've read the descriptions online but I'm not sure how to interpret which is "best". Obviously, it's subjective, but it appears that the newest-and-greatest technology is c-flex plus. I've been using a-flex for a year, which is fine, but I never like the inhallation. I take big breaths before I fall asleep and the machine conks out if I breathe in too long.

My AHI seems to hover around 2.5, but I'd like to get it down a bit.

Anyone have a simple guide to choosing a mode and level (1,2,3)? Obviously I can just play around with them, and I will, but just curious if you have advice.

So, what mode are you using these days on your REMStar?

Thanks for the advice!

D.J.

[Julie]

In general, using exhalation relief (EPR on some machines, C-flex on others) tends to raise your AHI by 1-2 #'s, so it's kind of a trade-off and you have to decide what's worth more to you... the pressure relief or a low AHI (which is not always the ultimate prize if it's low 'enough' and does the job). Just being able to say your AHI is 'so' low is only a goal if you otherwise feel good and don't have problems exhaling.

[Pugsy]

Your AHI of 2.5 or so.....what is the event category breakdown? Are you seeing any Flow limitations or snores to speak of? What are your current pressure settings...minimum and maximum? Your current Flex setting?

http://aflex.respironics.com/

The actual drop in pressure during exhale is limited to up to 2 cm at the maximum setting of 3 and even that is based on the force of your own breathing. It's flow based and if you don't breathe rather forcefully it doesn't drop as much.

From my own personal experience with CFlex and AFlex I found that AFlex was more like natural breathing than CFlex...I also found that the higher the setting the faster the machine seemed to want me to breathe and the setting of 3 almost made me feel like I was hyper ventilating...setting of 1 seemed a little slow but the setting of 2 seemed to match my breathing perfectly.

I tell people to use whatever "feels" most natural for them and not worry about the setting number.
The whole idea is to make the breathing more comfortable with the thinking being that if we are more comfortable then we sleep better and that's what we want....more/better sleep.
So play with your various settings and use the one that feels better.

If the AHI is not what you want and it is made up of stuff that is fixable with a change in pressure then I prefer to go about it with slight pressure adjustments (usually the minimum) but you could always experiment to see just how much of a difference (if any) that turning Flex relief off might make. The actual drop during exhale isn't as dramatic with the Respironics machines so it doesn't seem to always equal a higher AHI because of lessening the effectiveness of the pressure. It all depends on the setting and how forcefully one breathes and how close a person might be with there minimum pressure to a line in the sand where it might let a few apnea events happen. Some people use a minimum pressure that is borderline too low anyway. A tiny reduction during exhale might tip the scales but it isn't always a given that exhale relief causes an increase in AHI.

[jlaw3x7]

Clfex 2 is comfortable to me and I have miniminal impact on AHI from it.

[delfinparis]

Your AHI of 2.5 or so.....what is the event category breakdown? Are you seeing any Flow limitations or snores to speak of? What are your current pressure settings...minimum and maximum? Your current Flex setting?

http://aflex.respironics.com/

The actual drop in pressure during exhale is limited to up to 2 cm at the maximum setting of 3 and even that is based on the force of your own breathing. It's flow based and if you don't breathe rather forcefully it doesn't drop as much.

From my own personal experience with CFlex and AFlex I found that AFlex was more like natural breathing than CFlex...I also found that the higher the setting the faster the machine seemed to want me to breathe and the setting of 3 almost made me feel like I was hyper ventilating...setting of 1 seemed a little slow but the setting of 2 seemed to match my breathing perfectly.

I tell people to use whatever "feels" most natural for them and not worry about the setting number.
The whole idea is to make the breathing more comfortable with the thinking being that if we are more comfortable then we sleep better and that's what we want....more/better sleep.
So play with your various settings and use the one that feels better.

If the AHI is not what you want and it is made up of stuff that is fixable with a change in pressure then I prefer to go about it with slight pressure adjustments (usually the minimum) but you could always experiment to see just how much of a difference (if any) that turning Flex relief off might make. The actual drop during exhale isn't as dramatic with the Respironics machines so it doesn't seem to always equal a higher AHI because of lessening the effectiveness of the pressure. It all depends on the setting and how forcefully one breathes and how close a person might be with there minimum pressure to a line in the sand where it might let a few apnea events happen. Some people use a minimum pressure that is borderline too low anyway. A tiny reduction during exhale might tip the scales but it isn't always a given that exhale relief causes an increase in AHI.

Thanks! I'm currently reviewing your software reading tips. I just pulled a random (but typical) day from SH with all the data. If you don't mind, does anything jump out at you as something I can work on? Again, thanks for you help!

[Pugsy]

While your AHI is far from horrible if that report were mine I would probably try to clean it up a little more.
Not so much because of the AHI but because of the snores and flow limitations that are going along with it. Just a little bit too much "clutter" to suit me. I think all that might be needed to clean things up a little would probably be as little as 0.5 cm increase (maybe 1.0) increase in the minimum pressure. Just using a little more pressure all the time to help hold the airway open a little better so that those snores and FLs and other obstructive in nature stuff maybe get reduced a little.

It's probably not critical that things be cleaned up though...so if using a little more pressure causes problems like with aerophagia or something then it isn't something that just has to be done....assuming you are sleeping well and feeling decent otherwise.
Will such a small "clean up" help your overall well being? I don't know. It might and it might not. I have never been able to see a direct correlation to how pretty the reports look or don't look to how I feel in general. Some of my best days following what I thought was really good sleep I have reports that look like I should feel like crap. Go figure.
And other people say that they see a night and day difference between a night with AHI of 1.0 and 2.0.
One of my "miracle" days a long time ago my AHI for the night before was 10.something...as in 10.0 something.
I am still scratching my head over that one.

I do see a direct correlation, for me anyway, between sleep quality/quantity and how I feel. I feel my best with at least 7 1/2 hours of minimally interrupted sleep. The OSA part of my therapy is a walk in the park to manage...the other stuff that affects sleep is a different story though. Here lately it's been the dogs wanting out but this morning I couldn't even blame the dogs. Got maybe 5 1/2 hours of good quality sleep but it just wasn't enough hours and I have no idea why I woke up so early.

[delfinparis]

While your AHI is far from horrible if that report were mine I would probably try to clean it up a little more.
Not so much because of the AHI but because of the snores and flow limitations that are going along with it. Just a little bit too much "clutter" to suit me. I think all that might be needed to clean things up a little would probably be as little as 0.5 cm increase (maybe 1.0) increase in the minimum pressure. Just using a little more pressure all the time to help hold the airway open a little better so that those snores and FLs and other obstructive in nature stuff maybe get reduced a little.

It's probably not critical that things be cleaned up though...so if using a little more pressure causes problems like with aerophagia or something then it isn't something that just has to be done....assuming you are sleeping well and feeling decent otherwise.
Will such a small "clean up" help your overall well being? I don't know. It might and it might not. I have never been able to see a direct correlation to how pretty the reports look or don't look to how I feel in general. Some of my best days following what I thought was really good sleep I have reports that look like I should feel like crap. Go figure.
And other people say that they see a night and day difference between a night with AHI of 1.0 and 2.0.
One of my "miracle" days a long time ago my AHI for the night before was 10.something...as in 10.0 something.
I am still scratching my head over that one.

I do see a direct correlation, for me anyway, between sleep quality/quantity and how I feel. I feel my best with at least 7 1/2 hours of minimally interrupted sleep. The OSA part of my therapy is a walk in the park to manage...the other stuff that affects sleep is a different story though. Here lately it's been the dogs wanting out but this morning I couldn't even blame the dogs. Got maybe 5 1/2 hours of good quality sleep but it just wasn't enough hours and I have no idea why I woke up so early.

Thanks for the review!

So, right now I have the min at 8 and max at 10 on A flex. If I understand you correctly, up the min to 9 or 10 and then see what happens? Is it okay to always leave the max at 20? I'm assuming that can't hurt.

[Julie]

It won't hurt, but it's probably better to lower it to e.g. 15. HOWever, something doesn't make sense as you said you have the min. at 8 and max and 10, not 20... or did I miss something? I hope you're not confusing A-flex settings with regular pressure settings.

[Pugsy]

I don't know that you need to make such a big change and in fact I wouldn't if it were me. I prefer to make small changes and use the least amount of minimum pressure as I need to in order to get my desired results.
Now if your AHI was well above 5 and you were having a boat load of snores and FLs then yeah maybe a bigger jump in that minimum and some people just like to use more than they technically might need and that's okay if they are happy with it.

The maximum...you could open it up to see where it wants to go and it may not want to go very far from where it goes now. You have a little maxing out of the 10 maximum showing on the graphs but you don't spend an inordinate amount of time maxed out so it probably isn't a big deal. Some people like a tight apap range for whatever reason and that's okay too.
I always just left my maximum at 20 because sometimes my pressure wanted to go to 18 or so...and sometimes it never varied much over the minimum (I was using 10 minimum). The pressure changes never bothered my sleep and I never had any aerophagia issues though. If you think the pressure might want to go much higher than 10 (I don't think it will very much) and the changing pressures disturb your sleep or cause more leaks that wake you up...then I wouldn't change the maximum. There doesn't appear to be any critical need to. Or if you are just curious and want to see where it wants to go...then open it up to 20. It won't go anywhere without having a good reason.
For me...being curious is a good enough reason to do anything that's why I experiment a lot.
I get curious and bored and want to push the envelope....so I do.

Just make sure that you know what you are doing and why and what to expect.
I used AFlex for years...loved it. Decided to experiment with turning it off. Boy was that ever a big mistake and totally took me by surprise. Horrible, horrible sleep quality and aeorphagia out the wazoo and ill the next day with it. Never had that problem before. My body didn't like the change. I didn't repeat that experiment.

Oh...SleepyHead says the maximum on the above report is 20...you say it is 10???
Did I misunderstand? Looks like at 4 AM you had a brief spike to around 11 cm...probably REM stage sleep at that time.

[Raheel]

What are your current pressure settings...minimum and maximum? Your current Flex setting?

http://aflex.respironics.com/

The actual drop in pressure during exhale is limited to up to 2 cm at the maximum setting of 3 and even that is based on the force of your own breathing. It's flow based and if you don't breathe rather forcefully it doesn't drop as much.

From my own personal experience with CFlex and AFlex I found that AFlex was more like natural breathing than CFlex...I also found that the higher the setting the faster the machine seemed to want me to breathe and the setting of 3 almost made me feel like I was hyper ventilating...setting of 1 seemed a little slow but the setting of 2 seemed to match my breathing perfectly.

I tell people to use whatever "feels" most natural for them and not worry about the setting number.
The whole idea is to make the breathing more comfortable with the thinking being that if we are more comfortable then we sleep better and that's what we want....more/better sleep.
So play with your various settings and use the one that feels better.

a

Pugsy , thank you for this great tip. I was always wondering why was I being forced to breath. After reading the above I adjusted the A flex setting to 1 and I am feeling great now.

[Pugsy]

Pugsy , thank you for this great tip. I was always wondering why was I being forced to breath. After reading the above I adjusted the A flex setting to 1 and I am feeling great now.

You are most welcome.

I try to do this "Flex" explanation every now and then for people who are new and maybe don't understand that "more relief" is not always better for them in terms of comfort.
Yes, the setting of 3 offers the potential for more exhale relief in terms of potential pressure reduction but sometimes it isn't so much the amount of reduction as it is the timing of the reduction combination and since it is based on the force of one's breathing there's a higher degree of variability potentially among users.

It's just like pretty much everything else related to cpap therapy....they all come with big YMMV stickers because we all have different preferences and needs. In this case I just tell people to play with all the settings and even with it off and see what feels the best and not worry about the number.

Glad we were able to make things easier and better for you with such a little adjustment.
Sometimes the smallest of changes can make a huge impact...both good and bad. Glad it was good in your case.