Finally got my cpap

[saldivar]

I just got my cpap, it is a Remstar Auto Cflex, I was wonder if my pressure is suppose to be 18 why does it start at 4 and the goes up to 7, I would like to start it at 7 , 7 seems more pleasant, 4 I feel no air but it takes over 30 min or so to goto 5, is there a way to adjust pressures. thanks

[rested gal]

Hi saldivar,

Congratulations on getting your machine...it's a good one.

With the machine, did you receive two booklets? One for the "User" and another one named:

"Home Care Provider Setup Instructions"

If you don't have that second booklet, please PM me your email address.

[Bingo]

This would definately be something I would speak to your equipment provider about.

They can adjust the starting pressure and ramp time to your liking. A standard starting pressure for a new CPAP setup is 4cm.

Many users prefer to start a little higher though!

I would also suggest checking with them regarding your concerns over what your standard use pressure should be (You indicated you weren't sure what it was).

Bingo

[Guest]

I disagree with Bingo. I do NOT believe that 4 is a "standard" starting pressure. It is the default low pressure that the machine is able to deliver and what it is on when the machine is set up by an uninformed person.

I have not met or heard of many who can tolerate 4 for very long. Have your doctor write an order for +/- 2 or 3 cm from your titrated pressure from your sleep study, or change it yourself using that "2nd manual". You will be much happier

[Guest]

I just got my cpap, it is a Remstar Auto Cflex, I was wonder if my pressure is suppose to be 18 why does it start at 4 and the goes up to 7, I would like to start it at 7 , 7 seems more pleasant, 4 I feel no air but it takes over 30 min or so to goto 5, is there a way to adjust pressures. thanks

They can adjust the starting pressure and ramp time to your liking. A standard starting pressure for a new CPAP setup is 4cm.

Bingo,
The ramp function doesn't work when the Remstar apap is in auto mode.


Hello saldivar,
The ramp function doesn't work when your machine is in auto mode. Sounds like you probably received the machine at the factory-preset range of 4-20cms. Most people find they need to narrow their range to get the best treatment, and most find 4cms to feel suffocating, so you're not alone. You don't need to use your equipment provider to make adjustments if you'd prefer to do it yourself. It's very simple to change the starting pressure to 7. It sounds like your supplier must have removed the instruction booklet before they gave you your machine. They do that a lot. Job security, I guess. (Then they turn around and sell the instructions on ebay and make a nice little profit. It's quite a racket.) If you don't have the directions, send a PM to rested gal.
Do you have the software and card reader for your machine? It would be interesting to see if/when/how long you use your titrated pressure of 18cms during the night. If that titrated pressure proves to be correct, you may want to raise your starting pressure higher than 7.

[Bingo]

Sorry! I missed the "auto" part in his first post!

Heh.

Anyways, not sure why everyone is so dead-set against this poor fellow talking to the provider who setup his equipment about having them adjust it.

If nothing else, it's good to communicate with people. I know I'd rather have everyone involved in my care knowing what is going on rather than keeping people out of the loop! It's not like anything bad is going to happen if he asks these people for help. It's what they are THERE for!


What happens when they DO come out and do a pressure check and suddenly it's nothing like what they have written down?

And I really like the suggestion that the Equipment Providers are getting something by having the machine set the way it is. You DO remember that any provider is going to be REQUIRED to setup equipment in exactly the fashion prescribed by an MD?? If the machine is set 4-20, that is what the patients MD prescribed. Also, a provider does not actually get anything for coming out to change a patients pressure. A straight pressure change is not a service that an insurance company will pay for.

As far as Supplier Manuals being sold on Ebay, I am sure some people do. The couple times I have checked though, the vast majority were individuals selling scanned copies via email. They were not actually sending anything.

Bingo

[oldgearhead]

I would suggest it's not a matter of either/or. You should do both. Get the manual and contact the DME. They probably didn't set it up correctly.....

[Bingo]

Get the manual and contact the DME. They probably didn't set it up correctly.....

I'm genuinely curious here: Why on earth would you think that??

Bingo

[Guest]

Anyways, not sure why everyone is so dead-set against this poor fellow talking to the provider who setup his equipment about having them adjust it.

Dead-set against?

I wrote, "You don't need to use your equipment provider to make adjustments if you'd prefer to do it yourself."

Saldivar asked if there was a way to adjust pressures. He wants to be informed and take charge of his own therapy, as many of us do and have done. Whether he wants to do it himself or go through the equipment provider (the expensive, time-consuming, generally uniformed, defensive, trying-to-hang-onto-a-paying-customer, concerned-about-his-livelihood, and completely unnecessary middleman) is his choice.

Beware the evil DME .

[Bingo]

Anyways, not sure why everyone is so dead-set against this poor fellow talking to the provider who setup his equipment about having them adjust it.

Dead-set against?

I wrote, "You don't need to use your equipment provider to make adjustments if you'd prefer to do it yourself."

Saldivar asked if there was a way to adjust pressures. He wants to be informed and take charge of his own therapy, as many of us do and have done. Whether he wants to do it himself or go through the equipment provider (the expensive, time-consuming, generally uniformed, defensive, trying-to-hang-onto-a-paying-customer, concerned-about-his-livelihood, and completely unnecessary middleman) is his choice.

Beware the evil DME .

That's what I was getting at when I said 'dead-set against'.

Anyways, I would argue that an Equipment Provider is the exact opposite of the qualities you listed, but I rather doubt I would convince you otherwise, so I won't persue it!

Bingo

[oldgearhead]

Bingo -This post contains a lot of food for thought:

1) If the titrated pressure was, in fact, 18, why didn't the doctor script a bi-level machine?

2) If the DME read the script, wouldn't the auto be set up at 10-20 cm/H2O, and C-Flex at 2 or 3? To deliver it at 4-18 cm/H2O makes no sense.

3) Let's say this patient was given this machine for an in-home sleep/titration study. In that case the patient MUST have the DME manual.

[Bingo]

Bingo -This post contains a lot of food for thought:

1) If the titrated pressure was, in fact, 18, why didn't the doctor script a bi-level machine?

]

That's obviously very tough to answer. The way he wrote the sentence makes it a little difficult to interpret. Is he saying he never makes it to 18? Or is he saying that he would prefer his ramp to start at 7cm where he finds it more comfortable? Again, it's very hard to really determine what he meant with the way he wrote that.

2) If the DME read the script, wouldn't the auto be set up at 10-20 cm/H2O, and C-Flex at 2 or 3? To deliver it at 4-18 cm/H2O makes no sense.

Well, again - they are going to have to setup the equipment at whatever pressure the MD wrote the Rx for. To be honest, I am aware of a LOT of prescriptions written for autopaps set at 4-20cm. My feeling is that a lot of MDs would rather leave the machine wide open and let it titrate to whatever the patient actually needs than to write a narrower order and risk missing the right pressure for a patient. Again, that is just my opinion, however it makes sense considering the number of orders I have seen written that way and knowing the individuals who wrote them.

3) Let's say this patient was given this machine for an in-home sleep/titration study. In that case the patient MUST have the DME manual.

It is certainly possible. I don't know if I would say they MUST have it. I also certanily have nothing against this fellow setting his pressure himself to whatever the heck he feels like or whatever he finds most useful.

However, I do STILL feel (And the whole point of my initial post) is that he is BEST served by speaking with his Equipment Provider. It costs nothing, and it keeps everyone who is involved in his care all speaking with each other.

Communication is a good thing.

Bingo

[Guest]

thanks for all your help, i will contact my doctor and have him raise the pressure alittle. Yes I was refering to the auto pressure and how it starts at 4 making it very hard to breath. my toloerated pressure for the sudy was 18. I just noticed when the pressure is above 4 like at 5.5 then it becomes easier to breath, thanks once again.

[Bingo]

Heh. Sorry to have turned your thread into a discussion on Equipment Providers!!

/threadjack!

A lot of people seem to feel it is easier to breathe above a 4cm ramp start time.

Oddly enough, I find it perfectly comfortable. I have long suspected I am wierd though.

I'm currently on 13cm with my ramp starting at 4cm. Heh.

Bingo

[snoregirl]

Sorry to go back to the DME/Doctor discussion but I have to comment on a couple of items that have been addressed in this thread so far.

I was one of those people who bought a manual from EBAY before I could find someone to send me a copy of one. It was a REAL Manual not a scanned copy. Had to come from somewhere. The person I bought from has lots, and if they are all real then draw your own conclulsions as to where they come from.

As to whether or not one wants to contact the DME for a pressure change. Totally up to the person. Pressure changes are easier than setting up a VCR to tape a tv show. My DME is 45 minutes away. I can't imagine wanting to waste the gas to go there. Or sit at home waiting for someone to show up to do something that takes 2 minutes to do myself. On top of that as I have written before, my DME didn't know that ramp on an AUTO was split night, didn't bother to ask about my preferences for humidity, or cflex even though I had told him that I had used it before, and gave me some other bad info. I am not interested in "teaching the DME". I am an independant sort who wants to be able to deal with what appliances I own myself irregardless of whether the DME is getting paid or not.

Third thing, and this is my opinion from my own experience, is that I think a number of doctors have no idea what to prescribe for an auto machine. My doc didn't, and the useless sleep doc that read my study results (for $220 each time) told him that he couldn't give a range since my study was for CPAP not APAP. My doc was hesitant to make a range. In order to get a machine without the evil 4cm starting point where I can't breath, I had to read this forum and tell my doc and convince him that +/- 3 was ok.

I already knew from my CPAP experience that 7 was my min for breathing, and 8 was better yet.

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CPAPopedia Keywords Contained In This Post (Click For Definition): cflex, CPAP, DME, Ramp, auto, APAP