Help! Resmed S9 VPAP Adapt newbie

[TahoeGal]

I just got my VPAP Adapt today. I am new to xpap therapy. I have central apnea, AHI 32/59 in REM. I tried out the machine, and OMG the pressure is tremendous! I can hardly breathe against it. It pops my ears! It also doesn't appear to have a ramp function.
I really want this to work, but I don't know how I'll sleep. Anyone have experience with this machine? I really need help. I have the mask fitted right ( resmed swift for her) and it doesn't leak. If I hold my breath, the pressure really kicks in and forces my mouth open. (I am not a mouth breather). Any help/advice would be treated like gold!
Thanks!
(Ps: I don't know how to make a signature with my equipment on it)

[STL Mark]

Welcome to the forum. You have found a great resource here. Some people find that pressures in excess of 15 are difficult to feel comfortable with using pillow style masks. You are now beginning a journey where you will work to identify which mask works best for you. Don't assume that all masks will be equally uncomfortable in how you perceive the pressure.

There are several issues that came to mind in your post. The S9 VPAP Adapt came in two model numbers. The ones produced prior to October 2012 will have a Ref 36007 number on the sticker on the back. These units do not have ramp. The ones produced since that date will have a Ref number of 36037 and do have ramp. If I were you I would contact the DME and demand that they swap yours out immediately for a newer unit. ResMed should exchange the unit for the DME so there should be no problem. If you have problems with your DME, get your Doctor to modify the prescription to add a ramp value for you which will force them to swap out the machine.

Do you know your pressure settings? User control panel/Profile/Edit Equipment will get you to the proper area to enter your equipment. Consider using the machine some in the evening while watching TV. This will assist you in acclimating to your therapy.

[TahoeGal]

Thanks for the reply. I looked at the model and they unloaded an old machine on me. I will call them right away.
My pressures from the Sleep study read : ASV 25 max pressure / 15 max EPAP / 4 min EPAP / 4 min EPAP / 15 max PS / 0 min PS /3 Biflex and Auto BPM.

[RogerSC]

You might try using the machine when you're not sleeping to play with it and get more used to having it on. Better to do that than to lie awake getting acquainted...you might also consider using a sleep aid like Ambien for a week or so, that also can help you get used to sleeping with it. Sometimes that initial barrier can be a problem, but it sounds like you really want it to work, so these are a couple of ideas to get you over that initial barrier.

And, of course, as was already mentioned, finding the right mask for you is really important. You'll sleep a lot better if you're more comfortable.

[STL Mark]

The newer machine will also have the option of an ASVAuto mode that can make the machine's pressure more comfortable. If you have a good relationship with your doctor push through them to get the machine swapped out for one that offers ASVAuto and Ramp features. Even if not appropriate for your present treatment, having that option for future treatment modifications prescribed by your doctor will not be possible with the existing machine.

[TahoeGal]

Boy you guys are good.
I called my DME and they said they know nothing about the other model number. They said they will have to call their resmed dealer and ask. Getting the right machine is critical for me. I am your classic under insured person who has had to pay cash for all this.
TahoeGal

[Sir NoddinOff]

I don't know what your history with various CPAP machines is, however there is one HUGE difference with the ResMed S9 VPAP Adapt (either version of this ASV technology). They are 'ventilators' - this means that they will insist you breathe at a certain rate, which is adaptive to the last four or five minutes, mainly using a 'sliding sample window'. All this means is that you have to start out breathing at your normal pace and the machine will adapt to that for awhile, but when you start to fall asleep the machine's firmware algorithm will make it mandatory that you breathe in a regular pattern. If you skip a few breaths (hypopnea) then the machine puts out a surge of air (or many surges of air as required) that will force you to inhale. It does this all night long. This process sounds uncomfortable but if you can get on board with this concept, it will possibly knock down your AHI numbers to sub 1.0, which can be pretty impressive stuff. However, you have to let it do it's job. Many people say takes 2-3 months to adjust to ASV. Yes, I do use the same model of machine you do and, yes, it took me three months and a bit more

[JohnBFisher]

The suggestions and thoughts of others should help. Using it while watching / listening to TV (or an audiobook) is a great way to start to adjust to using ASV therapy. As mentioned, the reason the unit has such a strong pressure is that it helps sustain your respiration, even when you stop breathing. It takes time to adjust to the pressure. But you will adjust to it.

Another thing to consider is using a mask liner to help reduce leaks from your mask. You can find them at:

http://www.remzzzs.com/
http://padacheek.com/PAC_Maskliners.html
http://quietusliners.com/

I've used both the RemZzzs and Pad-A-Cheek mask liners and have been pleased with both.

Here's hoping your journey toward good sleep won't be too difficult.

[TahoeGal]

I am so impressed with all you guys/gals on the board. I spent the last 2 months reading old posts and new posts and I feel comfortable handling my DME as well as using the machine.

I did spend a half hour reading with the machine on, and I did find a rhythm. Here's to having a good nite!

I may need to try out cheek liners- I found during my test "reading time" that I had to really cinch down my mask to keep it from leaking at these pressures.

I am motivated to make this whole thing work. I felt better after my titration study than I normally do, and didn't get tired until the afternoon ( I am normally tired when I wake up)

The DME gave me 4 different masks to try. (He felt bad that the first machine they delivered was the wrong one- ( this is the second machine from them, and it looks like it will take a third try) another misadventure is my apnea journey.) I do not have a full face mask to try out.

I really appreciate your help. I will make it through even if it takes 3 months! I'll keep you posted.

TahoeGal

[Xney]

Your machine is also pretty "wide open", meaning - you can be breathing at a very low pressure (EPAP = 4cm) and in with that much, or it can go all the way up to 19. With an ASV, it can do that on a single breath - good for treating centrals, bad in terms of suddenness.

It might be more comfortable if you dial it down a bit, limit the range of in and out pressures so they are a bit more steady. For example, instead of EPAP=4cm, see if the doctor would let you try 6cm. Instead of PSmin = 0 and PSmax = 15 (the difference between in and out pressures, minimum and maximum), have them try PSmin=2 and PSmax = 10. That would give you a bit more feel of in and out and less instant "omg huge pressure increase" out of nowhere.

With PSmin = 0, it means that the machine will start out having the same in and out pressure, but then it can decide you need more and ramp it up all of a sudden. I find that to be a lot more disconcerting if you have no difference between in and out than if you do. It's easier (for me, at least) if it's simply increasing a pressure difference rather than causing a pressure difference. That's my own experience - you may find it doesn't work that way for you.

[johnthomasmacdonald]

Hi, I've got the Resmed S9 Vpap adapt machine with the auto Epap - the model number is 36057, With auto epap with heated humidifier and heated climateline hose: 36047 for auto epap and heated humidifier but no heated tube and 36037 for the auto epap with no humidifier or heated hose

my machine often shoots up to ipap of 25 but it doesn't seem to wake me but i use a ffm - the mirage quatro or the fitlife

[TahoeGal]

Well, I made it the night. All night with the mask on. The pressure was very uncomfortable at first, but when I woke up a few hours later, either I had become used to the machine, or it had calmed down a bit. I did wake up a lot, mask leaks, turn over, dry mouth, etc. at one point, i'd fall asleep and my mouth would open and my lips would flap in the wind! It kept happening, so I got up. I think I may need a FFM because of the lip flap.

Good news- my AHI was 1!

I will be following up with my DME today about getting the right machine.

Thank to everyone for your help!

TahoeGal

[dieselgal]

When I have nights of my mouth coming open it wakes me up everytime and I end up with horrible dry mouth. Sometimes just to get through a night I have been known to tape my mouth shut. Just a couple of strips of that paper medical tape over the lips like stitches. That will keep your mouth shut but can be removed quickly if necessary.
I have to admit it is quite a sight and I don't put it on until the hubby is in bed and the lights are out!

[JohnBFisher]

Be aware that most of the mask manufacturers have a free return policy for when someone is starting and needs to try a new mask. Your DME should be able to return the original mask and let you try a full face mask. Frankly, they should never have tried you with anything else. At high pressure it's almost impossible to keep your mouth closed. Even a chin strap doesn't really help. I personally use the Quattro FX Full Face Mask. However, it's not for everyone. Ask your DME what they recommend.

By the way, the pressure would probably seem lower when you awoke later in the night .. because it almost certainly was lower. We all tend to stop breathing as we fall asleep. This occurs because the mechanism that our bodies use to help trigger breathing changes as we fall asleep. During that changeover period we all just stop breathing. But if you have central apnea that's usually exaggerated. So, with an ASV unit, it will INSIST that you breathe. The pressure ramps WAY up quite quickly. But as you fall asleep the pressure would drop again to match your more regular breathing.

But it's great to see that you did so well. Here's hoping you overcome the small hiccups so you can enjoy that improved sleep.

[TahoeGal]

So here's an update-

I am getting used to the pressure, tho I am still waking up at night a lot ( I did before xpap, so nothing new). I have found, however, that my body has found a way to reject the pap therapy. I am using a nasal mask/ pillows (I am experimenting with the masks from the DME) and found that my mouth opens and lets all the pressure out my mouth. So after continuous flapping lips last night, I thought I'd try out the cervical collar trick I learned here to keep my mouth closed.

I got out my collar and put it on. I laid down to try to get back to sleep. Then I started getting the lip flapping! My mouth was shut tight! I a stared paying attention to the flapping. I couldn't find a trigger. I would flap until I breathed in, even tho that took "a while" as I got over the startle and thought about my strategy. Oh, body, what next?

On my machine and the DME-

I was able to get them to order the right machine for me (I hope). They told me it would come next week sometime. I am also having them bring a FFM when they deliver the machine.

TahoeGal