Auto C-Flex vs Auto A-Flex?

[sbeeland711]

After reviewing the SmartCard data for first week on REMStar Auto with A-Flex (AHI = 72; 02 desat = 72%; pressure setting 9-17 cm), Sleep Lab wants to increase my pressure to 18 cm and switch me to C-Flex. Two questions:

1. Is 18 cm setting considered "high", or "very high" range?
2. Why would they advocate going to C-Flex instead of A-Flex? Isn't A-Flex the latest technology?

Thanks.

[Wulfman]

After reviewing the SmartCard data for first week on REMStar Auto with A-Flex (AHI = 72; 02 desat = 72%; pressure setting 9-17 cm), Sleep Lab wants to increase my pressure to 18 cm and switch me to C-Flex. Two questions:

1. Is 18 cm setting considered "high", or "very high" range?
2. Why would they advocate going to C-Flex instead of A-Flex? Isn't A-Flex the latest technology?

Thanks.

Without seeing a report, it's kinda hard to answer some/any of your questions.
Could you please give some more information?
Did you not have a "regular" PSG (sleep study) in the sleep lab (all wired up)?
Are they basing this on an Encore Pro printout from the smart card?
Is it the smart card that showed the "AHI = 72; 02 desat = 72%" ? Were you wired up with a pulse-ox recorder?

If you had numbers that high, there could be many reasons.....including Central Apneas, GERD, bottom pressure too low and a whole lot of other possibilities.

Something doesn't quite make sense here. Either there's some parts of this puzzle that have been left out or you're dealing with some morons at that sleep lab.

But, yes, 18 is getting high enough to be on a Bi-PAP machine and, yes, A-Flex is Respironics' latest breathing relief technology for APAP machines.


Den

[Guest]

Den, why wouldn't you just paste instructions for sbeeland how to retitrate the device? LOL

[Wulfman]

Den, why wouldn't you just paste instructions for sbeeland how to retitrate the device? LOL

LOL......you got THAT right!

Ya gotta know where you're AT before you can figger out how to get where you're goin'.

Den

[Guest]

Yes, the Sleep Lab did the PSG plus 2 nights of titration testing. That's where the AHI, O2 desat, and initial pressure setting came from.

Then after first week on REMStar Auto M with A-Flex, they reviewed the Encore data after one week and will increase the top level pressure from 17 cm up to 18 cm.

Does this clarify?

[Goofproof]

We don't have much to go on, but if you are using a nasal mask, you could be loosing your treatment out of your mouth. If so the numbers don't mean anything except something's wrong. The leak rate hase to be in a controlled range, before anything works. Jim

[Wulfman]

I kinda figured that's where those numbers came from, but I just had to ask.
As far as them switching you from an Auto with A-Flex to "C-Flex", it makes me wonder if they're planning on taking the Auto away from you and just giving you a plain CPAP with C-Flex. A-Flex and C-Flex are both breathing relief technologies.....as was discussed in this thread yesterday.

viewtopic/t26015/biflexcflex.html

At that high of a pressure, you should probably be on a Bi-PAP.

Bottom line is......I smell a rat......or a "bait & switch" in your future.

Did they give you a copy of the Encore Pro report from the Auto? (probably not)
The fact that they set the pressure range at 9 - 17 (and for a limited time) and now come up with a higher single pressure raises a question in my mind.

If they're planning on letting you use the APAP at a single pressure of 18 and on C-Flex for testing purposes, then that would be one thing......but if they're planning on pulling the APAP completely and just leaving you with a CPAP at 18 cm., then that's another thing entirely.

Something doesn't sound right, here. Ask lots of questions and ask for copies of sleep studies and reports (and your prescription).

Den

[sbeeland711]

Actually, the CRNP I communicate with at the sleep lab is very open minded in terms of listening and sharing information. She said the Encore report showed RDI between 8.3 and 15.4 at 17 cm pressure. There was minimum mask leak (ResMed Mirage nasal mask).

She asked if I thought I could tolerate increasing to 18 cm. I wake up sometimes when the machine is at 17 cm and feel like my chest and lungs are sore (from the pressure?). I told her that I thought I could, but I wanted to keep the APAP with A-Flex at that level for the (hopefully) added comfort. She agreed to prescribe the APAP with A-Flex with pressure setting 9-18 cm.

I have a follow up appointment with the CRNP in 3 weeks and we will review the Encore data again.

I understand the machine can deliver maximum of 20 cm. Where is this headed?

[Wulfman]

Actually, the CRNP I communicate with at the sleep lab is very open minded in terms of listening and sharing information. She said the Encore report showed RDI between 8.3 and 15.4 at 17 cm pressure. There was minimum mask leak (ResMed Mirage nasal mask).

She asked if I thought I could tolerate increasing to 18 cm. I wake up sometimes when the machine is at 17 cm and feel like my chest and lungs are sore (from the pressure?). I told her that I thought I could, but I wanted to keep the APAP with A-Flex at that level for the (hopefully) added comfort. She agreed to prescribe the APAP with A-Flex with pressure setting 9-18 cm.

I have a follow up appointment with the CRNP in 3 weeks and we will review the Encore data again.

I understand the machine can deliver maximum of 20 cm. Where is this headed?

OK. That sounds better. Still a higher pressure, but maybe it'll turn out that you won't need that much.
I was actually prescribed a pressure of 18 cm., but with the software, I found out that pressures of 10 - 12 served me very well.

Good luck with your therapy.

Den

[sbeeland711]

After I see where I am after the 30-day follow up, I will purchae the software and start tracking this on my own. It is interesting that you were able to self titrate to a lower pressure. When you were at 18 cm, did your lungs feel sore in the morning?

[Wulfman]

After I see where I am after the 30-day follow up, I will purchae the software and start tracking this on my own. It is interesting that you were able to self titrate to a lower pressure. When you were at 18 cm, did your lungs feel sore in the morning?

Actually, I only left it at that pressure for less than an hour. Since I had the software from the very beginning, I thought I'd try something a little more "reasonable" to start with......so I settled on 10. I left it there for 10 months before deciding to try 11 and 12. Then I bought an Auto and used it for one week at a range of 10 - 15.....and it confirmed that I had made a better "GUESS" at my pressure than my doctor had. I use all three of my machines in single-pressure mode at 12 cm. I found that I achieve better results in CPAP mode than by using a range of pressures.

Den

[Guest]

Den,

Your findings are very interesting. The CRNP was advocating single pressure setting of 18 with C-Flex. I just didn't think I could take that high a pressure all night and get enough sleep, so we settled on the Auto M with A-Flex for now. This machine is also capable of being set up with straight CPAP with C-Flex, so maybe I can settle in at a lower constant pressure after we get through the first few months. For instance, I am quite comfortable at 14.

It is amazing what we can pick up from peer-to-peer conversations

Steve

[Wulfman]

Den,

Your findings are very interesting. The CRNP was advocating single pressure setting of 18 with C-Flex. I just didn't think I could take that high a pressure all night and get enough sleep, so we settled on the Auto M with A-Flex for now. This machine is also capable of being set up with straight CPAP with C-Flex, so maybe I can settle in at a lower constant pressure after we get through the first few months. For instance, I am quite comfortable at 14.

It is amazing what we can pick up from peer-to-peer conversations

Steve

Well, you're gonna have a good multi-mode machine with which to tweak your therapy.
Actually, my titration stopped at 16 cm. with a few remaining events (my guess was that it was probably "snoring"). My sleep doctor added another two centimeters to that (I've gotten the impression he LIKES to prescribe high pressure based on some other prescriptions I've heard he's written).

I started my therapy with a REMstar Pro 2 CPAP rather than an Auto. I have no regrets about how I got from there to here. I just feel fortunate that my therapy began at a time when the technology in the machines was becoming better and the software was easily available through places like CPAP.COM.

I've often wished I'd have been able to have some discussions with my sleep doc about some of the things I've learned on the forum, but I'm not about to pay HIM......for HIS education.
(he had the personality of a porcupine)


Den