C FLEX, Ramp, and Breathing Rhythm

Another newbie here with the same complaint you've heard 100 times, but I'll try to whittle it down to a very specific question. I have Dreamstation with nasal pillow mask and have set it up as follows:

Autoramp (7-14)
C FLEX - 3

When I first go to sleep, I have no problem. But I wake up every night after about 4 hours, and the ramp is maxed out around 10-12 or so. I cannot get the right setting to get comfortable with exhaling at that pressure. I tried A FLEX, which starts the de-pressurization before I have finished inhaling, and that does not feel natural to me, so I went to C FLEX to limit it to only kick in on exhale. This is better, but there is still one thing that bothers me - the Dreamstation starts the pressure back up before I have finished exhaling. It would be SO much more natural to me if the pressure did not kick back on until I started inhaling. Starting before that makes me want to rush my next breath instead of just using my natural breathing rhythm. I realize I should be trying to ignore the machine rhythm, but I am finding that impossible to do; if it just matched by natural breathing pattern in this way I feel like it would really help.

So my question is: Is the ResMed machine better than the Dreamstation in this respect (i.e. pressure does not start back up until you inhale)?

Welcome to the forum.

ResMed's exhale relief is different, you might or might not like it better. It's more like a true bilevel when EPR is used and it does feel different and it might suit you better. You can get a true 3 cm drop during exhale if you need it. Might make those higher pressures a little easier to tolerate. The bigger the drop the easier it is to exhale.

For now...try all the settings (if you haven't already) available in both CFlex and AFlex while awake to see which might feel the best at least while awake.
Don't assume that the setting of 3 is going to be the best setting for you because it offers the greatest amount of relief...which BTW even at the setting of 3 you can't get more than 2 cm reduction during exhale because the amount of drop is based on how forcefully you breathe.
It's more of a timing thing than a drop during exhale thing and you might find the timing of the other settings more to your liking.
I found that the setting of 3 seemed to "rush" me a bit...the setting of one seemed like the machine was always behind my respiration pattern but the setting of AFlex at 2...matched my own respiration pattern perfectly. Everyone is different and you just have to try all the available options to see if maybe one of the other settings matches your own respiration better.

tgs wrote: ↑

Tue Aug 28, 2018 3:11 pm

When I first go to sleep, I have no problem. But I wake up every night after about 4 hours, and the ramp is maxed out around 10-12 or so.

Reach over and turn the machine off. Wait just a second and turn it back on. It will be reset to the minimum pressure setting (7.0). An old trick. I used it a good bit when new to CPAP.

Footnote on terminology: My assumption is your machine is set at minimum pressure 7.0 and maximum pressure 14.0. Ramp is something different - wiki/index.php/Ramp

tgs wrote: ↑

Tue Aug 28, 2018 3:11 pm

So my question is: Is the ResMed machine better than the Dreamstation in this respect (i.e. pressure does not start back up until you inhale)?

Yes, see below:

Have you tried turning off C-Flex.......or using a lower setting?
I used C-Flex with a setting of "2" for quite a few years. Turned it off a number of years ago and wondered why I hadn't done it sooner. I found that I didn't have any problems with exhaling against the full pressure.


Den

.

Thanks everyone for your input. To answer some questions, yes I have tried all the settings (including no FLEX) because I really want to get it as close to right as I can and am just about there. (And yes I know min and max is different from ramp and how to set it back to min.) It's the sound of the machine as much as anything that throws me off - I have a noise machine to help mitigate it, but it does not completely mask it.

Looks like the ResMed might be better, but I'm going to stick with the Dreamstation for awhile because I made a discovery that helps a lot. I used the Medium Wide mask instead of the Small last night and suddenly had no problems! The mask fit was not 100%, but the AHI still seemed pretty good, so I'm assuming it's a fair trade off that helps me get acclimated for now.

Thanks again for the help!

tgs wrote: ↑

Wed Aug 29, 2018 11:26 am

Looks like the ResMed might be better,

It's certainly *quieter*.