Did I make a Mistake with Air Sense 10 for Her?

[RiverDave]

Hi Luthie,
I am a Autoset 10 user and will be getting a "for Her" version in a few days, so I will be sure to report in to you.

One question I have is, do you have any chemical sensitivities at all? If you are now using a new machine esp w new hosing, the plastic offgassing could be irritating your lungs??

I would suggest you try it again while horizontal and relaxed, and pay special attention to whether you are experiencing interference with your inhalation or your exhalation. I know this is different from what you are going through, but just as an example, I realized when I really tuned in to why I was having problems with the Dreamstation, it was because it was interfering with my exhalation due to the "pressure pulses" being too strong.

If settings of EPR3 worked for you on your old machine but now you feel like it interferes w your exhalation too much, well there must be something different about the actual pressure that you are getting, I would think (mask & tubing being the same). Do old CPAPs lose their umph?? Anyone know? Or is it an all or nothing thing, like either it works at the pressure or it doesnt. I don't know.

Is there a reason you are not supposed to use the ramp feature? Sounds like you could benefit from that - unless your medical professionals had a good reason to tell you "no ramp". It is worth asking.

I wanted to try and help a few different ways if possible. I'm actually a DME Respiratory therapist and commonly catch these questions. My initial reaction as to why Luthie feels different is that the claim of the "for her" machine, is that it hosts a different, more sensitive algorithm for women. This can be understood by the way the machine responds. Honestly speaking, and I don't mean to be discouraging, from a respiratory and home care stand point, we kind of think this is a bogus selling point instituted to drive revenue for companies like ResMed. My reasoning for this is, the sleep labs do not have a "for her" algorithm when they are testing people's airways. They simply do it. First night polysomnogram shows need. Second night titration finds what pressure best corrects the AHI. Pressure is pressure. You may not need as much as a male, or another female, but you still need it. A second reason I don't set my female patient's up on "for her" machines goes back to the clinical setting yet again. If this separate algorithm, or way of adjustment was so needed, we would see it in hospital settings on BiPAPs, NIVs and Ventilation, but we do not. It is non-existent in the clinical setting.

My suggestion would be to keep the machine, as the airsense 10 machine is a good high quality machine, but I would absolutely take it off of "for her settings" and change the settings back to the general auto prescription. I would then match it to your S9 in every way with the exception of the humidity as the Air10 options are different..

Your "expertise" isn't really wanted here.

Why? Just curious, not inflammatory.

[TASmart]

I welcome your advice.

[palerider]

Your "expertise" isn't really wanted here.

Why? Just curious, not inflammatory.

Well, first, many people are here because of the ineptitude of DME "respiratory therpists", but, to expand.

I wanted to try and help a few different ways if possible. I'm actually a DME Respiratory therapist and commonly catch these questions. My initial reaction as to why Luthie feels different is that the claim of the "for her" machine, is that it hosts a different, more sensitive algorithm for women.

The 'for her' algo is documented as:

The AutoSet for Her is similar to ResMed’s AutoSet algorithm with the following modifications:

• Reduced rate of pressure increments designed to help prevent arousals.
• Slower pressure decays.
• Treats apneas up to 12 cm H 2 O and continues to respond to flow limitation and snore up to 20 cm H 2 O.
• Minimum pressure (Min. Pressure) that adjusts according to the frequency of apneas:
  If two apneas occur within a minute, the pressure reached in response to the second apnea will become the new minimum treatment pressure until the next treatment session.

Patients who use AutoSet for Her will still get the benefits of ResMed's AutoSet technology including improved sensitivity to flow-limitation and Central Sleep Apnoea Detection with Forced Oscillation Technique.

That doesn't sound "more sensitive", (which implies that it would increase pressure *faster* not slower, as documented.

This can be understood by the way the machine responds. Honestly speaking, and I don't mean to be discouraging, from a respiratory and home care stand point, we kind of think this is a bogus selling point instituted to drive revenue for companies like ResMed.

"I don't understand it, I think it's bogus." Let's see, at cpap.com, Autoset: $883, AutoSet for Her $883. So, they spent however much R&D money to put in a new feature that they charge $0 for... Quite the revenue drive, eh? "companies like ResMed" is this feature driving revenue for other companies too?

My reasoning for this is, the sleep labs do not have a "for her" algorithm when they are testing people's airways.

Of COURSE not, they're TESTING, not TREATING... apples and oranges.

They simply do it. First night polysomnogram shows need. Second night titration finds what pressure best corrects the AHI.

This is often correct. I don't disagree with *EVERYTHING* said, ... but did it need to be said? Did it add useful information?

Pressure is pressure. You may not need as much as a male, or another female, but you still need it.

Really, So, if "pressure is pressure" then what's the point of an apap, plain bilevel, auto bilevel, ASV, VAPS? "pressure is pressure". As time has progressed and the state of the art has progressed, more advanced machines have come to market to better treat conditions... Maybe it's more complicated than arcp thinks.

A second reason I don't set my female patient's up on "for her" machines goes back to the clinical setting yet again. If this separate algorithm, or way of adjustment was so needed, we would see it in hospital settings on BiPAPs, NIVs and Ventilation, but we do not. It is non-existent in the clinical setting.

Because it's *NEW*. New things have to start somewhere, if everybody had that same attitude, we'd still be using a vacuum cleaner in reverse, like in the old days. Add to that the lunacy of comparing *HOSPITAL* ventilator needs with people with simple sleep apnea at home. More apples and oranges.

My suggestion would be to keep the machine, as the airsense 10 machine is a good high quality machine, but I would absolutely take it off of "for her settings" and change the settings back to the general auto prescription. I would then match it to your S9 in every way with the exception of the humidity as the Air10 options are different..

Nothing in the descriptions of the issues that Luthie2006 is complaining about have *anything* whatsoever to do with the ASFH mode, if you think about it, because she's complaining about *immediate* problems, like when the machine is first turned on, not after it's had some time for the ASFH algo to have done anything with the pressure. Therefore, the whole diatribe against the AutoSet For Her mode is completely off base.

That's why.

[Luthie2006]

I appreciate all the advice I am getting and do not think it is inflammatory from anyone. As I said, I am not new to CPAP. I am getting no help from the internet company I ordered it from. I just received it on Saturday. If anyone wants to know which one, I will let you know (not CPAP.com) it was bought by my boyfriend online.

I thought the Airsense 10 for Her would be a good machine for me since the S-9 is "trickling" water in the humidifier, and I am constantly taking my machine out of the outlet and bringing it for "sleep-overs" to my daughter's house back and forth. So a second one would have been great, so I thought.

I gave this online medical supply company (horrible, horrible company I just found out) my doctor's prescription and it was identical to what I have with the S-9. No ramp, pressure 11-20, EPR 3. When I received it, they left the EPR on 2 (so that was set wrong already). Luckily I had the clinician's manual and was able to turn that to 3 like my S-9). As soon as I tried it (yes in the kitchen) I was having trouble breathing in and out. I changed the EPR to 1 and that was a little better. There IS a definite difference in this machine from EPR 1-3 (not necessisarly good on ANY number). I went to bed on Sunday night and struggled in bed for 2.5 hours trying to breath and finally had to take it off and disconnect it and put it in in the linen closet and pulled out my S-9 and went to sleep. I am thinking maybe some of it is the humidifier. I live in Chicago and it is a little warmer this week. I have the S-9 at 76 humidity level and 3 on the climate hose. Before I 'pitched' the Air Sense 10 (by the way I switched the setting to just Autoset and not for HER) like my S-9 machine, I changed the humidity to 70 and 1. I still felt I was suffocating and finally disconnected the machine so I could get some sleep for work.

I like all the replies that I am getting. I never should have had boyfriend buy it, but too late now. Internet company wants nothing to do with me or helping me. DME that I go to (with my physician) will charge $350 for their time. My insurance will not cover this because my S-9 is only 3.5 years old and I did not buy it from them. I appreciate ALL your comments because I have tried to help some of you on here regarding chinstraps, etc. in the past, so I love any comments I can have. Otherwise, my birthday present, of over $800 sits in my linen closet and I am upset. (boyfriend too). When I try it again on Friday night, I will turn the humidifier OFF and turn the number to 1 and have no water? Last question, (thank you to the DME guest who wrote in) so that will turn all the humidity off? I did feel that with that climate line hose I was getting a lot of heat and humidity at 70 and number 1. I can turn off that number 1 to 0 and just turn humidifier off and leave out water? I don't get this either, because right now I am using the S-9 on 76 and number 3. I know the numbers are different, but I did feel with the climate line hose on Air Sense 10, it is really pouring out a lot of heat. I relish and am so thankful for any comments. (but not any sarcastic ones) We are all on here to support and help each other. Thank you so much. Luthie2006 from Chicago

[Arlene1963]

I had to turn the EPR down to a "1" from a 3 which I use on the S-9.

.....the auto set is from 11-20 and starts out at 11 just like the S-9 machine. Thanks so much for any help.

Hi Luthie,

Now that you've turned your EPR down to 1 from 3, your minimum pressure has increased by 2CM. You say that things felt out of sync (or is it sink?) in the kitchen from the get go, but changing the EPR from the very start makes a big difference, and now your minimum pressure is quite different to what you had on the S-9, despite the same numbers. This could explain some of your subsequent difficulty on recent nights. Just a possibility to consider.

[Luthie2006]

Thank you Arlene. I tried all the EPR settings and actually "1" felt better (but still impossible to breath without panting) than the EPR of 3 on the Auto Sense, and even the "1" still is very difficult to breath.
On the EPR of 3 I was really struggling to breath and it was literally impossible for me. The EPR setting of '3' on the Auto Sense "forces" me to breath very fast and shallow (on Auto Set). As I went down on the numbers, "1" was least difficult to breath but still difficult. I don't know; I really think this machine is defective. I just don't get it I have my S-9 machine set to an EPR of 3 (I double-checked) humidity of 76 degrees on "3" climate hose, no Ramp, and can breath. The machine is not returnable, so I am trying my hardest to make this work. Thanks.

[ChicagoGranny]

Your "expertise" isn't really wanted here.

Why? Just curious, not inflammatory.

Well, first, many people are here because of the ineptitude of DME "respiratory therpists", but, to expand:

blah, blah, blah

+1

Cpaptalk users rock; DME respiratory therapists, not so much.

[Arlene1963]

Unfortunately he did not buy it on our wonderful site, CPAP.com, but another site he said called 1-800-CPAP. There is no return once it is opened.

How do they think it possible to tell if a machine was damaged in transit without opening the parcel, taking out the machine, examining it, and switching it on?

I see that 1-800-CPAP accepts Paypal, and if your boyfriend used Paypal he should contact PP and see what they have to say about this situation. I sell online (not medical equipment, though) and a no returns policy is very hard to enforce when Paypal is the payment provider, especially when a buyer claims that an item is damaged in transit.

I wonder if they would consider an exchange?

[Luthie2006]

HI Arlene 1963: Thank you. Boyfriend paid with his Discover Card, not PayPal. The one time this company even returned my phone call back is that they said something about sending me out an RME (I guess some kind of order) and that most likely they will ship back the same machine to me. I don't know if I should have him get Discover involved and dispute the case. Online company will take it back, but they said they will ship the same machine back. The receipt clearly does say too, once it is opened, there are no returns. Not sure if it is that way with all CPAP machine internet companies?

[Luthie2006]

I have an update: This internet online company is taking it back with their "RMA" and of course I have to pay postage both ways. They will check it out, and if ok, they send back (I pay them postage) going back. If defective, they fix (they pay postage). I can't imagine that they have Res Med or qualified techs at this third-party company? They also want my Airfit P10 mask as well (the short tube and pillows) too. I don't know why they want the entire set, but their letter states they want to check it out. So luckily I have a spare short-tube and pillows. Not sure why they want this too when it works perfectly with my S-9 machine. I will pack it up this weekend and ship out to at least have them look at it. Do I pack up my $100 Airfit pillows mask and tube to them too as well? I hope they don't put the Airfit pillows on their face to test it.

[ChicagoGranny]

Do I pack up my $100 Airfit pillows mask and tube to them too as well?

That seems to be the terms of their RMA. Violating the terms may void the agreement, so I would send it back.

[emmagoldman44]

Hi Luthie,
It seems like your issue is resolved by now, but I thought I would post about my experience with the for her model anyway.
The main reason I got it was because of the advertised more "breath-by-breath" responsiveness that I hoped would lead to increasing pressure more effectively to abort an upcoming apnea. With my previous, non for her Autoset model, a lot of times, I would look at my sleepyhead data and see the warning signs and short obstructions while the pressure did not change until I finally had a longer apnea.
So the results from the for her model, which I have used now for about 2 weeks, is that my AHI index is lower, in spite of a slightly reduced pressure level (due to mask leakage - I reduced my pressure settings). When I look at my sleepyhead data, there are plenty of incidents of flow restrictions, snoring and "breath by breath" issues that do not trigger an increase of pressure, or only the most miniscule, such as from 6.1 to 6.15. I am not in a position to do a detailed statistical analysis comparing the responsiveness of the 2 machines.
So I can't really explain why I am having fewer AHIs, but I like it!

To address your initial question, in the initial pre-sleep phase, I could detect no difference whatsoever between the regular and the for her model.

Hope you are sleeping better these days

[SewTired]

When my brother got his new bipap, he complained that it was blowing very hard even though it had the same settings as his legacy bipap. It turned out that the seals in his old machine had gradually been failing, so yeah, the pressure WAS different. This could be the situation you are dealing with. If it helps any, lower your settings for a few nights (which is what I did for bro) and then increase a bit every few days until you are at your 'prescribed' low setting.