Hello! Noob question-any advice appreciated (self titrating)

apapnoob · Post by **apapnoob** » Sat Apr 27, 2013 1:00 am

Hi guys,

Great forum here!

I have recently discovered that i sometimes just plain stop breathing when I'm asleep. Sometimes it's as I'm going to sleep, sometimes its during sleep while dreaming, and sometimes while I'm waking up but still half asleep in bed. They are rare for me to notice, but sometimes I do. According to my research, I feel quite certain it is related to opiate-related pain meds I am on, in combination with my weight (320 plus pounds, im 6' tall and male). I'd rather not stop those unless totally necessary, so a friend has given me his RemstarAuto with C-Flex machine. I just got, from Amazon, the Quattro FX full face mask, as another family friend has one that I tried on and it felt pretty decently.

I will be using self titration. Judging from some other posts I have seen, I will start out around 8 or 9 cm in auto mode. I hear its best to have a card (my unit looks to accept them but i dont have one) and software, but I really don't have the spare cash right now. I hear I may be able to get data from the unit's screen for each night...is this accurate? You know, to determine AHI, leaking etc.

Can you guys give me your opinion on absolutely anything I've said so far? Just wanted some outside opinions from those who have been there.

Thank you!

CNoob

sleepstar · Post by **sleepstar** » Sat Apr 27, 2013 1:10 am

Hey. If you have an automatic machine is suggest setting the minimum pressure to 6 and maximum to 16 and monitor how you go.

Starting at 9 would feel pretty high at the start I'd think (for a lot of people anyway). Starting at 6 is a good place

caffeinatedcfo · Post by **caffeinatedcfo** » Sat Apr 27, 2013 6:23 am

Welcome!

If you can put your equipment in your profile (access through the "User Control Panel" above, we can be more helpful.

Regarding your mask, I started with that mask too. It's a good mask, but some people have troubles with it. This link has some tips that helped me get a better fit with it http://maskarrayed.wordpress.com/taming ... e-quattro/.

Also, make sure you have the right size mask: http://www.resmed.com/us/assets/documen ... mplate.pdf

Most machines do have an on-screen menu, but these do not give you much data to trouble-shoot with. SD cards are very cheap ($9-$10) http://www.walmart.com/cp/memory-cards/63988. SD Card readers are $10 too if your PC doesn't have this feature.

My signature has a link to the SleepyHead software many of us use. It is free.

Good luck and I am sure with a little work and communication, we can help you self-titrate.

Sheriff Buford · Post by **Sheriff Buford** » Sat Apr 27, 2013 6:31 am

Welcome... work all your issues here. Finding a mask that is comfortable and doesn't leak is the key to success! Educate yourself with the button at the top of this forum that reads "Where a newbie should start".

Sheriff

Pugsy · Post by **Pugsy** » Sat Apr 27, 2013 8:00 am

Let's figure out exactly which machine you have.
See this please
viewtopic.php?f=1&t=72302&p=665165#p665165

Remstar Auto CPAP with CFlex...did you get that off the machine? Normally the Auto CPAP has AFlex on the machine.

Let's figure out exactly which model you have.

If it is the older model that uses the Smart card for data gathering (the smart card is about the size of a credit card) you would also need a special card reader to use the software. The card reader will cost about $45. The Smart card about $12.

The newer machines (Phillips Respironics System One) uses a SD card...no special reader needed if your computer has a SD slot and if it doesn't a cheap generic SD card reader/adapter will work.

Software is easy...I can help with that but I need to know exactly what machine you are using and what the operating system is on your computer. Free..no charge.

Trying to self titrate using the data available on a Respironics machine is a challenge..not impossible but it is more work because the data available on the LCD screen is sorely limited.

So let's figure out exactly which model machine you have and then go from there.

Kate M · Post by **Kate M** » Sat Apr 27, 2013 8:03 am

apapnoob wrote:Hi guys,

... so a friend has given me his RemstarAuto with C-Flex machine. I just got, from Amazon, the Quattro FX full face mask, as another family friend has one that I tried on and it felt pretty decently.

I will be using self titration. Judging from some other posts I have seen, I will start out around 8 or 9 cm in auto mode. I hear its best to ...

Can you guys give me your opinion on absolutely anything I've said so far?

Welcome, apapnoob. I am very new here also, and was just recently diagnosed. So, as for my experience with PAP treatment, I have little to offer. I am however a healthcare professional. From what you've posted above, ( "a friend has given me, " Another family member had one" "judging from other posts I have seen here" "I heard it's best to") I am getting the impression that you have self-diagnosed and are about to self-treat based on what equipment a friend gave you and what you have read on an internet forum. If this is correct, I have to strongly caution you against doing so.

Although folks here talk about all the changes that they make and help each other figure out their issues, I would bet that every one of them started out being diagnosed through a sleep study and got a RX for their first PAP device. There are actually contraindications for PAP therapy, or for any specific type of PAP therapy, like APAP. You can harm yourself by using this therapy in some circumstances - like if you are prone to or have recently had a pneumothorax. Even if the therapy itself is not contraindicated, self-titration may be. In my recent research and reading of some clinical studies and peer-reviewed articles, I have read that self-titration with an APAP is generally NOT recommended for people with CHF, Significant COPD, nocturnal oxygen desaturations for reasons other than osa- like obesity hypoventilation syndrome, patients who don't snore, and patients with central sleep apnea.

I'm a newbie here also, but I think that anyone here that gives you advice on how to self diagnose and self treat without you first having seen a physician (or at least without knowing a heck of a lot more about you than you posted above) is doing you a disservice. A dangerous one. Treatment of Sleep Apnea is more involved than getting the right mask fit and software. But that's just my $0,02.

Blessings and good luck to you!

RandyJ · Post by **RandyJ** » Sat Apr 27, 2013 8:12 am

It sounds like he has the M Series Auto with C Flex (that pre-dated and then coexisted with the model with A Flex).

http://remstarautomseries.respironics.c ... tions.aspx

Pugsy · Post by **Pugsy** » Sat Apr 27, 2013 8:22 am

RandyJ wrote:It sounds like he has the M Series Auto with C Flex (that pre-dated and then coexisted with the model with A Flex).

Yes..but he didn't mention M series which is clearly stated on the machine...so either that one or the one just prior to it in the Legacy series.
My very first machine was the M series APAP with CFlex.
Either way the on screen data sucks but fortunately the Smart cards and the DT 3500 are readily available and not super expensive.
I have the provider manuals for either that I can get to someone. Just need to know which one.

NotLazyJustTired · Post by **NotLazyJustTired** » Sat Apr 27, 2013 8:33 am

apapnoob wrote:According to my research, I feel quite certain it is related to opiate-related pain meds I am on, in combination with my weight (320 plus pounds, im 6' tall and male).

You have made a very important step in coming here. Some of the best help on the internet is right here on this forum. It's patients helping patients and it is awesome!

However, I will have to agree with Kate M's assessment. Is there any way you can get a sleep study done? From what you say above I think there is a strong case for central apnea as well as obstructive apnea aka complex apnea. If so, you may require treatment with BiPAP or ASV. I am certainly not an expert in this area, and you are free to do what you want, but I would highly recommend seeking a medical diagnosis.

If you choose to start a trial on APAP, answer Pugsy's questions. It will be extremely important that you use a machine that logs detailed data so that we can help you. That data may confirm or deny your need for alternate treatment.

Pugsy · Post by **Pugsy** » Sat Apr 27, 2013 8:45 am

The pre PR S1 machines didn't flag Clear Airway apneas (centrals) separately but they were lumped into the apnea basket.
So with one of those reports if we saw a bunch of hyponeas (often) or obstructives that we couldn't reduce with more pressure then one would suspect the presence of centrals...and thus a real need for further investigation.

With this possibility...it's real important to be able to at least start with the data that is available using software.
Trying to self titrate using only the LCD data...not a good way to go if there is any hint of centrals being an issue.
Now if the onscreen AHI average..remember it shows only 7/30 day average...was nice and low and someone is feeling markedly better the chance of centrals would be greatly reduced.

Opiates can increase the chance of centrals but they don't always make centrals worse. They can suppress the respiratory drive or cause more floppy airway tissues for obstructives but they don't always make a huge impact. It's a maybe...but still worthy of keeping an eye on.

RandyJ · Post by **RandyJ** » Sat Apr 27, 2013 9:13 am

Pugsy wrote:
Yes..but he didn't mention M series which is clearly stated on the machine...so either that one or the one just prior to it in the Legacy series.

I was forgetting that the Legacy machines even had C Flex...

apapnoob · Post by **apapnoob** » Sat Apr 27, 2013 3:19 pm

I was almost shocked to see the amount of replies to this. I am very grateful to everyone!

I will go through and answer each question...

Hey. If you have an automatic machine is suggest setting the minimum pressure to 6 and maximum to 16 and monitor how you go.

Starting at 9 would feel pretty high at the start I'd think (for a lot of people anyway). Starting at 6 is a good place

Thank you...I tell you, I havent slept with it yet as my mask hasnt arrived, but when I tried my friend's it really kinda takes your breath away when you're not used to it, eh??

Most machines do have an on-screen menu, but these do not give you much data to trouble-shoot with. SD cards are very cheap ($9-$10) http://www.walmart.com/cp/memory-cards/63988. SD Card readers are $10 too if your PC doesn't have this feature.

Thank you. My machine indeed uses the "credit card" style, not SD...if it did, that'd be awesome as I'm already set up to read those!

So let's figure out exactly which model machine you have and then go from there.

On the front, it says just REMstarAuto, M Series. The only model info I can find is on the bottom, which might be the humidifier's model number, 1022334. I searched and found a machine that looks JUST like mine: http://us.ebid.net/for-sale/respironics ... 025576.htm

I am getting the impression that you have self-diagnosed and are about to self-treat based on what equipment a friend gave you and what you have read on an internet forum. If this is correct, I have to strongly caution you against doing so.

Thank you for this. I am 100% aware of this and agree with you totally. To be honest, though, I have no insurance. I can't afford several thousands of dollars for the studies, at least not at this level of apnea that I feel I have. In other words, though I definitely have it some nights, I don't feel it to be severe enough, often enough, to warrant so many thousands spent. Hope that makes sense. I do agree with you, though. This method is all I can afford for the current perceived severity of my problem.

It sounds like he has the M Series Auto with C Flex (that pre-dated and then coexisted with the model with A Flex).

That looks exactly like it. Mine has a C-Flex button. It does automatically adjust pressure though, as I used it recently for like 10 minutes to get the feel of it...with a nasal mask, which I utterly hated.

Is there any way you can get a sleep study done? From what you say above I think there is a strong case for central apnea as well as obstructive apnea aka complex apnea. If so, you may require treatment with BiPAP or ASV. I am certainly not an expert in this area, and you are free to do what you want, but I would highly recommend seeking a medical diagnosis.

Thank you, and I agree that its obviously best I do that, but it isn't financial feasible unless the apnea was ruining my life. No insurance, so I'm thinking a few grand for both trips.

Do you guys think I should forget trying to remedy the (possible) centrals? I had them before VERY VERY rarely, before the medication...but I'm almost certain it's a combination of my weight and particularly the meds. And sure, they might not be centrals, but from the description, that's what I'm assuming.

Next month i will have the spare cash to get the card reader and card, etc., as one user said both could be had for around 60 bucks.

Apapnoobster

Kate M · Post by **Kate M** » Sat Apr 27, 2013 5:13 pm

apapnoob wrote: Thank you for this. I am 100% aware of this and agree with you totally. To be honest, though, I have no insurance. I can't afford several thousands of dollars for the studies, at least not at this level of apnea that I feel I have. In other words, though I definitely have it some nights, I don't feel it to be severe enough, often enough, to warrant so many thousands spent. Hope that makes sense. I do agree with you, though. This method is all I can afford for the current perceived severity of my problem.

You are most welcome. I'm sorry to hear about your predicament. If this is your only affordable option, then it seems you (actually--both of us!) have come to the right place for guidance as there appear to be extremely knowledgeable people here who are willing to help. I just wanted to be sure you knew that your approach should probably not be option A --and you do! So all the best to you!

jdm2857 · Post by **jdm2857** » Sat Apr 27, 2013 7:18 pm

I had my diagnostic (and only) sleep study done for free as part of a clinical research study. I had to do a few
other things too (like a 3-hour glucose tolerance test), but it was worth it to get a study done at a
major university hospital.

You might want to check out if there any sort of research studies being conducted in your area.

Pugsy · Post by **Pugsy** » Sat Apr 27, 2013 10:10 pm

OKay, M series Auto with CFlex.

You will need this Smart card if your machine doesn't have one. To have the machine put the data to the Smart card so you can use the softwer
http://www.directhomemedical.com/100424 ... acard.html

And this Smart Card reader.... no substituting...this is the only one that will work. Need this to connect the Smart card to your computer.
http://www.directhomemedical.com/101435 ... eader.html

Quick set up guide
http://www.apneaboard.com/manuals51/REM ... 0Guide.pdf

This is an example of the daily detailed report you can get.

What makes you think that you are having centrals?

Hello! Noob question-any advice appreciated (self titrating)

Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)

Re: Hello! Noob question-any advice appreciated (self titrating)