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Looking for Definitions to the Clinician Setting modes
#1
I am new to CPAP machines and their use (on a quick learn curve). I have the REMstar Auto (M series) A-Flex and I just got into the Clinician mode. Is there somewhere where I can find the meaning and purpose to the modes such as:

C-flex setting
Ramp Start Pressure
Slit night time

. . . . I know that a sleep study is highly HIGHLY recommended, but I have to ask. I have recorded (audio) and got detailed reports from my partner (through out entire night survey) and my own monitored tiredness levels (in diary, that I HAVE SLEEP APNEA. Rather than pay a doctor and sleep study $1500 plus to tell me what I already know, what stops me from researching the heck out of this and letting my REMstar Auto give me what I need. Using the clinician manual to check any other settings I need to tune it in.

Am I missing something too big to ignore by avoiding the sleep study?Dont-know

Would love your insights,

Sleep jones-in & uninsured,

Dan

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#2
DeepDreamer,

Where are you located? And where did you get the REMstar M-Series machine? Is it used?

The reason I ask is this: The M-Series was discontinued some time around 2009 or 2010. They use a proprietary data card of some type and without the appropriate card reader, it will be impossible for you to get the full data off the machine that you need in order to "self-treat" your OSA with enough confidence that any changes you make to the clinical settings are helping the situation rather than aggravating it.

The data card and the card reader needed to get the data off of an M-Series machine is still sold from vendor #1 on the apneaboard vendor list (http://www.apneaboard.com/forums/Thread-...plier-List) You will need a copy of Encore as well since SleepyHead is not compatible with the M-Series machines. If these seem like rather formidable hoops to jump through to get the data you need to properly self treat your OSA, you may want to see if you can pick up a used PR System One Auto (Series 50 or Series 60) machine or a Resmed S9 AutoSet. These machines all use standard SD cards to record the data and they are all compatible with SleepyHead.

To answer your specific questions:
Quote:I have the REMstar Auto (M series) A-Flex and I just got into the Clinician mode. Is there somewhere where I can find the meaning and purpose to the modes such as:

C-flex setting
Ramp Start Pressure
Slit night time
C-flex setting: Off, 1, 2, or 3 sets the level of C-Flex. C-flex is an exhalation pressure relief system. When C-Flex is turned on, the machine slightly reduces the pressure at the beginning of the exhalation and then increases it back up to the therapeutic setting during the middle of the exhalation. The amount of relief varies from breath to breath and is based on how forceful the exhalation actually is. The higher the Flex setting, the more pressure relief is given. In the clinical menue, there are is also a setting called "Patient" that lets the patient control the C-Flex setting without getting into the clinical menu.

Ramp start pressure: If the minimum pressure is set to anything higher than 4cm, then the "ramp" can be turned on inside the Clinical menu. If "ramp" is enabled, the "Ramp start pressure" is the pressure that the machine uses when the Ramp button on the top of the blower unit is pushed. For example. If the minimum pressure in the Auto range is set to 6 cm and the minimum ramp pressure is set to 4cm, every time the Ramp start button is pressed, the machine lowers the pressure to 4 cm and ramps up to 6 cm during the preset ramp time. The ramp time must be set through the clinical menu.

Split night time: This is a little used "feature". In some situations a sleep doctor will want a patient to be on a fixed pressure during the second half of the night (presumably when the patient is fast asleep and least likely to wake up, but also most likely to be in extended REM cycles, which can be associated with more significant OSA in some patients). If a Split night time is enabled and selected, this sets the amount of time the machine runs in Auto mode before the machine switches over to a fixed CPAP mode with a fixed CPAP pressure setting.

Quote:Rather than pay a doctor and sleep study $1500 plus to tell me what I already know, what stops me from researching the heck out of this and letting my REMstar Auto give me what I need. Using the clinician manual to check any other settings I need to tune it in.

Am I missing something too big to ignore by avoiding the sleep study?Dont-know

Would love your insights,

Sleep jones-in & uninsured,
The fact that you're currently uninsured explains a lot about why you're wanting to start down the self-treatment route.

Going back to my first question: Where are you located? If you are in the US, is there any way that you will be able to get insurance coverage through Obamacare? If so, then it's well worth trying to tackle the sleep problems from both ends: Do what you can with the M-series and reading up on your own now, but also work your butt off figuring out how to get health insurance that will cover at least part of your costs.

The reason why is this:

While plain old OSA is the most common version of sleep apnea and while most people with plain old OSA do reasonably with with CPAP/APAP, there are other sleep disorders that can "mimic" the symptoms of OSA. And one of those other sleep disorders---central sleep apnea (CSA) often gets worse when the patient is put on a plain old CPAP/APAP machine. A person with CSA usually needs a very fancy machine called an ASV machine. (But note, CSA is relatively rare.)

And then there's another potential problem: About 10-15% of OSA patients who start CPAP/APAP therapy develop a problem with central apneas after PAP therapy is initiated. If the problem with centrals does not resolve after several weeks or if it gets worse, these folks wind up with a diagnosis of complex sleep apnea (CompSA), and in the worst case scenario, a person with CompSA will need to be put on an ASV machine.

Hence it's important to realize that as you start self-treating your OSA, there's a small chance (10-20% overall) that the CPAP/APAP therapy may not be the most appropriate way to treat your sleep apnea problem. And if you're unlucky enough to be in that minority of apnea patients, then you really will need help from a professional sleep doctor and you will (eventually) need a real sleep test. But if you are not in the small minority of patients with CSA to begin with or the small minority of OSA patients who develop CompSA, then your plan to self-treat may very well work out without any significant problems or complications.
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#3
Hi DeepDreamer,welcome to the forum
In Australia, sleep studies are covered by Medicare. I assume you,re in United States of America, don,t they have something called Medicaid and there are assistance for the uninsured and low income.

I,m in the opinion that only sleep study can diagnose sleep apnea, the symptoms might be or might be not sleep apnea related. Beside diagnosis, the sleep study will tell the type of apnea whether obstructive, central or mixed (each require different machine/treatment) and if any other sleep disorder found

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#4
Thank You Both for your comments.

I appreciate your time and insights into my questions. I am following up on the insurance side of things and realize that professional diagnosis is needed, despite my negative view of the wasteful and time consuming health care system. So moving forward with that, despite my "Self-sufficiency-money saving" part of my brain.

Until then I still am trying to take things into my own hands. Have two machines that were given to me (REMStar Auto M series and the REMstar Plus Pro 2). Wondering if I should just make an easy start on the CPAP Plus Pro2

From reading the FORUM I accept the fact that it is longterm process of getting the desired results that all of us want. I get that, but to wait for a doc appointment to tell me to get a sleep study, then time waiting for that appt. I figured Id just start and get conditioned to the comfort of mask sleeping and devour the operations tech info needed to steer effectively in the right direction. And if it helps me early then well GOOD.
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#5
robysu,

Thanks again for the very detailed explanation. KUDOS to you.

To all of you. . . .

I have to be embarrassingly honest and say that in the past I have made fun of the whole darth vader type characteristics of the whole CPAP culture (never thinking our natural evolution would need this, much less my own fit and healthy body), so to need something like this for myself is a big cookie to bite into for me. Moving from the old me in my scoffing attitude to finding answer to my desperate drive to get sleep, I devour tech details and experienced advice enough to guide my path into health.

Thanks Again,

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#6
If I remember right, the "Plus" in the name means it does not record any data, just hours used. For someone in your position, it is a shot in the dark to use it.

One thing you can do while you work out the insurance issue, is to purchase a recording oximeter. They aren't overly expensive. The CMS 50D+ will do for what you need. You can get it from Supplier 19 in the Supplier's List (link at the top of every page). Get the oximeter, figure out the software and how to use it and all that. Then wear it at night. Download the data. Do this for several nights and see what happens.

Big dips in blood O2 overnight may indicate sleep apnea. The reason you want to do it over several nights is that not everyone with sleep apnea has O2 drops. Some happen slowly, some happen hugely and suddenly. We're all different.

how to use the software:
http://www.apneaboard.com/wiki/index.php...2_software
acronyms/abbreviations:
http://www.apneaboard.com/wiki/index.php?title=Acronyms
glossary:
http://www.apneaboard.com/wiki/index.php?title=Glossary
American Health Care Act
https://www.healthcare.gov/
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#7
Hi DeepDreamer,
WELCOME! to the forum.!
trish6hundred
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#8
(11-09-2013, 01:30 PM)DeepDreamer Wrote: I have the REMstar Auto (M series) A-Flex and I just got into the Clinician mode. Is there somewhere where I can find the meaning and purpose to the modes such as:


I suppose you have already downloaded the Clinician Manual. It contains some helpful explanations.

http://www.apneaboard.com/forums/Thread-...P-Pressure
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#9
(11-09-2013, 03:35 PM)DeepDreamer Wrote: I have to be embarrassingly honest and say that in the past I have made fun of the whole darth vader type characteristics of the whole CPAP culture (never thinking our natural evolution would need this, much less my own fit and healthy body), so to need something like this for myself is a big cookie to bite into for me. Moving from the old me in my scoffing attitude to finding answer to my desperate drive to get sleep, I devour tech details and experienced advice enough to guide my path into health.

Evolution does work. Unfortunately, it works by killing off the "unfit" like us apneacs. I'd sort of like to avoid that

Evolution also doesn't work if us "unfit" people produce enough offspring before our genetic defects kill us. Or if modern medicine keeps us alive when natural selection would have killed us off. Killing off the old people who aren't producing or raising offspring leaves more resources for the breeders, so "evolution" doesn't have a lot of reason to keep us around.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#10
That does bring up a great point! "evolution", "darwinism" - etc... "Only the strong survive" (or, only the smart survive)...

The problem becomes if you happen to be one of the ones that *shouldn't* survive....

I am a great example! At age 49, my body just randomly decided to start creating blood clots in my lungs (aka PEs). After this happening not once, but twice, and many, many vials of blood sent out for testing, it turns out that I have some kind of genetic predisposition for clot creation?? The short version is, I am now on blood thinners for the rest of my life - or, go off them, and roughly 7-8 months from now I will once again have multiple PEs (read that as too many to bother counting), and could very well die.

In the coming Zombie apocalypse, I wonder how long I will survive???
*I* am not a DOCTOR or any type of Health Care Professional.  My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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