Potential Downsides to using CFlex+

[park_ridge_dave]

I have a Respironics REMStar Pro CFlex+ machine. I have been on therapy now for almost exactly 2 months.
As we all do, I have good and bad nights. My pressure is now 13 CM and I was wondering if I should ask my sleep doc if I could use CFlex+? (At present he has my DME disable the CFlex+)
Are there any potential "risks" to using CFlex+ (e.g. say, increased Centrals)?
From what I see, it appears to be only comfort related, but that's why I am asking.

I can certainly switch on CFlex+ but I would like to make sure that I am not exposing myself to any "undue" risk.

OBTW the main reason I would like to try it is that, at my pressure I think that I might be able to exhale better and perhaps sleep a little better? Also, I would like to see if I could get better "leak" control with a lower tension on my mask straps.

Opinions? (I am not asking for you "fellow members" to make up my mind I just don't want to do "something stupid)

Cheers,

Dave

[DreamStalker]

Exhalation relief lowers pressure upon exhalation (the period of the breathing cycle in which one is most likely to experience airflow resistance or apnea).

It is a comfort feature and can make breathing against CPAP pressure more "natural" (though not neccessarily easier). If one uses exhalation relief, they should consider increasing pressure settings to account for the decreased exhalation pressure.

In other words, setting c-flex to 3 may require bumping up CPAP pressure by 2 or 3 cm ... setting c-flex to 1 may require increasing pressure setting by 1 cm.

[wil]

Just a thought... From what I've read/been told/understand:

CFlex decreases your pressure by 1, 2, or 3 cm (CFlex 1 decreases 1 cm, etc.). CFlex+ decreases your pressure by up to 8 cm! Talk to someone who knows (A Good RT who's used to dealing with PR System One) and adjust accordingly... My RT says CFlex+ is almost an inexpensive BiPap setting...

I use AFlex on the lowest setting. Have used CFlex+ before, but I didn't like the way it made the mask move so much... The mask movement was more uncomfortable than breathing against the pressure.

One more thought... I needed the CFlex+ in the beginning, but I am no longer uncomfortable breathing against the pressure (and I use a relatively high pressure). You might use CFlex+ for a little while and then find you're comfortable backing down to CFlex...

[Wulfman]

I have a Respironics REMStar Pro CFlex+ machine. I have been on therapy now for almost exactly 2 months.
As we all do, I have good and bad nights. My pressure is now 13 CM and I was wondering if I should ask my sleep doc if I could use CFlex+? (At present he has my DME disable the CFlex+)
Are there any potential "risks" to using CFlex+ (e.g. say, increased Centrals)?
From what I see, it appears to be only comfort related, but that's why I am asking.

I can certainly switch on CFlex+ but I would like to make sure that I am not exposing myself to any "undue" risk.

OBTW the main reason I would like to try it is that, at my pressure I think that I might be able to exhale better and perhaps sleep a little better? Also, I would like to see if I could get better "leak" control with a lower tension on my mask straps.

Opinions? (I am not asking for you "fellow members" to make up my mind I just don't want to do "something stupid)

Cheers,

Dave

Here's the company information link:

http://www.healthcare.philips.com/main/ ... /cflex.wpd

"C-Flex pressure relief technology makes sleep therapy more comfortable by reducing pressure at the beginning of exhalation and returning to therapeutic pressure just before inhalation. The level of pressure relief varies based on the patient’s expiratory flow and which of the three C-Flex settings has been selected."

It's a COMFORT FEATURE and shouldn't affect your therapy.
C-Flex is NOT like EPR where the pressure is dropped by a specified number of centimeters as per the setting. As mentioned above, it is reduced at the beginning of exhalation, but keeps some pressure there to help prevent events from occurring.
It sounds like your medical professionals don't understand it, either.

Bottom line.......no risk.


Den

[Tielman]

I would agree with Den, but with one cavet: There is a difference between CFlex, and CFlex+

CFlex is a reduction in pressure during the beginning of exhalation
CFlex+ is a reduction in pressure during the beginning of both exhalation and inhalation

It should be primarily be used as a COMFORT issue, and according to Resprionics should not affect the level of your CPAP pressure.

I have turned OFF my Cflex+, and only use CFlex at the lowest level (1).

Please note that with many Respironics machines, there is a Mask setting that adjusts the pressure based upon the mask size (0,1,2,and 3) that may need to be adjusted, as this may affect the level of your CPAP pressure (slightly).

Hope that helps.

[DreamStalker]

I have a Respironics REMStar Pro CFlex+ machine. I have been on therapy now for almost exactly 2 months.
As we all do, I have good and bad nights. My pressure is now 13 CM and I was wondering if I should ask my sleep doc if I could use CFlex+? (At present he has my DME disable the CFlex+)
Are there any potential "risks" to using CFlex+ (e.g. say, increased Centrals)?
From what I see, it appears to be only comfort related, but that's why I am asking.

I can certainly switch on CFlex+ but I would like to make sure that I am not exposing myself to any "undue" risk.

OBTW the main reason I would like to try it is that, at my pressure I think that I might be able to exhale better and perhaps sleep a little better? Also, I would like to see if I could get better "leak" control with a lower tension on my mask straps.

Opinions? (I am not asking for you "fellow members" to make up my mind I just don't want to do "something stupid)

Cheers,

Dave

Here's the company information link:

http://www.healthcare.philips.com/main/ ... /cflex.wpd

"C-Flex pressure relief technology makes sleep therapy more comfortable by reducing pressure at the beginning of exhalation and returning to therapeutic pressure just before inhalation. The level of pressure relief varies based on the patient’s expiratory flow and which of the three C-Flex settings has been selected."

It's a COMFORT FEATURE and shouldn't affect your therapy.
C-Flex is NOT like EPR where the pressure is dropped by a specified number of centimeters as per the setting. As mentioned above, it is reduced at the beginning of exhalation, but keeps some pressure there to help prevent events from occurring.
It sounds like your medical professionals don't understand it, either.

Bottom line.......no risk.


Den

Wrong link Den ... he is referring to c-flex+
http://www.healthcare.philips.com/main/ ... explus.wpd

Also, the amount of pressure "relief" depends on the c-flex+ (or c-flex or a-flex) setting in addition to the pressure setting. It is not a one-to-one (or cm for cm) pressure relief to pressure setting but it is fairly close.

IT WILL AFFECT THERAPY and one who uses it should expect to up their titrated pressure if they were not titrated with the exhalation relief during their titration study.

I did an experiment on this about a year and a half or two ago trying a-flex and c-flex and no-flex comparisons.

Results:
Exhalation relief increased AHI over no-flex therapy.
Exhalation relief + increasing pressure setting to compensate = same AHI with no-flex.

I stopped exhalation relief altogether back then because having to increase pressure setting to compensate for exhalation relief would cause mouth leaks (I was able to control mouth leaks back then sans tape or glue). With no-flex, mouth leaks remained under control and therapy was optimized to 0.4 AHI.

Now that I have lost so much weight, even no-flex begin to cause mouth leaks. So then I had to come up with technique for eliminating mouth leaks (I keep saying I'll post a report of how I stopped mouth leaks without taping or gluing or going to FF mask but never find the time to do so ... oh well).

Point is that exhalation relief can indeed mess with the efficacy of your therapy.

[Photomatt]

According to my reading at Phillips, Cflex+ affords pressure at the END of exhalation, not the beginning, and continues the relief through the beginning of inhalation.

[Wulfman]

Let's just put it out there for everyone to read and make up their own minds.......and experiment with what works best for them.
Since C-Flex and C-Flex + only work in CPAP mode, you have your choice of those two (or OFF).
Some people don't have events at the end of their exhale cycle.
Some people who lose weight end up needing MORE pressure (for some reason).
Everybody's different.

Den


From the C-Flex + link:

C-Flex+ Pressure Relief Technology

C-Flex+ is our newest enhancement to comfort relief for our advanced CPAP units (REMstar Pro and Auto) when in fixed CPAP mode. Like C-Flex, C-Flex+ provides flow-based pressure relief at the beginning of exhalation. Like A-Flex, C-Flex+ softens the pressure transition from inhalation to exhalation to provide additional comfort in fixed-CPAP mode.

[DreamStalker]

All good points.

I just wanted to clarify the previous "Bottom line.......no risk." statement.

[Photomatt]

All good points.

I just wanted to clarify the previous "Bottom line.......no risk." statement.

I am going with this. I hope it is correct, because I changed from Cflex to Cflex+ almost immediately after getting my machine (March 25th). I see the dr. next week and I don't want to get my hands slapped (lol).

[Wulfman]

I'll stand by my "no risk" statement........for "C-Flex". I also doubt that there would be any for the "Plus" version,either. It's supposed to be comparable to the "A-Flex" in APAP mode and I've read many posts from those who didn't like it.......although many do.
Different strokes for different folks........


Den

[DreamStalker]

I'll stand by my "no risk" statement........for "C-Flex". I also doubt that there would be any for the "Plus" version,either. It's supposed to be comparable to the "A-Flex" in APAP mode and I've read many posts from those who didn't like it.......although many do.
Different strokes for different folks........


Den

I was not arguing whether c-flex is liked or disliked ... I agree with you there, different strokes for different folks.

Have you done the experiment yourself? ... Turned off c-flex and lowered pressure by 1 (maybe 2) cm to honestly see if AHI goes up or down or as you suggest, makes no difference at all?

[Tielman]

Have you done the experiment yourself? ... Turned off c-flex and lowered pressure by 1 (maybe 2) cm to honestly see if AHI goes up or down or as you suggest, makes no difference at all?

Sure would like to know how to to change the pressure by 1 or 2, the only option I've seen in my PR1 is 5 cm at a time. I cranked up by 5 cm, and turned on Cflex+ and my AHI went above 5 for a couple of nights, then I turned both the 5 cm down (from 10.5 to 10.0) and turned off Cflex+, and left cflex set to 1. My AHI dropped to around 3, and hasn't dropped to where it was since (it was around 2.2 prior to this stunt).

I did drop the mask pressure to 2 (from 3) when I changed to a large Swift FX mask without any issues.

As far as I can see, Cflex, and Cflex+ does not alter the pressure at the mask to increase AHIs any. Raising or lowering the pressure, however, has a marked notice on AHI levels.

Just my thoughts....

[Hawthorne]

10.0 cm to 10.5 cm is not 5 cm. it is 1/2 (.5) of a cm. You did not raise or lower it 5 cm- you raised or lowered it .5 or 1/2 cm. You can raise or lower the pressure by 1/2 (.5) cm as the lowest increase. It goes up or down by 1/2 (.5) cm at a time.

As far as the mask resistance concerned, if you are using it, I think a Swift FX Large pillow should be set at X1 since the Respironics nasal pillows mask (the Optilife large pillow) should be set at X1 according to the chart available for Respironics masks. The chart does not list other mask brands. We just have to go by comparable Respironics masks if we use the mask resistance.

[blakepro]

All I can say is I LOVE CFlex+ Sooo much better than the old CFlex. Thats my opinion on how it affects me.

The latest AFlex algorithm matches my breathing style very well too. I find them both very easy to get used to. With Aflex, I have to wonder how much it matters since its just going to up the pressure for me if I have a problem anyway.