REMstar Auto w/C-flex Pressure Vairations

Hi,

I just got my cpap 6 days ago and I have some questions my clueless rep from the medical supply company can't answer.

My doctor said that I have a "moderate" OSA (whatever that means) and he prescribed the auto with a range of 6cm - 15cm, which seems like a pretty wide range to me. Anyway, I've been using it every night and it goes pretty quickly from 6 to 15 but never goes back down. It gets to a point where its difficult to breath and I have to manually ramp it down, but then it goes back up again after a while. Can anyone tell me why it would not go back down on its own? I don't think I should need it at 15 since it wakes me up and makes it difficult to breath. I suspect they didn't set it up correctly but the medical supply guy insists they did, so I don't know. Any thoughts?

Also, I have an Activa mask and a Swift and I seem to recall reading somewhere that nasal pillows like the Swift make it difficult for the Auto to work, but now I can't find where I read that. I tried switching between the two and I don't see any difference in how the machine modulates the pressure. I also see a lot of people here using the Swift with the REMstar auto so I'm assuming they're having no problem. Any thoughts?

Thanks,
...Joe K.

jkovacs wrote:Hi,

I just got my cpap 6 days ago and I have some questions my clueless rep from the medical supply company can't answer.

My doctor said that I have a "moderate" OSA (whatever that means) and he prescribed the auto with a range of 6cm - 15cm, which seems like a pretty wide range to me. Anyway, I've been using it every night and it goes pretty quickly from 6 to 15 but never goes back down. It gets to a point where its difficult to breath and I have to manually ramp it down, but then it goes back up again after a while. Can anyone tell me why it would not go back down on its own? I don't think I should need it at 15 since it wakes me up and makes it difficult to breath. I suspect they didn't set it up correctly but the medical supply guy insists they did, so I don't know. Any thoughts?

Also, I have an Activa mask and a Swift and I seem to recall reading somewhere that nasal pillows like the Swift make it difficult for the Auto to work, but now I can't find where I read that. I tried switching between the two and I don't see any difference in how the machine modulates the pressure. I also see a lot of people here using the Swift with the REMstar auto so I'm assuming they're having no problem. Any thoughts?

I have used my REMstar Auto for 6 nights now also. First night pressure 4 -20. Then I changed it to 6.5-20. AHI is under 5, so it is okay. I do plan to keep on "tweeting." As far as your question about the pressure going up, and staying there, mine doesn't. It hasn't hit 20 yet. Does go up to 18 some. Not supprised at mine going up that high as I need high pressure. I know this doesn't answer your question about why you have this problem, but thought you might want to know that not everyone has the "stuck up" problem. Maybe you should look at your charts and set the machine at cpap, or try a different autopap. Wish I had a better answer.

As far as the Swift goes, I used mine for a couple hours this morning and no problems. I have been trying out a new mask, but put the Swift on this morning for a few hours. The data looked good from the Swift.

It gets to a point where its difficult to breath and I have to manually ramp it down, but then it goes back up again after a while. Can anyone tell me why it would not go back down on its own?

There can be a number of reasons, Joe, but I suggest you start handling this by telling your doctor that at this point, 15 is waking you up, and you'ld like to lower the top limit - until you get used to the higher pressure.

As for reasons for this behavior - except for the possible one that the machine is not set up properly:

1. A self adjusting machines attempts to figure out the meaning of your breathing pattern, and it adjusts iteslf to what it had figured out. In technical terms - it has an algorithm. Algorithms are proprietary, and one machine's algorithm can be great for you, while the other one's is dreadful.
Try to get another company's auto on rental to test it for a couple of weeks.
Puritan Bennett makes the GoodKnight 420E - it's functioning is more tweakable that the Remstar's, and in some cases, for some people, it gives better treatment when the IFL1 switch is turned to off. Resmed makes another auto machine, also worth trying out.

2. You might be waking up from a temporary 15, and it won't go down immediately because no machine will lower the pressuer immediately + they don't handle the patterns of waking breathing too well in any case. Which is why I suggested you have the top range limited - at least temporarily.

3. You might also have a leak in the system - hose or mask no properly connected - which makes the machine raise the pressure to compensate for the leak.

Good luck, and keep us posted of developments
O.

So many thoughts, I don't know where to begin!

First of all you need to get a copy of your sleep study. Secondly you need to find out your specific titrated pressure. Thirdly, you need to close the range your auto is set to so it is a few cms either side of that specific titrated pressure. Fourth, you need to examine your nightly data every day SO you can see what's happening at each pressure SO you will have the information necessary to conduct a series of self-titration experiments SO you can zero in on the optimum treatment. (It's possible you may determine your optimum treatment will be achieved using CFLE mode or CPAP mode instead of AFLE or APAP mode.)

Of course all this is assuming you have the smart card and card reader. Without that, its all just a crapshoot.

Here's the thread you were looking for on the Swift/Auto combo: Autos and Swift?

Are you snoring a lot? The Auto is very sensitive to snores.

derek wrote:Are you snoring a lot? The Auto is very sensitive to snores

....or other noises it might ineterpret as snores.
O.

ozij wrote:

derek wrote:Are you snoring a lot? The Auto is very sensitive to snores

:idea:

....or other noises it might ineterpret as snores.
O.

Ozij has offered really good suggestions. If you can get the software for your auto and take a look at what is happening through the night, this should help.

It is entirely possible that the RemStar auto algorithm is just not right for you; this can happen to anyone with any machine. It does not mean that your machine is defective, or that your are, just that you and the machine don't match well. Try a different auto machine; PB 420E is a good suggestion.

It is also possible that your RemStar Auto is defective -again, the software should help you to sort this out.

Check your hose to make sure that it has not holes/leaks. Also, check to make sure that you are getting a good seal between the humidifier tank and the machine.