Does Remstar Auto have C-Flex

Doovid · Post by **Doovid** » Fri Apr 14, 2006 11:19 pm

After reading the manual for the Remstar Auto, it appears that the Cflex mode can only be used when the machine is set to CPAP...not auto. Does that mean that there is no exhalure relief when the machine is set to auto? Or is the auto setting starting at a very low setting simulating C-flex. I'm not surre I understand what the manual is saying...help~!

rested gal · Post by **rested gal** » Fri Apr 14, 2006 11:44 pm

Doovid, the Respironics REMstar Auto with C-Flex can use C-Flex in either mode:

CFLE = cpap with C-Flex enabled.
AFLE = auto with C-Flex enabled.

What you can't use when the REMstar Auto with C-Flex is operating in auto mode (or auto with C-Flex mode) is "ramp".

The Respironics REMstar Auto with C-Flex has four operating modes you (or the person who sets the machine up for you) can choose:

CPAP - straight cpap, no C-Flex
CFLE - straight cpap, with C-Flex
APAP - autopap, no C-Flex
AFLE - autopap, with C-Flex

The older Respironics REMstar Autos did not have C-Flex. C-Flex was added to the REMstar Auto over a year ago.

Doovid · Post by **Doovid** » Sat Apr 15, 2006 11:12 am

Thanks for the info! Because the Auto starts at a lower pressure level, does that sort of take the place of the ramp feature? I know I don't like to start right out at my CPAP setting. It's only 10 cm. but it seems high when first starting out...

rested gal · Post by **rested gal** » Sat Apr 15, 2006 11:45 am

Doovid wrote:Thanks for the info! Because the Auto starts at a lower pressure level, does that sort of take the place of the ramp feature? I know I don't like to start right out at my CPAP setting. It's only 10 cm. but it seems high when first starting out...

This is just my guess... I think Respironics did not incorporate "ramp" into the auto modes of their REMstar Auto with C-Flex because they probably did not envision people using an autopap as a permanent treatment machine.

As I understand it (could be wrong) they orginally designed their autopap as a temporary device to be used for auto-titrating purposes. Once the doctor is satisfied with the "90th percentile" pressure shown by the machine after a week, two weeks, or month of use, Respironics expected the autopap would be taken away and the person would be put on a regular CPAP machine at a single fixed pressure.

Since most doctors and DME's seem to leave an autopap's setting range wide open (4 - 20 ) for the titration trial, yes, you're right that everyone concerned (including Respironics) probably thinks that there's no need for ramp if the machine is going to be starting out at only 4 cm H2O when it's turned on each time. That's not the way most of us autopap users use our machines, of course. Ramp would be a nice feature for many.

If you get a REMstar Auto, Doovid, do be sure to not try to set a ramp time when you're using it in either of its auto modes (APAP or AFLE.) The ramp timer MUST be set for 0 (zero) when using the REMstar Auto in either of its auto modes.

P.S. Puritan Bennett did take that into consideration. Ramp can be used with their 420E autopap. You can set a ramp starting pressure and a ramp time with the 420E auto operating in auto mode.

Guest · Post by **Guest** » Sat Apr 15, 2006 10:02 pm

Great info!
But, are you saying there is a way to try to set a ramp function when in auto? And if you do, I guess you're saying that it switches the machine to CPAP w/ C-flex mode (rather than auto)? That's still not clear to me... Also, what pressure setting does that auto start out? Is it the low end of the range that its set at? I guess I'm still not clear ass to how an Auto functions....

I get the impression from reading posts in this forum, that most apap users use the auto machine in a permanent auto mode...even though they can be switched to CPAP once the 90% criteria is clearly identified. Should we, in reality, be switching modes at that point?? I seem to recall several posts where users showed they got better treatment from a regular CPAP machine, compared to an auto.

Regardless, since the Remstar Auto has 4 modes, we have that flexibility. But please respond to my first question...I'm still in a quandary!

Guest · Post by **Guest** » Sat Apr 15, 2006 11:37 pm

Although you can't use RAMP in the Auto Mode... if you should awaken during the night, you can reach over and press the ramp button and the presure will back off to the lower presure setting in the Auto Mode

rested gal · Post by **rested gal** » Sun Apr 16, 2006 9:53 am

But, are you saying there is a way to try to set a ramp function when in auto?

No. It will not be a true ramp function. I'm talking about another mode that you don't want to use...there's simply no benefit in using it... called "split night therapy" mode. That's what happens if you set a number of "hours" in the ramp timer when using the REMstar Auto in APAP (autopap without C-Flex) or AFLE (autopap with C-Flex) mode.

In those two auto modes, you can put the REMstar Auto into "split night therapy" mode by choosing a number of HOURS (2:00, 3:00, or 4:00 hours) with the Ramp time setting. To avoid accidentally using "split night therapy" mode, the number of hours in the Ramp time needs to be set for zero. 0:00

Split night therapy mode means that for a set number of hours the machine will blow only the lowest pressure that has been set in the range.

In other words, if you are using the machine in auto mode, set for a pressure range of 7 - 15, AND if you set the ramp time for 2:00, the machine will use only a pressure of 7 for the first two hours of that night. It will not vary the pressure during those first hours even if you were having apneas or hypopneas that needed more pressure to clear them.

After the two hours is up, the machine would finally begin using whatever pressure you needed in the 7 - 15 range.

There's no reason to use "split night therapy" at home, other than just out of curiosity -- been there, done that.

So... in either auto mode, the ramp time on the REMstar Auto should be set for "0:00" so that it won't go into "split night therapy" mode.

And if you do, I guess you're saying that it switches the machine to CPAP w/ C-flex mode (rather than auto)?

Well, it will give that effect - as if it were straight cpap for those first hours in split night therapy mode. It won't start operating as a true autopap using varying pressures until the number of hours has expired, at which time it begins operating as an autopap for the remainder of the night.

That's still not clear to me... Also, what pressure setting does that auto start out? Is it the low end of the range that its set at?

Right. The auto will start at the low end of the range it's set at. That's true whether it's in APAP (auto without C-Flex) or AFLE (auto with C-Flex) or "split night therapy" mode.

What the other guest said is correct about what happens if you are using either auto mode and you hit the Ramp button during the night. If you are using the REMstar Auto at a range of 7 - 15, and you wake up during the night with the machine blowing 15 at you, you can press the ramp button to make the machine drop back down to 7.

Using the ramp button to start over is a good way to get instant relief if your sleep was disturbed and you suddenly woke up to a hurricane gale force blowing at you. Easier than turning the machine off and back on, and having to remember to also turn the humidifier back on.

dsm · Post by **dsm** » Sun Apr 16, 2006 7:51 pm

RG,

Great post - very informative. Something I hadn't come across before but worth being aware of

Thanks

DSM

NightHawkeye · Post by **NightHawkeye** » Sun Apr 16, 2006 8:02 pm

Guest wrote:Although you can't use RAMP in the Auto Mode... if you should awaken during the night, you can reach over and press the ramp button and the presure will back off to the lower presure setting in the Auto Mode

Thank you, Guest.

I have frequently found myself turning the machine OFF and back ON to accomplish this function. And then having to turn the humidifier back ON as well. Sometimes the humidifier doesn't seem to get turned back ON though - maybe because I'm too sleepy to think straight . . .

Now, if I can just remember this the next time I wake up at higher pressure . . .

Regards,
Bill

Doovid · Post by **Doovid** » Sun Apr 16, 2006 8:16 pm

Thanks I think I understand the concept a little better now!

Darth Vader Look · Post by **Darth Vader Look** » Sun Apr 16, 2006 10:27 pm

NightHawkeye posts - I have frequently found myself turning the machine OFF and back ON to accomplish this function. And then having to turn the humidifier back ON as well. Sometimes the humidifier doesn't seem to get turned back ON though - maybe because I'm too sleepy to think straight . . .

Bill, if you do this I was wondering how it would show up in myencore?

Ric · Post by **Ric** » Sun Apr 16, 2006 10:34 pm

It will show as a brief interruption, a white *blip*. If you are using the Remstar AUTO with C-flex, you will be PUNISHED 10 minutes for turning the machine off/on. (topic of an earlier thread). I think that's a bug in the "firmware" that controls the machine. Not sure how it behaves on other models.

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