Testing Remstar Auto Cflex with Comfortfull 2 Mask questions

[wdjensen123]

Hi there,

I have set the Remstar for AFLE mode (Automatic with C-flex level 1), 4 min, 12 max. Connected the mask, fit to face and ran a test.

Will air always leak out of the rows of tiny holes in the nose? The big hole is covered by the rubber flap valve. Exhaling only goes out through the little holes? Is the big flap of rubber valve just in case the machine goes off so you can still breathe?

When you exhale, does the warm CO2 rich air, pool in the mask a bit? On breathing in, there is some left when you first begin breathing in. Is this healthy and proper?

I simulated snoring for 2 minutes. The pressure reading never increased from the minimum of 4. How can I test to see if it automatically increases the pressure correctly?

I am a pseudo mouth breather. The mask now closes off what limited air flow I had through my nose due to slight pressure on the sides of my nose. The mask seems to fit well, maybe a very little bit leaky around the stubble of a beard on my chin, but very little.

Any thoughts? Thank you very much.

Sincerely,
Bill Jensen

[rested gal]

Hi Bill,

I have set the Remstar for AFLE mode (Automatic with C-flex level 1), 4 min, 12 max. Connected the mask, fit to face and ran a test.

I'd set the minimum pressure higher...4 would make me feel air-starved, especially using a full face mask...I'd want the minimum pressure to be at least 6, but if a minimum of 4 doesn't bother you, that's fine.

After experimenting with raising the lower pressure, some people find that they get smoother, more restful treatment with their autopap if they set the minimum pressure up fairly close to their prescribed single pressure, providing the prescribed single pressure is not uncomfortable.

Will air always leak out of the rows of tiny holes in the nose? The big hole is covered by the rubber flap valve. Exhaling only goes out through the little holes? Is the big flap of rubber valve just in case the machine goes off so you can still breathe?

Yes, to all those questions.

When you exhale, does the warm CO2 rich air, pool in the mask a bit? On breathing in, there is some left when you first begin breathing in. Is this healthy and proper?

A very small amount of CO2 may remain in the mask but most will be whisked out the exhaust vent, since air is blowing through the mask all the time, whether you're inhaling or exhaling. The lower the pressure used, possibly the slower the exhaled C02 would get vented out. If I'm not mistaken, there will always be a bit of "dead space" containing exhaled CO2 in any mask while being worn, no matter what...so that's normal.

I simulated snoring for 2 minutes. The pressure reading never increased from the minimum of 4. How can I test to see if it automatically increases the pressure correctly?

The machine probably sensed that your airflow was sufficient despite your simulating snoring. What I mean is, even with your simulated snoring you were probably breathing in and out enough air so that the machine sensed you were getting enough air...unlike what would happen if you were asleep and your air flow was more restricted. I don't know if the vibration of snoring alone would make that machine increase pressure. It might need to sense other things happening, like a certain amount of flow limitation before taking action.

Something else to consider...there is a settling time built in. I think that means the machine will disregard what's happening for x number of minutes (perhaps ten minutes or more?) when you first start it up each time. That's to allow for mask adjusting, oddities in breathing pattern while you're moving around in the bed to get comfy and "settling" down in general.

I am a pseudo mouth breather. The mask now closes off what limited air flow I had through my nose due to slight pressure on the sides of my nose.

That slight pressure on the sides of my nose (and I've got a small nose!) was one of the many things I disliked about the Respironics ComfortFull mask. It didn't close off my breathing through my nose, but I just did NOT like the feeling of the mask touching the sides of my nose even lightly. I used that mask for probably 5 or 6 months when I first got started on cpap.

When I finally switched to a ResMed Ultra Mirage FF mask, it was heaven, compared to the ComfortFull FF. The ResMed mask was roomier feeling inside -- didn't touch the sides of my nose and covered the mouth better when I'd let it relax open. The cushion was more comfortable on the Ultra Mirage, and was less leaky. Both were size "Small"...the ComfortFull was definitely small-er.

Bear in mind, though, I was using the original ComfortFull and you have a ComfortFull 2, so maybe the changes are an improvement.

The mask seems to fit well, maybe a very little bit leaky around the stubble of a beard on my chin, but very little.

If the ComfortFull 2 suits you and doesn't leak much, that's good. I like the Ultra Mirage FF and haven't tried the "2" in Respironics' FF mask. Each person's face is different, so whatever mask works for each of us is a "good one".

Sounds like you're well on your way to getting things dialed in to suit you. Good luck with your treatment!

[DME_Guy]

As always, excellent advice rested gal. The only thing I'd add is the Respironics machine won't raise pressure based on snoring. It only raises pressure based on flow. The Resmed auto machines do raise pressure based on snoring in addition to flow.

[rested gal]

The only thing I'd add is the Respironics machine won't raise pressure based on snoring.

Thanks, DME_Guy. Now that I think about it, it's a good thing if the REMstar Auto doesn't do that, given that mine kept chalking up lots of "snores" that weren't even happening.

My PB 420E auto rarely notes a "snore" from me (its Silverlining software calls it an acoustical vibration), so whatever the REMstar was sensing and marking as snores on my data were probably not real ones anyway. I did notice it was not bumping the pressure up for them, whereas my 420E does, on the rare occasions it senses one.

Interesting, the way the different autopaps go about their business.