Question about using my new Resmed S9Auto...pulsating

[knothead]

There may be something wrong with the generator, trial & error troubleshooting, if ALL fails, take it back. Sorry for your troubles , I love my Auto S9.

[Country4ever]

Thanks everyone.

I think I'm stressing because you know how important these devices are to us, and our peace of mind.........and I just hadn't expected to feel this way. Thank heavens I still have my old one to turn to!

Is there anything I might have not turned on, or not turned off in the setup? No EPR, I tried with and without ramp, Straight pressure of 9, and I sat there calmly for awhile and if I made any little change in my breathing, this huge gust of air would come through. Gosh I hope its a defective machine and not my crazy brain. I have trouble accepting new things...........but I was really excited about this model.

Question: I insisted on having the APAP machine, in case my needs changed in the future, even though I'm on straight cpap. Is it possible that I need a simpler machine.....and if so, would that be a straight cpap machine??
Worst case senario.........I just can't tolerate this model.....any suggestions on which kind I should try next? I'm definitely not looking forward to working through this with Lincare. But it would probably be even more difficult if I'd gotten it online.
Thanks for your help!

[Country4ever]

Thanks Knothead.
My sinuses are still throbbing.

Another question: If I've been using the S8 autoset for 7 years...........is the S9 that much different to use?
I know I shouldn't keeping asking questions until I have the DME check it out. (I hope they know how). I tend to be very analytical and need to understand things.
Plus....a little insecure about my perceptions. I'm just surprised that this is so difficult, when my old machine was so simple.
But I do want to make sure I haven't messed up something in the set-up menu........otherwise the Lincare people will say "See! See why you shouldn't mess with things!"

[Pugsy]

Is it possible that I need a simpler machine.....and if so, would that be a straight cpap machine??

Not at all...are you thinking the Elite might not do this "thing"...when you are in cpap mode with the AutoSet...for all practical purposes it becomes the Elite.

Go through the clinical menu right now and tell us exactly what the settings are right now for every choice you see in the menu. Every line...don't skip anything...
I don't have a S9 with cpap mode available to me to see what you are seeing.
Let's see if we are missing some little something in the menu that might be held accountable for the mystery pulses.

Also...can you get me an image of your detailed report from the SD card from this machine just for the time frame you have been testing it? Do you know how to do the SleepyHead stuff?
FOTs are easily seen on a zoomed in image of the flow rate and we could at least affirm or eliminate those being the culprits.

Worst case senario.........I just can't tolerate this model.....any suggestions on which kind I should try next?

Not at this point. I am really scratching my head here because the S9 really is a top notch model and your issues are not commonly seen issues at all.

[purple]

Did you set any pressure for the machine?. I have had a PR machine do something like this when the pressure was too low for me.

[Country4ever]

So is the Elite, the cpap only version of the S9?

Okay.........here's the settings. And no, I don't have the ability to see the info on the card. I was planning on getting more into that software, once I got used to the machine.

Mode: cpap
Set pressure: 9
Max Ramp: off
Start Pressure: 8 (although not bolded)
EPR: off
EPR level: off (not bolded)
Mask: pillows
Tube: slimline

Options
Climate control: auto
Sleep quality: Usage
Smart start: off
EPR inhale: med (not bolded)
Access: full

Anything else I should be looking at?

[Country4ever]

Okay.....maybe I'm over thinking this......but if I had a problem in my throat.....like a floppy/sagging epiglottis.......would this machine sense it as an obstruction (even if it weren't) and react in an inconsistent way? Seems like I would also have trouble breathing during the day...which I don't. Just wondering if I have an unusual throat/trachea and its responding to that?

[Pugsy]

Yes, the Elite is just the same thing as cpap mode in the Autoset. Exact same thing.

Sleep quality: Usage

This would need to be set to on to view any data beyond hours of use. So to even see flow rate it needs to be "On" instead of usage. Usage is factory default and used to report hours of use to prove compliance hours used.

Max Ramp: off
Start Pressure: 8 (although not bolded)

This not bolded and the EPR things not bolded ...not bolded means that part of it is turned off
In this case IF you had Ramp set to say maybe 10 minutes then it would start at 8 cm and not the normal 4 cm..

EPR...that not bolded medium just has to do with how fast the inhale and exhale happen..Medium is the default.

I don't see anything in the settings currently on the machine to account for your issues

And no I don't see that floppy airway tissues while awake and breathing normally would/could fool the machine that much into kicking FOT in (assuming that is what you are sensing and I am not so sure it is).
In CPAP mode...the machine really can't respond to anything beyond using FOT...FOT is not constant either.
With EPR off...it shouldn't be doing anything but blowing air at a consistent rate.
If you were using APAP mode with a range of pressures...then yeah, maybe some sort of "response" but not when using cpap mode.
In CPAP mode...with EPR off...the pressure or air flow shouldn't "pulse"... period...while awake.

[Country4ever]

Thanks Pugsy,

The EPR had originally had "med" on, but not bolded. Is it okay that I turned that off too?
I guess I turned off the default...which I think is fine.

Is there anything on another screen that I might not be seeing?

Sounds more and more like something is wrong with the machine. I hope so!

[Pugsy]

Since Medium, when pertaining to EPR, denotes how "fast" the inhale/exhale timing rhythm is...if EPR is turned off then it doesn't really matter what that setting is.
If you were using EPR and you were complaining of "the machine wants me to breathe before I am ready to inhale" then I would suggest turning that speed of medium down.
Most people never even bother to notice that setting anyway...they are quite happy with the default of medium
So that choice is for sure not a cause of your issue since EPR is not used at all.

I don't see anything in the settings that might account for what you are sensing.
Is it you being hypersensitive or is it the machine? I honestly don't know. It wouldn't be impossible for it to go either way.
The DME is likely to blame you though but to make sure it isn't the machine the only logical thing I can think of is for you to try a different S9.
You have already pretty much done everything I would have done if I were in your situation by trying various combinations of things...like EPR or whatever.

One thing though....have you tried apap mode at all?
Maybe try minimum at 9 and maximum at 9?
Wouldn't hurt to try...don't do a range though...do minimum to equal maximum. The machine will accept those settings in apap mode.

[avi123]

All Resmed S9 machines use the FOT to detect Closed vs Open Airway.

The air puffs oscillations are:

A 1 cm H2O amplitude sine wave at a
frequency of 4Hz is superimposed on the current pressure
and the resulting pressure and flow are measured within
the device using a pneumotachograph.

and should NOT be detected by the user of the of the machine.

There is no way that I could feel the FOT oscillations in my respiration flow:



See the FOT usage in these graphs:

http://www.resmed.com/us/assets/documen ... -paper.pdf

[knothead]

So is the Elite, the cpap only version of the S9?

Okay.........here's the settings. And no, I don't have the ability to see the info on the card. I was planning on getting more into that software, once I got used to the machine.

Mode: cpap
Set pressure: 9
Max Ramp: off
Start Pressure: 8 (although not bolded)
EPR: off
EPR level: off (not bolded)
Mask: pillows
Tube: slimline

Options
Climate control: auto
Sleep quality: Usage
Smart start: off
EPR inhale: med (not bolded)
Access: full

Anything else I should be looking at?

OK, I will take these and check against mine at home tonight and send comparison.

[Country4ever]

Thanks again Pugsy.....you're so helpful!
avi........You said you couldn't feel those pulses.....but you were asleep, right? And in the study you posted, I don't think it mentioned if the subjects ever sensed any pulses while awake.
I can't wait to figure this out. I'm not sure my DME is up to the challenge though.

[DoriC]

Just wondering, did they give you a slimline hose or standard hose? If you're using a standard hose you have to change the hose setting. Don't know if that would be causing the pulsing.

[Pugsy]

I gotta go fix dinner but later on tonight when things quiet down I am going to go into my old S9 reports and see if I ever had any FOT show up at the beginning of the night when I was likely awake. It shouldn't show up while awake.
FOT doesn't go on all night long..it only happens when the machine is deciding what to call an event should the perceived reduction in air flow meet criteria for a flagged event.
So it shouldn't happen while awake because there shouldn't be any sort of "event" unless there is some sort of flow restriction somewhere while awake and it shouldn't last and last and last like you are talking about...IF that is what is going on.

That's why I was wondering about looking at the flow rate graph...it shows up IF it is there so then that would either be eliminated (if it wasn't there) or a consideration if it was there..