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Sierra

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

Using the ramp can improve going to sleep comfort if you are finding the minimum treatment pressure uncomfortable. If you need to go higher than 9 cm it may become more valuable to you. If you are going to use it I would suggest a ramp start pressure of about 6-7 cm, whatever feels comfortable to you. I like a pressure that feels like I am wearing no mask at all that is restricting my flow. If you don't set the ramp start pressure the machine will likely default to 4 cm, which I find much too low for comfort. As for time 15-20 minutes works for most. Ideally you want it to be at the minimum pressure by the time you go to sleep. Using the ramp will not affect the treatment effectiveness, and you should see the ramp effect in SleepyHead.

The Bi-Flex is a little more complicated, and I was leaving that aside until you got your basic pressures zoned in. On the ResMed machines it is a little simpler and it does affect your treatment effectiveness and the basic pressures you need. It works essentially like pressure support but in the opposite direction. It reduces pressure on exhale to make it easier to breathe out. A setting of 1, 2, or 3 is simply the number of cm it reduces pressure. ResMed call it EPR or Expiratory Pressure Relief. The problem with EPR is that it can increase apnea events due to the reduced pressure during EPAP. If the machine is in automatic mode, then it in turn causes pressure to go up, so you go full circle. For that reason using EPR on a ResMed is not a great idea unless you only use it during the ramp, which is what I do.

Bi-Flex is as I say more complicated. To my knowledge there is no way to set it so it is used during the ramp only, so you have it full time or not at all. The 1,2,3 setting is not really cm of pressure reduction like the EPR, but more like, a little effect, medium effect, and more effect. That is because Respironics do not reduce the pressure for the full exhale cycle. They mainly smooth the transition from Inhale to Exhale and vice versa. I have not seen it documented, but it is my personal theory that Flex does not impact treatment to the same degree as EPR does. However, some do think it has an impact on effectiveness. Here is a link to what looks like a quite old (2009?) document on their Flex technology.

Respironics Flex Technology

This document shows how it affects the shape of the inhale exhale pressure. To my eye the affect is very minor, but Respironics have done studies which are claimed to show that users like how it feels to them.

So what does that mean for you? Again I think it is worthwhile to stay the course with optimizing the basic min max pressure settings first. When that seems to be working and you have a good baseline on what you can achieve for AHI it would not hurt to try the Bi-Flex at the various settings to see what it does to improve comfort for you. If it does nothing for comfort then just leave it turned off. If you feel it has improved comfort then leave it at the most comfortable setting and try it for a while to see if it has any negative impact on AHI. The objective is not only to get a low AHI but also equally important to get a long uninterrupted sleep. If the Flex can help get your there with no impact or very minimal impact on AHI I see no reason not to use it.