My Meeting with the Respironics Rep update

Berniem · Post by **Berniem** » Thu Apr 12, 2007 7:30 am

Hello All,
I met with the Respironics Rep and Dr Sleep last night. they gave me a new machine. A REMSTAR Auto/Aflex M seriies. I'm not sure which one to pick for my profile.
Anyway the purpose of them giving me the new machine was to determine the optimum pressure for me (see my previous posts)
A major problem I had with the old machine was exhaling. the pressure while exhaling was causing me to have the sensation I was blowing against the wind.
The new machine seems to sense when i am exhaling and lowers the pressure allowing a more comfortable feeling.
The new machine has a card in it and I am supposed to bring it in to the doctor in about a month.
I know the new machine does a lot of other things and as time goes by I will figure them out with help from you all.

The rep was very helpful in a way, but the machine did not come with a manual so i'm curious about what the buttons do. He said that I only need to concern myself with the on=off buton. Fat Chance!

Questions to begin with :
When I flip up the cover and press the setup key and then the arrow -->
the display says C-Flex 1,2,3. there is a dot flashing over the 3. what does that mean?
The mask alert is set to off. What is that?
The auto off says on. Jeesh isn't that confusing.
The doctor told the rep to set the machine to 4 and 15. I'm not sure what that means.
When I strap on the mask . the machine starts by itslef. is this normal?

Thanks for your replies in advance

Bernie

tomjax · Post by **tomjax** » Thu Apr 12, 2007 7:48 am

What did the rep tell the Doctor when he told him to set it between 4 and 15?

Did he tell the doc that the 4 setting is probably much too low and will lead to an increased number of apneas?

Since you are already on a machine, then your pressure shold not be that much of an undetermined quantity. I would think they set it about 3 below your current pressure and 3 or 4 above it to start.

Is set at 4, then why were you not advised to come back in about 3 or 4 days to get an initial range?

Maybe I am wrong, but I would think these settings are appropriate for an in home study to diagnose apnea, but not after the DX has been made.

One thing that I am convinced of is that a very high percentage of sleep and other docs as well as a much higher percentage of DMEs are simply not all that informed on the things they should be.

I could be wrong.
Someone help me if I am wrong here.
tom

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hayeswildrick · Post by **hayeswildrick** » Thu Apr 12, 2007 7:50 am

I think I can help with some of those questions!

1) When I flip up the cover and press the setup key and then the arrow -->
the display says C-Flex 1,2,3. there is a dot flashing over the 3. what does that mean?

C-flex is the feature that reduces the pressure when you exhale. When it's set at 3, it provides the maximum relief. If you find that you like to have a little more pressure to breath against, you can set it down to two, or even one.

The mask alert is set to off. What is that?
The machine can be set to alert you when you take your mask off. Dumb feature, since you have to be looking at the machine to see the alert!

The auto off says on. Jeesh isn't that confusing.
"Auto off" turns the machine off automatically if you take off your mask. But the feature has to be turned on or it won't do it. Yes, weird use of language. I personally prefer to turn my machine off with the push of a button so that it doesn't shut off by my simply pulling the mask away to readjust. But, some folks like it.

The doctor told the rep to set the machine to 4 and 15. I'm not sure what that means.

The machine will deliver pressures between 4 and 15, depending on what you need. It automatically senses if you are having apneas and hypopneas, and will increase pressure to eliminate them. It will constantly be seeking the lowest pressure within that range that will keep you from having events.

When I strap on the mask . the machine starts by itself. is this normal?
Yes. This is the opposite of the "Auto off" feature. It's "auto on." Unfortunately, I haven't found a way to disable this as, once again, I prefer to push the button. When it does "auto on" I'm not sure if it keeps your c-flex active or not. Someone else may need to answer that. My RT said that I have to push the C-flex button each time in order to activate the feature.

Hope this helps. I'm sure you'll have lots more questions. Ask away!

-Jeff

Guest · Post by **Guest** » Thu Apr 12, 2007 12:20 pm

Tom, The rep did question the Doc about limiting to pressure 15. he said that the machine will record all the pressures it uses and if my optimum number happens to be above 15 the machine will not record anything above what it was set at (15) so if my optimum number 13 16 for instance the machine will not know that.

Does anyone know how to reset these numbers? say from 6 to 20?
4 is way to low for me anyway.

Jeff thanks for your reply, makes a lot of sense

Lyza · Post by **Lyza** » Thu Apr 12, 2007 12:29 pm

Pull the power cord out the back (near where the card is inserted) now HOLD down the top 2 arrow buttons while putting the power cord back in until you hear 2 beeps. That will get you into the setup menu... you can change all the settings you want in there...

When done fiddeling with the settings, to save the changes just hit the on/off button (middle button between the ramp and cflex button)

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sleepingBear · Post by **sleepingBear** » Thu Apr 12, 2007 1:20 pm

You can download all of their manuals from their website.

http://global.respironics.com/manualsandliterature.asp

Good luck

JeffH · Post by **JeffH** » Thu Apr 12, 2007 1:22 pm

[quote="Lyza"]Pull the power cord out the back (near where the card is inserted) now HOLD down the top 2 arrow buttons while putting the power cord back in until you hear 2 beeps. That will get you into the setup menu...

You will have to press the + key to get into the setup menu here.

you can change all the settings you want in there...

When done fiddeling with the settings, to save the changes just hit the on/off button (middle button between the ramp and cflex button)

Berniem · Post by **Berniem** » Thu Apr 12, 2007 1:59 pm

OK, I will try a reset tonight. What's the purpose of the ramp button if the machine seeks its own level anyway

Linda3032 · Post by **Linda3032** » Thu Apr 12, 2007 2:22 pm

sleepingBear wrote:You can download all of their manuals from their website.

http://global.respironics.com/manualsandliterature.asp

Good luck

Those are the User Guides, which don't include set-up info.

blarg · Post by **blarg** » Thu Apr 12, 2007 2:26 pm

Ramp lets you start at a lower pressure to fall asleep. For example, if your typical range was 12-16, you could set Ramp at 8 for 30 minutes or so, and then when you're falling asleep, you would start below your 12 and end up there after a half hour.

Most of us don't use ramp because you tend to get more leaks at higher pressures, and we find we end up re-waking up to adjust the mask as the ramp increases. Also, usually the ramp is set to 4 which makes people feel starved for air.

Try clicking on the yellow light bulb at the top and browsing around. There's a wealth of info there.

Linda3032 · Post by **Linda3032** » Thu Apr 12, 2007 2:27 pm

Bernie, here's another site that gives set-up info for the M Auto.

http://www.cpap-supply.com/Articles.asp?ID=130

SleepySandy · Post by **SleepySandy** » Thu Apr 12, 2007 2:31 pm

Hi Bernie

The ramp button will deliver a lower pressure and step you up to your minimum pressure. Since your minimum pressure is 4, the ramp button won't do anything for you. 4 is the absolute lowest pressure the machine can deliver at any time.

But, if your minimum pressure is higher - let's say 9 - then the ramp could be set to a lower value, maybe 6. If you hit the ramp button it will start you out at 6 and move you up to 9 over the ramp time (which can also be customized).

I agree with others about concern that 4 is too low. Most people, myself included, find 4 to be difficult to breathe with - it feels like you aren't getting enough air.

The machine you want to select for your profile is "M Series Auto C-Flex CPAP".

This is the link to your machine: http://remstarautomseries.respironics.com/

This is the link to the manual for your machine: http://global.respironics.com/UserGuide ... esAuto.pdf

You can buy the software to read the card if you want to see more about what's happening. But, you should know the software is "techincally" for doctors and DME's. Fortunately, we can still get it in a legitimate fashion. People here view the software as taking control of our own therapy. I completely agree and have the software - I even told my doctor I have it.

You can get the software here: https://www.cpap.com/productpage/respir ... -1.6i.html

You also need a specific card reader for the card. You can get it with the software as a bundle from cpap.com, but the card reader is really expensive: https://www.cpap.com/productpage-bundle ... undle.html

Others get the card reader from here: http://www.two-factor.com/shop/ It's a lot less expensive but the reader is coming from Hong Kong so it takes longer.

If you get the software there are lots of people here who can help you understand what you're seeing. Also, if you get it there's a key setting you need to change before you download your card - otherwise the data on the card will get deleted. You want to read the card but you don't want the data to be deleted - the doctor will still need to see it.

Berniem · Post by **Berniem** » Thu Apr 12, 2007 2:55 pm

Thanks for the info on the manual web sites. resetting the machine seems fairly simple. Learning how to do it on the last machine (a basic Remstar) made a lot of difference especially when I increase the setting from 4 to 8

Funny thing, Dr Sleep didn't like me messing around with the setting on my last machine. The other nite at the appointment she made a sarcastic remark about "My Web Buddies." giving me advice. I didn't appreciate that and told her so. I said that I feel as if I need to be my own advocate and needed to know and research as much as I can. If I can't get info from her I will get it on my own. The sleep tech who conducted the lab tests gave me her E-mail address in February, but never answers my e-mails. From what i can gather on this web site. that is not so uncommon.

The medicals tell you "Go forth and CPAP, for you are annointed with the machine. and Don't worry everyone has a hard time."

Yeah well, thank goodness for this web site. At least I know I'm not insane.

Bernie

Snoredog · Post by **Snoredog** » Thu Apr 12, 2007 2:58 pm

your doctor doesn't sound very experienced to me, could be why he had the Respironics Rep there to setup the machine.

Problem I see with this situation is your doctor is in cohoots with the equipment side and will be biased towards only making a profit.

But the good thing is he gave you a Autopap from the start, that is if they let you keep it.

I say inexperienced because they sent you off with a machine setup to start at 4cm. Just because that is the minimum setting on most autopaps it doesn't mean you should use it.

At 4cm pressure you will be most likely starving for air just to breath while you are trying to fall asleep. The air will most likely feel warm and humid like you are rebreathing in a bag. Then 4cm is usually not high enough to flush out the CO2 you exhale. A better starting pressure would be 5cm or 6cm at a mimimum. The 15cm range at the top is okay.

A better setup would have been:

=============Setup Mode===================
1. Hold down the (<-) (->) buttons while plugging in the power on the back,
wait for 2 beeps or 5 seconds, release buttons.
2. Press the (+) key to enter Setup.

Navigation:
- (<-) / (->) buttons move to next field
- (-) / (+) keys decrement/increment field values.
============Available Values===============
Check the following field(s):

-Therapy Mode=Auto (CPAP/Auto)

-Auto:Max=15 (default=20.0cm)

-Auto:Min=6 (default=4.0cm)

-CFlex Setting=2 (options are off, 1, 2 or 3)

-AutoRamp Time=30 (options are 05 to 45 min)

-AutoRamp Pressure=6.0cm (4cm->AutoMin)

-Mask Alert Feature=ON (On/Off)

-Auto Off Feature=Off (On/off)

-Split Night Time = Off (off, 120, 180, 240)

-Show AHI/Leak Feature=ON (On/Off)

Press On/Off button to exit.

==========Resetting LCD Display Data====================

To reset LCD Therapy data (does NOT erase any data from SmartCard):

1. Hold down the (<-) (->) buttons while plugging in the power on the back,
wait for 2 beeps or 5 seconds, release buttons.
2. Press the (->) key and navigate to Therapy screen.
3. Press and HOLD down the (-) minus key for 5 seconds, therapy data will reset to Zero.
4. Press the (->) key to scroll back to main menu, press (+) key to enter Setup or
On/Off button to exit.

With the above settings, you put on the mask machine should start automatically unless you are using a FF mask. Pressure will start at 6cm where it will then increase throughout the night as needed.

If you feel the pressure is increasing too rapidly (like when trying to fall asleep) you can press the Ramp button. This will immediately drop the pressure back down to 6cm for 30 minutes. You can press that button as many times as you like to reset the timer.

Once you fall asleep and timer expires it begins with autotitration.

Once you get used to therapy you can increase the Min even higher and still use the Ramp feature to drop back down below the Auto:min.

SleepySandy · Post by **SleepySandy** » Thu Apr 12, 2007 3:04 pm

Berniem wrote:Funny thing, Dr Sleep didn't like me messing around with the setting on my last machine.

Then she definitely won't like it if you get the software, which I didn't mention is called EncorePro. I think you should get it so you can really see what's going on. If she doesn't know how to set the machine will she really know what the EncorePro reports mean? Maybe. Maybe not.

Berniem wrote:"Go forth and CPAP, for you are annointed with the machine. and Don't worry everyone has a hard time."

Well put!

Mask

Additional Comments: Equipment isn't correct, S9 ASV w/H5i