cpap vs apap

[Vonon]

I have a RemStar Plus M series with Cflex and a setting of 10. I also require oxygen supplementation into the cpap system with a setting of 4 liters. The pressure setting of 10 was arrived at in a hurry at the sleep lab because I didn't go into rem sleep 'till the last half hour of the study. I also had to sleep on my back (I'm a side/stomach sleeper) to keep from pulling the wires loose. I have learned much from reading this site but still don't know all the lingo.

My question is: Should I buy the software/card for my machine to better be able to tell how well it is working or should I get an apap that will automatically adjust to needed pressure? I feel pretty overwhelmed by the learning curve that accompanies this treatment and my provider is not very helpful.

Thanks in advance for your help.

[bdp522]

You need to fill in your profile so we can tell which M machine you have. IMHO, If possible, it is always better to get an apap. You will be able to retitrate yourself if needed and get all the useful info.

Brenda

[Wulfman]

If you have the "Plus" version, it won't give anything but "compliance" information (how many hours you slept). You would need the M Series Pro, the M Series Auto, the "classic" REMstar Pro 2 or the REMstar Auto machines in order to utilize the software and view your sleep statistics.

Den

[Vonon]

OK. Got the equipment thing going now. Thanks for the replies.

So, I think I understand that to get valuable information as to whether the therapy is being successful I must get a different machine. And I presume that in order to do that I have to have an order from my pulmy (new word for me). Surely it could not be as simple as taking my current machine back to the provider (Praxair) and saying I want a different one.

You people are the best. Thanks for taking the time to help.

[Linda3032]

No, it probably won't be that simple, but hey, it never hurts to try.

IMO, Since you didn't get a good titration, then Auto is the way to go. As Den said, you can get the M series Auto, or the older "tank" Classic Remstar Auto. The classic has been a workhorse for a few years now. The M series is the newer version, and is a fine machine also.

If your DME will switch to either machine, accept it, run, and count your lucky stars.

Good Luck

[Linda3032]

And it's probably a good idea to not mention the "software and monitoring" to either the doctor or the DME. Most are not too receptive to mere mortals knowing about the mysterious world of sleep apnea. (Or knowing more than they do), excluding our fellow hosehead, Matt, of course.

Insurance will not pay for the software or card reader, which will cost upwards of $200, but well worth it.

[Erin_Belli]

You can make it more likely to get a prescription for an APAP if you are having problems with aerophagia (swallowing air and getting bloated). Or if you are having problems handling your prescribed pressure. The APAP delivers lower pressure most of the time, thus reducing aerophagia. And less pressure is more tolerable. As for the software, it enables you to self-titrate, and I believe it is essential for ensuring that you receive the highest quality xPAP therapy possible. The Lord helps those who help themselves, but you can't help yourself much without the software.

[blarg]

And it's probably a good idea to not mention the "software and monitoring"...

Yeah, honestly, word to the wise, play dumb.

[StillAnotherGuest]

I have a RemStar Plus M series with Cflex and a setting of 10. I also require oxygen supplementation into the cpap system with a setting of 4 liters. The pressure setting of 10 was arrived at in a hurry at the sleep lab because I didn't go into rem sleep 'till the last half hour of the study.

A 4 LPM oxygen bleed-in is quite a bit, certainly suggests there's at least one other major issue underfoot. How did that come to pass?

Also, since the supplemental oxygen is fixed and the machine flow is variable, changes to therapy (pressure and/or mask selection, which may vary the overall leak rate) could affect that, especially if the balance is delicate. Monitoring nocturnal oximetry may be important.
SAG

[Vonon]

SAG,
I'm not sure what all the related problems are. I had several other medical problems going on when I was diagnosed and was pretty passive as a patient. One factor is living at 7350 feet. My oxygen level often drops into the mid 80s during the day so I'm not surprised about sleeping requirements. I see my pulmy next month and will be more agressive about information. It didn't occur to me that I may need a fairly constant pressure to deliver the oxygen. Perhaps an apap is not in the cards for me.

[StillAnotherGuest]

SAG,
I'm not sure what all the related problems are. I had several other medical problems going on when I was diagnosed and was pretty passive as a patient. One factor is living at 7350 feet. My oxygen level often drops into the mid 80s during the day so I'm not surprised about sleeping requirements. I see my pulmy next month and will be more agressive about information. It didn't occur to me that I may need a fairly constant pressure to deliver the oxygen. Perhaps an apap is not in the cards for me.

Well, there are a bunch of plain ol' contraindications to APAP, and a preponderance of central apnea is one of them. At 7000+ feet, periodic breathing associated with altitude (a central apnea syndrome) is a real strong possibility. Information relating to this will be in the sleep studies.

BTW, I disagree with the concept of "playing dumb". If one can't have an honest relationship with someone (be it personal or professional), then there's a problem with the relationship, and trying to run a scam won't help that a lot. Being aggressive is fine, being assertive is better.
SAG

[Vonon]

SAG, Thank you so much for your considered reply. You,ve given me topics to take up with my doctor next appointment.

So much to learn!

[StillAnotherGuest]

You're quite welcome.

In the meanwhile, you might want to get a hold of your sleep studies (the long versions) to see what additional information could be gleaned from there. Specifically, in your case, review the types (obstructive, mixed and/or central) and quantities of respiratory events and when they occur (REM vs NREM), how they responded to CPAP, and how the oxygen saturation behaves (desaturations and/or overall baseline drop).

When you say "had several other medical problems going on", does that mean they are (at least somewhat) resolved? Those are hefty desats even at altitude.

Have you thought about becoming a flatlander?
SAG

[blarg]

BTW, I disagree with the concept of "playing dumb".

As do I. Currently my insurance is provided by my dad's job, and the DME is the only one I can have under that insurance.

So, I'm ordering masks online now, because I don't like dealing with them. It's not worth my time/effort/everything to go through their hoops, except for the machine. Do whatever you want, just know that if this DME is your 'only shot', then there are risks involved in your revealing your knowledge. I think that "running a scam" is too harsh a judgement.

If you have more options in providers (or you live dangerously), then by all means, foster an honest and healthy relationship with your healthcare provider. I should have been more clear in my post above, and I apologize.