Dreamstation Expert

Phillips Respironics has introduced a new member to its Dreamstation line into Canada recently. It is called the Dreamstation Expert APAP with P flex. The difference with this machine is what they are calling "P flex" which supposedly unlike the a and c flexes and the Res Med EPR adjusts flex in accordance with changes in pressure and it seems like it isn't just a fixed value. I have not found anything specific to relate this to as there isn't much to be found online on this machine although I see it is available at several Canadian online sites. From what I did see that does appear to be their claim although I could be wrong.The new machine is only available in Canada at the moment and I have no idea if this will be introduced elsewhere in the future. I find it hard to believe that some variation of this would not also be released in other countries if this P flex is the next best thing in therapy. Time will tell. Just posting this information for any Canadians who may be looking at new machines soon and as general information to the rest with regards to the new feature. Don't shoot the messenger.

Table 1 and Figure 1, in the following article about various forms of pressure relief, may be helpful for further understanding P-Flex: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773618/

Personally my preference is that expiratory relief always be a constant, not varying. Changing work of breathing all night has the potential to confuse the body/brain of some patients with central components to their OSA, in my opinion. When an auto senses the need for an increase in pressure, it is often the expiration pressure that needs most to respond.I believe that in the prescription for an autobilevel, for example, it is the delta, the difference between the two pressures, that actually matters most and that should be enforced as a constant in the algorithm and settings, unless there is a good reason for a more specific and directed modality of pressure delivery to address other concerns.

Hey, just me.

I don't happen to like expiratory relief, as I've been using CPAP from before such a thing was available. If find the change in pitch very annoying.

jnk... wrote: ↑

Wed Dec 25, 2019 9:33 am

Personally my preference is that expiratory relief always be a constant, not varying. Changing work of breathing all night has the potential to confuse the body/brain of some patients with central components to their OSA, in my opinion. When an auto senses the need for an increase in pressure, it is often the expiration pressure that needs most to respond.I believe that in the prescription for an autobilevel, for example, it is the delta, the difference between the two pressures, that actually matters most and that should be enforced as a constant in the algorithm and settings, unless there is a good reason for a more specific and directed modality of pressure delivery to address other concerns.

Hey, just me.

Agree totally.
CFlex is bad (it's ok at 1), AFlex is so weird I just can't understand how it passed any testing.
PFlex seems to be a pressure dependant version of AFlex, so I'm assuming the weirdness gets even weirder at higher pressures...

SleepyPaolo wrote: ↑

Fri Dec 27, 2019 6:15 pm

CFlex is bad (it's ok at 1), AFlex is so weird I just can't understand how it passed any testing.
PFlex seems to be a pressure dependant version of AFlex, so I'm assuming the weirdness gets even weirder at higher pressures...

Like many things (most?) different people react differently. Some don't even notice the small pressure changes that *flex gives (at most 2cm, while breathing heavy), ... of course, Pflex will increase that, up to 4cm, so that'll likely be more of a problem.

In *theory* the *flex way of raising the pressure in preparation for inhale makes sense... but in *practice*, it screws up a lot of people

Reportedly, the strange quirks in Respironics auto algorithm apparently 'makes sense' to someone... in theory.

palerider wrote: ↑

Fri Dec 27, 2019 6:54 pm

In *theory* the *flex way of raising the pressure in preparation for inhale makes sense... but in *practice*, it screws up a lot of people