Problems with my M series Auto

Rather than start several topics, I think I'll just list all my problems here and ask for some advice.

A few weeks ago, I purchased a M series Auto from cpap.com. I did it so I could have a backup (my DME supplied M series Plus. I got downgraded from a Pro, but that's another story), I wanted the data recording capability, and I wanted to periodically check my titrated pressure (12cm H2O).

First problem. All the data seems to be there except the daily leak rate. It's displayed on the machine, but MyEncore syas no data and shows a blank graph. I also only got flow limitation data 3 out of 14 days. cpap.com customer service is guessing it might be because I did not have mask alert on.

So, after about 2 weeks of using it in regular CPAP mode to establish a data baseline (my AHI averaged below 1) I switched to Auto mode last night. Well, I tried to switch to auto mode. I'm pretty sure I set it up correctly (double checked with cpap.com customer service today) to RAMP start 7.0, Auto Min 11, Max 14, Cflex - 3. I put on my Swift and tried to go to sleep. The RAMP started at the pressure I set, but it didn't stop at 11 and went up to14 and stayed there. The CFlex also didn't feel like it was working. I know this becasue I had not fallen asleep yet, and felt the pressure was too high, so I looked at the display and it said 14cm H2O. cpap.com says the only remedy is to send it back to them and they'll send it back to Respironics. 4 week turnaround.

This is probably the bigest drawback to a mail order DME. When my first M series Pro stopped working after three weeks, the DME gave me another machine right away. Unfortunately, it was a slightly used Plus. However, they did promise me a brand new Pro after I completed the 90 day rental period and BC/BS paid up. The 90 days was up last week, so I'm waiting.

Anyway, any suggestions would be appreciated.

Rafe

Which "Auto" mode did you select? APAP or AFLE? (C-Flex only works in AFLE mode) When you set a minimum and a maxuimum pressure, there's no guarantee it's going to stay at the minimum. Something made it decide to keep on going......snoring?......A/H events?......leaks?......don't know for sure.

By the way, which version of Encore Pro do you have?

Best wishes,

Den

The M series menus aren't as confusing as the RemStar ones.

There should be a clear choice between CPAP and Auto, and then if you're in Auto it'll say Min and Max. CFlex is adjusted by just turning it on or off.

As for the data problems, you might try formatting the card with Encore if you can get away with it.

Rafe wrote:All the data seems to be there except the daily leak rate. It's displayed on the machine, but MyEncore syas no data and shows a blank graph.

MyEncore doesn't fully work with M Series machines (and the required Encore Pro 1.6). Might I humbly suggest trying Encore Pro Analyzer? http://james.istop.com/EncoreProAnalyzer/

-james

jskinner wrote:

Rafe wrote:All the data seems to be there except the daily leak rate. It's displayed on the machine, but MyEncore syas no data and shows a blank graph.

MyEncore doesn't fully work with M Series machines (and the required Encore Pro 1.6). Might I humbly suggest trying Encore Pro Analyzer? http://james.istop.com/EncoreProAnalyzer/

-james

And I mis-read that as Encore Pro.......saw Encore and missed the "My" in front of it. Sorry.

But the other comments/questions still apply. (unless I mis-read something there, too)

Den

Rafe:

Your AHI would be lower in CPAP mode. Sorry Wulfman, not too hard to mix up the mode(s), there are ONLY two options on the M series machine, unlike the classic, it doesn't have AFLE/CFLE modes (Auto/CPAP with CFLEX). Options are just CPAP/AUTO.

CFlex is now a seperate programmable field and includes "off" so options for Cflex in setup are: off, 1, 2 or 3. Selecting Off would be equal to changing CFLE to CPAP or AFLE to AUTO modes. Off is only displayed while in Setup mode (not available for change in User mode).

Setup should resemble the following for Rafe:
1. Hold down the <- -> buttons while plugging in the power
on the back, wait 2 beeps, release buttons.
2. Press the + key. <- -> buttons move to next field, -/+ keys decrement/increment
3. Check the following field(s):

-Therapy Mode=Auto (CPAP/Auto)

-Auto:Max=14 (default=20.0cm)

-Auto:Min=11 (default=4.0cm)

-CFlex Setting=2 (options are off, 1, 2 or 3)

-AutoRamp Time=30 (options are 05 to 45 min)

-AutoRamp Pressure=7.0cm (4cm->AutoMin)

-Mask Alert Feature=ON (On/Off)

-Auto Off Feature=Off (On/off)

-Split Night Time = Off (off, 120, 180, 240)

-Show AHI/Leak Feature=ON (On/Off)

Press On/Off button to exit.

Note: Rafe you didn't mention any Ramp timer. If it was at default =05 then after 5 minutes machine would move from 7cm pressure to 11cm pressure then start with autopap as you mentioned above.

If it has done this and gone immediately to 14cm pressure then I would lower the Auto:Max pressure to your lab-found titration pressure =12cm for the first few weeks (e.g range would be 11 to 12cm instead of 11 to 14cm).

The way the above should work:

1. Lay down in bed with mask on.
2. Press the On/Off button or take 4 breaths machine will start at 11cm pressure.
3. Press the Ramp button, machine should drop from 11cm pressure to 7cm pressure then increment back up to Auto:Min or 11cm every 5 minutes by .5cm pressure until it reaches the Auto:Min pressure where regular autopap therapy begins.

I would also first wipe the slate clean on your M series:

1. Erase the accumilated data in the machine displayed on the LCD, that data includes about 20 minutes worth of bench test data, so it is going to skew your results anyway.

To erase the LCD data:

1. Go into setup mode, but don't push the + key, instead press the -> key, and navigate to the Therapy Use screen, then press the - key for about 5 seconds it will reset all the LCD data to zero (it will keep machine hours).

2. If you have EncorePro, insert the SmartCard into the reader and use the SmartCard utility to "Setup" the card, it will erase the data it contains and start recording anew.

Snoredog wrote:Sorry Wulfman, not too hard to mix up the mode(s), there are ONLY two options on the M series machine, unlike the classic, it doesn't have AFLE/CFLE modes (Auto/CPAP with CFLEX). Options are just CPAP/AUTO.

Obviously, this ain't my night!
I need to spend more time studying the M Series.....

Den

Snoredog wrote: 1. Go into setup mode, but don't push the + key, instead press the -> key, and navigate to the Therapy Use screen, then press the - key for about 5 seconds it will reset all the LCD data to zero (it will keep machine hours).

Does this clear stored data on the SmartCard as well or just in the Machine?

For example can I do this while traveling so that I can see my nightly AHI (since the machine will only show averages) or will this remove the data from the card as well so I can't download it when I get home?

jskinner wrote:

Snoredog wrote: 1. Go into setup mode, but don't push the + key, instead press the -> key, and navigate to the Therapy Use screen, then press the - key for about 5 seconds it will reset all the LCD data to zero (it will keep machine hours).

Does this clear stored data on the SmartCard as well or just in the Machine?

For example can I do this while traveling so that I can see my nightly AHI (since the machine will only show averages) or will this remove the data from the card as well so I can't download it when I get home?

Thanks to everyone who replied to this and gave me some input.

James...I will try Encore Pro Analyzer when I get a chance.

Snoredog...I had all the settings as you described, except Mask Alert:On. ( I always had the Ramp time set to 20 mins, Cflex - 3.) Amazingly, the machine seemed to work correctly last night. Could this one setting have that impact? If so, Respironics should update their manuals. Or, the fault could be intermittent.

I'm also surprised that you would say that my AHI will always be lower in CPAP mode. Why is that? I always thought the Auto was superior. Everyone here seems to think so.

Rafe wrote:I'm also surprised that you would say that my AHI will always be lower in CPAP mode. Why is that? I always thought the Auto was superior. Everyone here seems to think so.

The Auto waits for an event to occur before it responds to it with increased pressure. The CPAP (if properly set) is already at a pressure that will preempt the events from occurring......or at least a higher percentage.

Best wishes,

Den

I understand that theoretically, if the titrated pressure is correct, it will eliminate just about all apneas, while an Auto has to react to an apnea. That's why when I first setup the Auto, I set it for Min 12cm H2O and Max at 14cm H2O thinking that if the titrated pressure was correct, then the Auto should never go up past 12cm H2O. I just wanted to validate the titrated pressure. When it went to 14 and the numbers still weren't looking good I got curious, so I went back to straight CPAP mode for a few weeks to get a good history of data. Then, a few nights ago, I tried to go Auto again and set it 11-14. that's when I ran into the issues I listed above.

When I get home tonight, I'm going to look at the data from last night and see what happened.

Rafe,

What was your pressure setting when your AHI was less than 1.0? 11, 14?

It sounds to me like THAT pressure (whatever it was) was right where you need to be.....and on straight pressure. Those kind of numbers are hard to improve upon.
After being on straight pressure for a year, I tried the Auto thing, too.....that reassured me that I had it right to begin with and went back to straight pressure.

Best wishes,

Den

When I was on straight CPAP, my pressure was 12 cm H2O, and my AHI was around .4 to .7.

I think I'll give Auto another try at 12-14 and see what the numbers look like.

Best regards,

Rafe

Rafe wrote:

I'm also surprised that you would say that my AHI will always be lower in CPAP mode. Why is that? I always thought the Auto was superior. Everyone here seems to think so.

I think you answered your own question in your last post, your lab found CPAP pressure would be the pressure that eliminates nearly all events yet still offering you the best sleep.

That lab found pressure should be the pressure that eliminates the events in all sleeping positions yet avoids triggering any CA or MA events if you are at risk of them. In your case that was 12cm pressure. If any CA events we seen by the lab tech, they would "back-off" pressure to the pressure found just before that CA was triggered. So they give you a found pressure of 12cm.

Then you switch from CPAP to AUTOPAP. The machine cannot see that central apnea, it may actually see that central apena as a obstructive one and actually increase pressure as a result, could be how you got to 14cm pressure. It may even log it as obstructive if you have the software. If it is a Respironics machine and you are lucky it will trigger a triple event, when the machine sees that triple event it will stop with pressure increases and realize it has detected a non responsive event.

Always a good idea to read and understand your diagnostic PSG and titration PSG carefully for any notation of CA or MA events. They will tell you if you were found at risk of CA. Your safest mode with any autopap is putting the Maximum pressure to your lab found pressure. If you have the recording software you can see if you are flat-lining and can make adjustments as needed.

My experience in using cpap for more than 5 years is your pressure doesn't fluxuate all that much from night to night or month to month. My pressure hasn't changed .5cm in over 5 years and I've gained probably 20lbs. since then.

If your titrated pressure was 12 and PSG shows CA or MA, I would put your machine to the following and make life easier to sleep with. Lower pressure always results in less noise, fewer leaks and greater comfort. From a AHI perspective, you may not feel any better with a AHI=.8 than one with AHI=8.

If you didn't feel any better with the machine going to 14cm I would put it back down and enjoy the added comfort the autopap offers. But that is your choice, if you can tolerate that 11cm Minimum pressure, then leave it as is. But if you want more machine comfort I'd set it as:

-Therapy Mode=Auto (CPAP/Auto)

-Auto:Max=12 (default=20.0cm)

-Auto:Min=8 (down from your 11cm, default=4.0cm)

-CFlex Setting=2 (your choice, options are off, 1, 2 or 3)

-AutoRamp Time=20 (options are 05 to 45 min)

-AutoRamp Pressure=6.5cm (4cm->AutoMin)

-Mask Alert Feature=ON (On/Off)

-Auto Off Feature=Off (On/off)

-Split Night Time = Off (off, 120, 180, 240)

-Show AHI/Leak Feature=ON (On/Off)

It could be you didn't EXIT the Setup mode properly the time before reason machine may have been erratic. I don't think changing the Mask Alert feature would cause the machine to run erratic, but you never know.

The Auto Off Feature is the one I think should be turned OFF. That feature can cause problems if you are a shallow breather, machine can turn off in the middle of the night during sleep. Then when you have rebreathed way too much of your exhaled CO2 the AutoOn feature starts the machine back up automatically so you never know what happened. Could that be the missing data seen on some reports during the night? Never know.

So you may spend hours going through those AutoOn/Off cycles. It is simply not that hard to press the OFF button on top of the machine. Disabling the AutoOFF feature still leaves the AutoOn feature functioning, there is no problem with the AutoOn feature.

At the same token as CPAP, if the events warrant, the machine can still run up to your lab found titrated pressure yet avoid the trigger that took it to 14cm. Yes they mess up with lab found pressures, but that seems to go with rookie lab techs. The experienced ones usually get it right.