Remstar Auto Cflex, Stays at max setting,

Settings are: REMstar Auto C-Flex (Core package N. Amer)
Mode=AFLE min = 8.0 max = 13.0 C-FLEX = 3 RampLength = 0:00 Alert = 0 LED = 0,
Main Question is why does the unit not go back down from 13, even when:???
The person is awake and breathing easy???
The mask is removed from the person???
Minor Question: RampLen is now zero, but what effect does the RampLen= "2,3,or 4 Hour" setting have in the AFLE (or Auto) mode??
Thanks!

When mask is removed from the person it definately will go up. It is like major leakage.

Ramp with Auto needs to be zero or it goes into "split" night mode which you don't want.

I don't know about why it won't go down when breathing easy.

Try this sit up and breath easy for 15 or 20 minutes when it is up high and see what happens then. I don't know how long it takes to adjust.

Do you have software or somewhere that could read it? Are you sure it isn't going down when you are asleep?

As I said in the other post, we breath differently when asleep and awake, you need a dumber machine so you can fool it. Jim

Only the machine knows, what Evil lurks in the heart of men!

You need to go into your profile and fill it out, it helps everyone when they are trying to sort out your problems. Since you are having problems, I am guessing you are using a nasal interface, and if the pressure isn't comming down, I guessing excessive leakrate. Did I guess correctly, based on a guess only. Jim

dcpap wrote:Minor Question: RampLen is now zero, but what effect does the RampLen= "2,3,or 4 Hour" setting have in the AFLE (or Auto) mode??
Thanks!

The "split night" therapy that snoregirl mentioned is something you don't want because...

If a person is using that machine in APAP or AFLE mode (either "auto" mode) and inadvertently sets what they think is a "Ramp" for length of time at 4 hours, then every time they turn the machine on, the machine would use ONLY the minimum pressure in their range (8 cm for you) for the first four hours. It would simply record data while blowing a straight pressure of 8 at you for four hours. During those first four hours it would not try to prevent apneas/hypopneas, or use more pressure to clear an apnea. Straight 8 is all you'd get for the 2, or 3, or 4 hours.

Only when the four hours was finished would the machine begin using the full range of pressures (8 - 13 for you) for the remainder of your sleep session. A "split night" of therapy, in other words.

As I understand it, the idea behind development of autopaps was that they'd be used as a auto-titrating device, and that the pressure range would be left wide open (4 - 20.) It was probably also thought they could serve as a very rudimentary sleep study of sorts, if a real PSG sleep study were impossible.

In that case a split night mode for initial data gathering would make sense. Using split night mode to get an idea of how bad a person's sleep apnea was without much "treatment" going on (pressure of 4) for several hours, and how much improvement there'd be when the machine could begin using its full range after the split night timer was up.

Most people need more than 4 cm H20 pressure, so minimum pressure of 4 would be almost like no treatment.

It would have been less confusing if the manufacturer had put the words "split night" right on the setting screen, allowing on/off for that, and then "split time" for the 2, 3, or 4 hours. Instead of using the word "Ramp" in any way for the split night timer. There have even been DMEs who set up the REMstar Auto with split night turned on, thinking they were setting RAMP in some way for the patient. The home health care provider instructions booklet that comes with the REMstar Autos does not stress the importance enough (imho) of keeping that timer set to 0:00. You did well, dcpap to know to keep that turned off.

M series REMstar Autos can use a traditional "Ramp" while operating in APAP or AFLE mode, gradually increasing pressure over a period of time up to as much as 45 minutes. But the REMstar Autos prior to the M series cannot....not in APAP or AFLE mode.

And even with the M series Auto, you have to know that if you see only the word "Start" on the setup screen...that single word "Start" is talking about "split night mode". Needs to be set for 0:00. With the M series Auto, "Ramp start" handles the true ramp timer of 5 - 45 minutes.

if the machine is programmed correctly, there are several factors which can cause it to stay at the Max. pressure setting.

1. Snores. Most autopaps "trigger" on a snore and increase pressure in an effort to eliminate them. However, the Remstars have a limit to those pressure increases if the snore continues after 3 consequtive pressure increases it will pause for 1 minute and even lock out of snore detection if they continue.

2. Unique Breathing pattern: While these autopaps are smart they are not all that smart, they have difficulty distinguishing the difference between a obstructive apena and a central apnea event and you can have both at the same time called a mixed apnea. If your airway becomes blocked from airway collapse the airflow stops for 30 seconds or however long the apnea lasts. The same thing happens if you have a central event and simply stop breathing for 30 seconds, in both cases there is no airflow. Too much pressure can also "trigger" central events, if the machine has increased air pressure as a result of snores and you are at risk of central events, the pressure increase from the snore can trigger the central event. You can only see centrals with a EEG monitor and the probes connected to your scalp like in a lab setting. The tech can see them, the machines cannot. Autopaps don't have EEG so they cannot distinguish the difference. Some build in to their algorithms to look for erratic breathing which takes place after a central event where they don't respond to the event because it was determined central. If a machine confuses a central event as obstructive, it can increase pressure which makes he condition worse. To properly set up any autopap one should study their diagnostic PSG and look for those CA and MA events to see if you are at risk of having them. They should also be noted on any titration report as well.

First thing one should do is check the programming on the machine and make sure it is set up correctly.

Settings Update:
REMstar Auto C-Flex (Core package N. Amer); FullFaceMirage;
Mode = AFLE min = 8.0 max = 13.0 C-FLEX = 3 RampLen = 0:00 Alert = 0 LED = 0;
No Software or Card Reader (Yet!)
Thanks
RestedGal thanks for "split" explanation.
Snoregirl. thanks for: removed mask = leakage info;
& will try sitting up, breath easy, see if goes down;
Snoredog. thanks, for snores triggering increases info;
& I will try to find about CA or MA events on either study.
Unresolved Problem: Why Apap seems to stay at Max and not tittrate down.
I will try the above ideas and report back.,
Thanks

[quote="dcpap"]Settings Update:
REMstar Auto C-Flex (Core package N. Amer); FullFaceMirage;
Mode = AFLE min = 8.0 max = 13.0 C-FLEX = 3 RampLen = 0:00 Alert = 0 LED = 0;
No Software or Card Reader (Yet!)
Thanks
RestedGal thanks for "split" explanation.
Snoregirl. thanks for: removed mask = leakage info;
& will try sitting up, breath easy, see if goes down;
Snoredog. thanks, for snores triggering increases info;
& I will try to find about CA or MA events on either study.
Unresolved Problem: Why Apap seems to stay at Max and not tittrate down.
I will try the above ideas and report back.,
Thanks

If you are certain the machine "STARTS" at 13 cm/H2O, its is broken.
I say this because RemStar APAPs "START" at minimum pressure.
Furthermore, your programming is correct.