Help on Pressure Relief on Exhale feature

Well it's almost time to buy a Apap and it has come down to one feature "Pressure Relief on Exhale" that got me stumped. The Sleep Center said my report was done and that 13 is the air level I need from my 2nd sleep test. I should meet with my GP doctor that will write my prescription for the Apap/Cpap. Also, I have read the yellow light info and it convicted me I want an Apap not Cpap.

I like the price of the DeVilbliss Auto but it is missing the "Pressure Relief on Exhale" feature. The Respironics M Series Auto CPAP with A-Flex has the Pressure Relief but at more than twice the price when you get the Heated Humidifier.

I would go for the Respironics M Series but since it is so big I would still have to buy another smaller unit like the DeVilbliss for travel.

But, in the back of my mind I think that this "Pressure Relief on Exhale" would just make my body weaker since I guess that it could give my body some exercise exhaling against the full 13 CM. I know I can turn this off on the Series M but if I don’t need that feature I can save a lot of money with the DeVilbliss Auto. Is Pressure Relief on Exhale a big deal if my air level is 13?


Thank everyone on this site. It's been a lot of help.

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CPAPopedia Keywords Contained In This Post (Click For Definition): auto cpap, respironics, humidifier, CPAP, Prescription, auto, APAP, Travel

You would most likely use that exhale relief, but that only helps you when you are AWAKE, not when you are asleep.

when your doctor says you need CPAP not autopap, tell them the auto can run in CPAP modes, if they make the extra cost excuse tell them you will have it for 5 years or more, over that period the extra cost excuse is not justified.

The autopap offers you many more options than CPAP with adjustable pressure where you can start off lower like when you are awake and it then increases towards the titration pressure as events increase.

For example, lets say you went with the DeVilbiss with NO exhale relief,

You could set a lower Minimum pressure of say 6.5 and it would go to that pressure when you turned on the machine, while you are awake trying to fall asleep the auto would stay at that 6.5 pressure, you really don't need exhale relief at that pressure.

Then once you fell asleep SDB events would start to show up, the auto would automatically increase from 6.5 to 7.0 or higher or in your case ramp up towards your 13cm pressure.

Now if your doctor claims you get better therapy the auto can be switched easily to run in CPAP mode as well.

The DeVilbiss has been getting pretty good reviews, the older models always offered very good therapy but they were noisy and the reports not very good, but I hear the reports for the new model are supposed to be pretty decent when they become available in a few months.

So you can get by without exhale relief quite easily. As you become accustomed to CPAP therapy you can increase the Minimum pressure up towards your titrated pressure and/or setup Ramp and use that.

Yes, I use the Aflex. I started out on straight cpap with a pressure of 17. For me, it was almost impossible to breathe out against that pressure. Even cflex did not help that much. My Dr. finally gave me a script for an auto w/aflex. A world of difference between the two machines and a world of difference between Aflex and Cflex.

Snoredog wrote:You would most likely use that exhale relief, but that only helps you when you are AWAKE, not when you are asleep.

Ok, now I am confused. Exhale Relief is not needed when I am asleep? So Exhale Relief is just a comfort feature to help me go to sleep like the Ramp up feature?

I went back and re-read the Yellow Light Info;

4. Exhalation relief (called A-flex and C-flex in Respironics machines and EPR in ResMed machines). Briefly reduces air pressure on exhalation, making it easier to exhale, a comfort factor making it easier to sleep. Comfort is not a frill; it leads to adapting to and continuing the therapy. Those who have a higher prescribed pressure or who need more exhalation relief may require a bilevel machine. Some, especially those with low pressures, don’t need or want any exhalation relief.

My sleep tech says my setting is 13 cm but I couldn't find a scale to tell me if 13 was Low, Medium or High air levels.

Snoredog and Jsmythe I do appreciate your answers. My normal GP doctor that isn't trained in sleep will just read a report to write my prescription for a machine. I am sure I can talk him into what I want.

The safe bet would be to get the M-Series and a DeVilbiss for travel but I think that is nuts if I don’t need the Exhale Relief. I would rather spend my money on both a Nasal & full face mask when I have sinus problems.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, C-FLEX, Ramp, Prescription, Travel

13 is probably on the higher end of the middle, if that makes any sense.

To get back to the original topic, the Resmed Autoset II (in the US) has exhale relief on both CPAP and APAP modes now. I have no idea of it's pricing though.

Colin

ColinP wrote: To get back to the original topic, the Resmed Autoset II (in the US) has exhale relief on both CPAP and APAP modes now. I have no idea of it's pricing though.

Colin

Colin

I had looked at S8 AutoSet II with Easy-Breathe but it was a lot more money. I just found the S8 AutoSet II with Easy-Breathe on one site that is in the same price range as the M Series Auto CPAP with A-Flex when you get the discount price.

It is still more than twice the price as the DeVilbiss IntelAuto but I guess since my 13 cm is almost at the high range, I should go with one that has an exhaust relief. The biggest problem I had with the M Series was it looked too big to travel. The S8 AutoSet II with HH looks to have moved to the top of my list. Thanks everyone.

Although most folks I've spoke to on this site struggle with mask issues, my biggest issue was this. Since my sleep Dr switched my machine to one
with this setting, things have improved greatly in my therapy. I went from 2-4 hours sleep a night with straight CPAP, to nearly 6-7 hrs without interruption. As with all other posters though, I can only speak for myself.
Good luck.

You did not mention you have use CPAP before. Have you use CPAP at the pressure 13 ? If is possible, loan a CPAP, test it out for a week or so, you will know if you need exhale relief.

For me, I need exhale relief either CFlex or AFlex mode. My APAP pressure is set to 14. I find that M Series Auto AFlex is very good. The APAP can be set to turn on/off exhale relief or just straight CPAP. In the past, I bring along my APAP (without humidifier) for traveling, I just put APAP with Swift II mask in my small backpack. It is not that big as you think.

Since I am paying for my APAP and masks, I am concern about price too. I find Resmed is good but tend to be *expensive*. I do know not what will be price for S8 AutoSet II, I believe it will not be any cheaper than the current s8. I tried to avoid Resmed products because of the price plus "Resmed internet policy". But unfortunately Swift II works for me, so no escape from Resmed.

GreenIce

I have never used any machine except for my 2nd Sleep test last Sunday. My Doctor (General Practitioner) sent me as a referral for a sleep test. After the 1st test the sleep center called me back for my 2nd test to use the Cpap. I called the sleep center wanting to talk to the Doctor that evaluated my sleep test but I don't get to talk to him. They told me my GP will write the prescription based on the sleep report.

The sleep center hinted someone will call me to come back after my GP faxes the Cpap prescription back to them. I don't know what a DME is only that many people on this board don’t like there DME's. So I think the sleep center wants me to meet with a DME when I come back. My personal job is a corporate computer system salesman. Salesmen hate getting ripped off by other salesmen. I smell high mark up and some DME salesman pushing their best profit deal at me.

I am going to short circuit this whole dog and pony show and go see my GP and make him write me an Apap prescription and buy one I like on-line. I maybe leaving my job soon so I want to get this apap as fast as I can while I still have insurance.

Shilohcane wrote:

Snoredog wrote:You would most likely use that exhale relief, but that only helps you when you are AWAKE, not when you are asleep.

Ok, now I am confused. Exhale Relief is not needed when I am asleep? So Exhale Relief is just a comfort feature to help me go to sleep like the Ramp up feature?

I went back and re-read the Yellow Light Info;

4. Exhalation relief (called A-flex and C-flex in Respironics machines and EPR in ResMed machines). Briefly reduces air pressure on exhalation, making it easier to exhale, a comfort factor making it easier to sleep. Comfort is not a frill; it leads to adapting to and continuing the therapy. Those who have a higher prescribed pressure or who need more exhalation relief may require a bilevel machine. Some, especially those with low pressures, don’t need or want any exhalation relief.

My sleep tech says my setting is 13 cm but I couldn't find a scale to tell me if 13 was Low, Medium or High air levels.

Snoredog and Jsmythe I do appreciate your answers. My normal GP doctor that isn't trained in sleep will just read a report to write my prescription for a machine. I am sure I can talk him into what I want.

The safe bet would be to get the M-Series and a DeVilbiss for travel but I think that is nuts if I don’t need the Exhale Relief. I would rather spend my money on both a Nasal & full face mask when I have sinus problems.

Keep in mind information contained under that yellow light bulb entitled collective wisdom is the contributing authors interpretation of it, the content it contains is what the author choose to put in that section not really what the collective minds here came up with.

But there is NO clinical study I know of to show where it is medically necessary. Those comfort features "may" help you maintain compliance which is good or if you were going to give up on therapy due to exhale pressure intolerance they would supply you a machine with it.

If you read your medical policy for example, it may say that you must "fail" with CPAP therapy before they will pay for a Bipap machine. That is what the first 30-90 days "trial" period is for, to determine if you can tolerate CPAP therapy.

Insurance will always go the cheapest route possible with therapy, machines without those features cost less.

If your doctor puts down "AFLEX" on the prescription then it doesn't leave much of a gray area as there is only one machine (an autopap) that has Aflex. Specifying that on the script doesn't leave the DME much room other than hoping you don't know the difference. Some may even say well Cflex is just as good, they would be misleading you if they did.

But again, those features only help you with your are falling asleep they do nothing after you have gotten there. Yes Ramp is for that very purpose on CPAP machines and not many use it but it has been there since day one. Ramp works by delivering a lower pressure that gradually ramps up to your titrated pressure. If you wake up during the night, you hit the Ramp button again and it drops pressure so you can get back to sleep. You can hit that button as often as you like.

If you are using say an autopap and the events seen ran the pressure up to your 13cm, if you woke up it may be blowing at that pressure, hitting the Ramp button would bring that pressure back down to the Minimum set then as events were seen it would climb back up, but hopefully you are asleep again and don't notice it doing that.

Snoredog did a good job of summarizing. I like the Ramp feature, my RT (respiratory technologist) turned that feature on for me...for some reason it was not initially turned on. But anyways, it does help when you wake in the middle of the night hit that button and you'd be surprised how much the pressure drops and you tend to fall asleep immediately. I too was not getting more than 2 hours of sleep until the ramp was turned on (I also started using aromatherapy with my machine from sleepguy.)

Also I have a RemStar unit that is Respironics older unit and it is bigger than the M series. I travel for work and pleasure and I have found it not difficult. Stowes nicely under the chair in front of me on planes.