Adjusting AFLEX to CFLEX or change numbers first?

Hi, I made a post yesterday about my sleep doctor changing my settings from AFLEX to CFLEX on my System 60 CPAP machine. It didn't go so well the first two nights and I told my doctor but they said (of course) "give it time" ok well yes I know, i know. That being said, I knew I felt definitely worse on CFLEX. She switched me from AFLEX 3 to CFLEX 2. Last night, I went back to AFLEX setting 2, but didn't sleep all that better (but feeling maybe a touch better than yesterday).

Anyway, I guess the question is -- let's go back to me starting at AFLEX 3...which I was at for 6 weeks, and my lowest AHI during that time was 2.5, at a pressure of around 14. Now I'm at a pressure of 15-20 and can't get AHI below 4 no matter what I do. Doctor is convinced by my graphs that I'm acclimiated to the pressure and I think I am too, so I can't imagine a higher pressure would be the CAUSE of the increase. Do some people need to gradually increase their pressure as they get "used" to CPAP, e.g. the body adapts and you have to push the pressure higher?

So the question is, if i'm at AFLEX of 3 and pressure of 14.5 pre-appointment, what would the best course of action be...i previous poster said don't do two things at once, which is what my doctor did, increase to 15.0 and change AFLEX to CFLEX 2. Let's say I keep it at 15...what then is the right "algorithm" for ranging the other settings? Is it best to go down on AFLEX from 3, to 2, to 1, and see if that improves AHI? Am I correct in assuming that AFLEX 1 would present more consistent/higher pressure than AFLEX of 3? What would be the downsides of an AFLEX of 1, assuming that I don't find the exhalation tedious or painful...could the added effort be CAUSING apnea or making me wake up?

I guess the point is, should I range through the AFLEX settings first, going from 3, to 2, to 1, or should I go horizontally, and go from AFLEX 3 to CFLEX 3...what would be the difference in the two? Can someone compare the AFLEX of 3 to CFLEX of 3? I looked at the graphs and explanation on respironics and felt it myself while breathing, but in practice, what is the typical response of someone going from AFLEX 3 to CFLEX 3? If I didn't do well on CFLEX 2, it doesn't seem like that means I should give up on CFLEX altogether right? But would it be better to try AFLEX3 -> CFLEX 3 than trying say AFLEX 3 -> AFLEX 1 if the goal is to increase the consistency of pressure to support airway.

I know this post is rambling but i'm pretty confused and I know i've been lectured about making changes too frequently but I know how I felt those two days on CFLEX at 2 and it felt just like I did pre CPAP machine which sucked...i was nonfunctional.

Thanks
Alex

satsumass wrote:Am I correct in assuming that AFLEX 1 would present more consistent/higher pressure than AFLEX of 3?

Flex based exhale relief is based upon your own breathing or air flow. It is not the same type of reduction in pressure that ResMed machines offer with their EPR and a set per cm reduction in pressure during exhale with a setting of 3 being a 3 cm reduction. The reduction that Flex offers isn't nearly so dramatic and you won't really even see it on a report. Resmed's EPR reduction is pronounced and can't be missed.

Flex bases the amount of reduction that is given on your own breath. A person who is a rather shallow breather can have less reduction at the same Flex setting than a person with a much more forceful respiration. Robysue explains it a lot better than me and hopefully she will stop by. It is hard for me to put into adequate words.

Did you read the stuff at the link I gave you about Flex in your other thread? I will be honest...it is a crappy explanation but it wasn't meant for us anyway. http://aflex.respironics.com/ link is for AFlex but the other Flex links are in upper right.

I used to use APAP with setting of Aflex 2. Pretty much mimicked my own natural breathing. Decided to do an experiment..and it was a total disaster. Take a look. I think that the actual change was the problem. My body was used to AFLex and when it didn't have what it was used to it missed its friend and I slept horribly. I am sure I could probably have gotten used to turned having it turned off with time.
I guess what I am trying to say it may not be so much the actual setting that is important. The fact that something changed period may have messed with your body. It was used to so and so and when it wasn't there you don't sleep so good.
viewtopic.php?f=1&t=67883&p=631376&hili ... mb#p631376

If it were me and I was in your shoes and the doctor increased my pressure to 15 I would have kept AFlex exactly the same because that was what my body was used to. It is a breathing rhythm thing and when we mess with rhythms then everything else gets messed up. Give the body some time to see what the change to 15 does...and then evaluate what to do with AFlex and if I had been using AFlex of 3....I would maybe try AFlex at 2 to see if it was comfortable.
I would also just do the demo of CFlex at its various settings. If one of them felt better to me then I would try that setting.
It isn't so much about the potential reduction with whatever setting...it is more about your own breathing and what feels comfortable to you. The reduction isn't all that huge but the timing is different.
CFlex doesn't hold the airway open any better or worse than AFlex. I don't know where your doctor got that idea.