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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Apappy
 
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Weinmann SomnoBalance vs. ResMed Autoset S9

Postby Apappy on Sat Feb 12, 2011 2:01 am

I'm a newbie here and to CPAP -- APAP now because my first doctor prescribed a 14.6 CPAP with full-face mask, and I did not have full confidence in this person so I went to another sleep lab with a much better reputation (deservedly so, as I have concluded), where I was prescribed for a 6-15 APAP machine (Weinmann SomnoBalance) with nose mask. I'm about 2 weeks into it now, and have been trying to get answers to several questions. I have tried calling the companies, but that doesn't help much because you don't get to talk to the experts, and you can't rely on their objectivity, either. Of course I will ask my doctor (the second one!), but I want to inform myself first. I hope someone can help.

I have read through a number of the threads here, about self-tritration and so on, and may have missed the ones discussing my question, but maybe someone can link me directly.

Does either one of these machines react to nasal blockage (as with a cold)? The Weinmann person I talked to said theirs does not, the ResMed people said theirs does. It seems to make sense that more pressure would help with nasal blockage, but does it? Or does the pressure actually make it worse? With the Weinmann, the last couple of nights I have woken up with my mouth open and my nose more stuffy than it was when I went to sleep. Opening the window and cool air often helps to clear the nose, otherwise the only alternative I guess is nose sprays and, if that doesn't work, a full-face mask so I can breathe through my mouth. I want to avoid that if possible, and with the nose mask it seems to be impossible to breathe in through the mouth, although you can exhale more quickly through the mouth (losing the benefit of the pressure, I guess, although it continues to blow), and I suspect that is why the mouth pops open, in an effort to get more air. I have tried lying awake with the mask and machine on and breathing through a stuffy nose, but the pressure doesn't go up with the Weinmann. I am wondering if the ResMed AutoSet does, and if that helps to clear the nose. Nasal blockage would be included in the measurements of "air flow," wouldn't it (though apparently not with Weinmann)?

2. I also read something here about ResMed not reacting to hypopneas, i.e. not breathing at all, with pressure over 10. Is this still true of the S9? I don't understand this. I have tried holding my breath with the mask on, after inhaling and after exhaling, for more than 10 seconds in each case (hoping the pressure would increase and help clear my nose), but the Weinmann does seem to react to this. This function -- forcing you to take a breath -- is more a central apnea problem and requires a different machine altogether, doesn't it? I believe both ResMed and Weinmann say that their machines do distinguish between obstructive and central apnea, but exactly how they react is not clear to me. I believe I have only chronic obstructive apnea, and as I understand it everyone has some "central apnea," (i.e., breath pauses) and overreacting to them can be harmful and actually cause more problems (more breath pauses).

By the way, I live in Germany.

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roster
 
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Re: Weinmann SomnoBalance vs. ResMed Autoset S9

Postby roster on Sat Feb 12, 2011 6:35 am

Just two comments, first, are you aware that breathing (or leaking) through your mouth while using a nasal mask will cause loss of therapeutic pressure and you may still have apneas? No reason to be afraid of a full face mask. I prefer mine to nasal interfaces.

Second, a prescription for pressure of 6 - 15 cm H20 is suspicious to me. Maybe the lab did not get conclusive results so a wide pressure was prescribed which is not optimal. For instance, it could be that your pressure needs are 11 cm, for example. The machine slowly increases pressure when it senses breathing events, so you could be having many apneas while it slowly raises the pressure from 6 to 11.

I would try to clarify what the single pressure is that bests controls your apneas. If it is 6 or 7, your prescription is OK. If it is much higher, adjustments need to be made.

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Apappy
 
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Re: Weinmann SomnoBalance vs. ResMed Autoset S9

Postby Apappy on Sat Feb 12, 2011 10:47 am

Thanks. Great to get such quick feedback. I will pursue the points you make. I have a much higher AHI on my back ( 2.8 ) than on either side ( .8 ) -- wearing the mask -- but I can't tell from the data sheet I was given how much pressure was used to achieve these results. The doctor did advise me to sleep on my side if possible, which I think is my normal position, though in the sleep lab I probably spent more time on my back due to all the attachments. I suppose it would be dangerous to lower the pressure range if there is a chance I will be sleeping any time at all on my back. I believe I've heard of ways to avoid this, e.g., by wearing something on your back -- yet more uncomfortable stuff to get used to. If I could read my own data I suppose I could get an idea of the time spent on my back by the AHI, but I don't know if the Weinmann Somnobalance allows this. Maybe for this reason alone it would be better to get a ResMed S9 Autoset, which apparently does allow it. Any thoughts?

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ozij
 
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Re: Weinmann SomnoBalance vs. ResMed Autoset S9

Postby ozij on Sat Feb 12, 2011 11:22 pm

Apappy wrote: Or does the pressure actually make it worse? With the Weinmann, the last couple of nights I have woken up with my mouth open and my nose more stuffy than it was when I went to sleep.

Yes, the air blowing in can cause nasal congestion (blockage) for some people. Before you go the expense of a new machine, there are a number of things you can do to take care of you nasal congestion:
  1. Check your humidification: some of us become congested, and start mouth breathing because our nose does not have enough humidity. For others, it's the opposite: too much humidity makes their nose congest -- you have to find out which is true for you.
  2. Try nasal rinses -- like the SinusRinse nasal wash from Neilmed http://www.neilmed.com/usa/sinusrinse.php -- this is much safer and better than a decongesant spray
  3. Additionally You may want to add something like Sterimar spray just before you go to bed - a saline microspray

ResMed machines respond - and do so quickly -- to anything the looks like its blocking the flow of air (that's called a "flow limitation") -- I dont' think any machine can really "blast through" bad nasal congestion -- and I'm not sure you'd want it to -- . The right solution for a badly, chronically stuffed nose is a full face mask, not a CPAP or APAP blowing at high pressure. However, yours sounds temporary - so nasal irrigation may help.

The new ResMed machines, the S9 series, raise pressure in response to flow limitations, snores and apneas. ResMed machines never respond to what they define as a hypopnea, because the people who created the algorithm decided that the breathing pattern they call hypopnea is not the result of an obstruction and should not be responded to. Unlike the S8 machines, the S9 machine's do raise pressure in response to apneas when those occur above a pressure of 10.

I'm not a doctor, by for what it's worth, I do not see anything, in what you've reported till now, that indicates your pressure is not set up correctly.

_________________
Machine: S9 AutoSet™ CPAP Machine
Mask: Hybrid Full Face CPAP Mask with Nasal Pillows and Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Software: Updated version of ResScan. First machine (5 years) was PB420E. Tried others including Autoset S8 II
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.

Antoine de Saint-Exupery

Apappy
 
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Re: Weinmann SomnoBalance vs. ResMed Autoset S9

Postby Apappy on Mon Feb 14, 2011 3:13 am

Thanks, ozij, this is helpful. The consensus does seem to be that increased pressure does not help nasal stuffiness (not total blockage), but from what you say the ResMed S9s do react to it. So I am wondering anyone has had experience with this (everyone gets a stuffy nose occasionally, don't they?), and if they find it helps or hinders.

I do use a neti pot saline sprays for nasal irrigation, and they help. I try not to use a decongestant because they apparently make things worse if used regularly. I am thing that having a full-face mask on hand for occasional use would be something that everyone should have since everyone gets a stuffy nose -- or am I still missing something?

Re the reaction time, I have noticed that my Weinmann continues to blast away, when I wake up, at the same pressure it was apparently going at in sleep (e.g. 10-11), even if I sit there on the bed and wait. How long should it take for the machine to wind back down? If I turn it off and then back on again, it starts over at the lowest pressure (6), but should that be necessary (turning it off and on)? And if I am stuffy and put the mask back on at 6 it is no easier to breathe than without the mask, whereas I thought the pressure would make it easier, but I can't really compare it because I can't switch back and forth between pressures in order to see if it helps. Maybe someone who can fiddle with their pressures has experimented and can tell me if it does any good (helps to open the nasal passages).

Did you mean (below) that the new S9s do raise pressure in response to hypopneas (vs. apneas) above a pressure of 10?

ResMed machines respond - and do so quickly -- to anything that looks like its blocking the flow of air (that's called a "flow limitation") -- I dont' think any machine can really "blast through" bad nasal congestion -- and I'm not sure you'd want it to -- . The right solution for a badly, chronically stuffed nose is a full face mask, not a CPAP or APAP blowing at high pressure. However, yours sounds temporary - so nasal irrigation may help.

The new ResMed machines, the S9 series, raise pressure in response to flow limitations, snores and apneas. ResMed machines never respond to what they define as a hypopnea, because the people who created the algorithm decided that the breathing pattern they call hypopnea is not the result of an obstruction and should not be responded to. Unlike the S8 machines, the S9 machine's do raise pressure in response to apneas when those occur above a pressure of 10.

I'm not a doctor, by for what it's worth, I do not see anything, in what you've reported till now, that indicates your pressure is not set up correctly.

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ozij
 
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Re: Weinmann SomnoBalance vs. ResMed Autoset S9

Postby ozij on Mon Feb 14, 2011 10:03 am

No.
In its older versions, once the pressure go above 10, the Resmed Autoset Algorithm would no longer respond to any apnea. This was based on knowing that there are more pressure induced (open airway) apneas above 10, and the need to avoid raising pressure in response to an open airway apnea.

The S9 tries to tell which apnea is "open airway|, and responds only to those that are obstrutive -- at any pressure.

_________________
Machine: S9 AutoSet™ CPAP Machine
Mask: Hybrid Full Face CPAP Mask with Nasal Pillows and Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Software: Updated version of ResScan. First machine (5 years) was PB420E. Tried others including Autoset S8 II
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.

Antoine de Saint-Exupery


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