Need some help

[palerider]

That's odd. The model 460 only has limited APAP mode available...it's obvious you should have or would have exceeded the 30 days that it comes with initially and even any reset abilities.

Go into the clinical set up menu to confirm mode and settings.
Something weird is going on.
Further more it looks like in the past you tried a higher minimum.

I thought that the atrial did a re-evaluation after some number of hours.

[Pugsy]

I thought that the atrial did a re-evaluation after some number of hours.

Depends on the mode of operation...I am pretty sure APAP mode for 30 days is plain APAP mode just like normal. I think there is another mode for the 30 hour re evaluation thing. I think it evaluates the data and not necessarily kick over to APAP mode.
I need to get that manual and see what it says....I don't have that one I don't think.
More later once I study up on how it works but I am pretty sure there is another mode of operation involved...or it's a feature of cpap mode.
I gotta go find that manual first.

[lzicc]

Here is the 15th details tab. The statistics looks the same as the first one I posted.

BTW, the mode is C-Check and it is set to 10. I have been making the changes myself the past year or so. There was a modem on the unit for the first month or 2 when I got the system, but they took it off after that.

[Pugsy]

Here is the 15th details tab. The statistics looks the same as the first one I posted.

Actually the first one didn't show me the detailed statistics and the main thing I wanted to see was what mode SleepyHead said you were using...
and despite SleepyHead saying APAP mode...it isn't.
Thank you. It's a SleepyHead bug...thinking it is APAP mode and it isn't...
We could use Encore to verify but I don't see the need to do the extra work unless you want to.

I have requested the manual for the 460 from the apnea board so that I can verify what I think the menu options are and be better able to help you.

[lzicc]

I was doing some reading on about the unit on the internet and found this. if you look at the end of the first paragraph, it states that the REMstar PRO is not an Auto-CPAP, so it sounds like you are correct.


Auto-Trial Mode (Close) delivers breath-by-breath Auto-CPAP therapy for up to a total of 30-days. At the end of the Auto-Trial period, the device will automatically transition into the CPAP-Check mode at the pressure the patient was at or below 90% of the trial period time. (Note that Auto-Trial mode is for temporary use only and must be used for a minimum of 3 nights to be effective. The REMstar PRO is NOT an Auto-CPAP Machine.)
CPAP-Check Mode (Close) checks on the user every 30-hours to determine if therapy pressure is optimal. If not, it automatically adjusts the nightly fixed CPAP pressure by 1 cm H2O (with maximum upper and lower limits of 3 cm) to obtain an ideal pressure.
Straight CPAP Mode (Close) is for use when therapy with no changes or checks is preferred. In straight CPAP mode the REMstar PRO will not make pressure checks or adjust therapy levels although normal therapy data will still be tracked.

[Pugsy]

Auto Trial mode is limited to 30 days but during those 30 days the machine will indeed function just like a full time APAP machine.
One those 30 days are up it does the 30 hour check thing unless you are in cpap mode.

Did you verify exactly which mode you are in? You need to go into the clinical setup menu to verify...because SleepyHead is thinking APAP full time but I suspect you are in the CPAP Check mode instead and it may have SleepyHead confused.

I think we can get you another 30 days if the prior 30 days has been used up...just rest the therapy data to zero. I believe that this reset trick can be done a total of 5 times before it becomes unavailable....at least that is the way it used to be when this model was released.

[lzicc]

The mode says C-Check.

Did you verify exactly which mode you are in? You need to go into the clinical setup menu to verify...because SleepyHead is thinking APAP full time but I suspect you are in the CPAP Check mode instead and it may have SleepyHead confused.

[archangle]

Auto Trial mode is limited to 30 days but during those 30 days the machine will indeed function just like a full time APAP machine.

I think: Auto-trial is a period of "normal APAP." Auto Check happens after auto-trial and does limited day by day adjustment of the manual CPAP pressure after auto-trial ends. Optistart adjusts the start pressure day by day, but I think that's only on the auto machines.

What version of SH is lzicc running?

[Pugsy]

What version of SH is lzicc running?

I don't know.

[archangle]

The RERA and snoring would suggest to me to try a higher pressure and see if the numbers on that improve.

lzicc, you might want to post your overview window from SleepyHead.

[Pugsy]

Here's the deal (at least how I think CPAP check mode might work)...if it is going just by AHI when it does its every 30 hour check thing and make adjustments accordingly the AHI itself is fine and on the surface of things it doesn't take into account the clustering of events that are seen and in terms of snores I have zero idea if it even factors them in.

This is one of those situations where on the overall surface numbers look okay (that Feb 15 AHI of less than 2) but it's a bit misleading because there are times during the night with minimal to none activity and then short periods of time where things go to hell and the good times are thus allowing an overall low average AHI to be seen.

So while we look at it manually and think a little more pressure is needed to break up the cluster...the machine in CPAP Check mode may not agree. I would take it out of CPAP Check mode if it were me and either do an APAP trial or just use cpap mode by itself (CPAP check isn't working in plain cpap mode) with a little more pressure in cpap mode...maybe 0.5 to 1.0 cm in cpap mode. I think that would probably break up the clusters and the snores.

[lzicc]

I'm not home now, but I believe I had the pressure set to 10 right now. You think I should change to CPAP mode and bump the pressure up to 11 and give that a shot?

Here is a screenshot of the overview window. There are allot of graphs so I uploaded them all. I can remove them if not needed so as not to clutter the thread.

[Pugsy]

Yes, if it were me and I wanted to continue with cpap mode I would take it out of CPAP Check mode and go to regular cpap mode and change the pressure to either 10.5 or 11.0 to see if the added pressure would break up the clusters.
Going to regular cpap mode would prevent the CPAP Check thing from overriding your pressure choice.
I don't think you will need a lot of pressure to break up the clusters you are seeing.
Now are these clusters part of your problem in terms of how you feel or sleep? We don't know but it's worth breaking them up to see if it helps...and I don't see it hurting unless you develop some sort of problem (aerophagia or centrals) with the increase and that is a very remote risk.

Now if you wanted to try APAP mode we might have to do a little bit of fiddling with things to get you some more APAP days if you have used yours up.
Though it probably isn't a critical issue unless for some reason those clusters are REALLY stubborn and end up needing a lot more pressure to break them up.

[lzicc]

I will do that tonight. Now once I sleep one night in this mode, I can post the new data for you to look at. I know when I put the mask on now, it is very easy to breath for me. When I put it in CPAP mode, will this change? Will the air be more forceful?

[Pugsy]

When I put it in CPAP mode, will this change? Will the air be more forceful?

Not really. You have been using cpap function already at 10 cm...changing it to cpap mode from CPAP check mode doesn't really change the way the air is delivered.
Make the change to CPAP mode from CPAP Check mode and leave it at 10 cm and try it...there isn't any difference.
Now a slight increase in pressure might feel a little different but you would have that in either mode.
You've been using a single pressure which is what cpap mode is. The only difference with CPAP Check mode is that the machine re evaluates things every 30 hours to see if it needs to change that single fixed pressure and give that to you.
It doesn't auto adjust while you are using it during the night...it adjusts only after evaluating the last 30 hours of data and makes that change prior to when you mask up.