Machine malfunction? or "I hate my DME"

[Pupcake]

In mid May I caught a cold and my nose was completely plugged up- CPAP just blew my mouth open or vibrated my lips. After a couple days I was able to use CPAP again but was miserable. It kept waking me, blowing my mouth open, tons of leaks, just impossible. (my nose WAS functioning ) after a few weeks I remembered to check my data. I was amazed at what I saw!

Within exactly 10 min my machine pressure would have gone from 8 to exactly 16.5. (without any events other than VS or VSS) It kept a min of 16.5 for the rest of the night, going up and down with major leaks, VS and VSS.

My settings are:
APAP min 8.5 max 20

For the past 1.5 years My pressure averaged 9.5 with <1 AHI.

I called my DME and asked them to walk me through the machine so I could see what was wrong. They said I would have to bring the machine to them so an RT could check it out.

So I drove the 65 miles to the DME. Got there at 12:30 and found a note saying they were closed until 1:00! (coulda told me ) Then they took my machine to "test" told me it was fine. I argued it was not possible my pressure needs would change in 1 day, they insisted it had. Their only suggestion was a chin strap. THEN I find out there is no RT there, I'm working with a tech or secretary or something, the RT wouldn't be there until 3:00. I got an appt at 2:30 (if she could get there in time)

I am an RN. I DO understand this stuff. The RT agreed with me & wanted to send my machine out and give me a loaner to see if I "really" needed that pressure. The tech said "$75 to send it out and we don't give out loaners" Machine is 15 mo old- they gave me the last old one they had instead of the Dreamstation, which they also had.

Husband is away (he takes his old machine on trips) so I asked the RT to show me how to reset his Dreamstation & I would use it to see if things changed. She hesitated & I said as an aside "you can either show me or I will look it up online, either way I'll figure out how to do it "

I ended up not using his dreamstation but everything went back down on my pressures last night.

I don't trust it to last. Here are my screenshots

http://imgur.com/a/cTBug

Is my machine shot?? Is there any reason the RT said I am not on APAP? (scarey)

Any input welcomed!

Pup

[Julie]

Can you get rid of the calendar - it's keeping info lower down on the left from showing up.

[TASmart]

It would be helpful for you to get both the calendar and the pie chart out of the left hand panel so needed information can seen, but I would bet that due to your cold the machine saw very high flow limitations and raised the pressure to try and overcome your swollen nasal passages. The increased pressure made it easier and more likely to get mouth leakage. Once the swelling due to the cold subsided, pressures returned to normal.

Odds are the device is working as designed. Your could use some adjustment on the auto parameters also, that's a pretty wide open range you are running. What I call lazy paping - the Dr and the Rt are too lazy to find an appropriate range so they basically run the machine as wide open as possible, and never fond the right narrow range. But then again your AHI is good, are you feeling rested? Having that wide of range causes some people to have arousals due to pressure changes.

[ajack]

If it was my chart, I'd run min 8.5 max 12
I think the runaway pressure was just that, the machine saw the V flow restrictions and panicked next time to will only bounce to 12

your apnea is very well controlled with the minimum 8.5 and it's functioning like a fixed cpap pressure, you could lower it if you wanted to and see where it went. I would assume you are handling the 8.5cm pressure fine and I would leave it alone.

[Pupcake]

How's this:

http://imgur.com/a/kNMn3

Pup

[Pupcake]

It has shot up to 16.5 every night for 16 days. My cold is gone, no problems- I cannot believe I need 16.5


Pup

[TASmart]

Is it possible that it is positional or something like that? It looks to me like it's trying to kill off some snoring. Kind of hard to tell what's going on. Can you present a time series of this is good, this is when it went bad. and once again turn off the pie chart, I would like to see the flow restriction number.

Making sure I understand, things were going along at a max pressure of 12, then you got a cold, pressure jumped to 16 max
and did not ever come back to the 12 max. Correct? you are thinking that the pressure increase and the cold are not related, rather that the pressure increase is due to a malfunction of the device. If I thought this I would set a pmax of 12.5 and see what happens


But overall, your number look good, and if you are rested and bot being aroused, I don't think I would worry to much.

[Pugsy]

I am confused...is the machine still doing the high gale force pressures or did it go back to normal?

everything went back down on my pressures last night.

This led me to believe that it quit the gale force pressures.

Highly unusual for there to be such a drastic change in pressures unless something is either going on physically or the machine's sensors are acting up.

Is there any reason the RT said I am not on APAP? (scarey)

Well...if the RT told you that you weren't on APAP then he/she doesn't know the machines and that's scarey and I wouldn't trust anything he/she told me about the machine or anything for that matter. This stuff isn't rocket science.

Is your machine shot? I don't know. If it is still giving you 16.5 then I am like you...I wouldn't trust it.
Oh...2 years on the warranty so keep that in mind.

Now if you wanted to have it checked out on your own and willing to foot the bill there is a place that can do it.
acbio.com
They also do warranty work so if there is indeed something wrong with the machine that is a warrantied item they can act as a go between to Respironics and get a new machine to you.
You shouldn't have to go that way but it sounds like your DME and the RT aren't going to be particularly helpful.

[ajack]

It could be a fault in the v circuit/microphone,
off hand,does anyone knows if it work by a microphone picking up the noise?

If it is faulty, I would think about using it in fixed cpap mode

the cost of fixing it would exceed it's value, when you can buy a new full auto dreamstation on amazon for 380

[Julie]

There's a list of stuff (results) under the colored report on the left but only 1-2 lines show even on the new shot... get rid of the pie chart.

[Pugsy]

To turn off the pie chart.
Go to Preferences/Appearance tab and remove the check mark for "show pie chart".

No....your machine is NOT behaving like a fixed cpap....it's behaving like an apap machine that on the "good" nights doesn't need to vary the pressure wildly but it is still doing the pressure probes (those spikey things) as well as some minor increases or decreases that stay for a short while.

Have you by chance unplugged the machine and plugged it back in again during the time all this was going on?

I have used Respironics machines in the past...they don't out of the blue start blowing wildly like this unless
1...major physical issues causing the machine to think it needs some heavy duty pressures to fight with
2...sensor malfunction

Do a test while awake...put the mask on and turn the machine on and let it run for 30 minutes or so (no ramp) and see what the pressure does.
If you are awake there shouldn't be any apnea events or flow limitations to fool the machine into thinking it needs to increase the pressure.
See what shows up on a 30 minute awake test in terms of pressure response.

[Pupcake]

Thanks for all your help guys.
I unplugged it yesterday which could be why it went back to "normal" last night. I will post last nights in a sec- I had to switch computers because when the DME looked at my machine they changed the card to one that had tons of data on it.


OK I think I have the graphs posted right

http://imgur.com/a/xhrFP

[Pupcake]

Here is last nigh't "normal". I tried leaving it on while I was awake to see if it did anything.

all it did was detect hypopneas???

http://imgur.com/a/c44sI

anyway-thanks again for all your help. Hopefully unplugging it did the trick.

Pup

[Pugsy]

Unplugging and then plugging back will force the software to "reboot" similar to a computer when we reboot it to clear out some cobwebs.
Hopefully that is all there was to it but do watch to see if it happens again.

The hyponeas while awake...probably very minor flow reductions from maybe pausing breathing a little. The machine doesn't always get the names right in situations like that so I wouldn't worry about it.
What I was interested in was what was the pressure while awake....if it had gone to 18 straight away while awake...definitely a problem with the machine because while awake you won't be having much to trigger the pressure to go anywhere. While awake auto adjusting machines shouldn't do much because there shouldn't be any airway collapses while awake.

[DB]

[quote="Pupcake"]Thanks for all your help guys.
I unplugged it yesterday which could be why it went back to "normal" last night. I will post last nights in a sec- I had to switch computers because when the DME looked at my machine they changed the card to one that had tons of data on it.


OK I think I have the graphs posted right



Your leak rates for these 2 nights are way too high with the first night showing a leak rate of over 60%. You started the night with several snores which also would have driven up pressure but the pressure stayed high due to the high leak rate. I suggest your turn off VS2 on your event flags. It doesn't mean anything. And turn on LL, large leak. Your last post you had a leak rate of 0 over red line and no snores. Again, VS2 doesn't mean anything. If these were my charts I would increase minimum pressure slightly to see if that would help with the hypopneas. Up your pressure slowly at .5 cm at a time. And be aware that you are getting large leaks on some nights.