Opinion on Best option for severe OSA?

Hi all,

Please excuse me if my final questions are silly. I don't have much valid data yet. My one and only hospital sleep study many years ago was a disaster (long story) and I put off getting the treatment I needed - big mistake!

I have severe OSA and have been testing a Remstar Auto for a few days (without c-flex). I can mentally cope with breathing under a fair pressure (I got the clinic to change the starting ramp to 7 cm) but it seems I need 19 centimetres of pressure most of the time.

I'm concerned that my respiration might be too shallow at such a high pressure or that I might need a stronger device (like the Remstar Auto BiPap w/BiFlex) right now, or soon if things deteriorate. The small clinic sleep therapist I visit only seems to sell Remstar CPAP's and I don't exactly trust her advice, as the business appears to work on a commission basis.

My query is which might be better - cpap alone, cpap with C-Flex or Auto BiPap? Comfort is a secondary consideration really- I just need to maintain the best o2 levels I can. Right now I feel as sick as a dog :/

Thanks.

if your titrated pressure is 19cm, you need the Bipap, the Bipap offers greater expiratory relief and probably even better treatment.

I would think you would do better with a Remstar Bipap Auto. If you are just starting, I would pretty much demand that machine from your doctor. Make sure you get the "Auto" you don't want to be guessing on the pressure, this machine will find the correct pressure automatically.

Go here, print out the brochure and info, take it to your doctor.

https://www.cpap.com/productpage/bipap-auto-biflex.html

Welcome to the forum.

If you haven't completed your trial with the Auto, you might be getting the "cart before the horse". On the other hand, it's nice to what the options might be ahead of time.

Much of it depends on what pressure you're prescribed. If it's somewhere in the vacinity of 20 or more, a Bi-PAP machine would be what you would want. It would allow more exhale relief.

I'm not sure if I understand how they configured the machine you're now using. Do you know what pressure range it's set for? You mentioned 19.....but I'm also curious as to why they didn't configure C-Flex on your machine (unless that machine is OLD and pre-dates the C-Flex technology). If it DOES have C-Flex, there would be a blue label on the top of the machine that SAYS "C-Flex".

If it turns out that you DO need a Bi-PAP, then the Remstar Auto BiPAP w/BiFlex would be the machine to get. There are other B-PAP and Bi-level machines that handle certain specific breathing and apnea situations, too.

If you haven't compared machines, you might want to go to this site (it's the sponsor of this forum) and check out the various makes, models and features of all of the machines.
There's nothing wrong with the Respironics REMstar machines, but you need to be knowledgeable about them when dealing with the DMEs, RTs and doctors. They've been known to provide the lowest level machines while charging premium prices.

Best wishes,

Den

Cheers both for your prompt advice

@Snoredog

I might be looking to get a Remstar Bipap Auto. My general doc has agreed to write a prescription so I can import a unit if I have to (I live in Australia)

@ Wulfman

Yes the unit I'm hiring is the older unit without c-flex. They have offered me a C-flex model but given my situation, I might be better to hang on to what I've got and perhaps purchase a BiPap. The machine is configured on auto to ramp from 7 - 20. I have my Encore Pro results and my mean average 90% pressure is 18.9 and I'm maxing at 20. My Total average AHI ranges from 15 to 35 (with 18 being the mode). Do you think a BiLevel machine might assist perhaps?

My "therapist" does not deal with BiPap and has not much of a clue it seems, so I have asked her to contact a respronics sales rep on my behalf for a quote on a Remstar BiPap Auto with BiFlex.

Is there a online service or somewhere I can get an evaluation of my Encore results? Seeing a respiratory physician or getting a proper polysomnography would take more time.

Thanks,

Mitch.

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, C-FLEX, Encore Pro, AHI, Ramp, Prescription, auto

Well, I wouldn't call us an online service, but we give pretty good "translations" here of your EncorePro reports, since many of us have the software ourselves (myself included). If you'd like to post your data, we'd be happy to let you know what it all means!

Hi Offlineon! and welcome to the forum. I have the Remstar Bipap Auto with biflex--and I have to say it is a very comfortable machine to use. By all means--do what you can to get this machine. It will give yu exhale relief, and if during the night when yuo are sleeping you don't always need a pressure as high as 19, it will give you only the pressure that you need. it also has a peak inspiratory pressure of 25--so you have a little bit wider range before it is maxed out. Good luck with finding out what is best for you--I just wanted to tell you how very comfortable this machine is to use... Cindy

The Respironics BiPAP Auto with Bi-Flex definitely gives me the most comfortable treatment of any machine I've used. I've bought (sometimes swapped with other users) many different types of machines by all three major manufacturers...not because I actually need anything other than straight cpap for effective treatment, but because I wanted to see which ones I liked best.

The BiPAP Auto with Bi-Flex rocks! Based on what I'd read about it, I bought it to be my primary machine and am very glad I did. BiPAP exhalation comfort and Autopap varying the pressure throughout the night to give only as much pressure as needed -- both great features working together at the same time. Love it!!

..and don't lose site of the fact your current xPAP machine's max pressure is a very optimistic 20 cm/H2O. At the very least get a Bi-PAP, any kind of Bi-PAP...

I use the Bipap auto with biflex and my doctor says it the best. If you get this machine you need to make sure it is set-up for your particular situation. For instance the following must be set for you:
Max IPAP, Min EPAP, Ramp start pressure, Rise, and some others I can think of.
The auto bipap uses a smart card to record moment by moment treatment. The encore software reads the card. Your use of the software may give you insights into your treatment that you wouldn't get otherwise.

Thanks all for your welcome. It looks like the Remstar Auto BiPap with the card reader and software may be what I need.

curtcurt46 wrote:If you get this machine you need to make sure it is set-up for your particular situation. For instance the following must be set for you: Max IPAP, Min EPAP, Ramp start pressure, Rise, and some others I can think of.

This is my concern (setting the unit up) if I buy from cpap.com. I would be pretty much on my own. I thought an Auto machine was self adjusting? I'd want to change the default ramp start pressure myself, but I was hoping the rest was automatic and I could review needed changes via Encore and make any adjustments myself. Is this true, and if so, do I need to purchase some sort of clinical instruction manual?

If I buy through my clinic I get some support (but not much it seems), and they are private companies that make their money through sales. For example their list price for the RemStar CPAP with C-Flex & Humidifier is $2,300 Australian dollars (US $1,720) FYI this comes directly out of my pocket and is not covered by insurance. If I buy extra insurance cover it will end up costing me more. Don't let me start ranting about the crazy state of having a mix of public taxed and private healthcare in my country I do need to calculate added costs like import duty and other taxes, but I'm thinking ATM it will be cheaper to buy from cpap.com.

PS: Yesterday evening I had my first 3 consecutive hours of genuine sleep in ages, a decent % was of REM sleep too. I still have mask leak issues - but this is fantastic!!!

Cheers.

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offlineon wrote:This is my concern (setting the unit up) if I buy from cpap.com. I would be pretty much on my own.

Not quite "on your own". You'll have this message board to turn to. For better or worse. Plus, the very knowledgable people at cpap.com's support phone lines. Ted (nickname Titrator) is one of the phone line people. He has OSA, was prescribed a very high pressure similar to yours, and he used BiPAP and Autopaps and the BiPAP Auto. He was also a sleep tech before going to work for cpap.com. Ask for Ted...very helpful guy!

offlineon wrote:I thought an Auto machine was self adjusting?

They are, but (imho) it helps to put the settings (especially the minimum pressure...in this case, the EPAP pressure) into a range more closely surrounding the prescribed pressure that came out of the sleep study.

For example, you were prescribed a pressure of 19. If that were my prescribed pressure, I'd set the BiPAP Auto this way to start out:

AbFLE (auto bipap mode with bi-flex turned on.)

10 Min EPAP
22 Max IPAP

8 PS (8 is as high as the "difference" can be set for this setting...the difference between EPAP/IPAP)

3 Flex (gives the most "bi-flex" relief to soften the beginning of the already lower EPAP exhalation pressure.)

0:00 Ramp

0:00 Start

0 Patient

1 Light (on)

offlineon wrote:I'd want to change the default ramp start pressure myself

You can. Right now ramp is rather essential to you because of that single straight pressure of 19. Whew. Treatment pressure with the BiPAP Auto will feel very different -- much nicer! -- because you'll be using a machine that is starting lower anyway.

When you get away from that ultra high straight CPAP pressure, it's very likely you might find you don't need ramp at all. But if you do, then I'd change the setup I described to this, when the "RAMP" screen is showing in the clinical set up screens:

0:15 Ramp (amount of time for the ramp to work -- can be set for as long as 45 minutes.)

5.0 Ramp Start
(or 4.0 or 6.0 or 7.0 -- or whatever feels comfortable to begin with)

0:00 Start
Note: Be careful not to confuse "Ramp Start" with the single word "Start". This is soooo important... any time you see only the word "Start" in the menu, be sure that is set for 0:00 so the machine will not accidentally be put into "split night" mode.

offlineon wrote:I was hoping the rest was automatic and I could review needed changes via Encore and make any adjustments myself. Is this true, and if so, do I need to purchase some sort of clinical instruction manual?

The rest is automatic, but it's just better (imho) to set the EPAP/IPAP at a range a little tighter than wide open. Piece of cake to do the settings.

Yes, it's a very good idea to get Encore Pro and the necessary card reader to monitor how things are going and make tweaks if need be.

People who buy their machines from cpap.com receive the Provider manual right there in the box. If you get the machine through a local bricks and mortar DME (home health care supplies store) the DME generally removes the manual and not let you have it. However....people on the message board will be happy to send you a copy or you can usually buy the manual on auction sites like eBay or yahoo auctions.

offlineon wrote:If I buy through my clinic I get some support (but not much it seems), and they are private companies that make their money through sales.

If you're going to be buying the machine out of your own pocket, the online price is usually much, much less than what a clinic or local DME store would charge. Even with insurance, by the time you figure in deductible, co-pay, etc., some people find it is less expensive to buy outright online.

offlineon wrote:PS: Yesterday evening I had my first 3 consecutive hours of genuine sleep in ages, a decent % was of REM sleep too. I still have mask leak issues - but this is fantastic!!!

And it will get even better. Way to go!!