CMS-50E oximeter + RemStar Pro with C-Flex

Heya... Newbie here...

Just wanted to share some of my story, and give a bit of a review of an oximeter I recently purchased and how useful it's been.

For the past few years I have suffered from extreme daytime sleepiness and depression, which has severely impacted my ability to work (programming) as well as other areas of my life.

A full night's sleep and several naps a day didn't seem to help. Doctor's visits just led to multiple blood tests revealing nothing.

I webcam'ed myself one night, and was surprised to see myself choking, gasping, sputtering, and ceasing breathing many, many times, which truly shocked me. I finally did get booked with a respirologist (indirectly, due to allergies), and had a sleep study done. As that process took many, many months (and I'm still waiting on the results of the study), I purchased a "grey market" used CPAP (Remstar Pro with CPAP) for a few hundred, as funds were tight.

I used it only intermittently for the past several months; it seemed to help a bit, but not a lot.

Recently, I purchased a CMS-50E oximeter from EchoStore. I was quite happy with the price and prompt shipping (especially to Canada, where things can take weeks from the US: this arrived within days). The unit is great, charges nicely, fairly easy to use, nice display, recording ability, USB upload ability, and simple but great software (Windows only).

I purchased wireless option, but the clip-on part to the oximeter is fairly fragile, and I wouldn't trust myself sleeping with it on; I think it could easily snap the connector, there's little protection against that. With the recording ability, it's not really necessary. I'd probably recommend against spending the money on this option. (I don't regret it, as I believe the USB wireless unit is fairly generic, and I can find other good uses for them.)

The unit stays on my finger well during the night; it's slightly tight, causing a bit of sweatiness and a cold finger now and then. Not disturbingly so, and it's better that it stay on, than fall off. I usually end up flipping it to another finger now and then during the night for comfort, which is easy to do and didn't seem to affect any of the results.

The first few nights with the device were truly revealing.

The software produces various reports with detailed graphs, and nice summaries. In particular, the number of "desaturation events" (4% drop for 10 seconds or more) and "pulse events" (variations in pulse by more than 6bpm for 8 seconds or more) seem to be very useful and brief overall metrics that jumped out at me:

Night 1, no CPAP, 5 hours: 14 SpO2 events, 75 Pulse events
Night 2, CPAP, 7.5 hours: 2 SpO2 events, 4 Pulse events
Night 3, no CPAP, 6.3 hours: 22 SpO2 events, 102 Pulse events
Night 4, CPAP 6 hours: 0 SpO2 events, 0 Pulse events
Night 5, CPAP 5.5 hours, 0 SpO2 events, 7 Pulse events

For a fairly unscientific and non-medically-approved approach, the oximeter definitely seems to be demonstrating my need for the CPAP. It drastically reduces the SpO2 events (2/0/0 vs. 14/22) and the Pulse events (4/0/7 vs 75/102). I didn't realize how significantly the apnea affected pulse variations.

While the oximeter isn't really required equipment for a CPAP user, for me it definitely hit home the need for me to wear this unit every night. That alone makes it worth the price. Not initially seeing dramatic results from the CPAP, I hadn't been wearing it consistently (despite reading it can take a couple of weeks of constant use). I'm definitely convinced now, and will use the CPAP religiously...

I had also picked up the card reader for the Respironics CPAP from cpap-supply. It's a nice unit, and works well. Unfortunately, it seems the RemStar Pro with C-Flex only reports hours of usage per night, and not mask leakage, pressure, breathing incidents, as some of the other units do. So the card reader didn't really provide me the utility I was hoping for there, but that's no one's fault by my own (for lack of understanding what the RemStar PRO was recording).

I'm quite happy with the RemStar Pro + C-Flex overall, especially for an older unit. It, and the mask, are fairly noisy (and I have some mask leak issues I'm working on), but they get the job done. The humidifier/heater just seem to result in a lot of messy condensation in the mask by morning, and I don't seem to dry out without them, so I never use that option.

The mask seems to leak around the edges where the rubbery-feeling part attaches to the hard plastic part; that probably needs to be replaced (or perhaps the entire mask). If I tighten things down enough, I can stop the leaks, but it causes slight discomfort to do so (and leaves temporary marks come morning).

I'm on a prescription to help the daytime sleepiness and focus, which is making a world of difference as well; I'm expecting with regular CPAP usage (and some weight loss, exercise, and other goodness) that the prescription is only a short term measure, and that getting proper air at night is the long term solution.

Anyhow, just thought I'd share how useful the CMS-50E has been for me in getting a better idea of what was happening during my sleep.

I should note that I don't recommend getting a CPAP off prescription as I have; clearly it's best go through your Doctor. I was desperate and frustrated with the extreme delays, and had to try something. (Also, with no health plan, a prescription for a new unit wasn't likely going to be that useful.) It will be interesting to see what my sleep study reveals (I'll hopefully get the results of that this week).

Overall, definitely an interesting and education experience for me.

-dale

Oh, I also meant to note: the improvement in daytime sleepiness has been greatly helping my work, and appears to in turn be helping the depression a lot. Being able to stay awake, deal with work (and life in general) is truly turning things around for me. I wish I hadn't gone undiagnosed for so long, but am grateful for finally getting on track!

Dale, welcome to the forum and thank you for sharing your story with us. I'm impressed that you web cam'd yourself. You definitely are on the right track, using your oximeter to track your progress.

When you get the results of your sleep study, be sure to get a copy. And of course, share it with us.

Welcome, Dale! I have found the oximeter to be very useful too. I'm using it to spot-check every once in a while. It's good to hear that you're now convinced about the importance of using CPAP consistently. It really can make a big difference in the way you feel once therapy is optimized! It'll be interesting to hear about your sleep study results.

If you register and fill out your equipment profile (via the User Control Panel at the upper left of the screen), there may be some forum members that can offer specific suggestions regarding your mask leaks. Some masks actually seal better when they're a bit looser, rather than tighter.

This forum is a great place for education and support. We're glad you're here!

~ DreamOn

Yep, I got the CMS-50D from EchoStore. For the price, it's a valuable tool to the arsenal.

Just out of curiosity, what settings on the CMS-50D did you use to determine events, both heart and oxygen? And, if it's not too much to ask, could you post your SPO2 Reports using Photobucket.

Thanks,

SG

What are the differences between the CMS-50D and CMS-50E??

What is the cheapest you've found them and where? How long ago?

Slinky wrote:What are the differences between the CMS-50D and CMS-50E??

What is the cheapest you've found them and where? How long ago?

Slinky, I didn't recognize you at first without your familiar avatar!

Here's a comparison chart that shows all the features of the various Contec oximeters, including the CMS-50D and CMS-50E: http://www.semedicalsupply.com/SPO2%20C ... 0Chart.pdf. And you can find the oximeter user's manuals here: http://www.semedicalsupply.com/user_manuals.htm.

I purchased my CMS-50E in mid-November from http://www.oximetersonline.com for $119.99, which was the best price I could find at the time. This company is run by the same people that own Southeastern Medical Supply.

I'm very happy with the oximeter, and the included software works great. The only possible drawback to the CMS-50E is that it uses a rechargeable lithium battery that cannot be replaced by the user. When it no longer takes a charge, it'll have to be sent in for replacement. The CMS-50D uses two "AAA" batteries. According to the comparison chart cited above, the 50D doesn't come with software. There is a 50D+ model that apparently does come with the software. The 50E has alarm features that the others don't have, and the SpO2 software is included.

Here's an example of one of the reports generated by the SpO2 software:



The vertical bars under the colored graphs indicate "events"--either oxygen desats or pulse rate. You can set the "start time" on the oximeter before you begin recording and then coordinate results with the CPAP software reports.

Now, if I could only figure out how to properly interpret this information!!! As you can see, I had 1 oxygen desaturation event and 28 pulse rate events. This was actually a very good night on CPAP, with zero apneas and HI of only 1.1 (8 recorded hypopneas during about 7 hours). All the hypopneas were grouped at the end of sleep that night. I have no idea why there were so many pulse events. Ideas, anyone? Is that considered "normal"? Related to sleep cycles/dreaming?

~ DreamOn

Dreamon, thank you!! Your're getting to my point!! Settings can make all the difference on the flagged events.

The best value I can get is to look at the duration of oxygen saturation below 95% and try to match with an erratic heart rate. Then, compare with the Encore Report.

Personally, the effort looking at the SPO2 Report is to assure nothing below 90%. But, duration of time dragging at 93%-94% has justified a day not really feeling too well.

Also, studying Sleep Study Reports, developing a correlation of values that relate to the SPO2 Report generated by the CMS-50D. But really, is there a Doc in the house?? Enlighten us on how best to set and use this thing??

Default setting on pulse is kinda scary with all those flags!! My heart is in great shape, come on!!!


Thanks,

SG

I just picked this date randomly. As you can see, bit of duration below 95%. Pulse seems erratic. For oximetry, I set it at 4% drop lasting more than ten seconds. Trying to follow along on how my M Series determines Apnea in the Encore Report.



How did I generate and post:

1. Generated Oximetry Report and printed to PrimoPDF.

2. Used online service to convert PDF to Jpeg.

3. Uploaded to PhotoBucket and copied link code

SG

SuperGeeky wrote:I just picked this date randomly. As you can see, bit of duration below 95%. Pulse seems erratic. For oximetry, I set it at 4% drop lasting more than ten seconds. Trying to follow along on how my M Series determines Apnea in the Encore Report.



How did I generate and post:

1. Generated Oximetry Report and printed to PrimoPDF.

2. Used online service to convert PDF to Jpeg.

3. Uploaded to PhotoBucket and copied link code

SG

It's very interesting to see other oximeter reports! Compared to my chart that I posted earlier, you certainly have A LOT more "pulse rate events" than I do (mine at 28 vs. yours at 254)! And your average pulse rate is quite a bit higher than mine too (mine at 67.7 vs. yours at 79.5). We used the same parameters to define the "events". What were your xPAP "numbers" that night? Was it a particularly bad night for you, or about average? My AHI (on ResMed machine) was 1.1, and that was all hypopneas, which were all grouped at the end of sleep that particular night.

You said that you have the CMS-50D. The comparison chart that I cited earlier says that model doesn't come with software, but says the CMS-50D+ does. Did yours come with software or did you get that later, or do you actually have the 50D+? My CMS-50E oximeter came with software, USB cable (which can be used to recharge the battery), AC adapter (another way to recharge), lanyard, zippered carrying case, and a very cute metal tin to hold it all.

I would really appreciate some education regarding interpretation of oximeter reports from anyone with extensive knowledge about this. I know that the oxygen desats and pulse rate rises can coordinate with apnea/hypopnea events, but what about the other spikes? Are they sleep cycle (REM?) related?

~ DreamOn

Encore Report - 10/15/09 to 10/16/09

Settings: 12 I , 8 E Bipap

OA: 0
H: .3
VS: 1.1

AHI : .3

Avg. Leak 32 with Comfort Fusion

Large Leak : 0

Frustrating isn't it!! These settings are after a Sept. Sleep Study. The first hour of my sleep study, I showed 22 events, 8 were Centrals.

Never, ever, did my Encore Reports show those kinds of events.

I called Respironics, because I don't have a DME. They passed me on to one person after another. Finally, I spoke with a Sleep Tech. For 45 minutes, he belittled my complaint that my data from the M series could be so different from my Sleep Study!!

His job, keep the Warranties down!! No way, something could be wrong with the machine!!! And, nobody is going to look at it!!!

I sleep on my side until I get a new DME! Watch the Oximeter very very closely!!

Dreamon, the software came with it. I think it's the same for everybody, the software. And, a USB cable. Only problem I've had is the time needs resetting if the batteries are a little low.

Sorry for the venting....

SG

SuperGeeky wrote:Frustrating isn't it!! These settings are after a Sept. Sleep Study. The first hour of my sleep study, I showed 22 events, 8 were Centrals.

You're talking about a titration sleep study in September, right -- using xPAP during the study?

I'm a relatively new CPAP user myself, and I know next-to-nothing about BiPAP machines. I'm wondering if your very high number of "pulse events" may be related to the way the machine works, and if there could be another setting that may work better for you? I'm assuming that you had numerous centrals during the remainder of your sleep study, and not just during the first hour? Sleep-onset centrals aren't that uncommon. Are you using a BiPAP machine because of the centrals, because your pressure is high, and/or because you have another breathing or neurological disorder? Just wondering....

Perhaps someone with more knowledge can share their insight. I'd really like to learn more about how to interpret these oximeter reports.

~ DreamOn

Yep, new titration settings after Sept. Sleep Study. Though, EDS is better since the new titration, there is one other interesting distinction.

AHI are still in the 1-2 range. But, Avg daily time in Apnea has gone from 1-2 minutes to less than 10 sec. I'll have to look, probably a shift from Apnea to hypopnea which keeps AHI the same overall.

I still have doubts about my Encore Reports. I've switched to Auto, keeping an eye on flow limitation etc...

Thanks dreamon...

SG

P.S. I think we should have a 'Topic' where everyone posts a Oximetry Report and Encore Report for that day. It would be interesting to compare...

Just a follow up on my original posting...

I got the report today, and it's surprisingly consistent with what the CMS-50E has been telling me:

===============
Event Summmary: Central apnea is .3, obstructive apnea 9.9, mixed apneas 1, hypopnea 28.5, total apnea/hypopnea index 39.8

Event by Position: Time in supine position 109 minutes with an apnea/hypopnea Index of 58. Time In non·suplne position 242 minutes with an apnea/hypopnea index of 32. Patient had a snore flag index of 322 events per hour.

Oximetrry Distribution: less than 95% 211.5 minutes, less than 90% 27 minutes. less than 85% 4.5 minutes. less than 80% .5 minutes. Patient had a mean saturation of 93% with a desaturation index of 35.4 events per hour. Patient had a mean heart rate of 64 beats per minute.

IMPRESSION: Stardust II level III sleep study with evidence of severe obstructive apnea.

-dale

I used my 50D to do my own titration report. I found the rule that starting out about 2cm below the maximum pressure my APAP would go to resulted in less events than letting it start low and then do it's own thing.