A home titration

Sleepless on LI · Post by **Sleepless on LI** » Mon Aug 29, 2005 7:34 pm

True, if you make it too high, he is actually getting therapy and that defeats the whole idea of a split study. Besides, I think the ramp set at 4 will start the machine at a 4 pressure anyway, if I'm not mistaken. And it certainly wouldn't be the first (or last) time I was.

Isn't it also true that they don't normally put people on CPAP therapy unless their titrated pressure is above a 5 anyway? A friend of mine told me that, but don't know if she's right. She was also the one who told me try to the Oracle because it was the "Cadillac of CPAP masks." I will say no more... .

th · Post by th » Mon Aug 29, 2005 8:23 pm

For me I can do a pressure of 4 with the swift mask. That is the only mask I would be able to use at that pressure. Maybe, you could try different masks and find the one that is the most comfortable. With any nasal mask it takes at least a pressure of 6.

loonlvr · Post by **loonlvr** » Mon Aug 29, 2005 8:24 pm

He is a mouth breather like me. Using a ff mask.

rested gal · Post by **rested gal** » Mon Aug 29, 2005 9:38 pm

After that time, it will revert to the pressures you previously just set.This is for a split nite study.

You're exactly right, loonlvr. I was wrong, thinking that in split night mode the machine would use 4 cm H2O no matter what, for the first hours of the split. As you correctly point out it will use a steady pressure of whatever "low" you have set for the low-high range while it performs the first part of the split time.

If the range is set for 4 - 20 cm, or 4 - 10, or 4 - anything, the first part of the split night will be done at a steady pressure of 4 cm.

If the range you set is 5 - 10, the machine will use a steady 5 cm for the first hours of the split. Just as you said. Thanks for the correction!

From the "Home Care Provider Setup Instructions" booklet under "Set the Pressures":

Note: For the Split Night mode, the minimum pressure setting will be the pressure delivered during the delay time.

When I did a "minimum" pressure test once with my autopap, I wanted the test to go all night, not be a split night study. I used a full face mask (to insure no mouth air leaking) and I set the autopap's pressure at a range of 4 for the low and 4 for the high. Ran it that way all night - slept 6 hours. Interesting results.... AHI of about 11, and almost 2,000 snores.

Will be very interesting to hear how the results of your nephew's experiment turn out. Sounds like he has the makings of a good lab rat. He's a game little critter. Must be genetic!

Too bad you can't round up a recording pulse oximeter to put on him during the test. Or maybe you can....would your doctor order one for you? hmmm.

loonlvr · Post by **loonlvr** » Tue Aug 30, 2005 4:08 am

WOW! I just corrected rested gal. Thats something, hehehehe Whats a pulse oximeter?

ozij · Post by **ozij** » Tue Aug 30, 2005 5:22 am

By the way, with the 420E you can do something similar, with the help of the "programming settings" option. Its programming capabilities look even more sophisticated, since you can set the date and time when the machine will switch from one setup to the next. You want a 4 week 4 configuration trial? No problem, just program the machine to change the settings.

And you can also make a real time recording form the machine to you computer (this is what they call, believe it or not, the "compliance on" option...).

I haven't tried either option. Given what I know of how the Silverlining presents data gathered by the machine, I would prefer a Remstar, with Derek's My Encore to help.

The reason is that in order for self titration to be informative, you have to know how many events occur at each pressure, and get an "event per time in pressure" index.

SL3 doesn't show that in any way.
O.

rested gal · Post by **rested gal** » Tue Aug 30, 2005 1:09 pm

The reason is that in order for self titration to be informative, you have to know how many events occur at each pressure, and get an "event per time in pressure" index.

SL3 doesn't show that in any way.

Showing my very untechie side here... can't that be deduced fairly well on a session-by-session basis by looking at SL3's 96 hour graph? I realize it won't figure an index for what you mentioned, but seems to me the 96 hour graph is plenty informative enough for self-titration purposes.

ozij, I'll trade you my REMstar Auto with C-flex, complete with software and card reader (no heated humidifier, though - I let that go to someone else as I'm using the F&P humidifier) for your 420E, software and d/l cable. Seriously. Have been wanting another 420E again for quite some time.

Sleepless on LI · Post by **Sleepless on LI** » Tue Aug 30, 2005 1:57 pm

RG,

What is it you don't like about the Remstar Auto? I have it, it's been the only machine I've ever had other than my one month rental of a standard Remstar, and I hear you talk about your preference all the time of the PB420e. What is it about that machine that you feel the Remstar Auto doesn't have or what is it about the PB420e that you prefer? I'm just curious.

tomjax · Post by **tomjax** » Tue Aug 30, 2005 5:15 pm

ozij, I'll trade you my REMstar Auto with C-flex, complete with software and card reader (no heated humidifier, though - I let that go to someone else as I'm using the F&P humidifier) for your 420E, software and d/l cable. Seriously. Have been wanting another 420E again for quite some time.[/quote]

RG- you have blown it with me!!!
I was about to buy a remstar like yours because all the things you say about it.
Now you are willing to trade it away!!
What am I supplsed to do and who can I trust????

But if you want to sell it, i will buy it- right price.

I need to know how to get the smart card/software also. I was hoping you would be my guru, but you are causing me to question it.

"What shall I do?" "Where can I go?" "Frankly, tomjax", I don't give a damn. RG O'Hara

ozij · Post by **ozij** » Tue Aug 30, 2005 9:00 pm

Showing my very untechie side here... can't that be deduced fairly well on a session-by-session basis by looking at SL3's 96 hour graph?

Probably yes - that's what I was attempting to do yesterday (I decided to raise my minimap pressure to 6, base on the fact that I rarely seemed to have hypop on of above that). But:

* I hate counting - I prefer the machine doing it for me, I usually get confused doing it.
* More seriously: I couldn't always figure out what a wide tick meant - 2 hypops in a row? 3?
* The index really is important, and also the length of the events - which you have no idea of with the SL3

ozij, I'll trade you my REMstar Auto with C-flex, complete with software and card reader (no heated humidifier, though - I let that go to someone else as I'm using the F&P humidifier) for your 420E, software and d/l cable

Sorry, rested gal, the software maybe not as informative (in some things), but the therapy.... I love the 420e - therapy, handling, everything but some missing details in the software....

O.

WAFlowers · Post by **WAFlowers** » Wed Aug 31, 2005 4:24 am

ozij wrote:* More seriously: I couldn't always figure out what a wide tick meant - 2 hypops in a row? 3?

Each tick means one or more events in a 30 second period. At least, that's what I remember from reading the manual.

A "wide tick" is just two or more ticks back-to-back indicating a series of events spaced 30 apart. I think.

ozij · Post by **ozij** » Wed Aug 31, 2005 5:04 am

... one thing I don' have - the clinician's manual...
O.

Sleepless on LI · Post by **Sleepless on LI** » Wed Aug 31, 2005 6:45 am

Getting back to the subject at hand, how did the home titration study go, loonlvr? I keep waiting to hear if you went ahead with it and what the results were. Please let us know ...

rested gal · Post by **rested gal** » Wed Aug 31, 2005 6:51 am

Lori wrote: I hear you talk about your preference all the time of the PB420e. What is it about that machine that you feel the Remstar Auto doesn't have or what is it about the PB420e that you prefer? I'm just curious.

Lori, I've used all three of the major brand autos and liked things about each one. While I got good treatment from each one - 420E, Spirit, Remstar - I much prefer these things about the Puritan Bennett 420E:

1. small size, light weight, flat top shape.

2. the Silverlining software - plenty of details and no card reader needed.

I don't need C-Flex, so don't really need the Remstar.

In looking back through my Silverlining data files from the 420E, I noted fewer "flow limitations" and hypopneas with the 420E than I get with the Remstar... night after night. Those things are more of a problem for me than plain apneas, which all three autos prevented great. Have used those two autopaps an equal amount of time - more than half a year each, so now have plenty of data to compare.

Overall, the 420E autopap simply prevents all types of events better for me. It's important to stress that, since different machines suit different people better. The hypopneas, limited flows, and snores that the Remstar was letting through are eliminated much better with the 420E...for me.

I've used narrow tube nasal pillows interfaces with all three autopaps with no problem. However, I do like the assurance of the 420E's separate sensor line "reading" airflow closer to the mask itself or to some interfaces' narrow connector hose. There has never been any caveat from Puritan Bennett about using the 420E autopap with any type of mask, even masks from other manufacturers. Nor any need to tell the machine what type mask you're using, like the Spirit requires.

I got excellent, smooth treatment from the 420E. So, I'm ready to settle back in now with my "first love".

Tomjax, fiddledeedee! Think about that tomorrow.

Sleepless on LI · Post by **Sleepless on LI** » Wed Aug 31, 2005 6:57 am

RG,
Thanks for the reply. I know the PB doesn't have the card reader, but for me that would be a pain as I have my office with my computer upstairs and my bedroom downstairs. So that would mean unplugging and carrying my PB upstairs to my office every day (yes, I read my results every morning, as anal as I am).

Other than that one distinction which for me would be a negative, now you have me wondering how much better control I would be getting with the PB. I guess I will never know unless I actually buy one out-of-pocket and try it. Since my insurance co. bought me the Remstar at the end of July, that's probably it for about five years, I think it is. I'm not sure, but I doubt they'll be even thinking to buy me a new one for a long time.

Glad to hear it works that well for you. I wish there was a way to hook yourself up to two machines at one time, like a "split hose study" to see what the readings of the data would be on one given night's events. Would be an interesting experiment. Too bad it can't be done. And only someone like you with both machines, IF IT COULD BE DONE, would be able to actually try it.