REMstar Auto 500M titration settings?

[MarkBox]

After 6 months on CPAP (9 cm pressure) I was starting to feel as if the therapy was no longer working as well as it should. My doctor sent me for a re-titration. I got the machine (in the subject line) yesterday (Friday) and wore it last night. However, I never felt any pressure increase like I experienced during the first titration 6 months ago. When I look at the LCD screen it simply says "4 cm" which isn't nearly enough and leaves me feeling a bit under-oxygenated. I suspect that my provider screwed up the titration setup and have this machine set to a fixed 4 cm pressure instead of on auto. If so, I won't end up with any titration results (sigh). I tried calling them but got nothing but answering machines.

Does anyone know what the LCD screen reading should look like on a REMstar Auto 500M BiPAP if it is setup for a one week titration study? What pressure settings/range would normally be used for a titration study? And why would they not zero out the therapy stats for a new user? I'll give it another try tonight to see if the pressure ramps up like I remember in the past. I know how to get into the setup but am reluctant to mess around with it and may just switch back to my non-auto 9 cm fixed machine until Monday morning when the provider should be more responsive.

[Wulfman]

After 6 months on CPAP (9 cm pressure) I was starting to feel as if the therapy was no longer working as well as it should. My doctor sent me for a re-titration. I got the machine (in the subject line) yesterday (Friday) and wore it last night. However, I never felt any pressure increase like I experienced during the first titration 6 months ago. When I look at the LCD screen it simply says "4 cm" which isn't nearly enough and leaves me feeling a bit under-oxygenated. I suspect that my provider screwed up the titration setup and have this machine set to a fixed 4 cm pressure instead of on auto. If so, I won't end up with any titration results (sigh). I tried calling them but got nothing but answering machines.

Does anyone know what the LCD screen reading should look like on a REMstar Auto 500M BiPAP if it is setup for a one week titration study? What pressure settings/range would normally be used for a titration study? And why would they not zero out the therapy stats for a new user? I'll give it another try tonight to see if the pressure ramps up like I remember in the past. I know how to get into the setup but am reluctant to mess around with it and may just switch back to my non-auto 9 cm fixed machine until Monday morning when the provider should be more responsive.

Here are the instructions/configuration settings for the Auto (I think the "500" is the Auto w/C-Flex)
From your description, it sounds like the "Split Night Time" may be turned on.....needs to be OFF.
And, considering your previous CPAP pressure has been "9", the minimum pressure should be set either to that or maybe 1 cm. lower....at "8"......in my opinion.
Please go through the settings and report back what you find. It's always "interesting" to see how badly some of these machines get mis-configured. NOT good for the patient, however.

Den


Hold down the <- -> buttons while plugging in the little power cord in the back, wait for 2 beeps release buttons. Then press the + key to enter setup mode, use the <- -> buttons to move to the next field, use the -/+ keys to decrease/increase values, when set press the On/Off button to exit Setup.

Therapy Mode = CPAP/AUTO
CPAP Pressure = NN (only appears in CPAP mode).
AutoMax = 20 cm (default)
AutoMin = 4.0cm (default)
C-Flex Setting = Off, 1, 2 or 3
Ramp Time = (0:05 to 0:45)
Ramp Start Pressure = 4.0cm (can be from 4cm to AutoMin pressure).
Mask Alert = On/Off (beeps on large leak, mask removal).
Auto Off = Off (turns off machine on large leak/mask removal) Suggest leaving it "Off"
Split Night Time = Off (options are Off, 120, 180, 240) Should be "Off"
Show AHI/Leak = On (enables logging to display) Suggest leaving it "On"
Patient Reminder = Off (days to remind you that you get a new mask w/Insurance).
returns to Therapy Mode =




==========Resetting LCD Display Data====================

To reset LCD Therapy data (does NOT erase any data from SmartCard):

1. Hold down the (<-) (->) buttons while plugging in the power on the back,
wait for 2 beeps or 5 seconds, release buttons.
2. Press the (->) key and navigate to Therapy screen.
3. Press and HOLD down the (-) minus key for 5 seconds and/or until therapy data is reset to Zero.
4. Press the (->) key to scroll back to main menu, press (+) key to enter Setup or
On/Off button to exit.

[GumbyCT]

Just be sure to write EVERYTHING down BEFORE you make any changes. If you think you made a boo boo unplug the power so the changes are NOT saved.
Good Luck

[Snoredog]

Go through and learn to program your machine yourself, use Wulfman's instructions if you don't have the guide. Never take the SmartCard in to have it read, prescription settings can be written to that card and as soon as you insert it into the machine it changes the settings.

Program the settings via the LCD and if you ever do take your card in double check your machine settings.

4cm Auto:Min pressure is too low as you suggested, you will starve for air at that pressure and be rebreathing your own CO2. Set it up to 6.0 or higher, set the Max at 20 cm. Observe the 90% pressure shown on the display, that is close to what your CPAP pressure should be, it is up to you if you want to increase the Minimum pressure up to that 90% pressure. Lower pressure is usually better for falling asleep, so if you have insomnia you can increase the Minimum pressure up to the 90% pressure then enable the Auto:Ramp. You can set Ramp pressure lower than the Minimum like 6.5 cm and 30 minutes, then when you put on the mask to sleep, hit the Ramp button, it will drop down so you can fall asleep and once there Minimum pressure will pretty much take care of things.

[MarkBox]

Thanks for the responses. It's extremely beneficial to have a place to discuss this with others that share the condition.

To clarify, my normal machine is the REMstar 200M and does not have a data card. The titration machine is a one week loaner 500M. Here are the current settings:

Therapy Mode = AUTO
AutoMax = 20 cm
AutoMin = 4.0cm
C-Flex Setting = 3
Ramp Time = didn't see this one
Ramp Start Pressure = didn't see this one
Mask Alert = Off
Auto Off = Off
Split Night Time = Off
Show AHI/Leak = Off
Patient Reminder = Off

Other than the AutoMin being set to 4 I don't see any obvious mis-configuration except there was no display info related to Ramp Time or Ramp Start Pressure. Perhaps that is why I'm not feeling any pressure change. Is there some setting to enable the Ramp feature?

It makes some sense to me that the AutoMin should be set higher although they may leave it at 4 cm in case the patients apnea has improved which could result in a lower titration result (which wouldn't be possible if they set the AutoMin close to the patients previous fixed pressure).

Last night I gave up on the 500M Auto machine at around 5AM and switched to my 200M with a fixed 9 cm pressure and slept a bit better.

[GumbyCT]

Change the Min to 8 and let it rip. Lay down for a nap. If it doesn't work it could be a defective machine. If it does, well it could be user malfunction.

[Wulfman]

You could also turn ON the "Show AHI/Leak" setting and get SOME data from the LCD screen. You may well have gone above the 4.0 setting during the night. It would be beneficial to clear out the data before the next night's use. That way it will not be averages.....just the most recent data......and it won't affect anything on the card.
And, I'd set the minimum pressure higher, too.......like 8 or 9.

Remember.....it's YOUR therapy.

Den

[GumbyCT]

Good point Den, turn Show AHI/leak on but instead of resetting it 1st get a good look at it, write it down, then tell us what it says.

[Guest]

I just now went back into setup mode and for whatever reason I now see the Auto Ramp Time and Autoramp settings. Perhaps these only appear after entering setup, exiting, and then re-entering setup?

Auto Ramp Time = 0:05 (I set this to 0:30)
Autoramp = 4.0 cmH20 (I set this to 6.0)

I also turned on Show AHI/leak and looked thru the data. Note: I've only had this machine for two nights and in general I wear my machine throughout the night except as noted above I only wore this machine for about 4 hours last night before switching to my regular machine.

Therapy Usage
------------------
7 Day Avg 2:54
30 Day Avg 2:12

Sessions > 4
--------------
7 Day Avg 3 sessions
30 Day Avg 8 sessions

90% Pressure
----------------
7 Day Avg 10.0
30 Day Avg 10.2

System Leak
----------------
7 Day Avg 24.5
30 Day Avg 26.4

Apn-Hyp Index
------------------
7 Day Avg: AHI=3.5
30 Day Avg: AHI=2.2

Compliance Check
----------------------
28396

Summary Data
------------------
Therapy Hours: 130.2
Total Hours: 131.0
Total Sessions: 17

Total Hours
---------------
131

I plan to zero out the data before hitting the sack tonight. Now that I see the Autoramp settings I suspect the pressure will ramp up this time (or perhaps it was and I didn't notice?). I'll need to look up some of these terms at some point (90% pressure?, what is a good system leak rate?, what is a good APN-AHI Index? etc). Wish me luck.

[rested gal]

You're getting a very nice low leak rate.

You're also getting a nice low AHI, but I'll bet the AHI would be even lower if the range of your machine were set at 8 (min pressure) to 20 (maximum pressure) instead of 4 - 20.

AHI is "apnea/hypopnea index" -- an average of how many apneas and/or hypopneas are sneaking through despite the machine trying to prevent them. Raising the minimum pressure (up to or close to the pressure that would be prescribed if using a straight cpap) usually prevents those events better for most people.

Your 90% pressure is 10. That means the machine had to use a pressure of 10 AND pressures below 10, ninety percent of the time. It also means the machine had to use pressure(s) above 10, ten percent of the time. So... 10 or 11 would probably be the pressure "prescribed" for you, if you were switched to straight CPAP.

Just my opinion. I'm not a doctor or anything in the health care field.

[MarkBox]

Thanks for that info. Sounds like good numbers although most of that data was collected with someone else wearing the machine (my usage hours are only 13 of the 131 total hours for the above data).

I reset the data and these are the one night numbers:

Therapy Usage (I'm not sure what this means)
------------------
7 Day Avg 2:36
30 Day Avg 2:36

Sessions > 4
--------------
7 Day Avg 0 sessions
30 Day Avg 0 sessions

90% Pressure
----------------
7 Day Avg 8.0
30 Day Avg 8.0

System Leak (this is L/min as in Liters per minute?)
----------------
7 Day Avg 26.2
30 Day Avg 26.2

Apn-Hyp Index
------------------
7 Day Avg: AHI=3.8
30 Day Avg: AHI=3.8

Compliance Check
----------------------
28396

Summary Data
------------------
Therapy Hours: 7.3
Total Hours: 7.3
Total Sessions: 1

I have Autoramp set to 6.0 through 20.0 as this is a 1 week re-titration with a loaner machine and I want to allow the data collected a wider range just in case my titration result would come out lower than it did before. 7 months ago I was titrated at 9 cm. Do they add 1 to the 90% pressure when deciding on a new titration pressure? If not, I've actually gone down 1 cm from 7 months ago. Thanks again for all the comments.

[slamdunkbear]

Any body feel chest pain by using REMstar Auto 500M(CPA)? I been using it for almost 5 years now. But lately I feel my CPA deliver the air that almost pop my lung when I waking up in the morning. I feed too strong but don't know what to do.

My model is REMstar Auto 500M

[FatiguedMe]

Any body feel chest pain by using REMstar Auto 500M(CPA)? I been using it for almost 5 years now. But lately I feel my CPA deliver the air that almost pop my lung when I waking up in the morning. I feed too strong but don't know what to do.

My model is REMstar Auto 500M

I would restart your own thread for this very serious question. You will get more answeres this way.
Good luck!

[Wulfman]

Any body feel chest pain by using REMstar Auto 500M(CPA)? I been using it for almost 5 years now. But lately I feel my CPA deliver the air that almost pop my lung when I waking up in the morning. I feed too strong but don't know what to do.

My model is REMstar Auto 500M

Well, how is your machine configured?
The instructions for checking are in this thread (which is how/why you may have found them).
If your machine is set to a wide-open configuration (4 - 20 cm), you may be leaking air (mask or mouth) and it's driving the pressure up to or near the max.

Do you have the Encore Pro or Encore Viewer software? I presume you don't, since you're here asking why things are happening......which you'd be able to see in the reports if you had them. Running an Auto in a range of pressures without software is a recipe for frustration.......as you're finding out.

PS.....The M Series Auto (500) wasn't available 5 years ago. Maybe 2 1/2 yrs.


Den

[slamdunkbear]

Thank you for all your help, I been using Cpap for over 5 years. I think you were right about M500 is about 2 1/2 years old. I only know how to turn on the machine and did not know what is the setting.

I been feel chest pain and feel a lot of air in my lung. I can't take it any more so I am looking for help.

I will check the setting and may be some one can help. Thank you for your help.