I have a REMstar Pro M Series.  After the C-flex initiates, (in 5-10 minutes) there is a significant exhaled - and inhaled - drop in pressure.   (The exhaled pressure is supposed to drop, but not the inhaled pressure.)

My Lincare provider says an inhaled pressure drop is not possible.  When I remove the mask, even for a few seconds, the correct pressure starts again, and their measuring device then shows the correct pressure.

CPAP is not helping because I remove the mask at 2-3 times a night, I’m guessing because of the lack of pressure during a sleep apnea.

Do I have a defective machine?  Is it something to do with the C-flex programming or sensors?



Last edited by MontyS on Fri Jul 11, 2008 11:50 am; edited 2 times in total

That is what C-Flex is supposed to do - drop the pressure for exhale. Evidently your device is slower to respond and reach inhalation pressure than what you need. Maybe you do not need your C-Flex set so low. Maybe you don't need C-Flex at all and maybe there is another brand of CPAP that responds faster to the end of exhalation and the start of inhalation.

And, maybe, your Ramp is set for too long or you don't need Ramp at all. One would think that a GOOD local DME RT would discuss these possibilities w/you and have some worthwhile suggestions, including, if necessary, consulting w/your sleep doctor.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

Hi, I'm a brand newbie here, newbie to sleep apnea, but noticed this thread, I have the same machine, and the same issues!

A few months ago I got the machine, and the 1st night using C-flex, my wife, & I didn't sleep much, by the 2nd night we were old pro's already. After about a week, I began to notice it seemed like the air pressure dropped, and the C-flex was not working during the night, and when I woke up in the morning. After a few more nights of the same thing, I called a good friend who is lives quite distant. He has 2 of these same machines, 1 for him, & 1 for his wife, after a long discussion, we agreed my machine was at fault. I then called up a Resperonics tech, and he agreed the machine was at fault also. Now after haggling with the medical supply company I got another brand new machine. That night when I tried the 2nd machine I noticed it seemed weaker then the 1st machine??? I gave it up, and decided to go with the flow.   
Well, I went to sleep, and all seemed well (although as I said the machine seemed weaker) next thing I knew, I semi-woke up in the middle of the night SUFFOCATING! I pulled the mask off, and the air started blowing from it strongly? but not when I put it back on? so I decided maybe it was me, and went back to sleep, a little while later I was suffocating again! and did the same thing with the mask, then went back to sleep,,, finally it happened again for the 3rd time! By this time I was quite angry, and took off the mask, & threw it onto the night table, vowing never to use that D**n  machine again!

In between all this I happened to have an oxygen setup in the house, so I would just put on the oxygen tube at night, and get some refreshing peaceful sleep, until this problem was sorted out, I never suffocated with that!  

To wrap this all up, after much confusion about what to do, much angst, and a few weeks of procrastination I decided to call my Dr. who actually put in a Presc. for a new machine. Hooray! I just got my 3rd machine, and it seems like the best of the bunch! But, after using it, it still appears to have the same issues that the 1st machine did, at least I'm not suffocating with this one, but it still seems to be losing pressure, & the C-flex function???  HELP!

MikDee, I doubt very much that you have had the misfortune to encounter 3 brand new devices in a row that begin to lose pressure after a short while.

C-Flex is a form of expiration pressure relief on exhalation. Unlike the Resmeds, the Respironics don't tell us how much relief. W/the Resmeds each EPR setting is 1 cms so w/EPR set at 3 you get 3 cms of pressure relief when you exhale. Meaning if your set pressure is 10 cms, the pressure will drop to 7 cms on exhalation and then build back up to 10 cms on inhalation. The Respironics' C-Flex works the same way except I'm not sure that a C-Flex setting of 3 actually gives a full 3 cms of pressure relief or not. It may be that you just need to set your C-Flex higher or lower.

Also, these devices have a Ramp function wherein it starts out at a lower pressure (which can be adjusted to a specific starting pressure) and over time it builds up to your set pressure. Ramp is usually set for the length of time it usually takes you to get to sleep. Again, I'm not sure about the pressure stages w/the Respironics, but w/the Resmeds it builds up pressure in .2 cms increments. So w/a Resmed w/Ramp starting at 4 cms and timed for 30 minutes, it would increase pressure by .2 cms until it reached 10 cms w/in that 30 minutes. It may be that you need your starting Ramp pressure raised or your Ramp time shortened or lengthened).

And, most of us start out aware of the pressure and pressure changes between inhalation and exhalation when we first lay down to sleep and then as we relax and fall asleep we become so accustomed to the pressure and pressure changes that when we wake up for any reason we aren't sure there IS any pressure. Pulling our mask from our face or opening our mouth to breathe proves otherwise in a hurry!! This latter sensation would be my guess as the most likely scenario.

Yet one other thing might be considered. Since you need oxygen during the day, it may well be that you will need 02 supplementation w/your CPAP as well.

Do you by any chance have COPD or emphysema? I have COPD. I was started on straight CPAP at 7 cms. It wasn't quite cutting the mustard so I was provided w/a loaner autoPAP for 3 weeks for an in-home titration which resulted in an increase to 8 cms. It still wasn't quite cutting the mustard so 2L of 02 was added w/the CPAP at 8 cms. That provided the most relief but after 17 months of CPAP therapy my sleep and rest still weren't that great. I was brought back in to the lab for an in-lab bi-level titration and then started in bi-level therapy and THAT was finally gotten me the best sleep and rest since my sleep problems began.

Other than the fact that you evidently have a Respironics device (because of the mention of C-Flex) you don't say just exactly which Respironics model you have. Is it a fully data capable Respironics which gives data that could be indicating just what your problem(s) might be? For instance how high a Leak rate do you have? Are they mask leaks due to an ill-fitting, uncomfortable mask? Or are they mouth leaks due to your attempting to breath thru your mouth? THIS would wake you up in all likelihood! Or are they small leaks of air slipping gently thru your lips whilst sleeping that do NOT wake you up. Whatever the reason, a high leak rate equates to your CPAP therapy leaking into the night and NOT opening and keeping your airway open as it is intended.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

CrohnieToo wrote:

MikDee, I doubt very much that you have had the misfortune to encounter 3 brand new devices in a row that begin to lose pressure after a short while.

C-Flex is a form of expiration pressure relief on exhalation. Unlike the Resmeds, the Respironics don't tell us how much relief. W/the Resmeds each EPR setting is 1 cms so w/EPR set at 3 you get 3 cms of pressure relief when you exhale. Meaning if your set pressure is 10 cms, the pressure will drop to 7 cms on exhalation and then build back up to 10 cms on inhalation. The Respironics' C-Flex works the same way except I'm not sure that a C-Flex setting of 3 actually gives a full 3 cms of pressure relief or not. It may be that you just need to set your C-Flex higher or lower.

It's not the relief pressure I have a problem with, it is the inhalation pressure, it seems to drop in a short time.

Quote:

Also, these devices have a Ramp function wherein it starts out at a lower pressure (which can be adjusted to a specific starting pressure) and over time it builds up to your set pressure. Ramp is usually set for the length of time it usually takes you to get to sleep. Again, I'm not sure about the pressure stages w/the Respironics, but w/the Resmeds it builds up pressure in .2 cms increments. So w/a Resmed w/Ramp starting at 4 cms and timed for 30 minutes, it would increase pressure by .2 cms until it reached 10 cms w/in that 30 minutes. It may be that you need your starting Ramp pressure raised or your Ramp time shortened or lengthened).

I don't bother with the ramp! Nor the button, no humidifier (it's too warm for me right now), and set at #2 on the C-Flex this works for me, then I just put on the mask (a nice Resmed Ultra mirage 11 nose mask), breathe into the machine and it autostarts.

Quote:

And, most of us start out aware of the pressure and pressure changes between inhalation and exhalation when we first lay down to sleep and then as we relax and fall asleep we become so accustomed to the pressure and pressure changes that when we wake up for any reason we aren't sure there IS any pressure. Pulling our mask from our face or opening our mouth to breathe proves otherwise in a hurry!! This latter sensation would be my guess as the most likely scenario.

I sat here yesterday with the rep when he brought the new unit (#3), just to show him, I turned the old unit (#2) on in front of him, and within 10mins the pressure dropped on the unit?! This was a repeat of exactly what I did, 1/2hr before he arrived, so it was consistant. Anyway, anytime I ever looked at the display it always said 10CFM? So, my next question is, what is considered 10CFM when I first turn it on, or 10mins later when it drops, or an hour, or more later, if it drops even more?   

[quote]Yet one other thing might be considered. Since you need oxygen during the day, it may well be that you will need 02 supplementation w/your CPAP as well.

Quote:

Do you by any chance have COPD or emphysema? I have COPD. I was started on straight CPAP at 7 cms. It wasn't quite cutting the mustard so I was provided w/a loaner autoPAP for 3 weeks for an in-home titration which resulted in an increase to 8 cms. It still wasn't quite cutting the mustard so 2L of 02 was added w/the CPAP at 8 cms. That provided the most relief but after 17 months of CPAP therapy my sleep and rest still weren't that great. I was brought back in to the lab for an in-lab bi-level titration and then started in bi-level therapy and THAT was finally gotten me the best sleep and rest since my sleep problems began.

No, I'm not on oxygen I don't need it now, a few months ago I had some medical issues, and my blood O2 was running low, but not any more,,, I still have the oxygen equipment here, so to help me at night to possibly prevent sleep apnea, (when I didn't trust the Remstar), I just decided to use the oxygen. I don't know what "bi-level titration" is?  

Quote:

Other than the fact that you evidently have a Respironics device (because of the mention of C-Flex) you don't say just exactly which Respironics model you have. Is it a fully data capable Respironics which gives data that could be indicating just what your problem(s) might be? For instance how high a Leak rate do you have? Are they mask leaks due to an ill-fitting, uncomfortable mask? Or are they mouth leaks due to your attempting to breath thru your mouth? THIS would wake you up in all likelihood! Or are they small leaks of air slipping gently thru your lips whilst sleeping that do NOT wake you up. Whatever the reason, a high leak rate equates to your CPAP therapy leaking into the night and NOT opening and keeping your airway open as it is intended.

I said the same machine as MontyS? Just to clarify, it is a Remstar Plus M-series with C-Flex (enabled) Yes data enabled,  I don't know what a leak rate is? but the nose mask fits fine, (if my mouth opens, I know it!) and I haven't noticed any leaks? just the relief valve in the mask, but I don't know anything about that?

Ok, on a point, I decided to try the old machine (#2) one more time, this time with oxygen set on #3, Sunday night (weeks after my last suffocating episode) just before the rep arrived with the new unit. I was able to sleep through the night with the O2 on, but pressure was almost non existant!
 
Finally, in summation, my second night with the new machine the pressure seemed a bit better, But I woke up a few times, not suffocating, But, Out of breath! So, at 3:30am after much annoyance, I ripped off the mask, & tossed it onto the nightstand, and went back to sleep.

The Joke is, These Units seem like they have a built in ramp feature, but it's a down ramp once they're on awhile!   

Ok, an update, I was able to get info on how to set up my unit, thank goodness, and I raised the pressure from 10CFM, to 11 CFM, and tried it again last night. Well, it was the first good night sleep I had since the very beginning! I'm only guessing here, but I think these type machines start off blowing strong, then settle down after a little while, because when I woke up this morning it hardly felt like it was working, But I had no suffocating, or running out of breath issues during the night.

Another update, All was well when I went to sleep, I woke up semi-conscious during the night, and my mask was leaking air, and was a bit wet? anyway, I just tightened the lower straps in my stupor, and drifted off again, although feeling I had a restless night, till the morning, I awoke to the same thing? it seemed like stronger pressure then when I went to sleep? I found it was actually blowing the mask off my face, that's why the mask was leaking I shut off the Unit, and noticed the humidifier was almost out of water? So, I figured this was the problem. I don't use the humidifier, in fact I have it shut off, so I don't know how, or why, this should affect anything, so I emptied the little remaining water, & cleaned it up good, left it empty, and put it back in. The Unit seemed to work normally again.

The next night, It started off fine again, and it appeared that all thru the night the pressure was dropping down, then returning to normal, then dropping down again by the time I awoke in the morning? I immediately took the hose off the mask, and the pressure from the hose seemed weaker then it should be? I shut off the Unit for a few minutes, then turned it back on, and noticed an increase in pressure?  

Last night, The exact same results, as the night before? I Just Don't Get It!    Does anybody know, do these Units have a tendency to lose pressure once they get warmed up? Or am I crazy?

Well, for one thing that Respironics M Series Plus w/C-Flex is NOT capable of providing anything more than compliance data. Just becuse it has a data card doesn't mean it is fully data capable. Plus's are NOT. So you and your DME are working "in the blind". There is absolutely no capability of that machine to provide ANY information that would be beneficial to your therapy problems.

For another, if you are not using the humidifier it should be dismantled from your CPAP and stored in the carrying case.

Your DME certainly seems willing to work w/you since this is CPAP # 3. But someone should wise up and provide you with a fully data capable CPAP. Either a step up to the Respironics M Series Pro w/C-Flex or even switched to a Resmed S8 II Elite w/EPR.

Do you have any idea of how many hours of use YOU have put on this latest CPAP you've been provided with? Since it is a Respironics, unplug it, then plug it back in. How many hours show up on the LCD screen? Do the number of hours seem to jive w/the number of hours you have used it? Or are there a lot more hours appearing than you could possibly have put on it? Those hours that appear are the TOTAL number of hours that unit has been used SINCE IT LEFT THE FACTORY.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

CrohnieToo wrote:

Well, for one thing that Respironics M Series Plus w/C-Flex is NOT capable of providing anything more than compliance data. Just becuse it has a data card doesn't mean it is fully data capable. Plus's are NOT. So you and your DME are working "in the blind". There is absolutely no capability of that machine to provide ANY information that would be beneficial to your therapy problems.

Thanks, being a newbie, I don't know what this means, but it does have a datacard?

Quote:

For another, if you are not using the humidifier it should be dismantled from your CPAP and stored in the carrying case.

Thanks again, I had thought about this, but I'll do it now, but, I'm pretty sure I'll be using the humidifier in the winter

Quote:

Your DME certainly seems willing to work w/you since this is CPAP # 3. But someone should wise up and provide you with a fully data capable CPAP. Either a step up to the Respironics M Series Pro w/C-Flex or even switched to a Resmed S8 II Elite w/EPR.

Yes, he is, but he's 60+miles away from where I live    There's no Apria medical supply nearer, and my Dr. is 30miles in the opposite direction, this makes things very difficult. I didn't know there was such a thing as an M series PRO? I'll have to read up on the 2 machines you mentioned.

Quote:

Do you have any idea of how many hours of use YOU have put on this latest CPAP you've been provided with? Since it is a Respironics, unplug it, then plug it back in. How many hours show up on the LCD screen? Do the number of hours seem to jive w/the number of hours you have used it? Or are there a lot more hours appearing than you could possibly have put on it? Those hours that appear are the TOTAL number of hours that unit has been used SINCE IT LEFT THE FACTORY.

Usage data - 4days 37.6hrs, Yes it's about right.

Then I'm out of ideas except that you INSIST that you be switched to a Respironics M Series Pro w/C-Flex. Its YOUR health and YOUR therapy.

Insurances do not contract w/local DME suppliers by brand and model but rather by HCPCS code. The HCPCS code for the Plus and the Pro is the same. Insurances contract w/the local DME suppliers for one set reimbursement fee for this HCPCS code (E0601). The Pro costs a little more than the Plus and the local DME just has to swallow the small cut in their profit margin. Be DIPLOMATIC, be TACTFUL, but be FIRM. You want the Pro instead of the Plus. The DME can then do a download after a week and you should be given a copy of that data download printout as well. The printout will tell you what is going on w/the pressure, or reveal a high leak rate, what your AHI is for the night, etc., etc.

Eventually you could even buy your own Respironics EncoreView software and cable reader and do your own downloads of data. Meanwhile, the Pro does provide some data on the LCD screen if access is turned on. (Insurances do NOT pay for the software and cable reader, you would have to buy them out of pocket).


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

CrohnieToo, Thanks for the info, although I don't quite understand all the terms yet. A few days ago, I decided to shut off the C-flex feature, and try straight CPAP, it seems to be working for me. At least finally I'm actually getting to use the unit every night, and get used to it. I still notice a drop in pressure a bit once the unit is on awhile, but it then stays steady, and I know what I'm dealing with. I'm now just trying to dial in a pressure I'm comfortable with, between 10 and 11 CFM, I think 10.5 will work for me, I'll find out tonight.

I could be wrong, but I think I know what may have been the problem previously, with C-flex on. I have a theory that  because I have bouts of very shallow breathing during the night, the unit would drop down to a low rate to compensate, then when I needed more pressure, it wasn't there immediately, causing me to run out of breathe, or suffocate temporarily.  

I don't know if anyone else has had a problem like this? or, can relate to this? But, anyway it's still (or, I'm still) a work in progress  

For me, I use the ramp at a setting of 8 because the full pressure at 13 is a bit much when I'm moving around and getting into bed.  I find after about 5 minutes of motionless relaxation my breathing gets much shallower and then have no problem with the higher pressure.  Perhaps that is what you're experiencing.


_________________
REMStar Pro M w/ c-flex and heated humidifier
ResMed Swift LT nasal pillow
Encore View Software
12 cm H20, 13 cm H20
CPAP start date: June 4, 2008

I have a Respironics M series BPAP and a lot of what I read in this thread is about the same as what I've been experiencing.