Exhaling problem

[safemoneypro]

I got my machine, a Respironics CFLEX with heated humifider just a week ago. I am using a nasal mask , or I should say trying to. I am having a problem exhaling , it is taking an effort to do so. Is this common , is this something that has to be gotten used to? I have set the CFLEX to 3 to the least resistance?

[Guest]

Yep, 3 is the greatest pressure relief upon exhale.
What is your current pressure?

[jcarn]

for many people, it takes time to get used to exhaling during CPAP treatment, even with C-Flex turned all the way up to 3. You have a good machine .. you'll eventually get the hang of it.
What is your pressure?
What is the mask name/model?

[Jim Eads]

I'm new to this also having been on the machine for only about 3 weeks.

Make going to bed a ritual. Wash your face so the mask will seal properly. Fill the humidifier and turn on the heat. Then, I've found it best to lie down and relax for 10 to 15 minutes or so before putting on the mask. That will let your water heat up and your respiration will slow down.

When I first put on the mask, I find it more difficult to exhale for the first few minutes. I take deep breaths and relax. As my breathing becomes more shallow I find that the exhale becomes easier. After I’ve had it on for a while, I can’t feel any resistance when I exhale.

I’ve also found it seems harder to exhale into a nasal mask (Activa) than into a nasal pillow interface (Aura). That might be my imagination.

Also keep in mind that many people use these all the time with no C-Flex. It can be done.

Finally, make sure you have the C-Flex turned on! I have a REMstar APAP and I can hear the difference in the sound the machine makes between inhale and exhale when C-Flex is on.

Jim

[Ric]

This may sound like a recurring theme, but I'm not sure from your post if you are using CPAP or APAP (?) It is often overlooked that an AUTO machine can allow you to use a lower pressure than what you might use on a straight CPAP setting at least SOME OF THE TIME, and only making excursions into the higher pressure settings as needed. That in itself affords exhalation relief, in addition to the C-Flex feature.

For myself, I spend MOST of the time at the lower limit of 6, even though my machine auto-titrates me to an 11. With C-flex set at 3 (max) I am exhaling against 3 cm-h2o (minimum value of 6 minus 3 for C-flex relief) instead of 11 MOST of the time. The difference is like waaaaaay "noticeable". Even without C-flex, having a APAP might give more relief than a CPAP with C-flex, depending on what pressures you are using. (assuming the minimum setting was more than 3 cm below the CPAP pressure)

[snorzalot]

For myself, I spend MOST of the time at the lower limit of 6, even though my machine auto-titrates me to an 11. With C-flex set at 3 (max) I am exhaling against 3 cm-h2o (minimum value of 6 minus 3 for C-flex relief) instead of 11 MOST of the time. The difference is like waaaaaay "noticeable". Even without C-flex, having a APAP might give more relief than a CPAP with C-flex, depending on what pressures you are using. (assuming the minimum setting was more than 3 cm below the CPAP pressure)

Please note that C-Flex does NOT lower your pressure settings 1, 2 or 3 cm H2O. I used to believe this was the case and another poster on this forum pointed it out and I did a fair amount of research to learn that they were absolutely correct. Likewise, I had an afternoon discussion with the director of my sleep lab who confirmed. After my second to last sleep test, I came home with a Respironics Auto running in CPAP mode with a 10 cm H2O setting and with C-Flex on 3. I believed that 10-3=7, so I thought the device was lowering my ePAP (exhale pressure) to 7 cm H2O on exhale, but that is wrong.

The C-Flex technology is designed to add comfort during exhale by quickly lowering the pressure (an unspecified amount) for a very tiny instance or moment in time prior to returning pressure to normal, but it certainly does NOT wait until the full exhale is complete. Make no mistake, this is NOT like BiPAP technology where you have two very different pressure settings for inhale (iPAP) and exhale (ePAP). C-Flex works wonders for some by helping lower the pressure for that instance of exhale, but it causes a fair amount of trouble for others by stacking their breathing or causing them to hyperventilate. According to my sleep lab director, he says that the cm H2O drop even maxed out at 3 is not even close to 1 cm H2O drop. It would be nice if we could get Respironics to comment exactly how much the pressure drops and for exactly how long.

I now have a BiPAP Auto w/BiFlex that can run in a variety of modes. For compliance they have selected standard iPAP 16 and ePAP 12 and I was allowed to select Bi-Flex 0, 1, 2, 3 (I selected 3). Once compliance is out of the way, I'll go into automode. I have quickly adjusted to the 16 cm H2O setting as last night I quadruple checked my machine thinking 16 wasn't high enough..

Basically to further illustrate the Respironics x-Flex technologies, my machine runs pretty close/constant at 16 cm H2O on inhale but then drops to 12 cm H2O on exhale, the Bi-Flex helps determine how sharply the decent from 16 to 12 occurs--I'm taking a very fast cut off on my pressure and it's working well.

I hope this helps a bit.

Thanks!

[Ric]

Please note that C-Flex does NOT lower your pressure settings 1, 2 or 3 cm H2O.

Thanks snorzalot, I am now older and wiser. (probably mostly just older). I hereby amend my statement to read something like: "I am exhaling against the minimum value of 6 minus a little more for the C-flex relief instead of 11 MOST of the time."

Having repented, I hope you don't miss my main point about APAP, that it too affords exhalation relief, compared with straight CPAP. That is to say, the pressure you must exert to exhale is lower when you are at a lower pressure setting. (that's a d'uh). But even without c-flex (or the equivalent), having an APAP device means that you may spend part of the night using lower pressures, and therefore performing less work overall. That's the OTHER kind of exhalation relief.

According to my sleep lab director, he says that the cm H2O drop even maxed out at 3 is not even close to 1 cm H2O drop.

My subjective impression (i.e. not based on any data or measurements) is that it sure SEEMS like more than 1 cm h2o. (But I'm not really arguing that point). Then again, if you had asked me a year ago (before APAP) what 1 cm-h2o "feels" like, could have only offered a perfectly blank look. I would feel better if I could see the specs, I'm sure they must be published in writing somewhere? As for the duration, I would also question that the C-flex is necessarily of such short duration. I doubt it's on a timer, (but then again, I don't know that either). I'm pretty sure I can trick it into fairly prolonged exhalations, though not to the bitter end, as you suggest. I would guess it listens to pressures and flow rates, not a clock. Please correct me if that is wrong.

[Wulfman]

I'm going to throw out something here from what I've noticed in my charts.

Encore Pro doesn't show any pressure change from my Pro 2 which is set at 10 and C-Flex set at 2.

HOWEVER, on my pressure charts in MyEncore, there's a (slightly) curved line running from "9" (at the bottom) up to "10" (at the top).

I'm wondering if MyEncore IS picking up the pressure change from the C-Flex and that the drop at a setting of "2" is 1 cm. (at least for the exhale pressure)


Den

[G00k]

After the first night on my respironics I thought I'd been using my chest to lift a car. It was a lot of work to exhale completely. The next afternoon, I thought I'd try a nap with it on (I was so tired), and found that since I was being inflated with fresh air, I didn't need to completely empty my lungs with each breath. I started breathing shallowly and soon fell asleep, later feeling much better (no overworked feeling).

I think most people do their first night's CPAP experience with only the training(LOL!) the Apria (or whoever sells the stuff) rep's introduction to its use. I spoke to my rep a few days later (trying to get a chin strap) and descibed my experience. She said they don't know what to tell us to expect - they don't use the products, personally.

CPAP users should create a booklet describing the feelings and effects they experience and the local sleep centers should distribute it. "Each morning when I awake, I know how champagne feels when it's uncorked. Five to ten minutes of releasing gases from every exit. The feel of removing the tape from my face so I can get that first cuppa joe. Looking like a Shar Pei until the lines and tracks fade. But I'm better rested, fer sure!"

Whadya think?