Sleep Doc approved Auto, but recommends using Manual settin

[Midnight Son]

Per my previous posts I was prescribed a Remstar Pro 3/17 despite wanting the Auto w/ C-Flex. As the remedy was waiting to see the sleep doc 4/14 for a different prescription Rested Gal and others suggested proceeding with the Pro unit being supplied by the DME. I finally had my appointment Friday with the Sleep Doc.

We discussed extensively the auto unit versus manual and he ultimately gave me a prescription for the Remstar Auto w/ C-Flex. What he said about the auto units was:

1) The sleep doc team at Univ of Michigan do not have full confidence in the auto algorithms, specifically mentioned the occasional central apnea that may result in the auto unit trying to increase pressure to compensate and feel other events may trigger undersirable responses..

2) He indicated the titration study recommends the max pressure they determined to halt apneas and hypopneas. They believe it is best to have the machine set at this level all the time, provided the patient tolerates the therapy.

3) If the patient does not tolerate the manual setting, their next step (after eliminating headgear problems) is to lower the pressure setting slightly (1cfm at a time).

4) They do like, and recommend, the cflex exhalation relief. It helps most patients.

5) In the event the above treatments are not tolerated well they then will recommend looking at bi-pap or auto units (I believe in that order).

6) As my insurance (50% co-pay through DME) provides no real benefit (it is cheaper for me to purchase the machine at 100% cost versus 50% of rental at DME rates). I plan to go ahead and purchase the machine from CPAP.com at my full expense. He concurred that the multiple modes of the auto w/ cflex unit will provide a broad set of options. (ie Manual with and without Cflex, Auto with and without Cflex.) However, they recommended I use the auto machine in manual mode w/ clex to determine if the constant setting (9cfm) is tolerable, and only experiment with the auto settings if this is not tolerated.

As a hosehead with 3 weeks of experience I may have errors in my technical explanation, but that is what I understood of their comments. I post this as I know other new users are somewhat mystified by all the options and hope this helps in discussions with your sleep docs.

As always, the comments from experienced users on this forum have been the biggest help in sorting through OSA. Thanks for taking the time to help those of us less knowledgeable.

Midnight Son

ps. my remaining question is how long I would have to wait for an M series auto unit, versus proceeding next week with ordering the current auto a/ cflex.

[rested gal]

Very good job, midnight son, getting your doctor to go along with your request for an autopap.

And good idea buying your machine online. It will come with both manuals, user manual and "Home Care Provider Setup Instructions" (clinical manual.)

I've sent you a PM...so check your private messages.

[diddler]

Hi,

I saw in another topic (can't recall) that Rested Gal was thinking of getting the pressure hose for the pur ben ??e to use with the aussie heated hose. I corresponded by e-mail with sleep comfort in Aus (New Z?) before I bought my heated hose. Through a misunderstanding they thought I might be getting the puritan ben. soon and so they threw in the tubing along with my order at no charge. I still have it and if you want to follow up e-mail me at

hlwinter@charter.net

The heated hose works wonderfully.

Later