Changing CPAPs and have a question for the group.

DrowsyRN · Post by **DrowsyRN** » Tue Jan 31, 2006 1:34 pm

Good Afternoon,

I have a question for the group. I am buying a my own CPAP to get away from my DME and also I will be moving out of the country. I am moving to Australia and thought since I have read good things about the Resmed S8s that I would buy an S8 Elite with EPR and a S8 Compact as a backup. I have looked at prices in Australia for new CPAPs and I want to buy these two CPAPs while I am still in the USA because it is so much cheaper to buy them here. I have researched my choices and have chosen to move away from the REMStar Plus with C-Flex I currently get from my DME and will going to the Resmed (Australian made) S8s. I was all happy with my decisions to switch from C-Flex to EPR until I ran in to a Respironics rep. while at a local store. He told me that of coarse his C-Flex is so much better, and that if I change to EPR my episodes of Apnea will increase because of the difference in the EPR and C-FLex. Before I started talking to this guy, who was carrying a CPAP box and several masks I was unaware he was a Respironics Salesman. Now for the questions. Is the statement made by the salesman true? Does anyone know if the EPR is more likely to increase Apnea episodes? I have read many posts about the S8s and people who love them, can anyone offer any information?

Regards,

Scott

Chaso88 · Post by **Chaso88** » Tue Jan 31, 2006 2:19 pm

have used the s8 elite with the humidifier for about 2 weeks and I have had no trouble. My DME guys was really good and he said that(he does setups on both the c flex and EPR) and he said the EPR was better. That being said, I cant say if it is true or not but I love mine. I have never used a c-flex. If you use it to travel the s8 without the humidifier seems small to travel with I took it to my parents one weekend and it was no problem at all.

wading thru the muck! · Post by **wading thru the muck!** » Tue Jan 31, 2006 2:28 pm

Scott,

My guess is that the Respironics Rep is basing his comments on the fact that C-flex reduces the expiratory pressure for only the first part of the expiratory cycle. The reason for this is because some "events" occur at the end of the expiratory cycle. ResMeds EPR reduces the expiratory pressure during the whole expiratory cycle. I can't say if the claims of the Rep are in fact true, but my guess is that this is Respironics rationale in making that claim. Too bad he couldn't whip out literature on an independent study supporting their claim.

All this being said, you are smart to make your purchase here in the States. ResMed is a very good Sleep Therapy Products Company, I would not necessarily let that Reps comments make your decision for you, but it is a good question to ponder

WillSucceed · Post by **WillSucceed** » Tue Jan 31, 2006 2:41 pm

You did not mention the pressure that you are at; you may not really need any expiratory relief. Also, if you are at a relatively low pressure, the relief that you would get from C-Flex is minimal. I realize that needing expiratory relief is entirely subjective but... if you don't need it, don't let it be a deciding factor relative to the purchase of a new machine. Ask yourself what you really need and, which machine/Manufacturer gives it to you.

Both Respironics and ResMed manufacture good machines. It seems reasonable to me that the Rep. from any company would support his/her own company and want you to buy from them. This could lead a Rep. to make claims or statements that are not entirely above-board.

Have you considered issues of warrenty and service? Is the Respironics warrenty international, such that it will be honoured in Australia? What about the ResMed machine that is purchased in the USA -will it have a warranty that is honoured in Australia? ResMed would certainly do service repair in Australia but would Respironics? Or, does Respironics ship product that needs servicing to the USA?

Good luck with your choice, and the move!

yardbird · Post by **yardbird** » Tue Jan 31, 2006 3:56 pm

My titrated pressure is only 7cm. I'm using a REMstar auto with cflex and even at my (relatively) low pressure requirement, I find teh c-flex makes it all feel so much more natural. I can't say if EPR is better or if cflex is better. Almost sounds like sales pitch hype to me. As was said, where's the data to back up the claim.

Relief is relief. My gut feeling is that you'll like it regardless of which one you use.

Goofproof · Post by **Goofproof** » Tue Jan 31, 2006 7:08 pm

[quote="wading thru the muck!"]Scott,

My guess is that the Respironics Rep is basing his comments on the fact that C-flex reduces the expiratory pressure for only the first part of the expiratory cycle. The reason for this is because some "events" occur at the end of the expiratory cycle. ResMeds EPR reduces the expiratory pressure during the whole expiratory cycle. I can't say if the claims of the Rep are in fact true, but my guess is that this is Respironics rationale in making that claim. Too bad he couldn't whip out literature on an independent study supporting their claim.

All this being said, you are smart to make your purchase here in the States. ResMed is a very good Sleep Therapy Products Company, I would not necessarily let that Reps comments make your decision for you, but it is a good question to ponder

daniel · Post by **daniel** » Tue Jan 31, 2006 8:02 pm

I have been using a Resmed s8 auto vantage for 3 weeks now. From what people have told me on this forum it is a very good machine. I was going to ask for a Remstar but the people here have changed my mind and I am going to stay with my s8.

Good luck!

dsm · Post by **dsm** » Tue Jan 31, 2006 9:09 pm

Both the ResMed S8 and the Remstar AUTO are excellent machines.

The story about Cflex vs EPR is a one sided story when coming from either a Respironics rep or a ResMed rep

My own experience is that once you get used to either they both work very well. There are some who may prefer the extended relief that EPR offers but as Wader has said, there is a counter argument that raises the point re events occurring late in the exhalation cycle.

Cflex *does* only reduce pressure in a short bursts at the start of the exhalation cycle. I can see this occurring on the readout of a Remstar BiPap with cflex and all the charts at Respironics web site spell out in illustrated detail when the Cflex pressure drop kicks in and kicks out.

EPR can be configured to reduce the pressure by 1 2 or 3 cms and holds the pressure down by this amount for the full exhalation cycle. As a user of BiLevels that appeals more to me. EPR turns an S8 into a 'mini' bilevel. Bilevels are generally regarded as the easiest xPAPs to use for people seeking maximum exhalation relief but to date Bilevels have been prohibitively expensive. Lower exhalation pressure ease the problems of mask leaks and squeaks and can ease the swallowing of air which *typically* occurs during the late phase of the exhalation cycle. I have found that a high cflex setting tended to increase my own exposure to aerophagia because a cflex of 3 causes a bigger burst of increased pressure into the exhalation cycle and that for me was a problem. It seems easier to take the resumption of pressure at the end of one's exhalation cycle than during it.

PS Resmed are not very helpful to people who purchase US Resmed machines & bring them to Australia even though the machine would have been made in Australia. That has been made pretty clear to me. But as you have an American accent you will probably get a more supportive response than any of us Aussies that import a machine.

Cheers DSM

Yoga · Post by **Yoga** » Tue Jan 31, 2006 11:50 pm

The Respironics rep told my sleep doc that tests they have run indicated that the S8 machines had a temporary spike in the pressure at the beginning of each expiratory phase. The sleep doc had gotten comments from several people using the S8 that they had a problem adjusting to the S8 because they had trouble breathing out against the pressure. The doctor tried it himself and agreed with the Respironics rep.

Guest · Post by **Guest** » Wed Feb 01, 2006 12:12 am

Also keep in mind the EPR function does NOT work in AUTO mode.

C-Flex can work in any mode.

rested gal · Post by **rested gal** » Wed Feb 01, 2006 1:12 am

The doctor tried it himself and agreed with the Respironics rep.

Interesting. I had an opportunity to try out a ResMed S8 for a little while. I set the pressure at 10 and EPR at 3 (for a drop of 3 cm's during exhalation.)

It was quite comfortable. I didn't notice any spike or any problem at all breathing out against it. I found it to be even more comfortable than using C-Flex, since the EPR feature maintains the lower pressure throughout the entire exhalation. C-Flex lets the regular pressure back in before exhalation is finished...no problem once you get used to that happening and IF you are using pressures that aren't rather high.

At high pressures (for me "high" is anything above 14) C-Flex doesn't make a dent in the pressure for more than a split second. EPR would still give the definite 3 cm drop during the entire exhalation, even at high pressures.

Guess it depends on the person and the pressure, as to which feels better. At moderate to low pressures (I'm betting the doctor tried it out at a fairly low pressure...lol!! ) and if a person was exhaling strongly (which the doctor might self-consciously have been doing without realizing it) C-Flex can drop the pressure more than 3 cm. That may be why the doctor felt that C-Flex was giving more relief during his little test.

Dunno...just some musings.

Guest · Post by **Guest** » Wed Feb 01, 2006 3:46 am

Yoga wrote:The Respironics rep told my sleep doc ..... <snip>

And I guess we can trust him completely (The respironics rep that is

It does seem that there is a bit of intense market warfare underway between Respironics and Resmed at the moment.

Cheers

DSM

WillSucceed · Post by **WillSucceed** » Wed Feb 01, 2006 9:12 am

Cflex *does* only reduce pressure in a short bursts at the start of the exhalation cycle. I can see this occurring on the readout of a Remstar BiPap with cflex and all the charts at Respironics web site spell out in illustrated detail when the Cflex pressure drop kicks in and kicks out.

C-FLEX pressure reduction can trigger breath-stacking in some users. The increase in pressure BEFORE the user has fully exhaled, makes for progressively shallower and more rapid breaths. The user ends up waking with breathing that is best described as panting.

Despite what some say about "training" oneself to breath out fully when using C-FLEX, when asleep, no amount of training is going to over-ride your bodies' natural response to C-FLEX. Breathing is hard-wired; we can alter our breathing when awake, but not when asleep or unconscious.

So, having said all of this, I have not tried a ResMed machine equipped with EPR but, as it maintains pressure relief for the entire exhalation, I'm inclined to think that I would like it. I found C-FLEX to be horrible for me. I fully acknowledge that C-FLEX is great for many users -I'm just glad that it can be turned off for those users who have problems with it. I'd love to try the ResMed machine with EPR so that I could make a comparison.

The bottom line here is, if at all possible, trial a machine for several nights before you buy so that you know you are getting what is best for you. We all have opinions about the machines, features, and masks but these opinions mean squat as the only opinion that really matters is your own.