Adjusting my Clinical Pressure Settings

[DoriC]

[quote="rested gal"].

[Here is a crucial difference between those two manufacturers designs for exhalation relief, the way I understand it:

Respironics' C-Flex does, indeed, let the pressure already be in place before exhalation is completely finished. ResMed's EPR, however, maintains its drop at the end of exhalation and even AFTER exhalation is over.

As you said, the amount of pressure drop C-flex gives is very dependent on the force of the person's exhalation...at the beginning...when the person STARTS breathing out. Breathe out hard, and C-flex drops more than if you breathe out lightly. C-flex does not maintain the drop in pressure all the way to the very end of the exhalation. When the Respironics machine senses that the exhalation is beginning to dwindle or lose its force, the regular pressure begins coming back in. With C-flex, the "prescribed" pressure is, indeed, in place before the person would start to inhale again.

RG, You've described Cflex exactly as my husband tried to explain it to me. For him, Cflex(and Aflex) felt like they were rushing his exhalation, so he shut it off fairly soon after starting therapy. He is fortunate not to have any allergy or sinus issues. Dori

[jda1000]

Rested Gal -

I am in awe of the amount of research you've invested. Your description of Resmed's function is just as it performs, and I did not understand why; I have not tried holding my breath as you describe, but did notice that if I paused before inhaling, the machine seemed pretty calm, and when I inhaled, there was a noticeable pressure surge.

[rested gal]

Rested Gal -

I am in awe of the amount of research you've invested. Your description of Resmed's function is just as it performs, and I did not understand why; I have not tried holding my breath as you describe, but did notice that if I paused before inhaling, the machine seemed pretty calm, and when I inhaled, there was a noticeable pressure surge.

Awww, thanks, jda. Actually, I wouldn't have known about it if someone who let me try a ResMed Elite several years ago had not said, "Hey, here, try this...and when you finish exhaling, hold your breath and count to 15." LOL!!

Tried that again a few times with same result, with an Elite I got later. Not that I needed another machine...just wanted to have one of those cute looking little things in my "collection." Yeah, it's become a silly hobby of sorts.

[ozij]

Yeah, it's become a silly hobby of sorts.

Not so sure its silly... but I did have this silly vision of your living with various cpap machine presented the way people have (had?) mooseheads... or trophies?

O.

[jnk]

Yeah, it's become a silly hobby of sorts.

Not so sure its silly... but I did have this silly vision of your living with various cpap machine presented the way people have (had?) mooseheads... or trophies?

O.

The word "hobby" didn't sound quite right to me, either. Considering how many of us have benefited from Rested gal's having all those machines, I think it would fall closer to being a "calling," wouldn't it?

I picture glass display cases and a sign out on the interstate giving directions toward the International CPAP Museum/Educational Center.

[raylo]

I just came back from my first follow up, 26 days into therapy. I thought I could add to this thread. First, my appointment was set to be with the RT, but instead I got the actual sleep doc. He seemed pretty good. He sounded glad that I was informed and answered my questions - the techs and RTs sometimes don't like all the questions and knowledge. He listened to me and we together agreed on changing my pressure 1cm (from 8 to 9), mostly based on my having just started using EPR. He shook his head in dismay when I told him that the machine I got from his folks (they also are the DME) had the EPR set to off. He had written EPR of 2 with it being accesible to me. They had not made EPR accessible to me (and I am not supposed to know how to change that ). His techs and RTs had all told me not to buy the software so I could look at results, he shook his head again and encouraged me to check the results.

The tech came in to open up EPR settings to me and change my pressure. I showed him where to set the EPR to ramp only. I told what type of new mask I was interested in. It might be helpful if the techs had a sheet of what brands and models they carry. I eventually got it sorted out.

I wrote this to illustrate how odd and frustrating it can be for a newbie. Not being able to make some of these adjustments myself is frustrating. When I first got the machine they seemed to believe that I should know how to turn it on and off, without touching anything else. They told me not to get software, etc. And they set it up wrong!

In this day and age, not being informed and active in your medical care can kill you. Giving an obviously informed patient the ability to participate in his or her care would seem vital. I know a couple of people with machines that have been collecting dust for months now. They all never had much explained to them or new how to change any settings and just thought that whatever they got was the way it should be. And now they have no therapy at all.

I'm lucky, at least the doctor seems to get it. And we all have these types of websites. I don't know if I would be anywhere near as compliant as I am without what I have learned here (every sleeping hour for 26 nights, except 2.5 hours - woke up without the mask). I will still have to fool around with the EPR ramp thing, I haven't yet checked to see if it is set properly.

[rested gal]

I got the actual sleep doc. He seemed pretty good. He sounded glad that I was informed and answered my questions
---
He listened to me
---
I'm lucky, at least the doctor seems to get it.

What a good doctor you have, raylo! Especially the part about, "he listened to me." I've always thought there are quite a few doctors who would go along with an obviously intelligent person who has obviously done quite a bit of research tweaking his/her own treatment settings. There are some with a "do as I say" godlike ego, but I do believe there are many doctors who are pleasantly surprised when someone who has the ability to do it responsibly takes an interest in his/her own treatment.

he tech came in to open up EPR settings to me and change my pressure. I showed him where to set the EPR to ramp only.
---
I will still have to fool around with the EPR ramp thing, I haven't yet checked to see if it is set properly.

It's been quite awhile since I went through the menu on an S8 Elite I have, but I think that if EPR is set for "Ramp", that means EPR will operate only for the duration of ramp time. And that the machine will not use EPR during actual treatment operation after the ramp time has expired.

That may be what you wanted...for EPR to work ONLY during Ramp time and then have no EPR happening at all during the remainder of the night.

But if you want EPR to do its thing all night, I think you need to set EPR for "Full time" (for all night) instead of for "Ramp Only."

A word about "Ramp" -- I guess you already know that even if you do set a ramp time and ramp start pressure, that doesn't mean the machine will automatically start out each night using Ramp when you turn the machine on or start breathing into your mask to make the machine start blowing. You have to actually press the Ramp button after the machine is going, to make Ramp happen.

You've really been doing your research well. No wonder your sleep doctor was happy to talk with you and liked seeing your interest in taking on a very active role in your own treatment! Good going, raylo!