A home titration

loonlvr · Post by **loonlvr** » Sun Aug 28, 2005 7:47 pm

I was talking to my nephew today and we got around to sleep apnea. Seems that he has all the symptoms. Before he investigates a sleep study and spends the money he doesn't have, I thought being a veteran I might put him on my Remstar Auto with c-flex for a night. I am wondering what pressures I should put him at as to get the best results. If the encore shows many apneas, we will due one more night to be sure. I was thinking in the 4-7 range. Not sure if I should leave the c-flex on, although I think it would best simulate regular breathing. Any suggestions on what would be a good pressure range for a home study?He is 25 years old and in excellent health.

Sergeant Bob · Post by **Sergeant Bob** » Sun Aug 28, 2005 9:57 pm

I'm pretty new at this but, I think I would start him at as low a pressure as he's comfortable with (so he doesn't feel like he's starving for air).
Leave the C-Flex on to make him more comfortable.
The reason I say as low as possible is so you can get a more accurate idea of how bad his OSA is. Then crank it up from there.

That's how I would do it if I was evaluating myself.

rested gal · Post by **rested gal** » Sun Aug 28, 2005 10:40 pm

If he can breathe even reasonably at 4 - probably too low to be comfortable, but try to get him to do it that way anyway - you can set the REMstar Auto for a "split night" by putting it on Auto mode and going to "Ramp"... setting the "Ramp" time at "4" (for 4 hours.)

I'd set the pressure range low, as Sgt Bob suggested... perhaps 5 - 10. That can't hurt anyone, imho. I'd leave C-Flex turned off for this experimental night.

What the machine will do with those settings (gotta be in Auto mode and with Ramp time set for "4") is it will run at a pressure of 4 cm H20 for the first four hours. Then it will switch to using the range of 5 - 10 for however much longer he sleeps. (If he sleeps at all! lol)

That will give you split night data to look at. The very low straight pressure of 4 will give you the best look-see that you can get (outside of a real sleep study in a lab or with a machine designed for "at home" sleep studies) at how many events he has during that first four hour period. The remainder of the night will let you see whether letting the autopap "do its thing" at least up to 10 cm makes a dent in things.

If you want to be really thorough, YOU stay up and watch him throughout the night. Will give you a better idea of whether he has mouth air leaks and how much of the recording time he's actually sleeping -- whether he (heaven forbid!) takes the mask off while sleeping, whether he snores even at 10 cm, you handle mask adjustments if needed, etc.

The only caution I'd have is this: Such an experiment could backfire in a big way....he might find that wearing a mask is sooooo uncomfortable that he'll get a bad impression of cpap treatment. That could happen even if you use a more comfortable pressure than "4" and the most "comfortable" mask possible for him.

He might go along with the experiment anyway, but dislike the whole thing so much that he would be reluctant to ever get a real sleep study done. A real study could reveal drops in oxygen levels that would be the REAL catalyst to literally scare him into deciding he'd rather learn to put up with a mask and machine than go untreated.

Only if he's already very convinced that he has OSA and has already made up his mind that he absolutely WANTS to get himself on cpap treatment if it turns out he does have OSA...then (and only then, imho) would such an experiment be useful as a "screening" test.

Otherwise, it might be totally counterproductive. If he's only "interested" in knowing, not absolutely gung ho about finding out, then his first experience trying to sleep with a mask and machine might drive him away from ever thinking about "cpap" treatment again -- perhaps not ever consider a sleep study at all in the future. That's the last thing you'd want to have happen.

Guest · Post by **Guest** » Mon Aug 29, 2005 4:16 am

Thanks for the suggestions, He is very interested in this, Says he would be willing to wear a mask the rest of his life if it made him feel better. He sleeps all nite and wakes up tired. He snores really bad his mom says. Feels tired during the day. Is a relative of mine lol. So he has the symptoms and is a very willing patient soi I foresee no reason he will be scared of by this.

th · Post by th » Mon Aug 29, 2005 2:38 pm

RG, I tried that on my RemStar auto. 4 hours(Ramp) and 5 to 10. When I started the RemStar auto up it went to a start pressure of 5 not 4.And then it stayed at 5. What did I do wrong? How do I make it start on 4 and stay on 4 for 4 hours?

[quote="rested gal"]If he can breathe even reasonably at 4 - probably too low to be comfortable, but try to get him to do it that way anyway - you can set the REMstar Auto for a "split night" by putting it on Auto mode and going to "Ramp"... setting the "Ramp" time at "4" (for 4 hours.)

I'd set the pressure range low, as Sgt Bob suggested... perhaps 5 - 10. That can't hurt anyone, imho. I'd leave C-Flex turned off for this experimental night.

What the machine will do with those settings (gotta be in Auto mode and with Ramp time set for "4") is it will run at a pressure of 4 cm H20 for the first four hours. Then it will switch to using the range of 5 - 10 for however much longer he sleeps. (If he sleeps at all! lol)

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CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX, Ramp, auto

loonlvr · Post by **loonlvr** » Mon Aug 29, 2005 5:09 pm

Seems like I had tried that also and had same results when I first got it.

loonlvr · Post by **loonlvr** » Mon Aug 29, 2005 5:27 pm

RG, I think I have it. First you set the therapy(apap), then the pressure range(5-10), then the ramp time to 4 hrs. The starting ramp pressure will be your low setting(5). This can't be changed. It will stay at 5 for 4 hrs then go into Auto mode with prssures of 5-10 for rest of nite. Is this right?

Sleepless on LI · Post by **Sleepless on LI** » Mon Aug 29, 2005 5:32 pm

I don't want to burst anyone's bubble here, but can you use ramp in auto mode? I thought someone once told me you had to turn it off if it's in auto. Now I'm wondering and have to go find the link to a post about split night studies. If I find it I will be backand post it.

This is a post I found on this site that RG, our resident expert, left. I think it may help. I will keep looking anyway for the other thread I was talking about.

You're correct, Davidmcc. Ramp is not available in any autos running in auto mode. Ramp is available only in cpap mode.

In fact, if a person is using a Remstar Auto and doing their own set up to run it as an auto (with or without C-Flex), they should set "ramp" at 0 (zero) when the "ramp" window appears in the menu.

If the machine has already been set for "APAP" (auto) or "AFLE" (auto with c-flex enabled) a time can be set, but it would be a big mistake to set it for anything other than zero. The options available - 2 hours, 3 hours, 4 hours - are not really "ramp" times. Those hours are for doing split night studies. The machine will deliver the lowest pressure possible and will not respond to any apneas, hypopneas, etc. that you have during those 2, 3, or 4 hours.

If you're running the Remstar Auto as an auto or as an auto with c-flex, and you fiddle with any settings in the "therapy setup menu" on top of the machine, be sure to keep "ramp" set for zero.

Sleepless on LI · Post by **Sleepless on LI** » Mon Aug 29, 2005 5:43 pm

viewtopic.php?t=4047&highlight=split+night

Very short thread, but has the link to the last quote from one of Rested Gal's replies.

loonlvr · Post by **loonlvr** » Mon Aug 29, 2005 6:08 pm

Looks like my interpretation is correct that I got from the set-up manual for doing a split nite study. The first 4 hrs(or whatever you choose) the pressure(5)stays the same to see how many apneas occur. Then it goes into auto mode(5-15) to see how it handles the apneas if they are present.

loonlvr · Post by **loonlvr** » Mon Aug 29, 2005 6:10 pm

Actually, i'll set it to 5-10 pressure range.

Sleepless on LI · Post by **Sleepless on LI** » Mon Aug 29, 2005 6:11 pm

Then it goes into auto mode(5-15) to see how it handles the apneas if they are present.

Do you have to set the auto pressure for 5-15 or does it automatically go into that setting? Because if you are already using it at let's say 8-17 and you don't change it, but you want to do a split study and use the ramp for four hours, how will you know if when the ramp turns off, if it will go to 8-17 or 5-15? Just curious. I wanted to do one a while ago but never did.

Also, 4 is so low, he might feel like he's suffocating. It took me a couple of night when I tried lowering my pressure before I could feel like I was getting air at 4.

loonlvr · Post by **loonlvr** » Mon Aug 29, 2005 6:27 pm

The order is as follows:
choose therapy type(apap, cpap, etc)
set high pressure , then the low pressure.
set c-flex setting if your using it
set ramp time. Here you set it for 2,3 or 4 hrs. After that time, it will revert to the pressures you previously just set.This is for a split nite study.
set it to 0 if your not doing a split nite study.

Sleepless on LI · Post by **Sleepless on LI** » Mon Aug 29, 2005 6:32 pm

The order is as follows:
choose therapy type(apap, cpap, etc)
set high pressure , then the low pressure.
set c-flex setting if your using it
set ramp time. Here you set it for 2,3 or 4 hrs. After that time, it will revert to the pressures you previously just set.This is for a split nite study.
set it to 0 if your not doing a split nite study.

Now that makes sense. I didn't know that the machine would know to automatically go to 5-10 if you didn't set it for that. Just be sure he's ready to feel very little air coming through at a 4 setting. Did you ever try it at 4? It can be alarming at first when it feels like you're cutting off your breathing O2. It may take some getting used to, if he can keep the mask on long enough to get used to it.

loonlvr · Post by **loonlvr** » Mon Aug 29, 2005 7:29 pm

I am going to try 5, see if he can do ok with it before he goes to sleep.Have him wear it for awhile to make sure he can handle it. If not, i'll bump it up. I just don"t want it too high. Trying to get as close to normal breathing during sleep as possible to get a true reading.