After reading through C-Flex vs EPR I am more confused.....

Being an advertising person I always look for the weak spots in an ad/discussion to tell me which is truth and which is fluff.

After reading this on EPR vs. C-Flex, I am now more confused than before. Why? From this at cpap.com it appears that C-Flex is more user friendly and EPR leaves doubt as to what it really does...or does not do.

Respironics C-Flex vs. Resmed EPR: There Is A Difference

Many similarities exist between Respironics C-Flex and Resmed EPR but they are NOT the same thing! Both are easy breathing, expiratory pressure reduction systems. Both decrease the pressure to the patient at the beginning of each exhalation and both have three comfort settings. However, major differences exist in the availability and effectiveness of these features.

Here are a list of the major differences:

* Auto Mode Pressure Adjustments. C-Flex works when the machine is in the "Automatic Pressure Adjust", or "Auto" mode. EPR only works in "Constant Pressure", or "CPAP" mode. EPR will not work when an S8 Vantage machine is in the "Auto" mode.

* Length Of Pressure Drop. C-Flex decreases pressure at the beginning of each breath. The decrease lasts for less than a second and then returns to the base pressure. EPR decreases the pressure at the beginning of each breath also but keeps the pressure low throughout the exhalation.

* Relative vs. Exact Pressure Drop. C-Flex settings reduce the pressure relative to the patient�s exhalation strength and the machine pressure setting. EPR reduces the pressure by one, two or three centimeters of water pressure.

* Sleep Disordered Breathing Event Handling. EPR has an Event Detection Circuit. When a sleep disordered breathing event is expected or has occurred, EPR stops until the event concludes and normal breathing resumes. C-Flex is of such short duration it is thought that is has no negative effect on sleep disordered breathing events and does not need to stop.

* Ramp Mode Pressure Relief. EPR can be limited to work in the ramp mode only. C-Flex can not be limited in this way.

So, if EPR reduces the expiratory pressure by a controlled 1, 2, or 3 centimeters, what is the difference between EPR and BiPAP (tm) or Bilevel?

Bilevel machines are categorized as "ventilatory devices". They use rapid pressure changes to expand and contract lung volume. EPR uses slower pressure changes, so there is little ventilatory effect. However, EPR does feel very much like a Bilevel to the patient.

Does anyone have any info that cuts through the cluuter and explains which is actually better?

Thank you

Elliot

You our obsessing over something that makes little difference in treatment.

Anyway you have three thing to obsess over now, A-Flex, C-Flex & EPR, and maybe if you get lucky they will come out with the ultimate, "Z-Flex", the name I would have picked if I was incharge.

These are "Comfort Features", the only bearing they have is they make use easyier, and they all provide benefit. Obsessing time should be better spent on getting a machine that gives you data and the software to see it, and reducing leaks to the lowest possiable level. Jim

First a bit of history so you can consider my opinion... By the way, I don't work in the health care industry in any capacity, I work as a technician in the entertainment industry.

I was diagnosed with OSA about 5 years ago. I received a straight CPAP machine with a pressure of 7. I used that machine until a couple of months ago. During this time I moved, and about three months ago I saw a new Dr. and did a new sleep study. He confirmed my pressure at 7.

I travel on business full time and was unhappy with the large size of my old machine and the fact that it lacked many features that might make traveling easier, features such as the ability to operate directly from a battery, as well as others.

I decided to replace my machine, and my doctor wrote me a new prescription. My existing insurance company was unwilling to replace a machine that they considered to be appropriate, so I was a cash buyer.

I decided that I did not want to carry my old machine on the road, so I left it at home. I made a plan to eventually end up with a Respironics M-Series machine. I purchased my "backup" machine first due to some financial considerations, and then after a couple of months purchase my new "primary" machine.

My plan included the purchase of an M-Series Humidifier that would work with both machines, however I would not get a backup humidifier. I had never used a humidifier before, and felt that if it broke I would be OK without one during whatever time it would take to purchase a replacement.

Original Machine, ResMed S6 Sullivan Lightweight II, straight CPAP pressure 7 used for 5 years. My opinion of therapy that this machine provided is that it was adequate and worked well.

My new "Backup" machine, Respironics M-Series Plus with C-Flex, straight CPAP pressure 7 with C-Flex enabled, used for 10 weeks. My opinion of the therapy that this machine provided is that it was superior to my original machine, and that the C-Flex feature was a good thing.

My new "Primary" machine is a Respironics M-Series Auto with A-Flex running in Auto mode with A-Flex enabled, used for only two nights so far. My opinion of the therapy that this machine provides is that it is clearly superior to either of my previous machines. My experience is limited so I am not sure if the improvement in comfort is related to the Auto feature, or the A-Flex feature. It is my unscientific opinion that the improvement is related to the A-Flex. I can feel the pressure drop at the end of the inhale and this really is more comfortable for me, at least while I am awake. My wife tells me that I usually snore a little every night, not the loud scary ones, but quiet snores. She tells me that last night I did not snore at all.

I have no experience on a machine with EPR, so I am not able to contribute.

In conclusion I would strongly encourage you to consider A-Flex as an option if you are looking at an Auto machine, I am really happy with mine so far, click on the picture below to view it at CPAP.com. The A-Flex feature is only used in Auto mode. My new primary machine will operate in the following modes...

Straight CPAP
Straight CPAP with C-Flex
Auto PAP
Auto PAP with C-Flex
Auto PAP with A-Flex

Consider my opinion as presented and make up your own mind.

Roadie

Excellent presentation of the facts. Thank you.

It sounds like you could toss a coin in the air and ResMed and Respironics would be somewhat equal except that the Respironics appears to be a bit more "User Friendly" and "User Usable"

I have the M Auto with C-flex....it is definitely louder than my ResMed Escape was but then again this has the C-Flex and the ResMed was straight CPAP.

I am "obessing" because I have to make a decision by the end of this month as the "Rental" period is over and the permanent machine is handed to me which the DME wants to be a CPAP.

2 Sleep studies said I am an 8 and this machine runs between 8 and 12 and mainly at 10 to 10.5....which is, to me, significantly higher than 8. I like the input so I can make a decision and not rely on the DME...which I learned from Day1 when I had the S8 and could not exhale properly.

Regards

Elliot

EPR is the ResMed version of exhalation relief. However it is NOT avaialble when using their machine (Vantage) in auto adjusting mode. So if you intend to use in single pressure CPAP mode EPR is something to consider ... keep in mind though that exhalation relief of any type becomes less noticable/necessary when your Rx pressure is relatively low (less than 10 or 12 ... different for each individual).

My pressure usually runs around 11 and I have never felt the need for exhalation relief but again, everyone is different. I have since sold my Vantage S8 and now have an older Remstar auto/CFLEX "classic tank" model and more recently the newer M series auto/AFLEX.

So if your pressure is high or you find it difficult to breathe against your Rx pressure, exhalation relief is something you should consider. If you intend to use APAP mode with exhalation relief, you can remove the ResMed EPR models from your options.

Thank you Dreamstalker......

That is quite clear and concise....I appreciate it.

So That brings me back to "fight" for the Remstar Auto with C-Flex or preferably A-Flex instead of letting them herd me into a straight CPAP Respironics.

I appreciate you clearing this up for me.

Regards

Elliot

elazarus wrote:Excellent presentation of the facts. Thank you.

It sounds like you could toss a coin in the air and ResMed and Respironics would be somewhat equal except that the Respironics appears to be a bit more "User Friendly" and "User Usable"

I have the M Auto with C-flex....it is definitely louder than my ResMed Escape was but then again this has the C-Flex and the ResMed was straight CPAP.

I am "obessing" because I have to make a decision by the end of this month as the "Rental" period is over and the permanent machine is handed to me which the DME wants to be a CPAP.

2 Sleep studies said I am an 8 and this machine runs between 8 and 12 and mainly at 10 to 10.5....which is, to me, significantly higher than 8. I like the input so I can make a decision and not rely on the DME...which I learned from Day1 when I had the S8 and could not exhale properly.

Regards

Elliot

Elliot,

I wouldn't call it "obsessing".....you're just trying to get as many facts as you can to make a decision that you'll have to live (sleep) with for a long time.
I consider that sound decision making.

As far as your noise level with your present M Series.....there seems to be varying opinions on the "loudness" of machines......and that can apparently vary between machines of the same make and models......"luck of the draw". Also keep in mind that increasing pressure can also increase the perception of "noise".

I personally consider the Respironics machines to have more options available to the user than the ResMed machines (for some of the reasons that DreamStalker mentioned).

Disclaimer: I've never used a ResMed machine or the M Series machines.
Just going by what I've read here.

Good luck,

Den

If your choice is down to the A-Flex or the C-Flex, it is easy. Get the A-Flex machine, it is only $11 more and does both A-Flex and C-Flex while the C-Flex machine is limited to C-Flex only. Check the specs...

Again, I have no experience with EPR, it may be the best for you, or perhaps either "A" or "C" Flex will be more to your liking. From what I have read each of the three technologies does slightly different things to the pressure at different points in the cycle. EPR seems to only affect the exhalation on straight CPAP, C-Flex has a different effect on the exhalation on either straight CPAP, OR Auto PAP, and A-Flex has its effect on the end of inhalation and the start of exhalation and works only with Auto PAP.

I could be wrong with my above assesments, if I am please feel free to correct me.

In my earlier post I neglected to indicate what my 90% pressure is. I made this choice because I do not have enough time to observe what I would consider a good long term comparison. However at this time it does seem to be running slightly higher than my static pressure was before.


Roadie