Defective ResMed S9?

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OceanBlueZZ

Defective ResMed S9?

Post by OceanBlueZZ » Sun Apr 19, 2015 1:19 pm

Hi, I'm new here. Trying to get the appropriate and effective treatment for OSA has been a continuous struggle, so I really appreciate this forum of knowledgeable CPAP users.

Aside from numerous problems, I have one issue about machine functionality to ask you all about. Here is the background (sorry it's long).

I was diagnosed with severe OSA about a year ago. Was given a trial ResMed S9 machine. It took me about 3-4 months to reach compliance with the rental machine of the DME company. My primary problem was taking the mask off during my sleep every night (I was not conscious of this). Towards the end of my compliance, I started feeling better for the first time in years. I still had fatigue, but I started feeling refreshed in the morning and experienced a moderate improvement of the daily fatigue.

After reaching compliance the DME said I had to 'switch out' the trial/borrowed machine to get a permanent machine, which was the exact same model. I wanted to keep the compliance machine but they said switching out the machines was a 'technicality' that had to be done. It turned out that the new machine never gave me the same effect. First, I was smothering with an upper pressure of 6 instead of 10 because the technician did not have the correct settings entered. (The lower setting was still the same, 4, on both the trial and permanent machine) It took me weeks of enduring this before I figured this out as I was banned from seeing the CPAP settings by the DME people. I asked them how to view the settings, and they told me I was not allowed. Thankfully, googling led to this forum, I think, where I found out how to access the settings and I fixed it, changing the upper limit to 10, which was the upper limit that the trial machine setting was on. Continued using the new machine for a few weeks, but it still didn't work the same. When I called to tell them that the new machine doesn't work like the trial machine, the DME told me this must be a psychological after-effect after smothering for weeks. I was told it was all in my head. At first, I was open to that conclusion, but things didn't get better as expected, so I had to continue jumping through hoops to get appropriate treatment.

After I changed the incorrect upper setting of 6 to the correct/initial setting during the compliance (10), it still never worked the same. I wake up feeling like I have a hangover almost every day. (One other thing I did after getting no help was do trials of continuous pressure at various levels/settings instead of auto pressure as no one would help me and I was desperate. These experiments didn't result in anything but at least I tried.) Having not given up yet, I switched doctors and DME. First, I took the machine to a repair shop at the new DME for testing. The repairman tested the functionality and said this new machine was not broke. He was helpful and discussed the settings with me in an effort to help me figure out the problem. He told me about the EPR, which I was unaware of before. So I called the last DME company to see what the EPR setting was set at on the trial machine when I was feeling good, but they told me that they did not know what it was and that it didn't really matter. Perhaps the EPR is not a big deal, but how could the configuration and settings be done so carelessly? Maybe this setting did make a difference with me. I don't know, but I experimented with the EPR but it never improved things for me. (To this day, I'm still not sure what to set the EPR to but have it on 3). I called the new respiratory therapist about the EPR also, and she had no real recommendation. I told her about the machine not seeming to work right, asked her about the settings, and she said one major thing changed as evidenced by my data report, but that the settings were good. I forget what the one thing was. More months went by and I continued to struggle with fatigue and malaise.

Then I met with the new pulmonary doctor, who said the data shows my treatment is effective as the 'numbers' look good - the AHI averaged about 1.5 (although I still only averaged less than 5 hours of use due to early awakenings). I explained to him how this machine doesn't feel or work the same as the trial machine, but he was focused on CBT for insomnia instead of ruling out causes of the fatigue or addressing mechanical problems with the machine. I was really disappointed. (He seemed to be, by the way, a good doctor, but he wasn't aware of the extent of all the prior struggles and got carried away with the CBT during that visit). When I went home, I looked at the data he printed for the appointment and noticed that my upper level was frequently reaching the maximum, which was set at 10. I thought, if I am hitting this exact maximum pressure, how does the doctor know if my apnea needs are higher? So I changed the upper limit to 11. Sure enough, after that, the data showed I was frequently at 10.6 and 10.8, which was consistent during a period of several months. Maybe .8 is not that much of a difference, but still. I was only averaging 4.5 hours a sleep per night because I'd wake up every single night (ostensibly from the apneas) and not be able to get back to sleep. I am the type of person who needs at least 8 hours of sleep per night. Instead of troubleshooting why I was awakening each night, he insisted I do CBT therapy. I almost gave up at this point.

Fast forward to at least 6 months later, and I still feel terrible. Instead of giving up, I called the new Dr. and insisted I wanted to get to the root of the problem instead of addressing some of the symptoms with CBT, that I was very unhappy with that last visit. So I met with him, again explaining how I felt much better with the trial machine and have continuously been feeling horrible after changing from the trial/compliance machine to the new permanent machine issued to me by the old DME. He apologized for the CBT thing, listened very good, and then decided they could let me borrow a machine from his office. It's been a week now, and I'm already seeing a difference. There are several differences so far:

--the AHI went from 1.5 with the old machine to 7 on the new machine on some nights (I suspect the old machine was reading AHI incorrectly, not that the new machine doesn't work as good). I know the 1.5 is an average over time, but the new machine is never 1.5 or less so I think this is notable considering the circumstances.
--my maximum pressure is up in the 13s on most nights! My old machine showed it never went higher than 10.8 over months.
--at the lower pressure of 4 (same pressure as always), it feels the air is coming out stronger and faster than my machine that was also set at 4. I noticed this difference with the trail machine too. When I put my hand on the outside of the mask (not leaks) it felt strong on the trial/old machine and on the pulmonary Drs. loaner machine, but not on the one that I believe is defective

My original hypothesis was that the sensory system in my machine does not work correctly. The repairman who looked at it said there are no sensors in the machines, and I don't understand how the machines detects the level of pressure needed and also how it collects the data. I am afraid the insurance company is not going to let me get a new machine since the repairman tested it and found no defects.

I expect some fluctuations in machines, but how could one machine give me a pressure of less than 11, and the next gives me 13? This loaned machine is working better already. I am sleeping for more hours because I am not waking up at night from apneas (I could never get back to sleep before), and it's helped eliminate the hung-over feeling. Still tired, but that's a start.

Sorry for the long post, but I'm really angry that I had to go through this for over a year and suffer with continuous malaise and fatigue that could perhaps have been better had the sleep experts listened to my concerns and took appropriate actions. How do the severely ill with multiple health conditions actually get help with OSA treatment? And I use it every single night. There seems to be an abundance of research and clinical guidelines out there, but in my experience, the evidence is not applied correctly. Worse there are too many shortcomings and inadequacies in the evidence in the first place. There were other treatment problems, but this is the one I'm trying to resolve now.

Has anyone had problems with a defective machine before? Is there a link to a site than anyone here knows about that explains the underlying operational mechanisms of these machines so that I have something to check into if the insurance doesn't allow me to get a new one? I feel like I've had to 'fight' just to get basic OSA treatment. Thanks to anyone who reads this.

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Pugsy
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Re: Defective ResMed S9?

Post by Pugsy » Sun Apr 19, 2015 1:42 pm

Is the new machine that the doctor loaned you a different brand and model from the S9 you are unhappy with?
When you talk about these machines it is really helpful if we know the exact model name along with the brand because there are different features available between models and even more differences between brands.

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Re: Defective ResMed S9?

Post by OceanBlue » Sun Apr 19, 2015 2:12 pm

I thought I made it clear the 3 machines were exactly the same, but I must not have.

There are 3 machines discussed in my message:

1. Compliance machine from old DME - used for 3-4 months
2. Permanent machine from old DME issued after compliance was met - used for about 1 year
3. Trial machine from Dr. - used for past week

All 3 are ResMed S9 AutoSet H5i. The point was to try another machine of the same model to compare to determine if it might be defective.

(Same exact hose and mask used for all 3 as well.)

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Pugsy
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Re: Defective ResMed S9?

Post by Pugsy » Sun Apr 19, 2015 2:25 pm

Sorry...I had some trouble following what you wrote.

There shouldn't be any real difference between exact same models.
There could be a difference between the S9 Escape Auto and the S9 AutoSet... I knew you were likely using one of those 2 models because of your mention of upper pressure settings but this
OceanBlueZZ wrote:trial ResMed S9 machine
didn't make it clear.

Now I said "shouldn't"...didn't say it wouldn't be impossible for there to be a machine that didn't seem to work as effectively as another.
Your complaint is not a common complaint though so it isn't something that we really can offer much input on.

These machines do indeed have electronic sensors in them (how else could they do their job and determine what kind of apnea event and how long it lasts and what pressure to use) and it wouldn't be impossible for there to be a problem with something inside the machine.

You are going to have an uphill battle though with the DME because all they can really check out is the pressure that is blowing out of the machine at whatever setting it is set at.
The machine really needs to go to ResMed for evaluation due to the DMEs limited ability to test anything other than pressure. There's a 2 year warranty...if it is defective it isn't the insurance's problem to buy another...it's ResMed's problem to either fix it or replace it and most often they just replace.

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Re: Defective ResMed S9?

Post by OceanBlue » Sun Apr 19, 2015 3:06 pm

Thanks for all the information.
all they can really check out is the pressure that is blowing out of the machine at whatever setting it is set at.
Yes, that seems like a limitation, but I'm thinking (hoping I should say) that the data proves that the sensor isn't working right.

I think my machine was refurbished (I thought they all were) so I'm guessing it may be older than 2 years. I'll see what my doctor says after I give back the loaner.

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Re: Defective ResMed S9?

Post by Pugsy » Sun Apr 19, 2015 3:29 pm

Did you happen to check the "run" hours to make sure it wasn't previously used by someone?
Therapy/used hours (found in the sleep quality report) can be reset to zero but run hours can't be reset but you wouldn't normally see run hours unless you were looking for them.

Do you know how to get into the clinical setup menu area where the run hours are shown?
If not it is explained here
http://www.apneaboard.com/resmed-s9-cpap-setup
You go to the clinical setup menu area and then push the little "i" button and scroll to the service area and the run hours are shown in that area.

Run hours don't always equal therapy hours because the cool down period counts towards run hours but not to therapy hours...but there shouldn't be a huge difference between run hours and therapy/used hours unless the machine was used by someone else and that person's data was removed.

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Re: Defective ResMed S9?

Post by squid13 » Sun Apr 19, 2015 4:05 pm

Here is a good video to watch on how to get into the various menu's all about the S9,watch the top video on the S9. http://www.cpaplibrary.com/machines.html

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Re: Defective ResMed S9?

Post by archangle » Mon Apr 20, 2015 7:08 am

OceanBlueZZ wrote:My original hypothesis was that the sensory system in my machine does not work correctly. The repairman who looked at it said there are no sensors in the machines, and I don't understand how the machines detects the level of pressure needed and also how it collects the data. I am afraid the insurance company is not going to let me get a new machine since the repairman tested it and found no defects.
It has a pressure sensor and an airflow sensor.

Image

This is the bottom of the main circuit board. Just below and to the left of the big octagon shaped hole, is the pressure sensor. It's labeled "sensor 1" and has a little white fitting on it. Near the top, just to the left of the thing that says 173-086, is a black rectangular part that has two little air fitting nipple things on the top. That's the airflow sensor.

When you reassemble the machine after taking it apart for service, these three air connections fit up with matching air fittings on the air handling parts of the CPAP machine.

You can buy one of these from our host, cpap.com and check the actual pressure it's producing. Do you still you still have "your" CPAP machine?

Get the free SleepyHead program and use it to look at your own data. It will tell you how your machines are actually set up and what pressure it thinks it's producing.

You may have to end up having to manage a lot of this yourself. You could set your machine to a fixed pressure and see what pressure it's really blowing with a manometer.

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Re: Defective ResMed S9?

Post by yaconsult » Mon Apr 20, 2015 10:46 am

Wow, this is a very strange case! Clearly, the same make and model of machines should produce very similar results. I agree with archangle that your best shot is using sleepyhead to compare the results that you are getting with both machines. Just comparing the AHI between both machines doesn't really tell you much as the AHI can vary a lot from night to night, especially if you are relatively new to therapy.

I suspect the problem is that you now only have the new machine, right? Ideally, you could have them both for a period and compare sleepyhead results from the two machines. I'm not hopeful that you'll get that option, though.

According to a review I just read on cpap.com for a Manometer, a different filter on the input affected the output pressure. You could try removing the little foam input filter for a night and see if it makes a difference. If so, the two machines may have used different filters. I know that some machines can have two filters and sometimes only one or another or both can be used. There's a regular foam filter and then a thin microfilter that can be put under the regular foam filter. My old machine had that.

In any case, you want to get familiar with sleepyhead and how to access your data.

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Re: Defective ResMed S9?

Post by palerider » Mon Apr 20, 2015 1:42 pm

you shouldn't assume the machines are set identically, we've seen too many reports of machines mis-configured.

read the data from both with sleepyhead and compare, as well as verifying the settings in the clinicians menu.

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Re: Defective ResMed S9?

Post by OceanBlue » Sun May 24, 2015 9:45 pm

Thank you so much for all the responses.

Archangle-that picture was really helpful. It's now obvious many things can go wrong from the inside, even it's just a loose part.
The run hours are 2,891. I've had the machine about a year, so that checks out ok.

The experiment would have been ok if my settings were the same with both machines. But my regular machine was 6-11 and the experiment borrowed machine was 6-14 per the doctor. (Had I known, I would have changed my machine to the 6-14 for a couple weeks before I tried out the borrowed machine). After seeing the experiment machine registered pressures of 12 and 13 during the 2 weeks, I changed the pressure of my regular machine to the same afterwards. Sure enough, my pressure usage was about the same with both old and borrowed. The AHI, however, was always a bit higher on the borrowed machine. so I'm not sure if the sensors are all correct in the regular machine, but I don't think that matters so much. And they did have the settings wrong-they had it set for a nasal mask, and I use a full face mask. Not sure if that setting makes much of a difference, but was glad I checked and caught that before using it.

The pulmonary doctor and respiratory therapists know little about the mechanics of these machines, I am realizing. Like is the hose too long? Should it be level with the bed or higher or lower? After asking these questions, they just say they don't know.

I've come to the conclusion that this is ridiculous. I think my fatigue is related to something else, but the reason for the CPAP focus is that my internist is not listening to me. The pulmonary doc/sleep doc was the only one who listened, which is why this process was initiated in the first place.