newbie with an old machine?

[Spearcatcher72]

Greetings.

First I'd like to say thank you for those of you who quite obviously invested quite a bit of your time and resources creating this forum. It is a repository of amazingly invaluable information that would be difficult to glean elsewhere.

I was diagnosed with OSA over 5 years ago, and after several months of waking up after 4 hours and not being able to get back to sleep with a mask on, I chucked the idea altogether--6-8 hours of poor sleep with no mask seemed to leave me feeling as poorly rested as 4 hours with a mask. However, the quality of my sleep continued to deteriorate until I recently decided to give it another try. I've finally reached a point where most nights I can get 6-8 hours of sleep with a mask on, and the difference is significant.

My question to you is should I replace my REMstar Pro C-Flex+ AutoIQ by Philips Respironics? I acquired it in December, 2011, and the DME had disabled the magical stuff. She had configured it to be a basic CPAP set at an even 6 CM and had disabled the ability to reduce the flow at the end of inspiration or the beginning of expiration.

About a month or more ago I stumbled upon this site and after reading several posts decided to venture out on my own (I'd been to see my sleep Doc, but he wanted to do another sleep study, and I wasn't sure I wanted to venture down that rabbit hole again). I instead elected to re-configure the machine on my own. I missed the recommendation to make note of the original settings that I could return to them, but in fact this was so mechanically configured as a straight CPAP machine at 6 CM that the mistake was minor. I would recommend to anyone doing this, however, to make note of the original settings prior to changing them. Excellent advice.

I had also not downloaded the SleepyHead software, and imported the data collected by machine from its SD card. In my case also not a serious crime, but it would have been better getting the horse in front of the cart.

In any event, I've followed the advice of many of you and begun taking ownership of my therapy. I just wish I'd known about this forum years ago when I first was diagnosed.

I enabled A-Flex and C-Flex, turned on the AutoIQ, and set the range at 6-20 CM H2O. The machine decided that I needed to be at 9 CM, which is where it is most of the time. My AHI is the only un-improved parameter, and is often at 4--slightly worse than where it had been with the original settings (a level 6 CM, CPAP). I only downloaded the SleepyHead software yesterday, so today I'll have another look at the settings and re-activate the Auto IQ.

I would like to get recommendations from any of you who might have experience with this machine, however--should I be looking at another, more modern machine that might have improved capability, or should I hang in there with this one. It seems to be a capable machine, although I might go back and re-initialize the AutoIQ program which does not run continuously. It seems that some of the newer devices are constantly evaluating the user's respiration and adjusting continuously to optimize performance. Is this so? Should I upgrade and keep this in reserve? Would anyone care to make a manufacturer/model recommendation? Is there already such a thread on this forum?

Thank you again for your amazing site--just when I wonder about what is happening in the world, I once again realize that most of our fellow humans are good and decent!

[robysue]

I suspect that you are using what is known around here as a PR System One Series 50 machine. To tell for sure, you should take the humidifier tank out, turn the machine over, and look for a model number on the bottom of the blower unit. Tell us what it says and we will know exactly which machine you have.

The System One Pro models (both Series 50 and Series 60) record full efficacy data, but the AutoIQ is only a limited version of autoset: After a certain number of days, the auto feature is disabled. There are ways around that if I recall correctly.

Nonetheless: You have a good machine capable of providing excellent therapy once the pressure setting is tuned in. If money is an issue, there's no compelling reason to upgrade the machine to newest machine.

Posting SleepyHead data will be the easiest way of getting some feedback on ideas to try for improving the efficacy of your therapy.

[Spearcatcher72]

RobySue,

Thanks for your timely response. Looking underneath the unit unfortunately is of no help--it gives the serial number but only says REMstar Pro, and then underneath that says REF 450P. The booklet I received for the unit calls the humidifier a System One Heated Humidifier, and while it isn't really integral to the CPAP machine, it was designed for use with it and when attached seems to be integral.

Next question is how do I post the SleepyHead data? In fact, I'm not a Windows novice, but I'm having trouble creating a shortcut on my desktop that will take me to the SleepyHead software I've downloaded. No matter what I do it wants me to start from the beginning as though I've just downloaded the software and need to install it on my computer. Kind of frustrating.

I had an appointment with my Sleep Doc about 6 weeks ago, and he told me that I would likely require a new sleep study if I wanted to purchase new equipment, including mask, because I'm now on Medicare (although Tricare is my supplemental insurance). I really don't want to do another sleep study. I'm more likely to purchase a new auto titrating machine, and hope that this insurance will pay something after the fact. Any thoughts?

Thank you again for your help RobySue.

[Guest]

I had an appointment with my Sleep Doc about 6 weeks ago, and he told me that I would likely require a new sleep study if I wanted to purchase new equipment, including mask, because I'm now on Medicare (although Tricare is my supplemental insurance). I really don't want to do another sleep study.

If you had a sleep study (and equipment) prior to getting on Medicare and it meets the Medicare requirements and have the documentation and a recent face-to-face with a doctor who documents that cpap is providing relief for you then Medicare will indeed pick up the cost for a cpap and supplies. Anything Medicare pays TFL will pick up the co-pay, flawlessly.

Either call Medicare directly (which so many don't do) or contact the SHIP in your state. Google "Find your State’s State Health Insurance Assistance Program (SHIP)" to find your SHIP.

Then you will need to choose a Medicare provider. If you don't need anyone coming out to your house or a local mask fitting and like mail order - I use Verus Health Care for my supplies, one of the few mail order or online provider that I know accept Medicare. They will also help you if your local DME also says you need another PSG but you feel that you qualify.

The hardest part may be finding a doctor to document the use of your cpap. I send my "download" directly to my sleep doc twice a year.

HTH

[SewTired]

Medicare will accept a sleep study that is less than 10 years old. If you were only diagnosed 5 years ago, your sleep study is STILL VALID. Have you had a significant health change? Otherwise, it's probably a waste of money to get yet another study when an APAP can work for you just fine.

[robysue]

RobySue,

Thanks for your timely response. Looking underneath the unit unfortunately is of no help--it gives the serial number but only says REMstar Pro, and then underneath that says REF 450P.

That REF 450P IS the model number---thanks for posting it. You have a PR System One Series 50 CPAP Pro with AutoIQ. It's a good machine. At the time you got it, it was state of the art. Other than integrated heated hoses, there's not much that a PR DreamStation can do that your 450 can't. There's no need to upgrade the machine if money is an issue or if you just don't want to bother with upgrading it.

Next question is how do I post the SleepyHead data? In fact, I'm not a Windows novice, but I'm having trouble creating a shortcut on my desktop that will take me to the SleepyHead software I've downloaded. No matter what I do it wants me to start from the beginning as though I've just downloaded the software and need to install it on my computer. Kind of frustrating.

There are two questions tied together here.

1) You seem to be having problems with getting SH to install a shortcut on your desktop. Unfortunately I'm not a Windows person, so I can't help you there.

2) You also want guidance on how to post SH data. Instructions on how to post images can be found at:
https://sleep.tnet.com/reference/tips/imgur
And here's a thread with some examples of which graphs we like to see:
viewtopic/t103468/Need-help-with-screen-shots.html

I had an appointment with my Sleep Doc about 6 weeks ago, and he told me that I would likely require a new sleep study if I wanted to purchase new equipment, including mask, because I'm now on Medicare (although Tricare is my supplemental insurance). I really don't want to do another sleep study. I'm more likely to purchase a new auto titrating machine, and hope that this insurance will pay something after the fact. Any thoughts?

I don't blame you for not wanting a new sleep study.

As for whether your insurance will pay for a new machine after you purchase it with your own money, I doubt it. Many insurance companies would claim you didn't have "preauthorization" and deny coverage in that situation I think.

Still it's worth contacting your insurance just to clarify what their policy for purchasing new machines actually is. When my first PR System One BiPAP Auto (a 750 machine) turned five years old, my doc had to write a new script, but I didn't have to have another sleep study done. But I am not yet old enough for Medicare, my insurance did not change, and the insurance company has the (good) compliance data from when I started out, as well as five years of CPAP supply claims.

[Spearcatcher72]

Wow.

Make that WOW!

If only I'd found all of you 5 years ago...

I'm going to re-program my machine to re-start the IQ and keep it going for 99 days--I think I can do that.

I'm also going to upload my data via SleepyHead.

Thank you all for taking your time to help me.

BTW I occasionally write articles for the excellent magazine Contrails that is published for retired Northwest Airlines Pilots (RNPA). I'm going to put together an article about OSA and make sure to push this site. Without meaning to be cynical (I'm serious) this site has been more valuable to me than the sleep study and the "professional" care I've received to date. Perhaps I bear some of the blame in that regard, but had I been steered here in the beginning I know I would be a much healthier person today.

Thank you all!!!

[Spearcatcher72]

RobySue,

Below are two SleepyHead charts; one is an overview, the other is night before last. Tonight I'll be using my device with Auto IQ set for another 23 days. It apparently only allows this system for 30 days total and I've already used 7, but I seem to recall reading someplace that it can be re-set. I'm strongly leaning toward purchasing a newer device that always operates automatically to optimize the situation and keeping this as a backup. It's 5 years old although it's only been used for 80 days.

Anyway, I'm hoping it was appropriate to post these on this thread, and that the images are actually viewable. Thanks in advance for the help if this works (BTW the instructions for making this happen were a bit of a stretch, and I'm hoping I got this right).

[Okie bipap]

I had an appointment with my Sleep Doc about 6 weeks ago, and he told me that I would likely require a new sleep study if I wanted to purchase new equipment, including mask, because I'm now on Medicare (although Tricare is my supplemental insurance). I really don't want to do another sleep study. I'm more likely to purchase a new auto titrating machine, and hope that this insurance will pay something after the fact. Any thoughts?

I am also use Medicare and Tricare for Life. If you decide to have the recommended sleep study, you will probably have zero out of pocket expenses. If you purchase a machine on your own, it is doubtful if Medicare will reimburse you. If Medicare won't pay, the neither with Tricare. I ended up having 4 sleep studies before I finally got my machine, and my wife had three before getting her machine, and we had zero out of pocket cost. My supplies are the same way, as long as I get them through a Medicare approved vendor. Your doctor will need to certify you are compliant in your machine usage, and it is helping your sleep apnea before Medicare and Tricare for life will pay for your supplies.

[LSAT]

The data indicates that the machine is set to auto with pressures set a 5/11...but...the charts indicate that you were at a fixed pressure of 9 for the night.

[Sleeprider]

The data indicates that the machine is set to auto with pressures set a 5/11...but...the charts indicate that you were at a fixed pressure of 9 for the night.

Also has a ramp of 4 for 15 minutes that does not show up in the flow rate. I haven't seen this before, but everything suggests fixed pressure at 9.0

[Spearcatcher72]

As I said yesterday, I decided to reset the machine to AutoIQ, and last night I felt that it was a pretty good night. However, my AHI was 6.46--the worst I've had in some time. ?????

Here are the stats:









I mistakenly deleted the snapshots I stored on imgur yesterday, so I've re-posted them here. If they're out of sequence I'll try to fix that but my dexterity likely isn't up to par with many of you. Thanks again for your help.

[Guest]

When your pressure was 9 AHI = 2.34
I would start moving your pressure up towards 9. First to 7 - then to 8- etc.
See what that shows you. Leave it in auto just increase your min. starting point.

[LSAT]

When your pressure was 9 AHI = 2.34
I would start moving your pressure up towards 9. First to 7 - then to 8- etc.
See what that shows you. Leave it in auto just increase your min. starting point.

I agree!

[Spearcatcher72]

Right now this is set to Auto--should I just bail on that or let it go for another few days to see what it does?