Review of Remstar M-Series Auto CPAP

Introduction

I am new to CPAP treatment, and my first machine is the Remstar M-series Auto machine that just came out. I chose it for several reasons:

1. Like a computer, I hope that by buying the newer technology the machine will last for a few years.

2. I won’t get any clinical advice or follow-up from my DME, so I wanted the ability to do my own titration studies with the Auto feature.

3. The EncorePro software and Derek’s MyEncore provide pretty detailed information about my night’s sleep.

4. The Remstar is small and portable.

My review is based on four nights of use. Other than my one-night sleep study at the clinic where I used a Remstar Plus, I haven’t had any experience with other machines for comparison, so I defer to the veterans of the forum to provide such feedback and correct my errors. Sorry I didn't include some figures from the manuals. I couldn't find a way to get them to download to this post.

What You Get

I purchased the Remstar with the integrated heated humidifier from CPAP.com for $875. The machine came in a compact travel case already put together and ready to go. An extra set of air filters, power supply and cords, and six foot hose are included.

The humidifier and CPAP machine are integrated as one unit that is 8.25” x 8.75” x 4”, weighs around 4-5 lbs., and fits quite nicely on my bedside table. The hose, smart card slot, and filters are located on the back of the machine and easy to access. The water container for the humidifier is accessed from the front through a lift-up door.

The travel case is black nylon with Velcro seals for the pockets, a zippered section for the main compartment, and a shoulder strap. The case is about 10” x 13” x 5”. It has a well-padded, zipper compartment for the Remstar machine, a thin pocket (8.5” x 12”) for manuals, and a pouch (10” x 11.5” x 2.5”) for a hose. You probably could fit some masks in the case as well.

CPAP.com provided all the manuals, including the all-important “Provider Quick Setup Guide” that allows you to access the Provider mode screens to configure your therapy pressure and other features. Manuals for the machines (but not the provider setup guide) also can be found at:

http://global.respironics.com/manualsandliterature.asp

General Overview

There are three buttons always visible: one to start or begin the ramp cycle again, the start/stop button, and a C-Flex button to change the setting. The ramp cycle gradually increases pressure from the ramp starting pressure to your treatment pressure over a specified time period. The buttons glow a dark blue that is comfortable at night and not too bright. The LCD data screen is not backlit, but you are unlikely to use it at night.

Under a lid above these three buttons is the LCD screen with its control buttons. When the machine is off (e.g., not blowing air), you have three options for using the data screen: 1) Use the minus key to take a FOSQ questionnaire (only available with the Smart Card installed); 2) Press the plus key to get to the Patient Setup Screens; and 3) Use the Left and Right Arrows to review your data if you turned on the ‘Show AHI/Leak data’ option in the Provider Setup Guide (see below).

The FOSQ Questionnaire might be useful to you if you wanted to monitor the success of your treatment in an objective way by taking the questionnaire every few weeks and compare your answers. The data download to EncorePro. I haven’t used the questionnaire.

There are several screens that are available in Patient mode (the normal operating mode) to change some settings without going through the Provider Setup Guide described below. To reset treatment pressure and some other features, however, you need to go through the Provider setup.

The Data Screens also provide several features. You get to these screens by pressing the left or right arrows. Unlike the Puritan Bennett machine, the data screen does not provide results from last night, but gives averages for the last 7 and 30 day time periods. You get running averages for your AHI, leaks, and if you are in Auto Mode, the 90% pressure. To see daily results, you need to download data to EncorePro and MyEncore using the Smart Card.

Remstar M-Series Provider Setup Guide

You must use the Provider Setup Guide to get the machine properly configured for the treatment you want. To do so, first unplug the machine. Then, hold down both the Left and Right Arrow buttons while plugging the power cord back in. When you hear 3 beeps, release the buttons.

The setup menu navigation and options are extensive. Press the + key to get to the setup features. The first five screens set the machine up for CPAP or AUTO, the CPAP pressure, the AUTO range (4-20 cm H20 in 0.5 cm increments), and the C-Flex setting (0-3).

This machine includes the option of a Ramp Time and Ramp start pressure. NOTE: Others have reported that the Ramp function was not available in earlier Remstar machines when they were in Auto mode, but it can be used in Auto mode with the M-series.

Finally, you have a Mask Alert, Auto On/Off a feature that turns the machine off when you remove the mask during the night, Split Night Study, Show AHI/Leak data on the Patient Screen (you definitely want to turn on this feature so you can monitor your data from the screen while in patient mode), and a Patient Reminder.

When you finish, press the Power button to get back to Patient/User Mode.

First Impressions

I have been running the machine in Auto Mode with a C-Flex setting of 2 for the last four nights. My Auto range is 6-11 cm with a starting Ramp pressure of 4 and a Ramp time of 15 minutes. My 90% pressure value has been around 7 cm. I am using a ComfortLite 2 nasal pillow mask.

The machine has done a good job of reducing my AHI. It is consistently less than 1 per hour with about 5-10 episodes of Apnea /Hypopnea each night. This is still 5-10 more than I want, so I probably will go for a higher range in AUTO or a higher fixed pressure when I’ve finished collecting a few more nights with these settings.

At these relatively low pressures, the machine is whisper quiet. I don’t have a decibel meter to measure the noise level, but it sounds like a soft breeze. When I inhale, tube vibrations are my loudest source of noise. The sound produced varies depending upon how I position the tube and what it might touch (bed posts seem to facilitate the conduction of the vibration and make the sound louder). Damping tube vibrations seems to be a much more important for reducing noise than muffling the Remstar M-series machine. It is hard to tell whether it is on or off by sound alone.

I remember the constant pressure from my sleep study and find the C-Flex to be more comfortable. I think my body relaxes more completely, and I sleep more soundly with the reduction in pressure when I exhale, but of course, I need to spend a few nights with the C-Flex off to test that out.

Some have expressed concern about the design of the M-series Humidifier. Check out the video clip from Respironics to see how it works:

http://mseries.respironics.com/Family.asp


I have not had a CPAP machine before, so I can only imagine what is like to bring a bottle of distilled water to my bedside and try to fill my empty humidifier in the dark (because my wife has already gone to sleep). I find it very easy to fill the Remstar M-series water chamber in the bathroom, carry it vertically to the bedside, and then slip it horizontally into place. I’ve done it in the dark several times now and have yet to spill a drop.

I had mild rainout on my third night. For the first two nights, it was warm (mid 70’s), and I had the Humidifier set to 3 (range 1-5). On the third night, it cooled down to the mid 60’s, and I got condensation in my mask. Last night was cool again, so I set the Humidifier to 1 and had no rainout problems. I suspect that if the temperature of my bedroom got into the 50’s, I would need to use a heated tube from Australia to control rainout; otherwise, the Humidifier settings seem work well, provided I check the temperature and adjust accordingly.

Tomorrow I am traveling for 10 days and, of course, the machine comes too. I’m still wondering how you find distilled water on the roads I’ll be traveling (drug stores may not be around the corner when I get to town and am on foot), but packing and traveling with the equipment will be a snap. It is very compact, lightweight, and the carrying case will make for easy navigation through airport security.

Overall Evaluation

I am very impressed with the technological sophistication of the Remstar M-series. You get a very smart machine for the price. It has most of the features that people on the forum seem to want: quiet operation at least in the 4-11 cm range (can’t speak to the sound it makes at higher pressures), lightweight, easy to setup and run, good humidification control, C-Flex for lighter pressure on exhalation, a Ramp feature with Auto mode, and now on screen data reports.

With the added data report features, you don’t need EncorePro and a Smart Card to check your AHI, System Leaks, and 90% Pressure values (when you have been running in Auto Mode), but you only get 7- and 30-day running averages. If you have a treatment plan that is working, these data are probably adequate to monitor yourself, but you will want the software if you like looking at daily data or are conducting your own titration study to get a treatment plan going.

The M-series Ramp feature also now works in Auto Mode, something missing in the earlier model, so I read. I like using it; it gives me a chance to settle in, relax, and adjust my mask before the pressure ramps up.

My one complaint has to do with the different setup modes (Provider vs. Patient) that make configuration a little cumbersome, but the setup screens are easy to navigate, so it really is only a minor quibble.

I think the Remstar M-series machine is excellent value and highly recommend it.

-Chris

Thanks Chris. Great analysis, overview, and good observations. I was particularly interested in your comments about noise levels, and you have answered them very well. I wish you much success with your new system.

Good review.

You may want to double check on that Ramp timer setting in the manual. Unless they have changed how it works, you could change it on the old model also, only problem was it doesn't function correctly when the mode was set to one of the auto modes.

The manual on the old model clearly states to set that timer at 00:00 when using ANY of the auto modes (APAP or AFLE). You would set that timer from 5-minutes to 45-minutes if you wanted to use it as a Ramp "when" using any of the CPAP modes (CPAP/CFLE). The old model had the split-night mode also. Split mode is a special diagnostic mode, starts off in cpap to specific settings then swtiches to auto-titration mode for the rest of the night.

There is no Ramp in autopap modes, there is really no need for it as the machine will sit on the low pressure until it sees an event that it needs to respond to. The Resmed machines have a Settling feature where the machine will "delay" any response to events for the timer value set. The Remstars don't have that feature that I'm aware of.

Note: The latest in the old model now has seperate fields for cpap or apap modes, it is possible there are seperate ones for that timer on your machine as well.

DATA from the LCD display? Did I read that correctly? you can now get AI, HI and pressure data from previous session directly from the LCD? You could never get that before.

Respironics went to all the trouble to create this DVD, expensive and fancy brochure, sending out a writing tablet the size of the machine and they didn't put in the video the MOST important feature patients have been asking for which is getting previous session data directly off the LCD without software.

Hi Snoredog,

It's my understanding that the LCD display will not provide you with a separate AI and hypopnea index, but rather a combination of the two, in other words a combined AHI, which is still not quite as useful as separate indexes.

Great info! Thanks for taking the time to report so completely on the user specifics of this machine!

[quote="Snoredog"]Respironics went to all the trouble to create this DVD, expensive and fancy brochure, sending out a writing tablet the size of the machine and they didn't put in the video the MOST important feature patients have been asking for which is getting previous session data directly off the LCD without software.

Hi Snoredog,

The Ramp function really does work in Auto Mode on the the M-series. The manual doesn't place any restrictions on the Ramp function; that is, it can work in any mode - Auto or Fixed pressure, and the device has a separate Ramp button that can be used any time during treatment to restart the Ramp period. I also have experienced the Ramp at work in Auto mode.

Last night, for example, I was having trouble with mask leakage and the machine had increased pressure to the point that I couldn't settle the mask and re-estabilish a seal. So, I hit the Ramp button, the machine immediately dropped to 4 cm of pressure (my starting pressure for the Ramp period), and I relaxed and settled the mask. For me, the Ramp function really is useful in Auto mode, and I'm glad it has it.

Regarding the data screen, Paul B is correct - you only get a running 7- or 30-day average of the AHI. If you want to look at apnea and hypopnea episodes separately, you'll need the EncorePro software to do it.

Note: the data screen won't give results from your previous session; last night's data get averaged with the previous 6 days' data. If you want to look at one night's data, you still need the software to do it.

Best,

-Chris

Yes, but can it make pancakes?

you are correct the "User Manual" doesn't place any restrictions on use of Ramp, BUT the Provider Setup Instructions did on the previous model.

Please consult that guide, look under "Set the Ramp Time".

Ramp Down button:
The Ramp Down button has always been used in the Auto mode to lower the current delivery pressure, that is not really new.

The question is does it Ramp "UP" or delay therapy pressures based upon that timer? I don't think it does, but if it does it is new.

Please refer to the Provider's Setup Instructions to the heading "Set the Ramp Time". If the M series is like the older Auto /cflex it will say:

"Range: 0 to 45 minutes (5 minute increments) for CPAP or CFLEX".

If it has that line, notice it doesn't have APAP or AFLE modes listed?

Then there may be an additional Note below it saying:

"For Auto-CPAP or Auto C-Flex therapy, set the timer to "O""

which effectively disables it (but the Ramp down button will still work to lower current delivery pressure down to the "Min" pressure).

Other timer values are: 2:00, 3:00 or 4:00 hours for Split-Night therapy.

What is Ramp?
Ramp is a feature commonly found on cpap machines (this autopap machine has 2 cpap "modes", CPAP & CFLE), so this one would have a Ramp feature. How it works is if you have a cpap pressure of 10cm and you assign a 30-minute timer for Starting Ramp and use the default 4cm Starting Ramp pressure, the machine will Ramp "up" in .5cm increments (every 5 minutes) going from 4cm pressure to 4.0 to 4.5, to 5.0, etc. until it reaches the "Max" pressure 10cm or the Ramp timer expires, whichever occurs first.

The object of the feature is to allow you to fall asleep before therapy pressure kicks in.

Hi Snoredog,

The Provider Setup Instructions come on a single card that shows data menu navigation. If I could figure out a way to post a figure of the menu for you, I would. When you get to the Ramp setup window, there are no Mode restrictions on the card or in the window for setting the Ramp Time. The range is still 0-45 minutes. When you move to the next Ramp Start Pressure setup, the window "only appears if the CPAP or Auto-Min pressure is set above 4 cmH2O." This quote comes from the instruction card; I take it to mean that the Ramp function will work in Auto mode.

And, as I wrote before, I have experienced the Ramp function working while I was in Auto mode.

-Chris

Sorry Snoredog - the last post was from me. Forgot to log in.

-Chris

[quote="Anonymous"]Hi Snoredog,

The Provider Setup Instructions come on a single card that shows data menu navigation. If I could figure out a way to post a figure of the menu for you, I would. When you get to the Ramp setup window, there are no Mode restrictions on the card or in the window for setting the Ramp Time. The range is still 0-45 minutes. When you move to the next Ramp Start Pressure setup, the window "only appears if the CPAP or Auto-Min pressure is set above 4 cmH2O." This quote comes from the instruction card; I take it to mean that the Ramp function will work in Auto mode.

And, as I wrote before, I have experienced the Ramp function working while I was in Auto mode.

-Chris

I really appreciate the review. I'm trying to decide between the Remstar M series and the S8 Vantage setup. I'm particularly interested in the M series since they make a portable battery for it as well.

Sounds like you are well satisfied.

Thanks again

I really appreciate the review. I'm trying to decide between the Remstar M series and the S8 Vantage setup. I'm particularly interested in the M series since they make a portable battery for it as well.

Sounds like you are well satisfied.

Thanks again

Portable battery? Hummmmm......another plus factor!
Does anyone know how long the battery lasts?