Got my machine

Firstly, I had been previously posting as "TooNew", but my membership was finally approved yesterday

I picked up my machine today (3rd business day after titration study) and was told it was set to a range and would automatically adjust to the pressure I needed.

Great, I think, it's a Dreamstation, so it must be a 500 model.

I get it home and look and it's a 400 model. What is going on here? Isn't the 400 a CPAP and the 500 an APAP?
How can the 400 be automatic? Did the woman know what she was talking about?

Is the 400 fully data capable?

The 400 is full efficacy data and it does have a limited trial of auto (apap) mode...30 days and I think there is a way to get more days by using the reset feature. Or at least there was on past Respironics models with auto trial. It eventually runs out though.

Go here and get request the manual. It's a combo manual...has the other models in it also but I think you can figure out what the Pro has.
the DSX400xxx is called the DreamStation Pro. My biggest gripe with it is not so much the limited apap as it is the fact that Flow limitations are totally ignored in cpap mode and in your situation those FLs might be important. They will show up in the trial apap mode though and we can see if they are going to be a problem.

I think I would be giving them a call back and say "did you know this is a fixed pressure machine and not an auto adjusting machine"...don't mention trial apap mode...and see what they say.

Pugsy wrote: My biggest gripe with it is not so much the limited apap as it is he fact that Flow limitations are totally ignored in cpap mode and in your situation those FLs might be important. They will show up in the trial apap mode though and we can see if they are going to be a problem.

My condition is more like UARS instead of OSA - how would those limitations potentially affect me?

I think I would be giving them a call back and say "did you know this is a fixed pressure machine and not an auto adjusting machine"...don't mention trial apap mode...and see what they say.

Apparently I don't need an APAP - right? Would they even precribe APAP for UARS?

Thanks,

Here's the link for the manual. I forgot to include it above.
Just request it. Instructions are about 2/3 down the page.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

Actually I think that UARS and apap might be a better fit than fixed pressure cpap only.
Don't know why they did that...the VA has always issued apaps in the past.

The Flow limitations...FLs are air flow reductions that don't meet the criteria for an obstructive apnea flag or a hyponea flag.
Since UARS is generally thought of as more along the lines of flow reductions causing arousals and not so much earning the normal flags I think that FL flagging is very important.
Flow limitations are also part of what the auto algorithm will increase the pressure trying to fight out. Probably why the flagging is turned off in cpap mode because the machine can't do anything about them anyway. Would still be nice to know if they happened but Respironics didn't ask me what I thought.

Now is the UARS flow reductions the same as the FLs that the machine flags...dunno but it is the best we have for trying to evaluate things when people seem to be leaning towards UARS.
Now the Pro will flag RERAs which might also be related to UARS but that's a maybe.

Pugsy wrote:Here's the link for the manual. I forgot to include it above.
Just request it. Instructions are about 2/3 down the page.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

Thanks!

Now is the UARS flow reductions the same as the FLs that the machine flags...dunno but it is the best we have for trying to evaluate things when people seem to be leaning towards UARS.
Now the Pro will flag RERAs which might also be related to UARS but that's a maybe.

OK, I had 68 of those during the first study. During the trial period, is the 400 as capable as the 500, or only partially (doesn't count the FLs possibly)?

The only time any Respironics machine will flag FLs is when it is in auto adjusting pressure mode (either with the single pressure or the bilevel pressure machines). So in the auto trial mode it will flag your FLs if you have them. If you don't seem to have many then the lack of Fls in cpap mode may not be that big of a deal. Remember I don't know for sure that the FLs it flags is the same FLs that are part of UARS.
When the auto trial days are used up (and no more resets are available) then the 400 becomes a fixed pressure machine. Still full data minus that one little data point called Flow Limitations.
I never had any FLs to speak of on any of my reports even when I was using sub optimal pressures (long story but the titration study got it wrong)...not everyone will have enough FLs for it to matter much. It's just that I like to have every single piece of data available just in case it is needed.

If they stand fast on giving you this model...and we find out that apap mode works best for you...you can always get just an apap blower and it will work with your humidifier, etc.
Having fixed pressures only isn't the end of the world. Just a bit more challenging in some respects. I do better with auto adjusting but I am now using a fixed pressure machine. Why, you might wonder? Because I wanted to try a different (newer) model and I ran across one that someone was selling a used one so cheap I couldn't pass it up. I knew I would have to do a bit of fiddling with the pressures to make it work but it wasn't that hard and I am doing very well on fixed pressure.

Also....some people find that the variations in pressure in auto adjusting mode actually cause sleep disturbances...so fixed works better for them anyway. Never was a problem for me as I used to see some pretty big swings and slept right through them but some people aren't so lucky.

So having a fixed pressure only machine isn't the end of the world. They can be made to work very well with just a little bit of extra work.

Since UARS patients typically tend to be sort of on the super sensitive side...maybe fixed pressures would suit you better if you find that the variations in pressure in auto mode tend to cause arousals...which of course you don't want.

We can most likely make the Pro work well for you. I don't know if they will swap...most likely not but it never hurts to ask.
Should they not swap and you try auto mode and fixed mode and it comes out that you really like auto mode best...you can always just get one yourself. We can find gently used ones or even new for not a huge amount of money.

It's the VA. If you want an apap machine, bring the machine back and tell them you were told you were getting an apap, not a cpap. They can have the machine and you will contact your doctor. Then walk over to the doctor's office (or call them) and tell them to rewrite the script for an auto machine. I told my BIL's son to do this and they gave him the apap he had been expecting.

It all depends on the VA place you are dealing with. Some are completely inflexible. As mentioned, Pugsy and others can help you through if you can't get the machine replaced.

A sorry way to treat a veteran.
Thank you for your service.

SewTired wrote:It's the VA. It all depends on the VA place you are dealing with. Some are completely inflexible.

I agree. That is why I have used the VA system very little. I was lucky enough to have health insurance through my company while working, and now rely on Medicare and Tricare for life.