[Poll] Do you use "exhalation relief" on your CPAP machine?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.

Do you use any form of "exhalation relief" on your cpap machine?

My machine does not have any form of exhalation relief available.
3
2%
My machine has exhalation relief but I don't use it.
20
16%
I use a bi-level machine so my inhale and exhale pressures are set separately.
25
19%
I use exhalation relief at the lowest setting.
12
9%
I use exhalation relief at the medium setting.
23
18%
I use exhalation relief at the highest setting.
40
31%
I didn't know about exhalation relief - I have to go check this out!
3
2%
I don't know or care about exhalation relief.
3
2%
 
Total votes: 129

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[Poll] Do you use "exhalation relief" on your CPAP machine?

Post by yaconsult » Fri May 01, 2015 3:13 pm

Note: this post contains a poll that people can vote in. If you are on a mobile device you will not see the poll and will have to visit this page on a computer to vote in the poll.

I took this definition of exhalation relief from this webpage: http://www.thecpappeople.com/what-is-ex ... tflex.aspx
What is Exhalation Relief like C-Flex, A-Flex, EPR, and SmartFlex?

Exhalation relief is the ability of a CPAP machine or BiPAP machine to reduce the inspiratory pressure during exhale, making it easier to breathe out against the pressure. Manufacturers have different names for exhalation relief, but they mostly work the same way. Pressure can be adjusted up to 3cm for comfort.

Respironics calls their pressure relief C-Flex, A-Flex, or C-Flex+. C-Flex lowers the pressure on exhale and quickly ramps back up to the prescribed pressure. A-Flex, available on Auto CPAP machines only, lowers the pressure on exhale and gradually increases the pressure during inhale. This allows for a more fluid breath.

ResMed uses EPR for pressure relief. Pressures are decreased up to 3cm during exhale and quickly increased back to prescribed pressure when inhale is detected.

DeVilbiss SmartFlex is similar to Respironics C-Flex and ResMed EPR.
Feel free to add comments, questions, and discussions as interesting information often comes out in these polls.

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Re: [Poll] Do you use "exhalation relief" on your CPAP machine?

Post by Matt00926 » Fri May 01, 2015 4:11 pm

The BiPAP machines can also have EPR/Easy Breathe. My Resmed Autocurve 10 has Easy Breathe and I use it in BiPAP mode at 19/4.
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Re: [Poll] Do you use "exhalation relief" on your CPAP machine?

Post by yaconsult » Fri May 01, 2015 4:15 pm

Matt00926 wrote:The BiPAP machines can also have EPR/Easy Breathe. My Resmed Autocurve 10 has Easy Breathe and I use it in BiPAP mode at 19/4.
Ah, well - I didn't know that. If any changes are made to a poll, it starts over again and all past votes are lost.

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Re: [Poll] Do you use "exhalation relief" on your CPAP machine?

Post by palerider » Fri May 01, 2015 5:36 pm

Matt00926 wrote:The BiPAP machines can also have EPR/Easy Breathe. My Resmed Autocurve 10 has Easy Breathe and I use it in BiPAP mode at 19/4.
bipaps don't have easybreath or epr, bipaps are a respironics thing, their version of bilevel.

resmed vpaps can have easybreath, which is not in any way related to EPR.

vpaps do not have EPR, it would be redundant.

EPR is a limited reverse pressure support for NON vpap (bilevel) machines.

easybreath is a pressure shaping technique that makes the pressure changes feel very smooth and gentle.

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Re: [Poll] Do you use "exhalation relief" on your CPAP machine?

Post by palerider » Fri May 01, 2015 5:37 pm

yaconsult wrote:
Matt00926 wrote:The BiPAP machines can also have EPR/Easy Breathe. My Resmed Autocurve 10 has Easy Breathe and I use it in BiPAP mode at 19/4.
Ah, well - I didn't know that. If any changes are made to a poll, it starts over again and all past votes are lost.
see above, that statement is incorrect.

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Re: [Poll] Do you use "exhalation relief" on your CPAP machine?

Post by chunkyfrog » Fri May 01, 2015 7:05 pm

The beauty of EPR is that it is adjustable, so we can use whatever works with a particular mask.

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Re: [Poll] Do you use "exhalation relief" on your CPAP machine?

Post by robysue » Fri May 01, 2015 9:18 pm

palerider wrote:
Matt00926 wrote:The BiPAP machines can also have EPR/Easy Breathe. My Resmed Autocurve 10 has Easy Breathe and I use it in BiPAP mode at 19/4.
bipaps don't have easybreath or epr, bipaps are a respironics thing, their version of bilevel.
PR BiPAPs do, however, have Bi-Flex, which adds an additional flexible reduction in pressure beyond merely the drop to EPAP. The amount of additional pressure relief is flexible and depends on the Bi-Flex setting and the force of the exhalation. If your IPAP = 14, your EPAP = 10, and Bi-Flex = 3, then at the beginning of the exhalation, the pressure might go as low as 8cm because of the Bi-Flex, but during the second half of the exhalation, the pressure will be increased up to EPAP = 10.
palerider wrote:resmed vpaps can have easybreath, which is not in any way related to EPR.
I beg to differ. On the Resmed CPAPs and APAPs, Easy Breathing is intimately related to EPR: If EPR = 0 on a Resmed CPAP or APAP, then there is never a decrease in pressure and the Easy Breathing algorithm is never used. If EPR = 1, 2, or 3, the Easy Breathing algorithm controls how the pressure is increased at the beginning of the inhalation and how the pressure is decreased towards the end of the inhalation. If you look at the Mask Pressure graph from a Resmed CPAP or APAP with EPR = 1, 2, or 3, you can see the Easy Breathing algorithm in action: It's what gives that graph it's wavy look.

The Resmed VPAPs use a (very slightly) different Easy Breathing algorithm to control how the pressures are changed from IPAP to EPAP and back to IPAP during the breathing cycle.

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Re: [Poll] Do you use "exhalation relief" on your CPAP machine?

Post by palerider » Fri May 01, 2015 10:05 pm

robysue wrote:
palerider wrote:resmed vpaps can have easybreath, which is not in any way related to EPR.
I beg to differ. On the Resmed CPAPs and APAPs, Easy Breathing is intimately related to EPR: If EPR = 0 on a Resmed CPAP or APAP, then there is never a decrease in pressure and the Easy Breathing algorithm is never used. If EPR = 1, 2, or 3, the Easy Breathing algorithm controls how the pressure is increased at the beginning of the inhalation and how the pressure is decreased towards the end of the inhalation. If you look at the Mask Pressure graph from a Resmed CPAP or APAP with EPR = 1, 2, or 3, you can see the Easy Breathing algorithm in action: It's what gives that graph it's wavy look.

The Resmed VPAPs use a (very slightly) different Easy Breathing algorithm to control how the pressures are changed from IPAP to EPAP and back to IPAP during the breathing cycle.
respectfully, I beg to differ a little with your differing,
EPR does use easy-breath, except (it seems) when in fast mode:
Image

however, while EPR uses the easy-breath waveform in medium mode, I don't believe it's right to say that easy-breath is the same, or part of EPR, in fact, resmed docs online say they have combined EPR with easy-breath, going back to the S8.

whether the easy-breath waveform is the same, or different in the vpap line, or not, I have no reference or knowledge of. I do know that resmed likes the term, since they also named the new s9 motor after it.

what I can show is the exact effect of EPR, (in medium mode), and easy-breath (in vpap s mode):
Image
Image

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Re: [Poll] Do you use "exhalation relief" on your CPAP machine?

Post by robysue » Sat May 02, 2015 1:37 am

palerider wrote: however, while EPR uses the easy-breath waveform in medium mode, I don't believe it's right to say that easy-breath is the same, or part of EPR,
I never said that they were the same, nor did I say that Easy Breathing is a part of EPR.

I said that Easy breathing and EPR are intimately related to each other. Meaning they work together in a very tightly controlled way. Which is exactly what is meant when the Resmed people you quote say:
in fact, resmed docs online say they have combined EPR with easy-breath, going back to the S8.
Combining EPR and Easy Breathing to make the pressure transitions smooth means that the two things are indeed intimately related to each other on the Resmed CPAP and APAPs.
palerider wrote:whether the easy-breath waveform is the same, or different in the vpap line, or not, I have no reference or knowledge of. I do know that resmed likes the term, since they also named the new s9 motor after it.
Here's a picture of a Resmed schematic of Easy Breathing being used on a Resmed VPAP Auto (probably an S8 vintage machine):
Image

And here's a close up of a Resmed schematic of EPR=3 + Easy Breathing on an S8 or S9 APAP:
Image

The red lines on the two graphs were added by -SWS in this classic post on a thread from 2011 called CPAP vs APAP vs BiPAP (poll)
As you can see, the VPAP's Easy Breathing pressure curve has the same rough wave structure that the EPR+Easy Breathing curve has.

But there are some subtle differences. The EPR+Easy Breathing curve is a bit smoother than the Easy Breathing curve on the VPAP. And by looking at the parts of the two curves marked by the red lines, we can see that the VPAP's Easy Breathing algorithm starts to increase the pressure just a wee bit later than the EPR+Easy Breathing curve does.

Those red lines represent the part of the pressure curve that corresponds to the flat part of the flow rate curve that represents a brief pause between the exhalation and the inhalation. And -SWS's post was in response to a long set of posts between me, -SWS, and others concerning whether the S9 AutoSet with EPR+EasyBreathing was really and truly the same as a "real" bilevel. My throat at the time said NO, it could tell a difference: Bilevels waited until my inhalation started to increase the pressure, and on my S9 Autoset the pressure started to very subtly increase while I was still exhaling and I found that the small increase in pressure would tickle my throat and make me feel as though the S9 were trying to make me inhale before I was ready to inhale.

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Re: [Poll] Do you use "exhalation relief" on your CPAP machine?

Post by palerider » Sat May 02, 2015 12:36 pm

robysue wrote:
palerider wrote: however, while EPR uses the easy-breath waveform in medium mode, I don't believe it's right to say that easy-breath is the same, or part of EPR,
I never said that they were the same, nor did I say that Easy Breathing is a part of EPR.
no, you didn't say that but the post that I was responding to originally DID say, or at least imply, that they were the same. that is what I initially addressed, and referenced.
robysue wrote:As you can see, the VPAP's Easy Breathing pressure curve has the same rough wave structure that the EPR+Easy Breathing curve has.

But there are some subtle differences. The EPR+Easy Breathing curve is a bit smoother than the Easy Breathing curve on the VPAP. And by looking at the parts of the two curves marked by the red lines, we can see that the VPAP's Easy Breathing algorithm starts to increase the pressure just a wee bit later than the EPR+Easy Breathing curve does.


Here's some actual measured data, as opposed to marketing drawings:
Autoset w 12cm, epr3
Image

vpap auto 12/9
Image

I agree, they *ARE* very similar, in fact, I have trouble telling them apart.
robysue wrote:Those red lines represent the part of the pressure curve that corresponds to the flat part of the flow rate curve that represents a brief pause between the exhalation and the inhalation. And -SWS's post was in response to a long set of posts between me, -SWS, and others concerning whether the S9 AutoSet with EPR+EasyBreathing was really and truly the same as a "real" bilevel. My throat at the time said NO, it could tell a difference: Bilevels waited until my inhalation started to increase the pressure, and on my S9 Autoset the pressure started to very subtly increase while I was still exhaling and I found that the small increase in pressure would tickle my throat and make me feel as though the S9 were trying to make me inhale before I was ready to inhale.
perhaps the biggest difference between EPR and vpap s/st/vauto is that you can change the how sensitive it is to triggering the next breath, as well as cycling back to epap, the above charts were done with trigger and cycle set to defaults (medium) if I changed trigger to very high, it would initiate ipap sooner on the inhale curve, if I set it to very low, it would initiate it later on the inhale curve.
m
I don't really understand what was happening to you, since EPR doesn't revert to ipap until you start to inhale. as shown earlier. unless something was wrong with the machine.

there may very well be the differences you experienced, my throat is not sensitive enough to notice that subtle a change normally, all I have to go on is the data traces.

if you'd like any other data images, let me know and I'll do my best to produce it.

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Re: [Poll] Do you use "exhalation relief" on your CPAP machine?

Post by SewTired » Sat May 02, 2015 7:50 pm

Cool! I had no idea about exhalation relief being a part of cpap machines. I thought it was limited to just the bipaps. This is so neat. So many questions to ask the respiratory therapist when I go in for my titration!

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Re: [Poll] Do you use "exhalation relief" on your CPAP machine?

Post by jlaw3x7 » Sun May 03, 2015 1:40 pm

I have difficulty exhaling at times. I have a 560p which has a flex and c flex capabilities. Any reason I would not want to try these settings out? Sounds like C flex would potentially affect AHI less is that correct? Its weird because once I almost felt like I was close to normal unmasked breathing as I was falling asleep. It was like the second night of PAPing. I remember thinking this was going to be a piece of cake... Other times it feels like breathing through cotton - very difficult. Sometimes I can lift my airfit M p10 pillows off my nose and reset in place get to the air flowing better as odd as that sounds - it seems to work.

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Re: [Poll] Do you use

Post by palerider » Sun May 03, 2015 2:01 pm

jlaw3x7 wrote:I have difficulty exhaling at times. I have a 560p which has a flex and c flex capabilities. Any reason I would not want to try these settings out? Sounds like C flex would potentially affect AHI less is that correct?... Sometimes I can lift my airfit M p10 pillows off my nose and reset in place get to the air flowing better as odd as that sounds - it seems to work.
typically *flex settings are seen as a purely comfort issue. so go ahead and try the different settings and see if you like it.

also, make sure you're using the right size pillow, for myself, I thought a medium would work, but a large works much better...

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Re: [Poll] Do you use

Post by robysue » Sun May 03, 2015 4:14 pm

jlaw3x7 wrote:I have difficulty exhaling at times. I have a 560p which has a flex and c flex capabilities. Any reason I would not want to try these settings out? Sounds like C flex would potentially affect AHI less is that correct?
Are you using the machine in APAP mode or CPAP mode?

A-flex is available only in APAP mode.

C-flex is available only in CPAP mode.

Yes, you should try whichever one is available in the mode you are using.

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Re: [Poll] Do you use "exhalation relief" on your CPAP machine?

Post by Wulfman... » Sun May 03, 2015 4:23 pm

I was thinking there could have been a couple of more options to choose from.......and that's why I didn't vote.

"I used to use exhale relief but now I don't."

"I didn't use exhale relief but now I do."

The first one applies to me. I currently don't use exhale relief, but I used to. I turned off C-Flex in early 2013 after almost eight years of using it.......and wondered why I hadn't done so years earlier.


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