Is my Remstar Auto working right??

[snoozalot]

How can I tell if my unit is working properly? I have it set up as an "AFLE", which I assume means Auto with C-flex. I set my range from 5.5-8.5, as my initial titration was a 6.

I tried to tell if there was any difference in pressure while faking snores, holding my breath, etc, but it just felt the same all the time. Is there a concrete way to tell if the machine is doing it's job?

I ordered my reader, but it's not here yet. I guess the report would be helpful, but I'm not sure if that will prove that it is working properly.

Also, I turned my heated humidifier on last nite, but when I woke up this morning, the tank was still full, and the green lite was off. Why?

Thanks!

Bob

PS> I love my Aura Headrest! Thanks for all your suggestions. I would have never chosen it if it weren't for this forum.

Remstar Auto, Aura Headrest

[Guest]

Is there a concrete way to tell if the machine is doing it's job?

I ordered my reader, but it's not here yet. I guess the report would be helpful, but I'm not sure if that will prove that it is working properly.

Assuming you have the software and the smart card, once you get the card reader it will provide the concrete way to tell if the machine is doing its job and is working properly.

Don't know why your humidifier shut off unless you shut off your machine for any period of time which would automatically turn off the heat as well.

[rested gal]

I set my range from 5.5-8.5, as my initial titration was a 6.

I tried to tell if there was any difference in pressure while faking snores, holding my breath, etc, but it just felt the same all the time.

A range that narrow is going to feel pretty much the same to most people. Not saying it's a bad range - that's ok, although if it were me I'd set the high pressure at, say, 10 or 12.

But the real reason you were not feeling any difference while you experimented with trying to fake the machine out is that autopaps are not supposed to yo-yo up and down instantly with changes in your breathing. That would be disruptive to sleep.

You may also notice this in the future...waking up in the morning with the machine blowing your high pressure and wondering why the machine doesn't drop back instantly to the low pressure since YOU know you're awake, sitting up, and breathing normally. How come the machine doesn't realize there's nothing wrong with your breathing now? Why is it staying up on a higher pressure than you "need" after you wake up?

It can take several minutes for the machine to gradually work its way back down from a higher pressure to lower. That's the way it's supposed to be. Pausing for awhile after each downward step to see if things stay ok. Again, that's to keep from jumping pressure up and down abruptly. Smoother treatment.

Like "a watched pot never boils", it can seem to take forever for the pressure to take the slow steps downward if you're sitting there watching the dial.

You'll have a better idea of how the machine is handling things after you get some downloads.

Yes, AFLE means the machine will operate in Auto mode with C-Flex enabled.

Tank full and green light off...did you take the mask off at some point during the night? Perhaps to go to the bathroom?

If you had to turn the autopap machine back on when you came back to bed, you have to also turn the humidifier back on again. The REMstar's humidifier will turn off automatically when the machine is turned off, but will not turn back on automatically when you start the machine again.

[wading thru the muck!]

Tank full and green light off...did you take the mask off at some point during the night? Perhaps to go to the bathroom?

If you had to turn the autopap machine back on when you came back to bed, you have to also turn the humidifier back on again. The REMstar's humidifier will turn off automatically when the machine is turned off, but will not turn back on automatically when you start the machine again.

As RG points out, the operation of the HH can be a little tricky. I'll add that if you turn on the HH but don't put on the mask soon enough (or manually turn the machine on) the HH will go off. I wish you could configure the machine to turn the HH on/off with the machine. Maybe they have added that feature to the new "M" series machines (we can only hope).

[NightTrain]

Having just started to use an AUTO 3 nights ago and I understand your concerns snoozalot. On the first night I left the AUTO settings at Min 4cm Max 20cm with C-FLEX set at 1. I slept like a baby, felt pretty good in the morning too. Night two I raised the min to 6 cm and lowered the max to 16 cm, my prescribed max. Other than a couple of mask adjustments everything was cool. Last night on the other hand was a disaster.

By 3 a.m. I was convinced the machine was dying and was no longer reaching pressure above the lowest level. Holding my breath and trying to trick the machine did nothing to raise the levels as you had said. I too am awaiting a smart card reader in the mail, the software is set up and ready to read what's happening. RestedGal has a good point in waiting to see what the smart card has to say. I also plan on taking the advice to jack up the min pressure and tighten it up with the 16 max. I'll try 9 and see how it goes. For the most part it was the low pressure I found annoying and anticipated the rise in levels that never came. I'm sure in sound sleep the REMstar Auto was working like a charm! Good luck!

[snoozalot]

Sounds like you are having the same experience as me, Nighttrain. I guess it's best that the Remstar doesn't react too quickly, or it would be very disturbing, but geeez, I held my breath for over a minute, and nothing changed! We'll see what the software says when I get my card reader.

Bob

[Roger...]

I use this machine and have found that unless there are no large leaks, the logic in the machine will not allow it to get above the low range value.

When the machine decides it has a large leak, it also stops recording AHI information during the period of the large leak. Unfortunately, I've developed way too much experience with large leaks and wish things worked differently, but they just don't. So, if you are finding the machine isn't getting up to the pressure level you want, consider looking for leaks or just raise the lower end of the range to to the minimum pressure you want. However, if you don't have the software to read the cards yet it would be best to wait until you see the data before drawing any conclusions because the change in pressure is hard to detect without a manometer connected to a chamber where the leak rate is controlled.

When I started with this machine I tried working with a large range thinking that the machine would zero in on the best pressure. Well, that belief has been shattered because there are so many things that can affect the machines logic that it just doesn't work as well I had hoped when the logic has to span a large pressure range. Instead, keep the range narrow and you find that you'll get better rest and will soon not think about whether the machine is working once you get within your need pressure range. To understand this last sentence you'll find Derek's MyEncore software ideal for helping you deal with pressure settings.

Back to pressure or a moment: One of the reasons the machine doesn't work well over a large range is because the logic is biased towards the low side and it needs a pattern of events within a set time frame to raise its pressure. I've posted the logic diagram in another thread on this forum as well as some massive leak graphs that I'll surface if there is any interest.

Let me know if you'd like more information and I'll go digging under my name for the post that might be relevant to this thread.

[NightTrain]

Thanks Roger. This is the info I needed to hear. If finding and posting your previous links wouldn't be to much trouble, they'd be very much appreciated. I save all the useful links I have been finding in this great forum to a Word file for later reference. The knowledge gained in this forum is a great motivator!

Snoozalot... I did some tweaking with good results. Setting the Min cm to 10 (prescribed at 16cm) worked out great for a quick nap with the C-FLEX set to 2. The level was unchanged when I jumped up a half hour later. The reply from Roger is making alot of sense. Hopefully I'll find that card reader in the mailbox tomorrow. Keep us posted, I'll do the same.

[Wulfman]

Snoozalot and NightTrain,

Are you using the RAMP feature in your machines? It seems to me that I read that you need to disable the ramp feature if you're using the machine in "auto" or AFLE mode because the machine won't reach your specificied pressure range.

The following is from a post from rested gal from last July on this subject:

Set the ramp for zero when using the REMstar Autopap in autopap mode (APAP) or autopap with C-Flex mode (AFLE). Never, never, never set ramp for any time other than 0 in those two modes unless you just want to do a split night out of curiosity. Been there, done that, deliberately...heheh. The data for that night was not pretty. Shocked

Here's what it says about that, word for word, from the Home Health Care Provider's Set-up Instructions booklet:
_____________________________

Set the Ramp Time
f. The ramp time will appear

Range: 0 to 45 minutes (5 minute increments) for CPAP or C-Flex.

Settings of 2, 3, or 4 hours are also available, but they are only available if the device is in Auto-CPAP or Auto-CPAP with C-Flex therapy for the Split Night therapy.

Note:
For Auto-CPAP or Auto C-Flex therapy, set the time to "0".

For CPAP or C-Flex therapy, if prescribed, set a ramp time between 5 and 45 minutes. If you do not want ramp, set the time to "0".

For Split Night therapy, set a time of 2:00, 3:00, or 4:00 hours.

To change the ramp time, press the ramp or humidifier button until the correct time appears. If you do not want ramp, set the time to "0".

Press the right user button to go to the next setting.

Best wishes,

Den

[NightTrain]

Thanks Den, I have the ramp feature set to off. Increasing the Min to 10cm and keeping the max in the tight range you previously suggested to 16.5 really did the trick for me last evening. I slept straight through the night and even remember having a dream or two. Feeling pretty good today! The card reader should be in the mailbox today, I can't wait to see last nights stats!

Thanks much!
Todd

[WillSucceed]

Roger... wrote:

One of the reasons the machine doesn't work well over a large range is because the logic is biased towards the low side and it needs a pattern of events within a set time frame to raise its pressure.

Interesting comment. When I trialed 3 different autopap machines before I made a purchase, I programmed them all for the same range. The PB 420E and the ResMed Spirit both gave good treatment and I felt well rested during the day. The RemStar Auto left me feeling tired during the day. When I compared the data from the software analysis for these 3 different machines, the PB and Spirit delivered slightly higher pressures relative to the events that were occuring during my sleep. The RemStar also responded to events, but the pressures were slightly lower than the other two machines. So, it seems to me that the RemStar Auto "logic" (algorithm), while right for many users, is just not right for me.

I THINK that what this points out is that the algorithms running the machines are different and, while all of the machines are good, any individual patient might do better with some machines than others.

Many posters on this forum make comments that one auto machine is better, or worse, than the others; while this may be true for that particular poster, (in my case, the RemStar is just not the right machine for me) patients new to autopap should, if at all possible, trial all of the different machines before they make a decision as this is the ONLY way that one can be assured that the auto machine that they are buying is the right one for their particular OSA.

Posters on this forum offer their opinions in good faith, based on their personal experience and, while this is well-meant, it is of limited value as the response that any individual patient will have to any machine is completely determined by the machine's ability to "read" that individual during sleep. Just because the autopap does a good job for one (or more) posters, it does not mean it will do a good job for someone else.

So, yell, scream, stamp your foot, cough up some cash out of pocket for rental, do whatever you have to do to trial as many auto machines as possible before you commit to any one machine.

[rested gal]

cough up some cash out of pocket for rental, do whatever you have to do to trial as many auto machines as possible before you commit to any one machine.

Good advice, Will. Here's a link that might help people try out machines:

click "Rental Information" on the far right under "Information"

[Roger...]

I THINK that what this points out is that the algorithms running the machines are different and, while all of the machines are good, any individual patient might do better with some machines than others.

[SNIP]

So, yell, scream, stamp your foot, cough up some cash out of pocket for rental, do whatever you have to do to trial as many auto machines as possible before you commit to any one machine.

Hello WillSucceed,
Your posting is so on target is should be made a sticky at the top of the forum for newbies who are wondering into this arena.

In retrospect, if I had known then what I know now I would have tried to rent a series of machines on the front end and purchased the software so I could view the night's titration feedback. For certain when it comes time to get a new machine that will be my approach so I don't get distracted by the current trends.

Thanks Roger. This is the info I needed to hear. If finding and posting your previous links wouldn't be to much trouble, they'd be very much appreciated. I save all the useful links I have been finding in this great forum to a Word file for later reference. The knowledge gained in this forum is a great motivator!

Hello NightTrain,
I gave the Search function a quick poke and I think the following will get you what you need:

Sleep Doctor Refuses to Allow APAP
viewtopic.php?t=5817&highlight=

I recommend the entire message be read so a perspective will surface about how this disucssion evolved. However, if you just want what I said, then the following with guide you.

Page-1 - 12th Message Down:
My perspective on the value of an APAP vs a CPAP

Page-2 - 4th Message Down:
My discription of how I understand the Resprironics Patent Logic
In this message are two image references. The first shows what a large leak looks like in Encore. Second Image is a graphic that highlights the logics requirements and actions.

Page-2 - 6th Message Down:
Some information about my large leak experiences and mask designed leak rate.

Page-2 - 11th Message Down:
Information about why a mask must have an adequate leak rate design

Page-3 - 4th Message Down:
More information on leak large rates with two Encore charts and a graph showing the designed leak rate of the Ultra Mirage Full Face mask.

Page-3 - 6th Message Down:
More information about my large leak experience and an Encore chart showing what a good night can look like even though the report shown is a failing grade.


"Getting Hosed", Day-5, A Data View
viewtopic.php?p=48999
This entire message is a discussion that highlights my experience in dealing with the process of dialing in my APAP. There are other pages where I talk about other aspect of the data and my experience with it that can be found by just entering my name: "Roger..." in this forum's Author's Search field.

Let me know if there are any questions.
Roger...

[Snoredog]

I agree with RG, your not going to gain much from the autopap/cflex modes due to your pressure requirement. While pressure has no bearing whatsoever on how severe your condition is, I'd be concerned using those modes do to starvation of air to breathe normally.

Since 6cm is so easy to breathe against you really don't need these modes enabled. If your awakening finding the machine to be off, then you need to disable any auto-start or auto off modes, especially if your using a FF mask. This feature causes problems with FF masks that have a anti-asphyxia valve. On a Resmed machine SmartStart is disabled when a FF mask is selected on the machine for this reason.

So if you want to use the auto mode to see if your pressure requirements are actually not higher or to prevent snores, I would set the machine to the following:

Set the mode to auto or afle
Set the low ramp pressure to 6cm (your titration pressure).
Set the high ramp pressure to like 10cm.
Set any timer value to 00:00 (only used as ramp timer in cpap mode or split-night mode, should be zero for auto modes)

Your new range would be 6cm to 10cm. If your 6cm titration wasn't botched you should sleep well, if you didn't hit REM long enough to obtain a good titration then the machine can adjust up as needed. You'll need the reports to find that information out. Sorry, but you won't be able to fake the machine out, we've all tried it at some point, the algorithm is simply to complex and long to successfully do that. Even for snore the machine stores the pattern in memory while also looking at your breathing volume.

Note: if you use any Cflex setting with the above, keep in mind it will drop pressure by said amount even though it does so dynamically, if you set it to 2 for example you'll be dropping to 4cm on exhale which may cause you to feel congested, cause headaches or starve for air. If your going to use the cflex feature say at 2, then I would increase the low pressure even higher than the titrated pressure to 8cm.

The autopap is a good machine to have for the long run, ideal to determine if your titration was correct, but if said pressure is low (like under 8cm) then I would just set the bottom/low pressure to the titrated value, then give your ceiling some room to work if needed to eliminate snores, compensate for leaks etc.

[NightTrain]

Good stuff Roger. Thank you! Haven't received the card reader yet, so not much to report. However, tightening up the range on the AUTO has made a HUGE difference. No problems sleeping the past two nights. It's nice having a happy, rested wife again!