Cflex, EPR and Straight CPAP

I've been researching a new auto, and so far, I've been pretty darned impressed with the features of the Sandman Auto HC. When OSHA, One Tired Puppy et al started dialoging about it on this thread, I realized it might be worth trying my Respironics M-Series Pro without Cflex for a few nights just to see if I could deal with a non-EPR machine. I elected to use a 5 minute ramp starting at 8.5 cm and cflex set to off with a pressure of 11.5. It was a little weird the first night, but right from the beginning since having turned off the EPR, my AHI has been under 1.0 every single night. I haven't gotten this much recuperative sleep in years.

So I'm just about ready to make the move to the Sandman Auto HC, once I get the funds, but I don't necessarily have to to it immediately since I'm suddenly getting decent results with my M-Series Pro. With all the vast capabilities of the Sandman, it's obviously superior software and my doing better without EPR, I'm ready to make the switch.

My opinion of cflex has now changed a little. It's great for getting used to just using the machine, but if your ahi can be improved by turning off cflex, the sooner you can get used to straight cpap without it, the better. I'm also finding I have less aerophagia when I sleep on my side than I used to with Cflex on. Every day I've been without Cflex, my asthmatic tendencies have decreased noticeably. I can breathe again.

Some questions and a request pop into mind:

Has anyone else found that their AHI drops dramatically when Cflex is off?
Is it easy to change pressure settings, etc. on the Sandman?
Is the available software just 'viewer' software, or will it allow you to make real changes on the card, data, etc?

Would someone please post an example report and screenshots of the software for the Sandman Auto HC? If you prefer, you can PM me.

I have over 500 hours over the past 75 days of use on my new Sandman Auto. I would endorse its purchase. In fact I was able to use it for 3 days while I nursed a head cold. Its presise humidification system allowed me to use when I was heavily congested. I used cflex for 4 years but with the Sandman I feel it is not even necessary since they have something called "adaptive pressure stability" which allows for a more accurate pressure sense of your breathing pattern. The settings are easily changed from the front of the machine by going into the clinician mode. I make changes often and the front screen is very easy to see since it is backlit for 30 seconds to allow you to view instead of getting up and having to look on top of the unit. The display will show the AHI,Leak usage time and averge pressure for the last five sessions. You can also change settings with the USB cable (purchased seperatly thru CPAP.com) The memory card is just a vehicle to transport the daily data to the software. It does not store information. The Sandman has data embedded into memory so the cable is needed to delete the data as it becomes full in the unit itself. Overall it is a fine APAP with impressive software. It appears that CPAP.com has recently lowered its price of the unit. You might also want to consider the fine filters to screen out those particles which may trigger your allergies. I use them and have been pleased with the results. Even the humidifier chamber seems durable. Hope this information helps you!!!

Just a quick comment re use of the acronym EPR - that acronym is Resmed's name for their pressure relief so any critical remark referencing EPR wouold appear directed at Resmed rather than at C-Flex which is Respironics brand for exhalation relief. The two are quite different in how they work.

I am assuming from what you wrote that you aren't referring to Resmed EPR ?

Slinky would be impressed

DSM

Thanks for the information about your good experience with the Sandman Auto, Thunder Road.

As the memory in the machine fills up, the older data simply gets overwritten with the newer data, doesn't it? I don't think you have to delete data at any point...or at least you don't have to with the PB 420E. I think the same manufacturer makes both machines, but I could be wrong about that.

Sounds like a very good autopap.

Thunder Road wrote: Hope this information helps you!!!

Thanks, it's been very helpful.

dsm wrote:...I am assuming from what you wrote that you aren't referring to Resmed EPR ?

Expiratory Pressure Relief - EPR - I wonder if the term can really be trademarked. I was actually thinking 'Exhale Pressure Relief' which sounds less 'coffin-inducing' and is easier to remember. I notice that cpap.com calls the generic term 'pressure relief on exhale' in the comparison charts. (It's not in the CPAPopedia yet.) So I mean "Exhale Pressure Relief" when I use the term EPR here. I hope that's okay.

Incidentally, the EPR method by Resmed does seem like it might be better than the Cflex/Aflex method by Respironics. I have to agree with you (and Slinky) there.

I found this link leading to the patient manual. I'm contacting them about example reports and screenshots. I hope I'll get a reply.

@rested gal,
They talk about data in the manual. It's stored in the machine while it's functioning. You only use the card to transfer the data from the machine to your computer. Puritan Bennett, Sandman and Covidien are all apparently recently acquired subsidiaries of Nellcor. Sandman software also makes the software and hardware that's used for recording PSG's at a lot of sleep labs. Have I got all that right?

Can anyone chime in about why you would prefer Sandman over a 420E? I'm not sure I see much difference in the comparison charts of their features.

I have a 420e, and am thinking seriously about buying a Sandman for the following reasons:
1. The auto algorithm has been enhanced - I wonder if it will do a better job at understanding my flow limitations
2. The Sandman is quieter
3. The Sandman is more precise in reporting hypopneas with and without cardiac oscillations - very relevant for me
4. The Sandman has a sophisticated humidifying system which intrigues me.

O.

Thunder Road wrote:I have over 500 hours over the past 75 days of use on my new Sandman Auto. I would endorse its purchase. In fact I was able to use it for 3 days while I nursed a head cold. Its presise humidification system allowed me to use when I was heavily congested. I used cflex for 4 years but with the Sandman I feel it is not even necessary since they have something called "adaptive pressure stability" which allows for a more accurate pressure sense of your breathing pattern. The settings are easily changed from the front of the machine by going into the clinician mode. I make changes often and the front screen is very easy to see since it is backlit for 30 seconds to allow you to view instead of getting up and having to look on top of the unit. The display will show the AHI,Leak usage time and averge pressure for the last five sessions. You can also change settings with the USB cable (purchased seperatly thru CPAP.com) The memory card is just a vehicle to transport the daily data to the software. It does not store information. The Sandman has data embedded into memory so the cable is needed to delete the data as it becomes full in the unit itself. Overall it is a fine APAP with impressive software. It appears that CPAP.com has recently lowered its price of the unit. You might also want to consider the fine filters to screen out those particles which may trigger your allergies. I use them and have been pleased with the results. Even the humidifier chamber seems durable. Hope this information helps you!!!

That is great info, thanks for the feedback on that machine. Display of data on the LCD was a question in everyone's mind that had interest in that machine.

Re the Sandman, does anyone know where it comes from ? (by this I mean - is it a new product altogether or a new market entrant or from some existing known manufacturer ?

It certainly gets good reviews.

DSM

dsm wrote:Re the Sandman, does anyone know where it comes from ? (by this I mean - is it a new product altogether or a new market entrant or from some existing known manufacturer ?

ozij posted quite a bit about that back in June:

viewtopic/t31913/Sandman-Info-and-Sandman-Auto.html

Here are some more links:

Covidien - Puritan Bennett

"A leading innovator in mechanical ventilation and respiratory care devices for over 50 years, Covidien's Puritan Bennett brand has developed some of the world's most trusted critical care devices," ... (etc.)

________________

http://www.technical-textiles.net/htm/f ... 015144.htm

Medical Textiles
Issue: March 2007, page: 10

Covidien is new name for Tyco Healthcare

Tyco Healthcare is to be renamed Covidien once the global healthcare products supplier separates from parent company Tyco International and becomes an independent, publicly traded company.

________________

http://www.puritanbennett.com/prod/list.aspx?S1=SPT

Sleep Therapy CPAP/Bi-Level Devices
Sandman Auto™ CPAP Device

At the bottom of that page is a link to "Covidien" that opens a window.

This was in the window when I clicked:

"10/21/2008 8:03:00 AM

Covidien Announces Latest Advance In "Unite to Treat Sleep Apnea" Initiative
Sandman Alliance(SM) Personalized Patient Support Program Maximizes the Benefits of Continuous Positive Airway Pressure (CPAP) Therapy

BOULDER, Colo.--(BUSINESS WIRE)--"

RestedGal - many thanks for that info - I had figured that any machine with that many smarts & good rap had to be from a known manufacturer & had wondered if Puritan Bennett was behind it. PB have impressed me immensely over the years from using some of their roducts & from what I've seen of their past products.

It is very reassuring to know they are still able to keep to the fore.

Tks

DSM

PS - from some of the links it looks like the PB42x range are still being sold as Puritan Bennett models. Is Sandman a parallel brand - haven't been able to figure that out ?

According to this Covidien Press Release referenced earlier by rested gal,

Globally, less than 50 percent of OSA patients recommended for continuous positive airway pressure treatment continue their therapy beyond the first week, and up to 25 percent of remaining patients can be expected to discontinue CPAP use within three years.

"One of the biggest problems with sleep therapy is getting patients to comply with their treatment plans," says Kevin Mongonia, President of Assist Management. According to Assist Management's internal data, patients enrolled in the Sandman Alliance program comply 82 percent of the time, up from less than 50 percent compliance for OSA patients recommended for treatment. "The Sandman Alliance program helps OSA patients remain committed to their CPAP therapy," he said.

This 'program' still promotes the 'priesthood and catechism method' of therapy, whereby only 'specially anointed' people can tell the patient the 'mysterious' rote answers. Unfortunately most of the specially anointed have never used the machines, so they have no idea what they're talking about, other than from what they've been told by others higher in the 'priesthood'. I've said it before: If OSA were more immediately life-threatening like diabetes, they couldn't hide behind this purposefully-slowed-recovery method just to skim profit from the ill health of others. They would have to teach us how to diagnose the best settings to achieve the best AHI for ourselves because anything less would be immediately life threatening. Patients don't comply because they have no control over the most immediately important self-controlled function of their lives - their breathing. All it takes is a poor setting like a ramp start pressure of 3cm in a 45 minute ramp for most people to want to rip the mask off.

Below quoted is the response I got from Puritan Bennet.

Puritan Bennett Technical Services Team -- wrote:Dear [DREAMDIVER],

Thank you for using the Puritan Bennett SolvIT Center.

Question:
I am one of a growing number of patients who actively participates in sleep therapy looking at my nightly reports so I can verify large leaks, centrals and AHI, etc. Software is very important to me. Can you please provide example reports for various modes (CPAP, APAP) and a few example screen shots of the software used by the Sandman Auto HC? It would be nice to know if the software will accommodate a multiple cpap household using the same software on one computer. What's the official name of the software and it's current official version? Will the software automatically update to the most recent version? Can I download the data to a spreadsheet for further analysis?

Answer:
Unfortunately, the Sandman Therapy software is restricted for use by the Clinician and Homecare provider as it allows for prescription configuration changes. Therefore we can only dispense limited information to patients. Specifically:
• The Sandman Therapy software can accomodate multiple CPAP units on one PC
• The current version is 1.1
• The software does not automatically update to the next version
• The data can be downloaded to a spreadsheet
You can certainly take (or mail) your memory card into your homecare provider for them to download the information and then give you the reports.


Sincerely,

The Puritan Bennett Technical Services Team

One thing about the response is nice - at least they answered my questions. Thanks for that. I guess it would have been too much to expect that they might actually send me some example reports. The formulaic 'restricted to homecare provider' blurbs are obviously legalese to cover their a**es. I can live with that -- at least until we can get some rules changed regarding what constitutes appropriate health care for OSA.

DreamDiver wrote: This 'program' still promotes the 'priesthood and catechism method' of therapy, whereby only 'specially anointed' people can tell the patient the 'mysterious' rote answers. Unfortunately most of the specially anointed have never used the machines, so they have no idea what they're talking about, other than from what they've been told by others higher in the 'priesthood'.

.....thanks, that is rich.

Does this also mean that they restrict usage of CPAP to the missionary position only??

Guest wrote:Does this also mean that they restrict usage of CPAP to the missionary position only??

As a female type person I'd have to say no. You're not supposed to sleep on your back, it's bad for OSA patients!

carbonman wrote:Does this also mean that they restrict usage of CPAP to the missionary position only??

fortomorrow wrote:As a female type person I'd have to say no. You're not supposed to sleep on your back, it's bad for OSA patients!

This has been fun. Thanks, carbonman, fortomorrow - you've both made my day.