Why have a smartcard and software?

Robin_ · Post by **Robin_** » Fri Mar 28, 2008 6:55 pm

Been using a Respironics M Plus for 6 months now. I'm enjoying the snore-free sleep and restful nights. I'm sold on using a CPAP machine. I now have an opportunity to get a new machine so I'm wondering about the benefits of upgrading to a "Pro" machine with a smart card. So I'd like to educate myself on what the advantages are of having a machine with a smart card and getting the software to read it.

Can some members who use the software please tell me how it benefits them? ...or point me to a link to read, or maybe some threads on this forum, that discuss the advantages of having a the software and how CPAP users benefit from if?

Thanks
Robin

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, CPAP, Smart Card

RipVW · Post by **RipVW** » Fri Mar 28, 2008 7:16 pm

The smartcard, card reader, and software enable you to track the results of your CPAP therapy, to see exactly what's going on while you sleep. This data is necessary if one really wants to be sure they are getting optimal results. I'd say that all of the "old timers" on this forum will highly recommend that CPAP'ers use data capable machines to track their therapy.

"You are getting sleepy . . ."

Robin_ · Post by **Robin_** » Fri Mar 28, 2008 7:33 pm

RipVW,

Thanks. That makes sense. But I guess, what I'm really asking is how do I educate myself to achieve the desired benefits from the card and software? For example, where would I go to learn about the things that seem to be "taken for granted" by most of the experienced users here. Things like....

What is an AHI?
What are "events" and how do you control them?
What are the expected effects of varying the EPAP and IPAP?
How does pressure settings effect leak rate (which seems to me to be more a function of how well the mask fits)
What do terms like "titrater pressure" and "sup pressure" mean?

In short.... How do I learn about this stuff?

Robin

RipVW · Post by **RipVW** » Fri Mar 28, 2008 8:25 pm

Robin, I'd suggest that you begin by clicking the Yellow Lightbulb at the top of the forum--you'll find so much info there. And, as you learn and have more questions, the authorities here will answer any questions you have. RestedGal is our "Queen," and she really cares about all forum members, will help you as she does everyone. There is much to learn, and it takes time, but if you'll take it a step at a time, it will all come together and make sense. By the way, I knew NONE of this when I discovered this forum last October. I've learned so much here, and I continue to learn more everyday.

Here are a few of the definitions and terms (from viewtopic.php?t=22969&view=next&sid=0d6 ... 2008bea7ee)

DEFINITIONS:
APNEA = cessation of airflow for 10 seconds or greater.
HYPOPNEA =>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.
APNEA/HYPOPNEA INDEX (AHI) = apnea plus (+) HYPOPNEA/hour of sleep.
RESPIRATORY AROUSAL INDEX (RAI) = AHI +snoring related EEG arousals/hour of sleep.
AHI/RAI** Scale =<5 events /hour = (none); 5-15 events/hour = (mild); 15-30 events/hour = (moderate); >30 events/hour = (severe).
Respiratory related sleep fragmentation: Sleep arousals due to respiratory events or snoring.
Desaturation = Drop in O2 oximetry distribution saturation by 3% below average saturation.
SaO2 scale: >89%=(none); 85-89%=(mild);80-84%=(moderate); <80% (severe).
EPWORTH SLEEPINESS SCALE =<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).
RESPIRATORY EFFORT RELATED AROUSALS (RERAs)=Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.
StageIII and StageIV are combined and referred to as Deep Sleep.
Sleep Efficiency = Normal is >80%
As established by AASM/ABSM 1999.

Normal Sleep Architecture:
Stage1: 5%
Stage2: 50%
Stage3: 10%
Stage4: 10%
Stage REM: 25%

Goofproof · Post by **Goofproof** » Fri Mar 28, 2008 9:05 pm

Robin_ wrote:RipVW,
What are the expected effects of varying the EPAP and IPAP?

The Pro you are planning to get is a CPAP, only Bi-PAP has EPAP and IPAP.

The software is like giving you a car with a steering wheel, right now you are steering your treatment by dragging a stick on the road. If treatment like you have is all you want, a stick may get you there, I want power steering. Jim

And a V-8!
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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, Power

GumbyCT · Post by **GumbyCT** » Fri Mar 28, 2008 9:26 pm

To add to what Rip said - get comfy, put on your reading glasses then -

Start at the Yellow Lite bulb - Our Collective Wisdom
viewtopic/t14303/New-To-CPAPtalkcom-Cli ... tbulb.html
cpaptalk-articles.php

READ cpaptalk.com FAQ
cpaptalk-faq.php

For Acronyms & Definitions
http://www.sleepnet.com/definition.html

Oh learn do a search - there is a button on the top of the page and also a way to use Google.

Good Luck,
GumbyCT

Robin_ · Post by **Robin_** » Fri Mar 28, 2008 10:01 pm

Thanks Gumby and Rip. Those are good links to get me started. The definitions offered by RipVW already put a few things into perspective. I appreciate the detailed reply.

Also found some useful information on the Resperonics web site. And of course there's ALWAYS Google.

The Pro you are planning to get is a CPAP, only Bi-PAP has EPAP and IPAP.

OK, that makes sense. But my understanding (I could be wrong) is that the new M series (the Plus and the Pro) CPAP machines already have auto alogorithm fetures with C-Flex available. But you can also get a Pro machine with A-flex. I believe A-flex is available on a CPAP machine (as opposed to a Bi-PAP machine). Is that true? And what are the advantage to A-flex?

Robin

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

Goofproof · Post by **Goofproof** » Sat Mar 29, 2008 12:24 am

Robin_ wrote: But my understanding (I could be wrong) is that the new M series (the Plus and the Pro) CPAP machines already have auto alogorithm fetures with C-Flex available. But you can also get a Pro machine with A-flex. I believe A-flex is available on a CPAP machine (as opposed to a Bi-PAP machine). Is that true? And what are the advantage to A-flex?

Robin

The plus and pro are CPAPs, no auto, auto adjusts your pressure as needed, CPAPs blow at one pressure.

Cflex and Aflex are exhale relief based on exhale rates.

Bi-PAPs have two pressures one inhale and one exhale, and those are adjustable. Jim

rested gal · Post by **rested gal** » Sat Mar 29, 2008 12:29 am

Robin_ wrote:But my understanding (I could be wrong) is that the new M series (the Plus and the Pro) CPAP machines already have auto alogorithm fetures with C-Flex available. But you can also get a Pro machine with A-flex. I believe A-flex is available on a CPAP machine (as opposed to a Bi-PAP machine). Is that true? And what are the advantage to A-flex?

Robin

Robin, I sure can sympathize with your confusion! I still remember so well, five years back when I was trying to figure out what I needed and was digging into an apnea message board, my confusion about what the words meant, what machines did what... WHAT should I get???

When we use the word "auto" we are usually referring to an "autopap" which is a machine that can be set for a range of pressures, like 4 - 20 or anything in-between, like 7 - 15. An autopap will vary a single pressure throughout the night, based on what it senses we need from feedback it gets about our breathing...our "air flow." We might need a pressure of 7 or 8 most of the night, but need 10 or 12 or 15 some of the night. An autopap will raise and lower the pressure, as needed.

The M series Plus and Pro CPAP machines are not autopaps, so I don't think I'd use the word "auto" about them. Nor would I speak of "auto algorithms" in regard to those two machines. They are straight "cpap" machines that can blow only one straight pressure all night.

C-flex is a feature, not a type of machine. C-flex has nothing to do with making a machine be an "auto." If C-flex is turned on, C-flex simply drops the pressure somewhat (a vague drop depending on how forcefully a person happens to exhale) when a person STARTS to exhale. It's a pressure relief feature to make it easier to start breathing out each time.

C-Flex doesn't drop the pressure in exact cm's. In other words, setting C-flex at "1" does not mean the pressure will drop 1 cm when a person breathes out. And "3" doesn't mean the pressure will drop by 3 cms.

A-Flex doesn't come in a "Pro" machine. A-Flex is a kind of exhalation pressure relief that comes in only one machine...the Respironics REMstar Auto with A-flex M series machine.

A-Flex not only drops the pressure at the beginning of each exhale (like C-flex does) but it also smooths out the pressure transition between our exhaling and then inhaling again. Rounds out the transition instead of giving an abrupt change. To me, as nice as C-Flex can be, A-Flex feels smoother. A-Flex feels much more like "natural" breathing and is even more comfortable to exhale with.

To confuse matters further, the Auto with A-Flex actually has both C-flex and A-flex in it. You can't use both at the same time, but when operating that machine in "auto" mode, you can choose to use either C-Flex or A-Flex. Or you can choose to use no "Flex" at all.

Robin_ wrote:I believe A-flex is available on a CPAP machine (as opposed to a Bi-PAP machine). Is that true?

Well, yes and no.

The "yes" is, yes, you're right that A-Flex is not in any BiPAP machine. BiPAPs can have "Bi-Flex" which is very similar to the "A-Flex" in that one autopap I mentioned.

The "no" is if, when you use the word "CPAP" you're talking about a plain CPAP machine that blows one straight pressure and cannot "auto-titrate." Because A-Flex is in only one particular "autopap" machine -- the Respironics REMstar Auto with A-Flex M series machine.

But, here comes a confusing extra "yes"...LOL. Technically, officially, and according to Medicare and insurance companies, an "autopap" really is a "CPAP" machine. It's a CPAP machine that can "auto-titrate."

Like a plain CPAP, an autopap blows just one pressure. The difference is that a plain CPAP can't change that one pressure it is set to blow all night. An "autotitrating CPAP" machine (an autopap) can be set for a range of pressures and can automatically change the pressure...automatically varying the "single" pressure to another "single" pressure, to another, etc., throughout the night.

But I think you, like most of us, mean "plain, simple, one single pressure all night" when we say "CPAP" machine. That puts me back to "no"... A-Flex is not in a plain, simple CPAP that can only be set one way...to blow one pressure all night. A simple CPAP can have C-Flex, but not A-Flex.

All those "Flex" words are Respironics' trademark names for features found only in their machines.

ozij · Post by **ozij** » Sat Mar 29, 2008 12:31 am

Jim, you're still in Tank mode... The M-series Pro is data capable.... it was ony the Tank Pro that wasn't....

http://remstarpromseries.respironics.com/

REMstar® Pro M Series with C-Flex
Encore® Pro SmartCard® capability for enhanced compliance reporting of apnea/hypopnea index, elevated leak levels and snoring

Respironcs explains it various Flex modes here:

http://sleepapnea.respironics.com/technology/

http://flexfamily.respironics.com

O.

Robin_ · Post by **Robin_** » Sat Mar 29, 2008 2:49 pm

Thanks for the answers, everyone. Especially Rested Gal, who went in to so much detail. With this base of information, I should be able to "go digging" and learn the things I need to know. I can see that I won't really know how to take advantage of a data capable machine until a get a good grasp on these basics, plus a deeper understanding about the physiological benefits of the basic CPAP machine, itself.