reducing AHI and flex or epr

[dusk_to_dawn]

I wanted to give an update on my progress and will start with the specifics

The key to reducing my AHI, in addition to finding the best min setting, was reducing/eliminating the flex setting; the difference between inhale and exhale pressure.

For me, this was a possibly-necessary two month process. Being able to wear the mask for the duration of the evening took a big portion of the two months. Gradually increasing the pressure, getting comfortable with the mask and eliminating annoying (wake me up) leaks.

The min setting started to lower the ahi when I got up to 9. I am currently at 11 and have settled on a max of 20 with no flex/epr.

For the dreamstation and sleepyhead, flex/epr shows as the difference between the red and green lines in the pressure chart. Aflex1,2,3 float around a difference of 1.5 to 2 at all times. Aflex3 was more exhale relief (bigger difference vs inhale). Aflex2 and aflex1 are less relief. Cflex is a big difference from aflex and helped lower my ahi significantly. This difference shows up as a smaller delta between the red and green lines in pressure vs. aflex. It takes a few nights to adapt vs. aflex since the exhale relief is less. My biggest reduction in ahi came when moving from aflex 2 to cflex1. I didn't try, but likely cflex3 would have been an easier move after aflex2. My next biggest drop came from moving to no flex. I realize everyone is different, but for my case some of the changes did result in a higher AHI at times. Reading through all of the other knowledgeable bloggers (thanks Pugsy) and other web sites, much of the increases that happened for me were due to getting a better nights sleep as I progressed through all of the different sleep stages. My AHI is moving between 2 and 4 now, but I feel more well rested when it is a 4! When I look in sleepyhead i can see when the REM states occur because they require an increase in pressure, but this is not causing me to awaken that I remember. I've had nights of 2, but the pressure didn't have a period of increased pressure and I didn't feel as rested. I could tell I wasn't getting through all of the various stages of sleep. I have noticed this pattern more readily after a night of a couple of drinks (beer/wine).

Comfort and getting rid of the leaks was also key. I started with a mask that covered my nose and mouth, but couldn't find a comfortable position that didn't leak. I next tried the nose pillows and found I needed something to keep my mouth closed. I started with a chin strap and I am currently using a 3" collar which keeps my jaw closed and micropore tape which keeps my lips closed. This is still an experiment in process.

Have you had similar success moving from aflex to cflex to no-flex?

Good luck and as many of the expert bloggers point out, don't give up. You will get there and it is sooo worth it!

[Pugsy]

People's preferences and needs in terms of exhale relief are going to vary widely.
What works well for one person may not necessarily work well for the next person. I have had the occasion to use a Respironics machine and experiment with CFlex, AFlex and even no Flex.
I couldn't tell that CFlex did anything at all and my very first APAP machine didn't have AFlex available so I used no Flex and thought I was doing quite well.
Then I got an APAP machine that had AFlex available and I fell in love with AFlex at 2. It totally made the breathing with the machine feel like barely any pressure being used at all (settings of 10 min and 20 max). It was just so comfortable and natural feeling.

So my experience has been different than yours but that doesn't mean much. I always suggest that people try all the settings and use whatever feels best for them and lets a person sleep more soundly and feel better during the day. It doesn't matter what works best for me...what matters is what works best for each individual no matter what the setting.

So I used AFlex at 2 for probably 2 years I guess and then I got a wild idea to just turn it off and see what happens....bad idea. My body didn't like the change at all and I documented it here in this thread.
viewtopic.php?f=1&t=67883&p=631376&hili ... mb#p631376

I have since moved on to a ResMed machine and I found that I like even more exhale relief in terms of Pressure Support than what Flex offered. A difference of about 4 cm feels really good to me and when I first start bilevel I found that I was sleeping longer and feeling better as a result of sleeping longer...and that's always been my goal...sleep better and feel better.

Flex relief to me was more of a timing issue and not so much the actual drop in pressure. Since the drop in pressure when using Flex is based more on how forcefully one breathes than just a set number drop it seems to affect the timing of the respiration cycle. A setting of 3 made it seem like I was breathing too fast and the setting of 1 seemed like the machine was lagging a bit but the setting of 2 was remarkable in how it matched my own respiration rate and pattern.

I have never really been able to tell any difference in how I feel during the day in relation to what my AHI was the night before. For me it's always been more related to sleep quality and how much sleep I actually got. Heck, one of my "best" days followed an AHI of 10.2.....go figure that one. I thought I finally had the miracle and just knew my AHI was 0.0 (back then I didn't check AHI until the evening so that I wouldn't cloud my perception of how my day went.

So I suggest that people try whatever is available that they want to try and use or don't use whatever seems to work the best for them. I have always felt and anything that makes us more comfortable in general will in turn benefit sleep and we gotta get the good sleep first to have any chance at all of feeling better. The 0.0 AHI doesn't mean squat if we don't sleep so great.