REMstar Auto A-Flex Readouts

[Bobtwo]

Hi new to forum but diagnosed with OSA around 1994.
Very new to everybody in those days especially to GP, had to show him a newspaper article about OSA, and also outpatient depts.
First sent to ENT which was run by a surgeon, sent for a nose straightening op, which had no effect. Surgeon then wanted to laser the back of throat. Had a row with ENT surgeon and was finally refered to chest clinic.
Had oxymeter test and immediately diagnosed with OSA.
Issued with CPAP machine, 18ins x 12ins x 5ins, think it came from a hovercraft, it certainly sounded like one.
Think the mask was from an Army surplus gas mask.
I work nights and my wife works days, think that saved the marriage!!.
The machines were crude but effective. Within a couple days started to feel more lively and alert.
After a couple years got a new CPAP machine 10ins x 6ins x 3ins, came from a mini hovercraft.
Very little pressure variation in both machines, both were like being connected to a wind tunnel.

At the begining of 2008 started to slobber, very similiar to a bloodhound, had to have a towel on pillow all night and changed in the morning. Also had a constantly dripping nose. Very embarrasing.

Went back to chest clinic and was issued with a Remstar Auto A-Flex and new nose only mask, the ones that look they had been left from a Dr Who CYBERMAN.
Strict instructions were only to use the central button to switch the machine off. Told not to use the 4 buttons under the flap.
Cured the slobering and drippy nose.

Having trouble getting used to machine and mask.
I am waking up during the sleep period, sometimes finding it difficult to breath and sometimes with the mask off.

I drive for a living at night, mostly short local trips. As I am self employed if there is any sign of tiredness I can pull over for a break.
Sometimes there are longer trips, 3-4 hrs. I have often turned these trips down if I have been unsure of the sleep quality during the previous sleep period.

Questions.

Does the machine record the number of apnoeas per sleep period.
Does it record the number of leakages and length of leakeages per sleep period.
If so is there any menu on the LCD screen that I can view when I get up.
If so how?

Daily readings wouild be extremely helpfull rather than 7 or 30 day averages.

Sorry for the length of post. Thought some early history would help you appreciate how far the machines have advanced since the last century!!!

ps My wife now lets me have a night off and sleep in the same bed at the time. I know too much info.
}

[Tigers Fan]

Four buttons to heaven

Hi Bobtwo!

Wecome to the forum after all that time! I can only imagine what the early CPAPs were like.

If you work through the threads you'll find an early one of mine banging on about the Medics not trusting we patients to use our intelligence when it comes to APAP settings.

The answer to your first two questions is 'yes, if....'. I assume there is a smart card slot in the back of your machine (extreme left as you look at the back, next to a power connection)? Is there a smart card in it? That card records everything you want to know and then some!! To extract that info you'll need a PC and a card reader. Try an American site to see exactly what it is you need - http://www.cpap.com/productpage-bund...er-bundle.html and http://www.cpapsupplyusa.com/Respiro...r-DS510HS.aspx will get you started.

Do you know what the four buttons are for? There are two modes - patient (not a lot of info) and clinician (where the goodies are).

You sound as if you may well be a tweaker, like me. If you are, the smart card and reader are a sound investment. Furthermore, added bonus, you can print the reports and present them to your consultant/whoever. They get bent out of shape when they see you've been at the clinicians' menu - which I would count as a small revenge for wanting to laser your throat!

Try "Unlocking the Remstar" by chelseauk, down the page in the same section this post is in.

Tigers Fan

[Bobtwo]

Hi Tigers Fan.

Many thanks for the welcome and info.

Bit more background.
have an excellent working relationship with the Sister in charge of the OSA dept at local hospital and also with one of her sidekicks.
They have both been there since day one so all of us have been on the same learning curve. Even so they both still get a bit sniffy if you show too much interest in the inner workings of the machines.

The Remstar does have a memory card.

If I did get the software and hardware to access the mem card will it register every time the card is withdrawn from the Remstar?

Likewise using chelseauk info will that leave any trace either in the machine or on the card?

Did a bit of TWEAKING!!! Using the right Arrow of the LCD found a bit info but all gobblydook on three screens

Is there anywhere that a clinician manual is available for this machine
As stated in previous posts would really like to know leakages time, no of aponea events and pressures on a daily basis. Do not intend to change settings just trying to understand whats happening when I am asleep.

[Bobtwo]

[ATTACH]
Hi Tigers Fan
Thanks for the advice
Have a good working relationship with the chest clinic staff. Especially the sister in charge an one of the nurses. They both started the clinic very much at the same time in 1994 and we were all on the same learning curve. They do however get a bit sniffy if you ask them too many questions.
Have loged four days info from the LCD screen and hopefully attached it to this post.
Same info in both blocks but laid out to easier read any differences.
No manuals so dont have a clue as to what the readings refer to.
Any help gratefully accepted as to what the columns refer to, especially if they refer to aponeas or leakages or accidental mask removals whilst asleep.
Although now sleep with the wife, she refuses to sit up all night taking readings of the Remstar

If I remove mem card or use chelseauk method of accessing the machine will there be anything that will tell the staff at the chest clinicwhat I have been upto??

[Bobtwo]

Sleep Patterns Remstar2.txtUpdated Remstar readings

[Tigers Fan]

Doing well, but .....

Hi Bobtwo

You are doing well but a couple of obvious improvements can be made.

Six and a half hours sleep a night does not sound like it is enough to me. Can you get more?

Your machine is set in a way that you might expect an APAP to work but they don't actually. Yours is set with a low CPAP or base pressure and the other end of the scale has been left at maximum. So, you go to sleep and breathe easily with a low base pressure, not high enough to prevent you having 'events' (hypopnoeas and apnoeas). For a hypo, the machine cranks up the pressure a bit, your airway opens and you don't know a thing . But then you have an apnoea, the machine cranks the pressure up to open your airway and keeps on going till it can go no further. It stays there till it knows good and well that you are still breathing and breathing easily. Except, long ago, the leakage around your mask and your difficulty breathing at that pressure woke you up, wide awake

Screen 1 is your sleep time. Screen 2 is max and min pressures you used. Screen 3 is your 90% pressure (you spent 90% of the time not above these pressures) and your AHI in the last column.

So, your variation of pressure is too great and you need to modulate this to get a smaller amplitude - stop the high peaks - by bringing the base pressure and the max pressure closer together. You can do this yourself if you access the clinicians' menu but the staff at he Chest Clinic will definately know. Besides which, you haven't said what your staff titrated base/CPAP pressure is. (What was your old machine set to?)

Best way is to take the machine to the Chest Clinic and tell them you want a narrower pressure band. Perhaps they want you to use the machine for two weeks so they can see what you need - these machines are often referred to as auto-titrating. The other method is guess a number and see how you get on - but they should already know your base pressure after all these years. Set that as your base pressure and then set the max say three, four even five cmH2O higher. See how you go and tweak a half cm at a time.

If you do it yourself, you can tweak every couple of days. They take how long? My lot got very sniffy but they clearly didn't understand an APAP very well and I've learned to do it myself, with a lot of help from James and the forum. First off, though, I'd recommend going back to the Clinic.

James will be along tomorrow to give you a more professional analysis of your numbers, I expect.

Tigers Fan

[Bobtwo]

Hi Tigers Fan

Many thanks for your last post, It clarified and confirmed some of the conclusions that I had painfully arrived at.

Had the last CPAP for about seven years, no proper sleep study since first oxymeter test in 1994.

The machine, compared to the Remstore, was extremely crude. The only setting was either ON or OFF. Beleive pressure was set in the mid to upper teens. No ramping, turned on machine and straight into the windtunnel.

It was only at the begining of 2008 when the slobering and dripy nose became uncontrolable and embarrassing and the noddy effect started that I asked the chest clinic about it. Also Ibegan getting sores on either side of my nose that I asked about other masks. More on masks later.

Ref the figures posted,
Assume the 7 and 30 refer to average figures over 7 and 30 days of readings.

As the AHI in col 13 is an average this would indicate that I have had nights where the AHI would be up in double figures.

Are the figures in col 11 and 13 an hourly average or sleep period average

I did mention to the clinic staff that daily readouts would be helpfull so that I could judge on a daily basis as to what work I could or could not complete.

What level of AHI would be considered too high for driving.

[Bobtwo]

Many thanks for your last post.

Working nights is a bit of a bitch.
Aim to be in bed by 08:30. There allways seems to be something to do, so often stay up till 09:00-10:00 phone calls, bank managers, accountants, postman, meter readers etc. Beleive me a 24 hr economy it aint down here. Allways wake up at about 17:30.

The last time I was at the clinic I mentioned that there must be a lag between an event beginning and the machine reacting to it. but was aassured that the machine would cope. Did not know enough about the Remstar so did not argue. Pointed out that they were only showing me the average readings over 7 or 30 days so at times the number of events must have been higher/lower to get an average. Eyes started to mist over so did not push the point.

Assume that the readings in my post are averages over the last 7 and 30 days.
Are the figures in cols 11 and 13 an average over each sleep period or hourly averages within a sleep period.

What is considered a dangerous no of events per hour or sleep period both for personel health and with regard to driving.

As previously posted had the last CPAP for about seven years. One control ON/OFF no ramp believe the presure was in the middle teens. Mask on switch on straight into the windtunell.
Have not had a proper sleep assesment since first diagnoses in 1994.

The learning curve between Remstar and the old machines especially without the help of official info.

Over the last couple nights have had difficulty breathing during the first half hour so.
TWEAKED the base pressure to 6.
Screen 2 still shows>4 but during operation LCD shows 6.
Hopefully the clinic will let go as its Christmas and everybody very busy!!!!!

Looking to any input or bollockings from James.

Many thanks foryour help
Have printed all your posts will pass them to Sister at clinic as my excuse/encouragement!!

[Tigers Fan]

Too low

Hey Bobtwo!

I'm not aware of a direct link between AHI and Being Safe to Drive - it has to vary with each individual and other variables in your life. The test is much more simple - do you feel sleepy during the day? Do you nod off at traffic lights?

James suggested I keep tweaking up my base pressure till I got an AHI below five. He also suggested setting max pressure three to five cm above my base pressure.

Your AHI is not bad but could be improved. You might want to try going up a half cm a night till you get an AHI of 5 and then try adjusting every other night. However, beware going beyond the ideal pressure and giving yourself problems with leakage, breathing and being inflated. Rushing the increase may not give you time to adjust and learn to breathe at the increased pressures. Having said all that, if the pressure on your old machine was mid-teens, it might be an idea to start going up from ten or twelve. The old machine may have been set too high, however. Your call where to start.

This is personal opinion only: I want frequent, regular, fine control of my therapy and that does not describe the NHS as I know it. To get what I want, I have to take charge of my own therapy - so I get lots of frequent, regular, fine control and a nurse getting sniffy with me annually. Easy choice! Additionally, there is always great support here in the forum, especially when James isn't too busy packing and sending my new machine to me.

For consistency and to make comparison easy, all the figures are per hour.

Come to think of it, as your last oximetry study was fourteen years ago, why not ask for another - then you can really see how well you are doing on the Remstar.

Tigers Fan

[Bobtwo]

Hi Tigers Fan

Just a quick reply whilst eating my cornflakes.

Yet again many thanks for clearing up what may seem to be the obvious.
Somehow I do not think I paid enough attention to OSA over theyears.
If it dont seem to be broken leave it alone.
Next couple of weeks will be busy and everyone else on holiday.
Will get back in seriously in the new Year.

Once again many thanks, Have a good Cristmas and New Year.

Bobtwo.

ps sorry for the double post.

[Tigers Fan]

and to you, too!

Happy times for the season, Bobtwo - and for all our readers!

Tigers Fan

[Tigers Fan]

Sudden thought

A reminder in another thread, really......

If you have a smartcard in your Remstar, Bobtwo, you can send it to James at Intus and he will make an analysis for you.

Tigers Fan

[DAZZBOD]

I too had too lower pressure before "ramp" took effect & too higher pressure once an "episode" took place. I did find the unlock for the remstar's clinical menu here on the forum & tweaked the pressures back to something like my old fixed cpap machine were set to. Basically I increased the initial ramp pressure & lowered the maximum.
Result a full night's sleep & no more mask leakage at 2am!

[James @ Intus]

I too had too lower pressure before "ramp" took effect & too higher pressure once an "episode" took place. I did find the unlock for the remstar's clinical menu here on the forum & tweaked the pressures back to something like my old fixed cpap machine were set to. Basically I increased the initial ramp pressure & lowered the maximum.
Result a full night's sleep & no more mask leakage at 2am!

Well done Dazzbod! Just keep an eye on the statistics report to make sure the AHI is consitently low too. This should confirm your intitial findings of improvement. You don't want the upper too low either so keep an eye on it.