Puritan Bennett machines and software

RosemaryB · Post by **RosemaryB** » Sat Aug 18, 2007 8:48 pm

When I was getting my autopap, I had the choice narrowed down to a Puritan-Bennett 420E and a Remstar Classic auto with cflex. I liked the features of both machines. At the time I bought, both had software for the patient with the company's blessing.

I ruled out ResMed because I didn't like their software policy. I thought that if they didn't care enough about my health to make it easy to buy their software, I'd just pass on them.

It was a close, difficult choice. I loved the idea of PB as a travel machine. The software of the PB machine gave superior data (more indepth information). I liked the idea of the machine not needing a card and card reader. It was also more "battery ready." There were no software glitches.

The Remstar Classic Auto, the one I chose, had a couple of advantages. First, it had CFlex, which I didn't understand, but some people seemed to like. The classic Remstar (as opposed to the M series) was sturdy and had a good humidifier.

CFlex was the deciding factor for me. However, as it turns out, CFlex doesn't work well for me at all. For me it causes MORE aerophagia. I have a relatively low pressure setting at 8.5, so I don't really need it to help with breathing against a high pressure.

So, today, if I was choosing, there would be no doubt in my mind that the PB would be the machine of choice for me. Since I don't like CFlex, and the PB machine's software yields more sophisticated data. No card to forget to put back into the machine. Better travel machine, more battery adaptable, and I also like the company better, since they are more patient-friendly.

You rarely hear about the people who don't need or even dislike CFlex or EPR. I suspect that there are many of them out there. If a person is at a low pressure, they rarely would need cflex. Feel free to correct me if I'm wrong on this, members.

The MSeries is not as good a travel machine because of the ungainly power block. I own an M-series but only because I got a very good deal on a practically new one. Plus I got my original machine and software before the ban. So, I'd already invested in the software.

In choosing a backup machine to go with the PB, I'd buy a classic Remstar, lightly used if possible. This would be at a very reasonable cost. It would not matter if this machine was a Plus and didn't have a humidifier, it would be mainly for backup, not data. I'd get an HP 150 humidifier which is superior to any of the attached humidifier and use it with both the PB and Remstar at home. I'd only use the built in PB humidifier for travel.

I haven't seen any discussion of this machine for quite some time. For those who are considering a machine and want data capability, this might be an option. Particularly at the lower pressures or if you know you don't like or need pressure relief.

Call me old-fashioned, but I appreciate a company that does right by me.

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CPAPopedia Keywords Contained In This Post (Click For Definition): 420E, resmed, humidifier, cflex, Power, auto, Travel, aerophagia

Perchancetodream · Post by **Perchancetodream** » Sat Aug 18, 2007 8:57 pm

Thanks, Rose. I just posted a question about the PB software on another thread.

Did I read you correctly that the PB gives more complete data than the REMstar classic? Does this differ from data of the REMstar Pro or M-Series?

I haven't made a final decision, but am leaning towards the REMstar. The most important "extra" for me is the data that is available.

Thanks for your help,
Susan

RosemaryB · Post by **RosemaryB** » Sat Aug 18, 2007 9:26 pm

Perchancetodream wrote:Thanks, Rose. I just posted a question about the PB software on another thread.

Did I read you correctly that the PB gives more complete data than the REMstar classic? Does this differ from data of the REMstar Pro or M-Series?

I haven't made a final decision, but am leaning towards the REMstar. The most important "extra" for me is the data that is available.

Thanks for your help,
Susan

Here's an example of the silverlining software
http://www.flickr.com/photo_zoom.gne?id ... 725&size=o

http://www.flickr.com/photo_zoom.gne?id ... eam&size=o

http://www.flickr.com/photo_zoom.gne?id ... eam&size=o

Here's a thread where I asked about the three choices of software before I got my first machine

viewtopic.php?t=19088&highlight=silverlining+software

The MSeries Pro and Remstar Classic Pro would be the same software as those from the same lines in Auto. The difference between the Auto and Pro readouts would be that only one pressure would show up in the pro machines, plus in the autos you would see the flow limitations. As far as I can remember, those are the differences.

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CPAPopedia Keywords Contained In This Post (Click For Definition): auto

WillSucceed · Post by **WillSucceed** » Sat Aug 18, 2007 10:09 pm

Rosemary B:
For years now, I've been astonished by all the bark and woof on this forum about the "wonders of C-FLEX." I've always thought that it was colossal waste of money and still do.

This forum, however, is very Respironics friendly -I suspect that the old adage of 'misery loves company' is true in that despite all the complaining I read regarding problems with Respironics smart cards and leaking humidifiers, users of Respironics machines (with C-FLEX, of course -still have not figured out why this is mentioned EVERY time... after all, C-FLEX, or A-FLEX are on all of their machines) still seem duty-bound to advise new users to "get a Respironics with C-FLEX." A bit of the I-did-it-so-should-you phenomenon.

Unfortunately, people end up buying the machine, without trialing the other machines and then find that they coughed up their cash for C-FLEX and are not happy with it. I really wish more posters on this forum could think broadly enough to always suggest that new users do whatever they have to do to be able to trial as many different machines as possible. Even if it costs them a bit of money up front, it is well worth it, especially when considering purchase of an APAP.

The jackals will be yapping at me for this posting but, who cares? I'm with you... C-FLEX is not heaven-sent and really should be tried before being purchased. Sure, it works for some, perhaps even many, but NOT for everyone.

RosemaryB · Post by **RosemaryB** » Sat Aug 18, 2007 10:20 pm

Hello Will,

I do think C-Flex and/or A-Flex is great for some. If it helped my aerophagia, I'd be thrilled! But it really seems to make it worse. No ramp for me, either! But I lent my auto to a friend who had a bare bones machine so he could see his data and forgot to set the ramp and it blew him away. I can see how someone who had problems solved by any of these things would be giving glowing info about it.

I did read your suggestion when I was getting my machine and it seemed like a really great idea, but given my very demanding work schedule, my tired state, and how difficult it was to find a DME, it was all I could manage to get an auto of any kind.

If you or anyone else knows how to pull this off (try before you buy), I'd love to suggest it in posts to newcomers. Since I first read it, I've been impressed by this idea. But no DME near me had machines I could try of different brands and with different features.

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

TXKajun · Post by **TXKajun** » Sat Aug 18, 2007 10:27 pm

Hmmmm, this is a topic I've been considering commenting on for a long time now. Yeah, Ive got a PB 420E and the Silverlining software and absolutely love the combinationit! Ii'm at a kind of high pressure..14 cm.and find no problem exhaling or with aerophagia. I start with a ramp of 20 minutes from 9 cm. I used my APAP in apap mode for about 2 years but thought that I wasn't feeling as good as I should, so I switched over to CPAP mode and wow! The last several months have been fantastic. The big advantage is that I was prescribed at 16 cm and found, using the APAP mode and the SL software, that 14 cm was just fine.

I read every day (well, every day that I come online) about how wonderful Cflex, Aflex, XYZflex and Respironics are. Then I see that the software is almost impossible to get now, then you have to get a separate card reader, then you have to jigger with the installation, someone has written a better version of it that they offer as a free enhancement, etc and I literally thank God that I was smart enough ( or lucky enough! LOL) to get my PB bundle, of course purchased from our hosts here, at a fabulous bundled price. Another plus is that the PB, like mentioned earlier, is battery-ready with the purchase of a couple of cables. And I realy like the the auto adjusting for altitude, especially since I do a lot of travelling all the way from home at 3,300" to sea level to 6,000' and don't notice any difference.

I don't necessarily think it's a case of "misery loves company" here, though. Lots of folks seem to be getting great therapy with their Respironics machines. I do agree, thought, that trying out various machines would be an excellent idea. As for me, well, I think I'm gonna shut up now! LOL

Kajun

Perchancetodream · Post by **Perchancetodream** » Sat Aug 18, 2007 10:36 pm

The tech at the sleep center (which also is a DME) did not appear to think too highly of the C-flex feature, saying that it reduced pressure on the exhale, but only by a small amount. I guess the implication was that if you needed pressure reduction on exhale a bipap machine would be the way to go.(?)

I asked my doctor to prescribe an autopap if the pressure allowed it (via telephone discussion with his nurse). Do any of the non auto CPAPs from PB include the software?

Rosemary, thanks for the link to the information that silverlining gives. Fascinating! And to think that someday I will know what it all means!

Thanks,
Susan

RosemaryB · Post by **RosemaryB** » Sun Aug 19, 2007 9:03 am

[quote="Perchancetodream"]The tech at the sleep center (which also is a DME) did not appear to think too highly of the C-flex feature, saying that it reduced pressure on the exhale, but only by a small amount. I guess the implication was that if you needed pressure reduction on exhale a bipap machine would be the way to go.(?)

I asked my doctor to prescribe an autopap if the pressure allowed it (via telephone discussion with his nurse). Do any of the non auto CPAPs from PB include the software?

Rosemary, thanks for the link to the information that silverlining gives. Fascinating! And to think that someday I will know what it all means!

Thanks,
Susan

tillymarigold · Post by **tillymarigold** » Sun Aug 19, 2007 9:49 am

I have UARS and the PB 420E works great for me, for the reasons mentioned above.

I'm not sure what your problem is with the PB humidifier? I live in the desert and the build-in humidifier works perfectly well for me. I mean, it would be nice if they operated together the way Respironics does with their machines, but I'm assuming that a different mfr's humidifier wouldn't solve the problem.

Silverlining's main problem is that it was originally written in French and the translation to English (both the translation of the manual and the localization of the software) is horrible. When it's easier for me to read the French manual than the English one, despite having studied French for only a year ten years ago, you know something's wrong.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, humidifier

ozij · Post by **ozij** » Sun Aug 19, 2007 10:57 am

Thanks Rosemary....
It often gets lonely out there, with all those Respironics machines and recommendations....

I"m doing fine with my PB420E, and get lots of important info from the software. That details graph is wonderful!.

And the ability to track leaks by the minute is tops: One of the things I learned is that pressure blowing out of my mouth - which happens when I don't feel like taping - feels terrible, and wakes me up, but the leak is usually not above the maximum pressure level - its' not like a mask leak.

However I miss getting info about time spent in apnea. Suppose I have the same no. of apneas at 7 and at 8 - but, the apneas are resolved much faster at 8. I wouldn't know that on SL3.

And ditto for number of events at pressure.

O.

6PtStar · Post by **6PtStar** » Sun Aug 19, 2007 11:16 am

I'm sorry folks but I have cut my C-Flex off and it is a LOT harder for me to sleep without it. I don't ramp so maybe if I did I could get buy with out C-Flex but why. My DME pushes the PB machines but my sleep study specified C-Flex or EPR and they were not happy about it. As I said it works for me. I really dont understand if the technology is available why it is a feature on all machines that way if you need it, you turn it on, if you don't need it you turn it off.

Yea, I am PO'D abvout the attitude of the Big R's but not enough to loose sleep ovcer.

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

ozij · Post by **ozij** » Sun Aug 19, 2007 11:26 am

6PtStar wrote: I really dont understand if the technology is available why it is a feature on all machines that way if you need it, you turn it on, if you don't need it you turn it off.

C-Flex and A-Flex are Respironics patents, EPR is a Resmed patent - the technology is not "available" for all machines.

By the way, what is your pressure, 6P?

O.

6PtStar · Post by **6PtStar** » Sun Aug 19, 2007 1:44 pm

Not that high but still noticable. 10 cm/h2o. Why is it not like ramping. They all have that feature. I'm sorry I guess I don't understand. Sorry but without it it makes it harder for many patients.

ozij · Post by **ozij** » Sun Aug 19, 2007 2:45 pm

6PtStar wrote:Not that high but still noticable. 10 cm/h2o. Why is it not like ramping. They all have that feature. I'm sorry I guess I don't understand. Sorry but without it it makes it harder for many patients.

Higher pressures make exhalation harder for some people - and pressure relief makes it easier for them. There's no argument about that - and if C-Flex helps you that is a reason to use it.

I don't know enough about the technology to say why ramping is not proprietary, and the exhalation relief technologies are. Maybe rampling is simpler because ramping only depends on a timer, whereas exhalation pressure relief means the machine has to identify and the change in your breathing from exhale to inhale and then react to ti. So it needs sensors so sense the change and software to identify it and give a "Ok, now lower pressure" command to the motor.

O.

scottbla · Post by **scottbla** » Sun Aug 19, 2007 5:19 pm

I was just wondering...are there any decent references one could use to understand what the software says? For example, with my PB 420E & Silverlining software, I see things labeled like this (under the "last 96 hours record"):

Code: Select all

                          Number      Index/h
                  Apneas:   13           0.1
 Apneas w/Cardiac oscill:   29           0.3
               Hypopneas:  103           1.1
   FlowLimited Hypopneas:   61           0.6
   Acoustical Vibrations:   27           0.3
  FlowLimitations - runs: 3267          34.3

   Cycle states
Flow Limited cycle: 22%   Invalid cycle: 0%
      Normal cycle: 66%   Intermed cycle: 12%

And I'm trying to figure out what "good" is, etc. I think that the apnea count looks good(?). I have no idea what that "FlowLimitations - runs" number means.

And "leaks" is generally in the 0.2 to 0.4 "l/s" range...I don't know what that could be measuring or if that range is good. I've currently got a Twilight NP mask and it fits the best of any mask I've ever had.

Anyways - any references to help explain things would be appreciated!

Thanx!