Rem Star Auto M Settings from sleep Doctor

I was diagnosed with sleep apnea November of 2008. My titrated pressure setting was determined to be 16 cm h2o. The machine I was supplied with was a Fisher & Paykel HC 233. A real bare bones leaf blower. I had trouble with my mask from the git go. After many bad nights and long studying (1 year and numerous different masks) I determined that I needed an APAP. My Doctor gave me a hard time about it saying I wouldn’t be any better off as 16 cm h2o is still 16 cm h2o no matter what machines I use and the leaks would stay the same. He wrote a prescription to my supplier for an APAP. My equipment supplier set me up with a Rem Star auto M with c flex for 4 nights for a test that he turned into my Doctor. From this test, my sleep Doctor determined that my pressure needed to be set at 4 min and 20 max. My question is, does this make sense to have the range so wide? If this makes sense, then why did I need a sleep study to begin with to get my prescription of 16 cm h2o? Very expensive. I feel I'm not getting much support.

josef wrote: From this test, my sleep Doctor determined that my pressure needed to be set at 4 min and 20 max. I feel I'm not getting much support.

Your doc does not have a clue.
Your feeling is correct.

Get a copy of your sleep study.
Get a copy of your Rx.
Get an Apap machine.
Get educated, here.
Become your own best therapist.

lol Your doc determined NOTHING! Those are the limits of the machine.

I would suggest starting with the limits at 14-18. (Titrated pressure =/-2) Use that until you get your mask adjusted to minimize leaks and your numbers settle down. Then you can start fine tuning.

You can see how you like c-flex and try the different levels now, of course. C-flex is just a confort thing and shouldn't affect therapy.

Do you know the "secret handshake" to get into the settings menu?

It appears you already know more than your doc and your DME put together! Keep up the good work!

That is bogus. The lowest setting on a machine is 4 and the highest on that type of machine is 20. It's set wide up and probably will do more harm than help. With it set that wide, your machine won't be able to adjust fast enough when an event happens.

Either your doc is a quack, a jerk of you just really p*##ed him off.

Gerry

I believe you are correct about me really pissing him off. It certainly wasn't intentional. I am inclined to continue to work with him as long as I can as I live in a small South Texas town and he is the highest recomended. I have only used the machine 3 nights. (other than the original test) Last night was the best night I have had in ~20 years. When I look at my 90% pressure, it's 8. My leak rate is 29 L/min and my AHI is 5. I'm not real sure if this means anything yet as it hasn't run long enough. I am deffinitely encouraged by last night though. I have recently purchased a CMS-50E OLED Fingertip Pulse Oximeter which does sleep studies. It should be in later this week. I have also purchased the software for the Rem Star and it will also be in later this week. It has been suggested that I play with the settings myself, I am reluctant to do that at this time as it will show up on the smart card and as I say, I hope to work on a better relationship with this Doctor, for now anyway. He really pushes the bare bones machines. My DME stated, "I have never placed such an expensive machine in a patients house before". Remember, this is South Texas.

Gerryk wrote:That is bogus. The lowest setting on a machine is 4 and the highest on that type of machine is 20. It's set wide up and probably will do more harm than help. With it set that wide, your machine won't be able to adjust fast enough when an event happens.

Either your doc is a quack, a jerk of you just really p*##ed him off.

Gerry

Since you don't want to switch docs have you thought about going in and talking to him. Telling him you want to be part of your own therapy. Ask him if he would like you to send the data to him from your machine instead of just compliance therapy, which is probably all the DME has sent him? Time to either sit down and talk with your doc and work things out or go elsewhere.

Gerry

josef wrote:My equipment supplier set me up with a Rem Star auto M with c flex for 4 nights for a test that he turned into my Doctor. From this test, my sleep Doctor determined that my pressure needed to be set at 4 min and 20 max. My question is, does this make sense to have the range so wide?

As the others have said, a wide open setting range of 4 - 20 is not the best way to use an autopap.

Based on this:

josef wrote:When I look at my 90% pressure, it's 8.

If it were me, I'd set the range for 10 - 20 and see what your data shows.
If you don't have the software for your machine, I'd be sure to reset the data to zero each day, so you can see just your last night's data the next morning.

How to reset the M series machine "weekly"/"monthly" details back to zero, in order to view just last night's results the next day:

viewtopic.php?p=239127#239127

viewtopic/t29141/Resetting-the-data-on-Respironics.html

Since you had previously been prescribe a straight 16, there's nothing wrong with trying a range of 14 - 18 as LinkC suggested. Or even 14 - 20. It's the minimum pressure that will be the important pressure to have "high enough" to prevent most events right from the get-go. Unused pressure up above (the max) will simply be unused pressure, no matter whether it's an unused 18, or unused 19, or unused 20.

I think your Dr was trying to "teach you a lesson" for "arguing" with him about something he's clueless about, so he's trying to sabatoge your therapy by leaving your settings wide open which spells disaster. Take the recommendations above, ask questions and read Cpap Wiki. Good luck, you're in good hands now. Dori

Honestly, I don't think anyone on this board has received an Auto that was set any different than 4-20 cm. I think that's just the way they write the script for an Auto. And then they tell you not to touch the settings yourself.

Definitely change the settings yourself. Don't say anything. See if the doctor even notices. If he does, just play dumb and act surprised when he chastises you.

Cheers,
B.

I'm trying real hard to understand here. If my 90% pressure was 8 and I had an extremely good night, why would I want to change my range to 14 to 20. That's 6 over my 90% pressure. I believe that my precription pressure of 16 was for sleeping on my back, a position your fairly well forced into in a sleep study. I also believe that this pressure is position sensative. (don't really know this) I sleep basically 100% of the time on my right side after a bad accident quite a number of years ago fracturing my ribs.

Since you had previously been prescribe a straight 16, there's nothing wrong with trying a range of 14 - 18 as LinkC suggested. Or even 14 - 20. It's the minimum pressure that will be the important pressure to have "high enough" to prevent most events right from the get-go. Unused pressure up above (the max) will simply be unused pressure, no matter whether it's an unused 18, or unused 19, or unused 20.[/quote]

I think "sabotage" is a bit strong. Since he's never prescribed an Auto before, he may be unsure of the proper settings and figures 4-20 is a good starting point, and he can narrow it from there.

Many (if not MOST) Autos are prescribed at wide open. Presumably, they figure they'll let the machine "do its job"!

I would start with 2cm's below your 90% and then a gradual increase from about 2cm's above that. If after several days your 90% is that maximum try changing the maximum to 2cm's above that and see where your 90% is. (this advice is for everyone)

I was titrated at 11cm, recently checked my range between 9-13cm and the 13cm was my 90% pressure. I then did a 10-20cm range test and it seems to me that my pressure should be 11-15cm two up and two below my 90%.

This should be your actual range: 2cm below pressure and 2cm above pressure; this is to give the machine a chance to work properly in preventing events which could sabotage your therapy.

DJ

LinkC wrote:I think "sabotage" is a bit strong. Since he's never prescribed an Auto before, he may be unsure of the proper settings and figures 4-20 is a good starting point, and he can narrow it from there.

Many (if not MOST) Autos are prescribed at wide open. Presumably, they figure they'll let the machine "do its job"!

Link, I guess you're right, come to think of it. I'm getting too "passionate"! Our Sleep Dr originally set our auto on 5-18cms and he didn't have an agenda at all, he was really nice and supportive, but just clueless. I already knew about auto settings from this forum but when I innocently asked him his rationale for the wide open settings, he gave me the "do it's job" theory also.