Any reason to not use smartflex(pressure relief)full time?

[Gmdfunk]

Is there any reason I should not use smartflex full time? It seems more comfortable to me. Are their any downsides to smartflex or other expiratory pressure relief systems?

[Lizistired]

What machine is that?
Please list your equipment in the user control panel so it shows in your signature.

[Gmdfunk]

Done.

[pap4life]

I can't imagine any reason to not use it full time if you are so inclined. It is a user comfort feature. Most machines and/or manufacturers have 2-3 different setting levels for your use. The more the comfort, the more you will use the machine, and the more benefit you will receive.

[Lizistired]

I'm not familiar with your machine but here is a post I made on another similar thread today...

The thing to understand about comfort features, ie. exhale relief, humidity, and ramp, is they are designed to make you compliant. If you won't use the machine because the pressure makes you uncomfortable, you don't get therapy, and most importantly, your DME doesn't get paid for the machine because most insurance requires >4 hours for the first 30 days. Then the DME has a used machine to get rid of and the stats on cpap therapy success look dismal. Additionaly, you still feel like crap and go back to your dr searching for other causes.
It's really individual. Some people need it some don't. It seems most docs and DMEs start you out at 3 to help you adjust to the machine.
If you look at my avatar, where the the red graph(AHI) drops off is where I finally turned the EPR off after screwing with my pressure for 6 weeks.
If it ain't broke, don't fix it or If you want, experiment with it. At 9cmh20 I don't think you will find it that important. But you may have other lung issues that make it difficult to exhale against the pressure.
If you want to try other settings, I would try dropping it first rather than raising it. Just try them all and see what is comfortable for you. That's all it is, comfort.
If you aren't happy with your therapy, I think the more variables you can eliminate the better.
Just my 2 cents.

[sol]

I don,t think there is downside if you finding it comfortable and helping you getting used to the pressure .

[Mitch40]

Yes Liz has some good points here. (Thanks for responding to my other post).

[Linus]

I find that the pressure relief causes my stomach to fill with air dule to the changes in pressure. I turned mine off after I got used to the machine. Vibratory Snores dropped as soon as I turned it off.

[archangle]

Exhale relief may cause your mask to pump up and down due to the pressure change. This may cause problems with fit or leaks. The pressure change make make the machine more noisy. I find it sometimes makes my ears pop.

Some people think it helps with gas or even with their apnea levels, especially central apneas.

Once you get comfortable with CPAP, experiment with turning exhale relief down and then turning it off. I think once you get used to no exhaust relief, you will feel fine without it. However, if you find CPAP works better for you with it, use it.

[rested gal]

ResMed's EPR (expiratory pressure relief) that Liz was using works quite differently from the way Respironics (Philips Respironics) "flex" features work. I'm not familiar with DeVilbiss's "SmartFlex."

Each manufacturer has their own proprietary way of handling reducing pressure when you exhale.

Whenever I use a ResMed CPAP machine and want to turn on EPR (which I like at a setting of EPR "3" full time) I raised the CPAP pressure an equivalent number of cm's. For example, if I need CPAP 10, I'd set the pressure this way:

EPR off or during ramp only - I'd leave the CPAP pressure set at 10.
EPR 1 full time - I'd set the CPAP pressure at 11.
EPR 2 full time - I'd set the CPAP pressure at 12.
EPR 3 full time - I'd set the CPAP pressure at 13.

That's just the way I prefer to do it when I use a ResMed CPAP with EPR. I don't change the CPAP pressure setting when using Respironics' C-Flex, C-Flex+, or AFlex.

Here's why I do raise the CPAP pressure when using ResMed's EPR, and don't raise it when using Respironics' various "flexes":

Cflex 1-3 Levels
topic started by jucs - January 2, 2010
viewtopic.php?p=436054#p436054

Although that topic was about C-Flex in a Respironics machine, my replies farther along in that thread also talk about EPR used by ResMed machines.

[jamiswolf]

Gmdfunk,
Just to offer some opposing opinions...and these aren't necessarily mine. I've been hanging out in some other forums and enjoy the variety of viewpoints. The techs usually consider comfort features as "Therapy reducing features" which they actually are. For maximum efficiency of treatment from cpap...shut all that stuff off.

And with borderline patients with high pressures...some sleep Docs won't consider flex/epr or even Bipap because the drop in pressure gives some time for the airway to collapse.

These ideas are more for an obese patient with somewhat resistant apneas. Just thought I'd mention that because these so called "comfort features" aren't benign.

Personally...I don't use flex, ramp or rise. Give it to me straight...
J

[rested gal]

I've been hanging out in some other forums and enjoy the variety of viewpoints.

Been there, done that, and I enjoy the variety of viewpoints, too. I still do both - hang out and enjoy.

The techs usually consider comfort features as "Therapy reducing features" which they actually are.

Well, all "comfort" features are not created equal. I'd agree with them that EPR could be a therapy pressure reducing feature in the sense I think you're saying they mean that... that they're saying the effectiveness of therapy might be compromised when a comfort feature reduces the prescribed pressure at a certain point. That's why I raise my pressure setting if I turn on EPR.

However, Respironics's "C-Flex" comfort feature is a whole different breed of cat. C-Flex reduces the pressure at the START of exhalation, but allows the full therapy pressure back in BEFORE the exhalation is finished. So, other than a brief blip of reduced pressure the moment a person starts to breathe out, and partway through the act of breathing out, there really isn't any "therapy reducing" thing about the C-Flex feature. With C-Flex turned on, the full prescribed therapy pressure IS there to maintain an open airway, well before a person attempts to breathe in each time. So, I don't think "C-Flex" could be described as a "therapy reducing" feature. Not in the sense of prescribed therapy pressure not being there when it matters -- before a person even starts to try to breathe in again. With C-Flex, the prescribed pressure will already be in place again before an attempt to breathe in happens.

Not so with EPR, unless the exhalation and/or the pause after breathing out has finished goes on for an unusually long time before the person is ready to breathe in again. In which case, EPR "times out and suspends itself", letting the full therapy pressure back in. If the pressure in place during EPR's exact cm reduction is below the pressure needed to prevent collapse of the airway, then yeah, a person might not be able to even start a new inhalation until EPR timed out.

Of course, there are some people who are bothered (for lack of a better word) by the sensation of C-Flex bringing the full therapy pressure back in before they have completely finished breathing out. Some experience "breath stacking" from that, and their therapy does suffer. Those people do better with C-Flex "off." I'd venture a guess that most people do benefit from the more natural feeling of a drop in pressure at the instant they start to exhale -- while they're awake anyway, and maybe even while sleeping. For them, C-Flex is indeed a "comfort feature." Gotta keep remembering -- C-Flex is not a "therapy reduction" at all. C-Flex is not at all the same thing as EPR. When using C-Flex, the full therapy CPAP pressure is back in place well before it's needed -- for getting a new inhalation started.

Many cpap users, DMEs, sleep techs (and sleep doctors, for that matter) probably think ALL exhalation pressure reduction "comfort features", from any manufacturer, are the same. They are not.

For maximum efficiency of treatment from cpap...shut all that stuff off.

Depends on which "stuff" (which brand's 'comfort feature') a person is talking about. It can't be said often enough. EPR is not at all the same as C-Flex.

I'd also mention "maximum compliance" as being a pretty important factor to consider in achieving "maximum efficiency of treatment." I know, I know... you're talking about treatment pressure, not "compliance." However, a "comfort feature" can make all the difference in the world when it comes to being willing to actually USE a machine, all night, every night...for some people. "Maximum efficiency of treatment" with CPAP means nothing if the treatment is so uncomfortable a person cannot/will not use the machine.

And with borderline patients with high pressures...some sleep Docs won't consider flex/epr or even Bipap because the drop in pressure gives some time for the airway to collapse.

Well, some sleep docs won't consider a lot of things. Once again (I'm sounding like a broken record...) "flex/epr" don't work at all the same way.

These ideas are more for an obese patient with somewhat resistant apneas. Just thought I'd mention that because these so called "comfort features" aren't benign.

Everyone's different, so nothing about any "positive airway pressure" therapy, or the various kinds of "comfort features", be it flex, EPR, or bilevel IPAP/EPAP, is necessarily benign -- or effective, either in terms of good treatment or good comfort -- for everyone. For some people (not sure what "obese patient with somewhat resistant apneas" has to do with it, when considering C-flex rather than EPR) using straight "therapy" pressure with no "comfort feature" is not necessarily benign either.

Personally...I don't use flex, ramp or rise. Give it to me straight...

You got it, J! Your choice. You've found what works best for you. That's great -- for you! Truly. Great for you and probably quite a few more people. Who knows? Perhaps the majority.

It's also not so great, or effective, or compliance enhancing for probably quite a few others. Who knows? Perhaps the majority.
Personally, I don't use ramp either, but I do like the various "comfort" features. And I got 'em. Thankfully, I get perfectly effective therapy with most comfort features. Some people don't.

[Lizistired]

For me the EPR timing was off and made me feel like the machine was telling me when to breathe, or I was waiting for it to. It kind of made me anxious.
I never experimented with raising the pressure to compensate for it because if I could do cpap at 8, but raised my pressure to 10 so I could have EPR at 2, I would still be exhaling against 8. It just didn't work for me.
Maybe you'll get some input from Intellipap users.
The bottom line is, you have to try it and see if it helps YOU or not. Experiment with the different levels at your normal pressure first.

[Emilia]

Here is the DeVilbiss site explaining SmartFlex. Your choices are to use SmartFlex during Delay only, Full Time or not at all. It is truly up to you to decide what feels better for yourself.

http://www.devilbisshealthcare.com/prod ... /smartflex

[rested gal]

Thanks for the link, Emilia. As best I could tell from that page, it looked like DeVilbiss's "Smart Flex" is more similar to ResMed's EPR than it is to Respironics' C-Flex. If that's so, then if I wanted to use Smart Flex on a DeVilbiss machine, I personally would raise my pressure setting accordingly. Same way I do whenever I use ResMed's EPR.

Regarding EPR in the ResMed machine you have, Liz...

I never experimented with raising the pressure to compensate for it because if I could do cpap at 8, but raised my pressure to 10 so I could have EPR at 2, I would still be exhaling against 8.

Well, this might not be the case for you, but if you ever had experimented with raising the pressure to 10, in order to use EPR at 2, I think you might have been pleasantly surprised at how easy breathing out " 8 " felt relative to breathing in at 10. And that breathing in at 10 was a piece of cake.

In at 10, and out at 8 feels very much more comfortable to me than both in and out at any single number -- 8 or whatever as a single pressure. It's the relative difference between a higher pressure for inhaling and lower pressure for exhaling that seems to make a "comfort" difference. But of course, each person is different, and it might not feel that way at all to you, if you ever try it just as an experiment.