Remstar Auto and 2 hour ramp

I just wanted to check with you knowledgeable people and comfirm what I thought I remembered from an old post.

My DME set up my machine yesterday (Remstar Auto) and told me I had a 2 hour ramp. AND that if I pushed the ramp button I would get 2 hours at the minimum pressure 10 for me (range 10 - 15) then it would go back to auto.

I thought I remember that the ramp on a Remstar Auto was a split night. It says this in the manual too but doesn't really describe what that means.

I also thought that I remember an old post that said something like someone's machine turned off in the middle of the night. And the response was that the machine was set on split night.

I promptly took out my trusty (Ebay bought) clinitians manual right when I got home from the DME and checked all of the settings at home and when I saw the 2 hr ramp, I reset it to 0

Could someone please go over again, what exactly that split night would have done to my machine if I hadn't changed it to 0?

Thanks a lot.

It wouldn't have done anything if you didn't push the ramp button. Pushing the ramp button would have set the machine to your lowest setting for the first 2 hours of use and then you would have gone into auto. Durring that first 2 hours the machine would not have increased pressure to try to take of any events that might have occured.

My understanding of it anyway. I could always be wrong. It has been known to happen occasionally.

That is interesting. I can't imagine why the guy at the DME would think I would have wanted that without asking me. I want an auto for the ability to adjust not to sit at my lowest pressure.

He also set the CFLEX to 3 which is not what I wanted but I remembered to look at that while I was at their office (I know I can change that myself without anyone having a fit, but the guy just making an assumption, and not even the one recommended irks me.


Thanks

Handgunner45 wrote:It wouldn't have done anything if you didn't push the ramp button. Pushing the ramp button would have set the machine to your lowest setting for the first 2 hours of use and then you would have gone into auto. Durring that first 2 hours the machine would not have increased pressure to try to take of any events that might have occured.

My understanding of it anyway. I could always be wrong. It has been known to happen occasionally.

That's very close to right, Handgunner. Very good explanation. The only thing I'd clarify is that those first two hours of lowest setting would start when the machine is turned on...pushing the ramp button is not necessary to start the split-night therapy mode.

snoregirl wrote:My DME set up my machine yesterday (Remstar Auto) and told me I had a 2 hour ramp. AND that if I pushed the ramp button I would get 2 hours at the minimum pressure 10 for me (range 10 - 15) then it would go back to auto.

Your DME told you almost right about what would happen, given the way he set up your machine. (Astonishing to me that he'd set it that way...in a "split night therapy" mode.) It would have started out using a single low pressure of 10 for two hours just by virtue of turning the machine on...not because of pressing the ramp button.

If the single pressure you were prescribed from your sleep study happens to be 10 or 11, probably no real harm would be done, having the machine blowing a straight "10" at you for two hours every night. But it's certainly a very odd way, imho, for the DME to set up an autopap.

snoregirl wrote:I thought I remember that the ramp on a Remstar Auto was a split night. It says this in the manual too but doesn't really describe what that means.

You're right, snoregirl...that's what it is, if the REMstar Auto is being used in auto mode (APAP) or in auto with C-Flex mode (AFLE.) In either of its cpap modes (CPAP and CFLE) the ramp is a true, "traditional" ramp.

Handgunner described well what would happen with the machine set for a 2 hour "split night". That would begin when you start the machine, each time.

snoregirl wrote:I also thought that I remember an old post that said something like someone's machine turned off in the middle of the night. And the response was that the machine was set on split night.

No, split-night therapy mode would not cause the machine to turn off at any time. It just does what Handgunner said...uses the low pressure in the range you've set for two hours...in this case, it would use a straight pressure of 10 for two hours. When the two hours is done, the machine begins working as an autopap, able to finally use the range of 10-15 as needed.

You did right to change that "ramp" time setting to 0, snoregirl. You are smarter about it than the person who initially set it up for you, imho.

Thanks rested gal.

I am so glad I caught that. I have apneas right when I start falling asleep. In fact I snore myself awake in 5 minutes. While I don't yet know how much pressure those apneas require I don't want to bank on my starting pressure for 2 hours. I plan to get the software but am trying to not play with the machine or the card any more than I have to in case it raises issues for compliance. The whole point of going through the DME is to get the insurance to pay and I don't want to jepordize that.

This is the same guy who wasn't going to tell me about the white filters (I have allergies) and when I did tell him that I wanted them he said "most people don't use them because they make it harder to put the grey filter in" Then he proceeded to try to put them in in reverse order (white on the outside). I corrected him and he fixed it.

It doesn't take much brain power to know that the finer filter goes on the inside towards the machine and away from the room air so the gross filter can take out the big stuff first.

Didn't ask anything about humidity or cflex level even though I told him I had used a Remstar Pro before. Just set it up his way not even the recommended settings. I told him what I wanted and he changed it.

Also turned on the machine without the hose on it. The manual says not to do this. I am not sure why exactly, maybe (just a guess) the machine works harder without the air being confined to a limited area? Anyway, I pushed the off button right away. Told him that the manual said not to do this. He turned it back on and I turned it off and said to him "since I will be owning this machine in the future, I prefer that you not do this". He put the hose on.

I plan to stay far away from this guy now that I have my hands on my machine.

Thanks for the info on the split night!!

Rested Gal,

I missed one comment on my CPAP pressure. It is 13 so that is why I was wary of the 10 for 2 hours.

The sleep doc who read my study who has never met me (not my regular doc who wrote the script) told my regular doc that he couldn't give him a range to put on an APAP script since my sleep study was for CPAP.

Amazing. I really doubt that there is a different study for APAP. This guy got $220 two times (both sleep studies for essentially nothing). I have copies of the reports and they are filled up with stuff like "patient should be counseled that the use of alcohol can excerbate apnea. Duh, and by the way -- if that had any relevance to me -- should have been discussed BEFORE I was sent for a sleep study. Not much meat in the report when you discount all the things I "need to be counseled on". I think that this guy has a prewritten report and he sticks a couple charts on the boiler plate and collects his $220.

I got with my doc and used the +/- 3 rule. And I decided +2 was good enough, at least for the 3 month compliance. My pressure is high enough already why push the top end. Then, when I get the software I will decide if it would be better at 16 I can always do that later.

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RG,
Thanks for the clarification. I didn't realize that it would "split night" every time it was turned on. I would have thought that the split would only be activated with the ramp button. I knew that sopmeone would catch it if I was wrong.