DOC WOULD NOT PRESCRIBE AUTO C-FLEX

Can't Remember wrote:1: Put on mask, turn on machine, watch TV for 1 hour - software reports 35 snores, 12 hypopneas, 7 apneas during that hour (all while I am awake, no, I didn't doze off).

Why would you do that (wear the mask and run the machine while awake)? I'm taking an educated guess here, but I suspect the algorithms won't work properly on wakeful people.

Why don't you put on the mask and turn on the machine as the last thing you do before you close your eyes? During my titration I read for a bit to unwind then, when I finally yawned, called the tech to help me with the mask (I was already wired), turned out the light and fell asleep in 9 minutes. Normally (with OSA induced sleep deprivation) I'm asleep much faster (2 minutes my wife reports), but the mask took a bit of getting used to.

BTW, I've read that well rested healthy people take 20 minutes to fall asleep. Amazing!

Note that I'm not trying to criticize; I'm just asking to understand. Your comment has me truly puzzled.

I can tell you from my experience, anyway, that when I get sleepy, I put the machine and the mask on. Even if it means lying awake watching TV for 20-30 minutes, it's better than falling asleep without the cpap on. So, I tend to put it on when I get into bed.

Why would you do that (wear the mask and run the machine while awake)?

A new user might do this to help acclimatize to the machine. Also, it might be a good way to test the machine/software.

Interesting experiment... I think I will try hooking myself up, reading a book for an hour and then seeing what Silverlining says about nmber of events and treatment provided.

WillSucceed wrote:A new user might do this to help acclimatize to the machine. Also, it might be a good way to test the machine/software.

OK, I'll grant you the first point, but I'm not sure it would be a meaningful test.

NeurosurgeryNP wrote:I can tell you from my experience, anyway, that when I get sleepy, I put the machine and the mask on. Even if it means lying awake watching TV for 20-30 minutes, it's better than falling asleep without the cpap on. So, I tend to put it on when I get into bed.

If you're sleepy and have gone to bed, why do you have the TV on? Or am I misunderstanding what you said?

If I'm not sleepy enough to fall asleep (as if I've been like that for over a year!) I'll stay up and read or watch TV in the family room or be on the computer. When I'm ready to go to sleep I go to bed, turn out the light and close my eyes.

Really, I'm not a troll trying to upset anyone. I'm just a n00b who is getting really confused by this thread. Isn't maintaining good sleep hygiene part of treating our problems?

When I asked the doc to prescribe Auto C-Flex it was either his way or the highway. He did not even attempt to work with me a little. From what I understand the Auto feature can be turned off & the machine can be operated as a straight C-Flex. Therefore if I found the machine not doing what it is supposed to do, I would be able to switch the auto off & it would become just like the machine he wrote on my prescription. He was dead set against the auto even though I don't have to use the auto.
What would be his motivation for doing this??? He stubbornly dug in his heels & refused to even try it. It may be that with the auto it will report the titration level that I need. They had trouble in the sleep lab getting the titration level. I think he wants me to do another lab test so they can charge the insurance company some big bucks. I don't know what else to think.

Mr Tired

Mr tired do you mean straight cpap as opposed to c-flex?

Yes charge more bucks,as there is a danger dmes may become redundant, if you were to monitor your own progress!

Mr Tired wrote:Just got back from the doc. I asked him to change the prescription from c-flex to auto c-flex. He would not do it. He said the auto feature is unreliable & has not been perfected yet.

Getting the same stuff from my sleep doctor. His staff says he doesn’t believe auto-PAP’s have any advantage over CPAP’s so he won’t prescribe them.

Tried to return the REMstar Pro 2 he’s renting to me for $500/month today, but the front desk staffer REFUSED to take it back, saying she’s not allowed to accept rental machines back without permission of the doctor.

Now I’m feeling crappy for not just setting it down and walking out rather than letting her pressure me into another appointment next Tuesday with the sleep doctor to discuss it. <SIGH>

If you're sleepy and have gone to bed, why do you have the TV on? Or am I misunderstanding what you said? ....Isn't maintaining good sleep hygiene part of treating our problems?

For some, such as the TV watcher you're responding to, using some sort of distraction from anxiety about insomnia can be part of good sleep hygiene. Many people read for a short time after going to bed for that reason.

What would be his motivation for doing this??? He stubbornly dug in his heels & refused to even try it.

Doctors are humans too. In this case, Mr Tired, your very human doctor sounds like a classic example of a "Wizard of Wind" (ty, unclebob! LOL!!)

Your doctor considers himself a god. How dare you venture a commonsense suggestion, or even question pronouncements from on high?!

gracie97 wrote:For some, such as the TV watcher you're responding to, using some sort of distraction from anxiety about insomnia can be part of good sleep hygiene. Many people read for a short time after going to bed for that reason.

OK, people cope with these issues in different ways. The empiricist in me says I should let it drop because if it works for them, who am I to question it.

My sleep lab presecibed a Remstar Auto with a setting of 5 to 18 which is like saying "I have no idea". I recently purchased a Goodknight 420E for travel and backup. I find the results to be remarkedly consistant between the two with the Goodknight perhaps giving me 1/2 cm lower average pressure reading. Both machines tell me they spend most of their time at 6 to 7 cm. It's not exactly clear how much the snores effect the pressure but there seems to be more of an effect (raise the pressure) with the Remstar than the Goodknight. Derek did some interesting work in this regard. I, and several other posters have found that straight cpap or apap with a narrow range, in my case it might be a cpap of 7 or and apap of 5 to 8 gives very good results (AHI's 1 to 5).

For me anyway, I don't know what I would do without an autopap machine to give me optimized titrations which give me these low AHI's. Clearly the old 5 to 18 setting didn't work at all. It does seem that apap machines have some trouble with these very wide ranges and particularly the very high pressures. I don't think the mask exists, for my noggin, that would function at 18 cm. In this regard I absolutely agree with Can't Remember that getting the right mask is the first order of business. If the mask doesn't fit right and hold a seal it doesn't matter what type machine your are running.

BTW, I really like the Goodknight 420E. Still trying to decipher all of the Silverlining software stuff. It is a bit more sophisticated than the Encore Pro.

WAFlowers wrote:I'm taking an educated guess here, but I suspect the algorithms won't work properly on wakeful people.

You're right - and if you search for "algorithm" you'll fine some fascinating reading - including links to patent applications.

O.

Can't Remember wrote:

He said the auto feature is unreliable & has not been perfected yet. Is this true?

You be the judge.
<snip>
Big disappointment. Pressure runs at max 90% of the time, and C-Flex makes the mask feel like its alive (it breathes on its own). Didn't solve anything.
<snip>
As for other posters calling your Doc an idiot, they're being a little quick to judge. Give whatever he prescribes some time, it may work just fine for you. If not, TALK TO HIM! You might be surprised.

I liked your well reasoned and sensible reply.

To all the others calling the doctor a 'liar' - sorry but that is an emotional over reaction & based on hearsay input. Give the doctor some credit. He may be wrong and he may be right. Runaway AUTOs are stilll regarded as problematical & doctors still have to consider the potential for medical litigation by disgruntled patients.

But I am a believer in AUTOs and suspect that as certain brands (I won't name them) get their act together in the AUTO space, these machines will become the standard & conventional CPAP will fade the way BiPAP/VPAP are now doing (other than for specific medical related needs).

I too was advised not to get an AUTO but after much reading here I bought one. I currently have it set to CFLE mode while participating in a research project. When that study ends, I am going Auto. My current plans are derived from reading posts by 'WillSucceed'. His experience is ahead of mine and I seem to be following the same path.

Anyway. Lets try to avoid emotional reactions to hearsay reports on what the doctor DME said or didn't. Base any criticism on known facts or actual experience. Sorry to sound a bit tough but I felt a reality alert was needed.

Cheers

DSM

gracie97 wrote:[
Tried to return the REMstar Pro 2 he’s renting to me for $500/month today, but the front desk staffer REFUSED to take it back, saying she’s not allowed to accept rental machines back without permission of the doctor.

Is this true ? - do doctors really charge $500/month to rent out a machine that can be bought for the same price from cpap.com ?

This is worrisome. If this is what your doctor charges then it seems plausible that such a doctor might become seduced by the value of the treatment rather that the value to the patient.

Cheers

DSM