Remstar Auto With C-Flex

Allen Cox · Post by **Allen Cox** » Wed Dec 22, 2004 11:37 am

I just spent the night with my new Remstar Auto With C-Flex . All I can say is move over Resmed youve got some catching up to do!!
This new machine is a GIANT step foreward in CPAP/AUTO PAP therapy.

sinemac · Post by **sinemac** » Wed Dec 22, 2004 11:59 am

Excellent! Mine should be arriving tomorrow!

wading thru the muck! · Post by **wading thru the muck!** » Wed Dec 22, 2004 12:28 pm

Hi Allen,

I'm curious what in specific is a "GIANT step forward in CPAP/AUTO PAP therapy" with the Remstar auto with c-flex? Is it the c-flex/auto combination. My thoughts on that are if the pressure remains low thanks to the auto feature the c-flex is less necessary. If you spend a large portion of the time at a higher pressure then the auto feature really is of little benefit. I've read the ipap/epap variant with c-flex is about 3cm. That doesn't seem like enough if you have a pressure of 14cm+.

Now if someone would create an auto adjusting bi-pap... that would be something. Add a recording oximetry feature and I'd be in hosehead heaven.

Guest · Post by **Guest** » Wed Dec 22, 2004 2:20 pm

wading thru the muck! wrote:Hi Allen,

I'm curious what in specific is a "GIANT step forward in CPAP/AUTO PAP therapy" with the Remstar auto with c-flex? Is it the c-flex/auto combination. My thoughts on that are if the pressure remains low thanks to the auto feature the c-flex is less necessary. If you spend a large portion of the time at a higher pressure then the auto feature really is of little benefit. I've read the ipap/epap variant with c-flex is about 3cm. That doesn't seem like enough if you have a pressure of 14cm+.

Now if someone would create an auto adjusting bi-pap... that would be something. Add a recording oximetry feature and I'd be in hosehead heaven.

My preasure reaches 14cm during the night and all I can tell you is the new machine was much more comfortable than the old RemStar Auto.

wading thru the muck! · Post by **wading thru the muck!** » Wed Dec 22, 2004 2:48 pm

Thanks Allen,

You probably fall into the mid-level pressure range for which this machine is perfect. Not too high, where the c-flex delta is not enough but not to low where c-flex becomes less relevent. I'm sure there are quite a few users in your pressure range that would benifit greatly from this machine.

Thanks for posting your comments and explanation. It's helps others in sorting out what machine to buy.

Miko · Post by **Miko** » Thu Dec 23, 2004 12:42 am

Allen, how does the noise from the machine, hose, and mask compare to the other Respironics machine? Same, more, or less? What about user interface? Do you have to download the data to view the results such as AHI/AI or can you view it on the machine's LCD?

Miko · Post by **Miko** » Thu Dec 23, 2004 12:45 am

wading thru the muck! wrote:

Now if someone would create an auto adjusting bi-pap... that would be something. Add a recording oximetry feature and I'd be in hosehead heaven.

They dont have an Auto Bi-pap? OMG, you would think they would with how much they cost. Perhaps it has something to do with physics of the therapy and/or the auto software/algorythm is not that sophisticated, as my sleep doctor says about auto-paps in general.

rested gal · Post by **rested gal** » Sat Jan 01, 2005 2:30 am

While I have no problem exhaling against pressure up to about 14, there are people with asthma or other conditions that give them difficulty exhaling, even down at what most of us would consider low-medium pressures. They could benefit, I'd imagine, from an autopap that offers C-Flex. It's either that or go to a bi-pap for them, and bi-pap means they're stuck using a single inhalation pressure all night. I can also see where even a small difference between inhalation/exhalation could be more comfortable to a lot of people even if they didn't have pulmonary problems. Mileage definitely varies with what level of pressure is comfortable or not, so I think an autopap with C-Flex is a good step forward, maybe even a giant step for some. Wouldn't be for me, but could be for some.

wader, you wrote,

Now if someone would create an auto adjusting bi-pap... that would be something. Add a recording oximetry feature and I'd be in hosehead heaven.

They may have.
ResMed has a remarkable machine being trialed in the U.S. right now. Already being used in other countries. This seems to qualify as a truly giant step breakthrough - lifesaving, even, for patients with serious heart problems.

ResMed's CS2 machine

Requires Adobe Acrobat reader to view.

Miko · Post by **Miko** » Sat Jan 01, 2005 3:36 pm

rested gal wrote:While I have no problem exhaling against pressure up to about 14, there are people with asthma or other conditions that give them difficulty exhaling, even down at what most of us would consider low-medium pressures.

That's why it's prudent for one to try out the CFLEX before buying. A reduction of 3cm is not much for most people and it usually isn't worth the extra price vs an autopap. Again, YMMV (your mileage may vary).

john57 · Post by **john57** » Thu Jan 20, 2005 11:57 am

During the interview the RemStar folks did say that that the C-flex setting of 3 does not equal a 3cm of reduction but that is all they will say. On the other hand I think that many people can tell the difference even long term users of straight CPAP when C-flex is engaged

wading thru the muck! · Post by **wading thru the muck!** » Thu Jan 20, 2005 12:21 pm

hi john57,

Regarding the relative pressure reduction of C-flex my guess is it is one of the following:

1.) There is no pressure relief correlation because it only creates a perceptive relief.

2.) Publishing such data would reveal trade secrets to their competitors.

3.) The pressure relief varies based on user breathing patterns.

I can tell you from experience that even though after a week using the Remstar Auto w/c-flex it is less noticable when I first switched, a C-flex setting of 3 felt as though the pressure dropped off to nothing...very comfortable to use.

Paul B · Post by **Paul B** » Thu Jan 20, 2005 2:52 pm

When the pressure drops off with C-flex, I wonder whether hypopneas and apneas are more able to exacerbate your therapy.

wading thru the muck! · Post by **wading thru the muck!** » Thu Jan 20, 2005 4:20 pm

Paul,

The pressure kicks back in just before the end of your exhalation. This is when most apneas/hyponeas occur. Some have complained that the pressure boost catching the end of your exhale can cause an acceleration of respirations. I have not found this to be the case.

-SWS · Post by **-SWS** » Thu Jan 20, 2005 7:58 pm

The C-Flex pressure relief is, indeed, "relative". After that pressure reduction is sustained at the beginning and middle of expiration, C-Flex achieves an IPAP-equivalent pressure toward the end of exhalation. The acronym for this IPAP-equivalent pressure being restored by the end of exhalation is "PEEP" (Positive End Expiratory Pressure). Since incipient obstructive events tend to manifest at the tail end of expiration, these IPAP-equivalent PEEP pressures negate the need for a new titration, as would be required if a patient were switching from CPAP to conventional BiLevel.

Aside from the obvious comfort benefits of C-Flex for ordinary (obstructive) "hoseheads", there are apnea patients with certain concomitant pulmonary disorders such as COPD that might benefit from "Positive End Expiratory Pressure". That is because patients like this often cannot completely expel enough air at the end of respiration so that their lungs can reach ambient pressure. Rather, at the end of expiration these patients have a residual positive respiratory pressure known as "Auto-PEEP". The problem with this residual pressure known as Auto-PEEP is that these patients must make additional respiratory muscular effort to initiate inhalation. PEEP pressures are typically set on BiFlex machines slightly lower than AutoPEEP to help these patients more easily initiate inhalation (via a lesser pressure differential between residual respiratory and ambient).

C-Flex and Bi-Flex are essentially the same expiratory-relief feature (both delivering PEEP). These features are exclusive to Respironics, with BiFlex being deployed in an EPAP-precise (programmable) BiPAP machine and C-Flex being deployed via a "relative EPAP pressure relief" in both AutoPAP and CPAP models.

Paul B · Post by **Paul B** » Thu Jan 20, 2005 8:06 pm

Thanks for the explanation SWS. Would you concur that c-flex pressure relief would not increase hypopnea activity during that release time interval?

Machine

Machine