Respironics REMstar Setup Seems Less Effective Now

[foxman]

I have been using a Remstar machine for 12 months, I have changed out the cushion every 3 months and just got a new one. I use a full face mask Quattro that I have adjusted to well over time. The results for the first 9 months were very good but the last 2-3 months I feel like I am not getting the quality sleep I once was, I am sleeping lighter, waking up earlier and feel less rested overall. Not quite as bad as before with no CPAP but not nearly as good as it was last year and earlier this year. After I made the adjustment to the machine and mask I was getting very good quality sleep, the best in many years. But I am feeling now somehow the machine and my whole CPAP program is now much less effective than it once was. Perhaps its the components, perhaps the pressure but not sure, setting is 8cm.

[Julie]

Why not try raising it to 10 cm, and/or using Apap?

[Janknitz]

Whoa, before you go changing anything, do you have access to data? It would help a lot if you would post your equipment. Not all Remstars are data capable, so that would help us a lot if you could tell us which machine you have and whether or not you have the software.

Since you don't know what the problem is, it's kind of irresponsible to go changing your settings. Either make an appointment with your sleep doctor (it's time for a follow-up anyway) or take a look at the data to see what's going on. It could be many things:

Newer mask cushions just don't seem to be holding up as well as they once did. Some insurance companies allow MONTHLY replacements.

It could be leaking from your mouth or the mask.

It could be a pressure issue--but without data, there's no way to tell. Perhaps you are just having more nasal congestion because of allergies?

Once you have a better idea of what the problem is, then you can see how you want to proceed with solving the problem.

[foxman]

The RemStar Plus has the following settings:

* CPAP Pressure (only in provider setup mode) 8cm
* Altitude
* Fine Pressure Adjustment (only in provider setup mode)
* C-Flex Setting
* Ramp Time
* Ramp Start Pressure
* Mask Alert
* Auto Off
* Patient Reminder (only in provider setup mode)

I don't have access to the data off the smart card.

[6PtStar]

The RemStar Plus has the following settings:
I don't have access to the data off the smart card.

Would not make any difference if you had access to the data off the Smart Card because the Plus machine only collects compliance data (number of hours used). It does not have the sensors to collect revelent data. With out data you are flying blind. I would be hesitent to start raising the pressure with out the ability to look at the data. If you can work it your option might be another sleep study or purchase a data capable machine and keep the Plus as a back-up.

Jerry

[Janknitz]

Too bad, all you have is a brick that's a tattle tale. It will tell your insurance company how many hours and days you use it so they will pay, but it doesn't tell you or your doctor one bit about whether the machine is doing a good job or your mask is leaking or any other data that could be really helpful in this situation.

You will need to see your sleep doctor and either get a new sleep study or some other access to a data capable machine so you can figure out why you are not getting good effective treatment any more. Sorry.

[jweeks]

After I made the adjustment to the machine and mask I was getting very good quality sleep, the best in many years. But I am feeling now somehow the machine and my whole CPAP program is now much less effective than it once was. Perhaps its the components, perhaps the pressure but not sure, setting is 8cm.

Foxman,

It is very possible that something has changed. You should get your machine into the DME every 6 months or year to have a calibration run. Your machine might not be putting out the right pressure. It is also possible that your body has changed. For example, OSA is highly correlated with age, and you are a full year older. 8cm is a very low pressure, so you might have been right on the edge of your right pressure, and a little bit of age pushed you out of the sweet spot. Another possibility is that you are actually doing really well, so well that you are more relaxed than you used to be. In fact, so relaxed that it made your OSA worse, especially during REM sleep. At this point, I think your best option is to see if you can get a follow-up sleep study. A data capable machine would also be nice so you can track your results and issues over time, and possibly see changes like this as they develop.

-john-

[Slinky]

JWeeks hit the nail on the head w/one of my thoughts - take your Plus in to your DME provider and have them check the pressure output. There is a certain pressure variance that is allowed so it would be nice IF your provider had checked and recorded the pressure output before providing the Plus to you - but that is HIGHLY unlikely.