Turning Off Aflex and Cflex

[DoriC]

I don't see much here about NOT using the flexes at all. Are there some of you who do better not using the flexes at all? My husband has no allergies and pretty strong lungs and he can't seem to tell the difference between any of the settings anyway. I read here that the flex settings make the machine noisier and I wonder if not having it turned on would help with leaks. A lot of questions, I know. thanks.

[eutychus]

I turned my c-flex off - mainly because of the noise, but also because I actually felt more comfortable breathing back against my own pressure, which is only at 9cm. Can't help you with the leaks - mine have actually gone down since I turned of the flex. That could just be a coincidence, though. I've only been on cpap for a week now, so a couple of mask adjustments could be why my leak rate has gone down.

Without knowing your husband's pressure setting I wouldn't necessarily recommend turning the flex off (not that I'd recommend keeping it on, either). I do know that I'm fine without it - and again, I'm at 9cm.

Mike

[Babette]

Dori, recently DreamDiver posted that his AHI has been lowering since turning off his Flex. I was intrigued, so I turned off all Flex 3 nights ago. I've slept very comfortably, and my AHI has remained below 3.0, but it's not zero yet. Grumble...

I don't notice that the machine is quieter overall, but I do notice it doesn't make that "breathing" noise that sounds like an ICU ventilator, which has always creeped me out.

Give it a whirl and see what you get!

Cheers,
Barbara

[DoriC]

Babette, that's good to hear since your pressures are somewhat similar to Mike's I would guess, and you're so right in that description of the ICU sounds. That's a plus right there, so will try it. Thanks.

[DoriC]

Mike, sorry I missed your reply. My Mike's settings are 11-15 but his 90% is about 13. I'm hoping that turning off the flexes will also help his leaks too. Thanks.

[Babette]

So? How'd it work out, Dori?
B.

[eutychus]

Yeah, how'd it work out?

[DoriC]

Oh well, here's what happened, I decided to change the flex back to Aflex=2 where he started. I had changed it to Cflex=2 awhile ago to try it (no difference in comfort) just noiser and the mask leaked more (maybe coincidence). So following the advice here, I did not want to change 2 things at the same time. Last night back on Aflex seemed to be better than on Cflex, so I will keep it the same for 1 or 2 more nights and then turn if off and see what happens. I'm trying to reach "perfection" for my Mike. Are you both still doing better on No Flex? Thanks for your interest.

[Babette]

Sounds like a plan! I'm still doing fine with no flex at all.
B.

[bap40]

I don't use any flex at all on my Aflex. My pressures are around 13. Just never bothered as my first machine had none. I lost the ramp about the 3rd night also. I have no problems breathing thru the pressure.

[rested gal]

I liked C-flex, and I like A-Flex even better. I do well with both and do like pressure relief for exhaling, even if I don't absolutely need it. I can also do fine without either.

Those features really are an individual "comfort" preference for many. They can be anything from "WOW...so comfortable!" to annoying or even counterproductive to treatment for some people.

It's nice that such adjustable comfort features are available. And it's good that they can be turned on or off.

[Pineapple]

Dori,

I too dropped the flex. I started by just reducing it and when I found I felt better, I decided to try without it.

You might also want to check the ramp setting as bap mentioned (if your using it). My DME has the habit of resetting into the basement and for 45 minutes long - alot of people have trouble at that low start (typically 4) and it just takes to long to get the machine up to a good pressure.

Another thing I have found is that I don't seem to be able to tolerate heated humidity. After you have the flex issue optimized, you might want to move on to that as a possible cause of bad nights.

[carbonman]

They can be anything from "WOW...so comfortable!" to annoying or even counterproductive to treatment for some people.

To flex or not to flex....

RG, thanks for taking the pressure off.
I have used A and C, and like C the best.

I have tried straight cpap, twice.
The first time, I could only take it for 10min.
The second time I did it for 3 nights.
All three mornings, I had sinus congestion and a headache all day.

I thought, geez, if Babette can take it straight, so can I.

...but, alas, I have no cpap pump'a'tude.

......BUT, that's ok.....because I'm doing very well on the 'flex.

[DoriC]

We don't use ramp or HH anymore so that's OK. I will change the Aflex to 1 for a few nights and then to Off and see what happens. Can you tell me what your Apap settings are so I have a reference point?

RestedGal, I know you've explained this before but can you tell me why you advise opening the max to 20, I was told here to keep the spread tighter( I'm on overload so forgot the reason why). We're set at 11-15, titrated at 13, but sometimes his 90% is at 15, so should I change the settings? We've been at these settings from the beginning, haven't changed anything because we were dealing with mask issues. The UMFF seems to be working out better now.

[DreamDiver]

DoriC,

It's different for everyone. If your current therapy is working okay, but you just want to see if you can get it even better, making a single change from one form of exhale pressure relief (EPR) to another or just turning it off altogether can be a good way to explore what might work better.

My problem with the cflex is likely due to the algorithm it uses. The pressure relief with cflex is only for the beginning of the exhale. Yes, you get immediately relief as you exhale, but the prescribed pressure comes back a little 'early' before the next expected inhale. My autonomic brain tries to match the 'early' signal whether I'm asleep or not. I call it "Cflex-Related Autonomic Sympathetic Early Exhale Response Syndrome" or CRASEERS. Because of this, I end up breathing faster than normal while wearing a mask and using cflex. The body can only keep this up for so long before it decides to rest. That's when I start seeing apneas and hypopneas. For the first few weeks on cflex, my sides and diaphragm were aching with the extra inhale/exhale work caused by the syndrome. My muscles got used to the extra work, but my nervous system still tried to autonomically match a swifter-than-normal inhale/exhale pattern. Ironically, the faster my brain tries to match cflex, the faster the early response kicks in. It's a vicious cycle. For me, cflex setting 3 gave me the worst AHI's for a specific pressure because the difference in exhale pressure is the most pronounced - hence easier for the autonomic nervous system to recognize. Lowering it reduced AHI's a little, but not significantly enough for my body not to recognize the cflex-caused autonomic 'early' inhale signal. Turning it off altogether removed that problem. No early signal means I breathe at the pace my body regulates - not the machine.

From what rested gal wrote here, the EPR on resmed machines is a little more like BiPAP, except using from a from-1-to-3-cm difference from the set pressure of the CPAP machine rather than 4-or-greater-cm difference in exhale relief of a true BiPAP. The exhale response of resmed EPR algorithm is a little delayed, but the inhale response may not start early, and hence, may not cause CRASEERS. It's entirely possible that a more 'mini-BiPAP-style' algorithym would actually be better for me than cflex, or even better than straight CPAP without any EPR. Since I don't have a resmed machine, and I'm doing pretty well without cflex for now, I've got time to explore my options. Aflex may be Respironics' quietly-unadvertised 'DOH!' response to CRASEERS. I don't know enough about the algorithm to make a convenient guess. I imagine if it's more comfortable, they will at some point stop promoting cflex altogether and adapt all newer boxes to use aflex - Auto and Continuous PAPs alike.

Not everyone on CPAP has CRASEERS. However, I suspect there are more of us out there with CRASEERS than Respironics would care to admit. If you've hit a wall in your therapy, try turning off cflex altogether for a week. If you see a significant drop in AHI for that week, you have CRASEERS.

Edit - originally used 'inhale' as part of the acronym - it should actually be 'exhale'.