Remstar Auto and nightly pressure...

[mommaw]

Without having the software, is there anyway to see what the highest level of pressure you are reaching at night? Can you look at the machine at any time and see what pressure you are at?


Gilda

[Zees Pleez]

I will answer the second question. You can't see the highest pressure becuse you typically are asleep (or at least mostly, and too incoherent to make sense of reading). Mine has gone as high as 13 pretty much every night according to the card reading, but I never have seen it above 10 and only once that high. Usually by the time I am alert enough to read it, it has returned to the lowest pressure in my range, so it isn't all that informative to read the LCD at night. If it were an LED, it might be another story because you could see it right away.

[littlebaddow]

I can think of two ways:

1. Assuming you have the card in the machine, find someone who has the card reader & software and send the card to them. They could download the reports and send them to you when they return the card. I'd offer, but I'm a long way away

2. Get someone else to look at the reading when you're asleep.

[mommaw]

I do have the card in the machine. I will take it to the DME and get it read tomorrow. Since I am only on the auto for a 1 month home titration to see if I can use it instead of the bilevel I was on. I had just saw posts where they stated that they woke up and the pressure had gone up and wondered how they could see what it was. So, you can see what the pressure is on the screen if you can get your glasses on and awake enough to see it.


Thanks for the info,
Gilda

[wading thru the muck!]

Gilda,

Good luck with your trip to the DME tomorrow. Without regard to how the data comes out, how do you feel after your month using the auto as an alternative to the BiPAP? Has it worked to provide more comfort and do you feel rested?

[JerryR]

Gilda,

Good luck with your trip to the DME tomorrow. Without regard to how the data comes out, how do you feel after your month using the auto as an alternative to the BiPAP? Has it worked to provide more comfort and do you feel rested?

I'd be very interested in knowing the answer to this also as I am about to order one. I finally got hold of my script, am returning my current equipment to my unscrupulous DME and taking control of this matter myself.

[mommaw]

Wader,

Have only been on the auto for 2 weeks but I feel great! But I felt good using the bilevel, the BIG difference is in how EASY it is to fall asleep with the auto. With the bilevel on 18/14, even with the ramp setting, it was still blowing at 14 making it harder to fall asleep! With the auto set on 6/20, I can go to sleep on 6, it just like normal breathing. If my AHI numbers are ok, and I think they will be, in 2 weeks, I will be returning the bilevel and keeping the auto. I have both now. My doctor said if the numbers are good then I can have the auto. My insurance has agreed to let me switch (I would assume so since the auto is much cheaper than the bilevel I have now).


Jerry,

IMHO you can't go wrong with the RemStar Auto w/c-flex and heated humidifer, unless there is another reason you might need a bilevel. I will get my card read tomorrow and post the numbers for you. I have my report from the 1st month on the bilevel, so I can compair them.


Wader,

a question for you, I was using my breeze on my bilevel, and used it the 1st week of the auto. Last week, I got my new AURA and am using it now. In your opinion, will using a different mask make much of a difference? I am of the opinion that they won't, especially since both are nasal interface and both have the narrower tube connection. Also you and rested gal were right, the AURA is GREAT.


Gilda

[rested gal]

Gilda, good luck on getting the DME to print out all the information you want, even if they download the card for you. They are likely to give you just one page of "compliance details" - tells the number of hours the machine was used and a little bit more, but nothing like what you want to see.

Make sure they understand that what you want printed out are the "details" pages. Specifically, you want every page that is titled:

"Sleep Therapy Daily Details"
Those are the pages with the interesting graphs and charts for each night individually for the most recent 5 days or so.

You also want the last pages that are titled:

"Summary of Daily Details"

"Summary of Compliance All Data"

Make them write down what you want printed, or you're likely to be sorely disappointed by what little they bother to give you. Some DMEs have never ever downloaded a smart card before. Some don't have the software or the card reader. And even among those that have it.... it's usually just for glancing at the "compliance" info to be sure the patient is using the machine. They generally are not interested in looking at the details of treatment like we are.

[wading thru the muck!]

Gilda,

Sound like the REMstar auto with C-flex is working for you just as we had hoped. I think the machine will offer a better level of comfort for many BiPap users. I think the aura should work just as well for you as the Breeze did. The fact that you will be able to see that data using each for one week will be a good indicator in this regard.

[mommaw]

Ok all you number crunchers, the results are in! Just back from DME with reports from the autopap. A little background data first:

VPAP lll bilevel used 2/3 to 3/15. Pressure setting 18/14. Breeze nasal pillows. Averages were:

AI....1.0 events per hr
HI....5.3 events per hr
AHI...6.4 events per hour

RemStar Auto w/c-flex used 3/16 to 3/29. Pressure setting 6/20. Breeze nasal pillows 1st week, Aura nasal pillows 2nd week. Averages were:

AI....1.1 events per hr
HI....2.1 events per hr
AHI...3.2 events per hr

90% of time pressure at 9cm H20 ...... highest reading 13cm H20 for 21.5 minutes. Only reached 13 one night, rest of nights were 10 or under.

Never came close to the titrated numbers of 18/14. Pretty amazing and just shows that a one night PSG cannot give you accurate settings. IMHO that is, since I am NOT a doctor or trained in any way in the medical field.

Will get another report in two weeks on the auto, then the doctor and I will decide what machine I will keep. Of course I already know.

Gilda

[rested gal]

Very nice report Gilda! Looks like you are well armed now to make a good case for what you want.

Oh, one thing that you might find interesting... the "90% pressure" number doesn't mean you spent 90% of the time AT the pressure of 9 cm H20. It means (gosh, I hope I phrase this right, but I think you can figure it out) that 90% of the time (or when dealing with 90% of the events, not sure which it means) a pressure of 9, or pressures BELOW 9 took care of things for you.

If you were able to see the charts for each night, you might see that you spent a few minutes at 10, 11 and 12, and a modest amount of time at 9.... but the bulk of the time was with pressures below the "90%" pressure number.

[mommaw]

rested gal,

I understand what you are saying. I do have the charts for the last week and I can see what the pressures were and the amount of time spent at each pressure. I still have alot to figure out about the data but was very pleased with the numbers. I want to thank you for your post earlier telling me exactly what reports to get. I printed your post ( parts of it) not the bad DME stuff and took it with me today. Was very helpful.

Thanks
Gilda

[Joe A]

Momma W:

It seems that you were indeed overtitrated, however....what concerns me is that even with overtitration you experienced 5 hypopneas/hr. This tells me that you Bi-Level machine is out of sync with your breathing.

Bi Level titration is ALOT more difficult to get right. It's not all about pressure...it's about pressure AND syncronization. If you read my lengthy post about "Bi-Level Success and How I got there." It is very eveident that even with 20-30% higher pressures than you need, if the IPAP and EPAP setting aren't timed with your breathing, it's like having no therapy at all.

I wonder what your #'s would look like at 13/9 WITH an adjustment to the IPAP/EPAP sensitivities, IPAP/EPAP Times and RT(Rise Time) on your machine with the interface you intend on using. Good luck finding an RT that knows how to do this...it took me two weeks of tinkering to do this on my own. The dopey RT's at my DME looked at me like I had 3 heads when I asked them to adjust these settings and proclaimed, "Oh those settings do nothing...it's all about the pressure. With the proper synchronization I sleep now like I did in high school. Exactly 6 1/2 hrs after falling asleep, my eyes automatically open and I couldn't sleep a minute more! (I tried sleeping in...I can't!). A shower, and a cup of Green tea and I'm off to face the world with my brain and short term memory intact! Took me five years to get my therapy dialed in like that!! I always felt hungover in the AM! And If I slept in(In those days I could have slept in any day!). I felt worse!

It's no wonder Auto PAPs are so popular, give the wide range of skills that exist amongst RT's.

[mommaw]

Joe,

I had read your post when you first posted it and was very concerned that my bilevel was not set up correctly. As far as I know, the DME just set the pressure and that was it. I know that it was not set to my breathing pattern since I picked the machine up at the store and the only thing they did was have me put the mask on, adjust for air leaks (sitting in a chair) and said there you go. I do know that in the month I used it, the 18 pressure would kick in before I had finished my exhale and vice versa. In other words it was not in sync with my breathing pattern, it was close, but not exact. I had began to feel alot better using it BUT I also was diagnosed with PLMD and put on medication for that. I think THAT has contributed a lot to me getting a good nites sleep. My PSA AHI was 12 per hour but my PLMS was 58 arousals per hour. Most of my AHI are hypopneas, I have very few apneas but during my PSG my oxygen saturation fell to 81%, so I know that I need cpap also. Hope this makes sense to you.

Gilda