CFLEX and pressure relief on exhale

I am going back to my sleep doctor in a week to have my first evaluation since I was put on my bi-level. What should I expect? Will the data he gets from my Resperonics VPAPlll show AHI etc?

My main question is tho.....How much relief do you get with the CFLEX settings? I am at 18/14 on my bi-level, I cannot exhale against the 18 . I talked to the DME and she stated that the CFLEX will NOT give me as much relief as the bi (4 whatever you call it). I know there are three setting on the CFLEX, 1..2..3.., do those each represent a 1 whatever? I know this is probably confusing, but I don't know what the settings are called. I want to ask my dr to let me try a RESmed Auto w/CFLEX and am hoping that I don't need the 18 pressure all night.

I also see people talking about their AHI at night and adjusting their pressures, I am assuming with the RESmed I will need to purchase the software to adjust the pressures? Or can it be done on the machine? I know I will need the software to check my AHI.

Sorry for the long and confusing post but I really need the answers.

Thanks a bunch,
Gilda

Gilda,
Respironics are very vague about quantifying the 1,2,3 settings on C-Flex except to say that an increasing degree of pressure relief from 1 - 3. They state explicitly that the numbers themselves do not mean anything.
Derek

I don't know the answers to MOST of your questions, but I do believe that most of the discussion about AHI and such is based on having an AutoPAP, not a CPAP or a BiPAP. I don't know that either bi or C have the sensitive sensing equipment necessary to provide the level of feedback an Auto does.

Liam, taking a guess, hoping someone has better info.

Gilda, I've never used a VPAP III and I'm not a doctor or anything in the health field at all. So....what I'm going to say is just my opinion and could be way wrong.

As I understand it, there's no precise "cm" number that can really be measured in the pressure drop that C-Flex gives. It's just..... a drop in pressure when you exhale. C-Flex set for "1" gives some drop. C-Flex at "2" gives more drop. C-Flex at "3" gives the most drop. I know that sounds silly to not be able to say, "It drops it one cm at a setting of "1", and 3 cm (or 5 cm) for a setting of "3".

But the fact is, even Respironics doesn't try to say how much drop each C-Flex setting represents. My personal opinion - I think they don't say, because it probably varies with each patient's own style of exhalation.

I believe it probably depends on the amount of force with which a patient breathes out. At least that's what the sound of the motor indicates to me when I try a soft, light exhalation as opposed to a strong, forceful exhalation at the same C-Flex setting of 3. Going just by sound of the motor, it sounds to me as if a stronger exhalation produces a greater drop - but it's difficult to tell that from the actual feel of breathing out strongly or lightly.

Either way, C-Flex does give a comfortable drop in pressure. Exactly how much drop? It probably depends on how hard or how lightly a person exhales....or perhaps how long the exhalation lasts.

All that said, the RT is telling you "kinda' right", in that C-Flex can't be set to an exact pressure drop number, so can't give anywhere near as wide a range of difference between inhalation/exhalation as a bi-level machine like the VPAP III or a BiPAP could be set for.

There are certain patients and certain situations where a bi-level machine would no doubt be the only machine they could use. Extremely weak lungs, for example. However, I don't think that difficulty exhaling against 18 means a person's lungs are necessarily "weak". 18 is tough going for most people - that's pretty high up there, compared to what most cpap users seem to get prescribed.

Having used an auto with C-flex a couple of months now, and having experienced the very comfortable drop that C-flex (at 3) gives every time I breathe out, I'm becoming more and more convinced that moving a cpap patient to a bi-level (VPAP III or BiPAP) only because the patient has difficulty breathing out against pressure - especially a high pressure like 18 - is jumping the gun in many cases and is not really serving the patient well. I think a trial on the only auto that presently can offer relief on exhalation (C-Flex) might offer better pressure relief for two reasons:

1) the patient might not need the high prescribed pressure much, or even any, of the night.

2) it it turns out the patient doesn't use the high prescribed pressure much, C-flex would almost certainly provide sufficient relief on exhalation.

Pressures can be adjusted on any of the modern machines just with the buttons on top, if one knows how to get into the "therapy menu". You don't need software for that, with either the VPAP III or the Respironics autopap with C-Flex. The value of software is in getting to see more detail about how the treatment is going - graphs, charts, etc. (Very valuable info, imho.) With the VPAP III you can get some additional data from the buttons on top, but if you want to see graphs and charts, you'd need the software for it too.

mommaw, you mentioned you plan to ask your doctor to let you try a "ResMed Auto with C-flex". Be careful what brand you ask for.... those manufacturer's names get confusing. The machine you want to try is this:

Respironics Remstar Auto with C-flex and of course, get the heated humidifier with it too.

Good luck!

I can highly recomend the ResMed Auto also. It doesn't have C-Flex technology but since it is an Auto PAP it will only titrate up to what it senses you need so the exhalation isn't bad at all. I also had trouble exhaling with the VPAP Machine they used during my study and have no problems with my ResMed Auto....I will say that it seems easier to exhale with a Nasal Mask than the Nasal Pillows though, but I got used to both. Maybe you'll want to start with the Nasal Mask to give it an honest trial.

Jeff, does your pressure ever get up to 18cm? If it did I bet you wouldn't be so comfortable with that ResMed auto. In Glida's case whether or not the Auto with C-flex wold work for her depends on how much time she would spend at 18cm. I doubt that C-flex would be sufficient to provide her enough expiratory pressure relief at 18cm but if she spent most of the night below 12cm it would probably be better. This all depend on whether or not she has some other need for the Bipap. Respironics is actually admitting that the Auto with C-flex may provide better therapy for patients swiched to a Bipap for the sole reason of difficulty tolerating a high pressure setting. As far as the exact pressure releif of the C-flex, Respironics will not say, but they did say it is not 1-3cm corresponding to the 1 thru 3 settings.

For guest that assumes that all of us are playing doctor. I am not a doctor.

First, did the doc prescribe the Bipap for any reason OTHER than compliance? If so, you will more than likely have to stay with it.

If not, an auto will make a difference as it will only go to the highest pressure when needed. A good part of the evening you will be lower than that pressure.

Cflex will provide additional comfort with its 3 levels. I would concur with Rested Gals (nonmedical) opinion. The more forcefully you exhale seems to relate to the pressure relief. (could be just perceived tho)

Thanks all,

As far as I know the dr only prescribed the bipap because of the high pressure needed to keep my airway open. At least that is what the DME told me. When I went to the dr for the results of my sleep study, I was a total greenhorn. I had not found you great folks. Since I have, I plan to ask a lot of questions when I return to the dr in a week. I do have a summary of my PSG and from what I can figure out, during 4.6 hrs of sleep over the total test, I had: total obs=4, Obs Hyp=31. This study was done over 2 nights. The first night it says out of 180 minutes sleep, I had 12 AHI (does not break down apnea vs hyps), the second night was on the machine and says: for time during the 18/14 recommended bilevel pressure of 18/14, I had AHI 3 per hr (no breakdown). So I dont think my biggest problem is with apnea but hypopneas. I am going to discuss all with doctor!

Rested Gal, yes I meant the Remstar auto, I even have a copy of Waders review and a copy of info from cpap.com to take to my doctor with me. I am getting all the info I can. The pressure of 18 is driving me nuts .
The ONLY mask I am comfortable (use term loosly) with is the Breeze nasal pillows (side sleeper) and with all that pressure concentrated in those small openings, my throat blows up like a balloon! I can actually feel it expand with each breath. I am hoping I can get an auto and not need the 18 all time.

Thanks again to all,
Gilda

Gilda,

I look forward to learning how this goes for you.
I have a bipap and have the 18/14 prescribed pressures. But I don't know much about the autos, and my doctor insists on the bipap. I struggle with the high pressures still, but it slowly seems to get better. Exhale doesn't seem to be the problem, but I do get confused about it, wondering what the problem is when I wake up at nite with the wind tunnel affect buzzing my mask. (nose mask) It's hard to figure out just what the problem is when I'm so sleepy when I wake up with the pressures affecting me. Thank goodness for the ramp. So I'm always interested in how it goes for someone with similar pressures. Good luck with things.

Linda

Linda,

I'll definitely let you know what the doctor says. How do you get a nasal mask to seal with the 18 pressure? I have tried 2 different ones and they just flop in the breeze. Hence the nasal pillows. Also do you find that your nose and mouth are very dry? I am running my heated humidifier at the highest level, 6, and still dry out. I guess it is all that wind.

LDuyer

I looked back and you posted earlier that you had obesity related hypoventilation. This is one of the alternate conditions that calls for bipap therapy. See link below:


viewtopic.php?t=1726

Fly Gy --- good detective work. Yes, I have that and yes the doctor said that's why I need the bipap. And I have oxygen added to the treatment and that has restored oxygen to normal levels. Did you have to bring up the "O" word?

But yes, that's what I was told. As to the pressure, the mask does seem to want to fly away when it reaches that high pressure. Tightening the straps seems to have helped some with that. I've not tried the nose pillows. The doc thought I would have more problems with dealing with the pressure with those....I don't know. He also thinks I would have problems with a full face mask due to the shape of my face, again I don't know. But he seems to be right on most things so far, even if his interpersonal skills suck. So I promised to give this a chance for awhile. He thinks it will get easier to deal with as time goes on. Hope he's right. He also says that often after a year or so, most of his patients ask to have the ramp adjusted upwards, after getting adjusted to the higher pressures. We'll see.

Thanks.

Linda

Linda, I can just about promise you ("just about" - not gonna go out on a 100% limb ) that the Breeze with nasal pillows would hold up great against a pressure of 18. I've experimentally tried my Breeze at 19 for a few minutes, just out of curiosity. There were no leaks at all, even when I tried some tossing and turning. The Breeze is not great for people who sleep on their back, but is great for side sleeping at any pressure.

It might be worth a try for you.

Caveat - the three hints to successfully getting along with the Breeze apply:

1. hang the main hose overhead so hose won't tug on headgear or snout.

2. put the Breeze's straps down low for more stability.

3. get nasal pillows that you or the person fitting you for them would say are "too large!" (they'll seal better and be more comfortable sitting outside your nostrils.)

Good luck!

Thanks Rested Gal,

This is nice to know, because I don't have much confidence in relying on the word of my doctor. Besides, anything is worth trying, right? What I dislike about my doctor is that he doesn't use any compassion or admit to there being alternatives. He could have said, "Well, I believe it won't work for these reasons........, but give those a try if you'd like to try something else out." Or something to that affect. ...... So, thanks. It may take me some time to set it up, but I will give it a try.

LDuyer wrote:Did you have to bring up the "O" word?

There are two types of hypoventilation which indicate use of a bipap.

- obesity related hypoventilation
- primary alveolar hypoventilation

You had indicated the yours was related to your obesity. That's the reason I brought up the "O" word.