ResMed S9 user having issues--seeking your experiences

[dtsol]

Hi All,

I've been using various CPAP machines since around 2003. I'm currently using the ResMed S9, and am finding that most days, I just don't feel rested. My compliance is generally good, and when I've gone in to the sleep doctor and they've looked at my data readouts, my AHI is pretty low. I love how quiet the machine is, but it's getting to a point where I'm really having trouble in my daily life due to not feeling rested.

One odd thing I notice about the machine; if I hold my breath for a little while (for instance, if I'm thinking about something), the machine starts to "pulse." I've already returned one machine under warranty, thinking this was a defect, but the replacement does it as well.

Has anyone else had issues with this particular machine--either the pulsing I'm describing, or other issues of it just not giving you a good night's sleep? Any recommendations for how I should try to solve this problem?

Thank you so much!

Dan

[apneawho]

Dan,
From what I understand, the S9 will pulse to check for obstructed airway.That is how the machine will sense obstructive vs. central apnea. If you are holding your breath, this will not register as obstrucive apnea. I have not held my breath while I am awake so I haven't felt this pulse, but others on this forum have described this.
Are you saying you felt rested using another manufacturer for years and only now you don't feel rested using the S9? When you say your compliance is generally good what does that mean?
I get a good night's sleep with my S9 Elite. I do not have the Autoset. Which one do you have? Take a moment to complete your equipment profile under user control panel top left.

[Perrybucsdad]

Hi All,

One odd thing I notice about the machine; if I hold my breath for a little while (for instance, if I'm thinking about something), the machine starts to "pulse." I've already returned one machine under warranty, thinking this was a defect, but the replacement does it as well.

The machine is working as it is intended to. See this LINK for a video explaining it all. About 1:20 into the video, it will discuss exactly what you are feeling. It is looking to find if you are having a central apnea or obstructive apnea. The mask pressure it detects from the pulses is what will differentiate it and allow the unit to respond accordingly (higher pressure for an obstructive)

Also, this LINK is the page on ResMed that discusses this too.

- John

[squid13]

I have a question about this. If you have a central and the S9 senses this, pressure will not increase, but you won't take in any air to breath until your brain says breath, right? So what does the S9 do to stimulate breathing when you have a central?

[apneawho]

I have a question about this. If you have a central and the S9 senses this, pressure will not increase, but you won't take in any air to breath until your brain says breath, right? So what does the S9 do to stimulate breathing when you have a central?

Nothing

[robysue]

So what does the S9 do to stimulate breathing when you have a central?

No CPAP/APAP does anything to stimulate breathing during an apnea. Bi-levels without a so-called T (trigger mode) also do NOT stimulate breathing during an apnea. It's true that the APAPs running in Auto mode will increase the pressure in response to one or more apneas. (My System One BiPaP Auto does not increase the EPAP if there's only one isolated OA, but will increase the EPAP if there's two or more in a short period of time.)

The reason why is simple: To stimulate breathing requires something much closer to a real ventilator. It doesn't have to be an invasive vent, but it does need to be a vent of some sort. The Bi-levels with trigger mode act rather like vent when the T-mode comes into play when it "triggers" a breath. The ASV and AVAPS machines that some forum members use are noninvasive vents when they are set to trigger breaths.

The idea behind CPAP/APAP and regular bi-levels is simply to use pressurized air to make it much, much harder (but not impossible) for the upper airway to collapse. These machines are not designed to "breathe" for us or to "make us breathe". They are designed to help us breathe more normally by preventing the upper airway from collapsing an excessive number of times during the time we're asleep.

[moresleep]

I have a question about this. If you have a central and the S9 senses this, pressure will not increase, but you won't take in any air to breath until your brain says breath, right? So what does the S9 do to stimulate breathing when you have a central?

Nothing

Remember, Cpap is an "air splint" that holds the airways open. I you are experiencing obstructive events, the airways are not open, and more pressure is needed. But, if it's a central event, the airway is already open and more pressure would not help. Worse, more pressure might cause more central events, as that's known to happen at some pressure point for many people. So, the auto Cpap wisely does nothing in that situation.

Now, if the situation with centrals or central-like events (periodic breathing, etc.) is bad enough, a BiPap or ASV machine may help...

[squid13]

The reason that I asked that is I have an S9 AutoSet and according to SleepyHead I had 48 clear airway events, Hypopnea 2, Obstructive Apena 1. Resmed software said I had 7.1 centrals per hour and .1 obstructive so that's why I wanted to know if the S9 did anything for centrals.

[Pugsy]

Resmed software said I had 7.1 centrals per hour and .1 obstructive so that's why I wanted to know if the S9 did anything for centrals.

Did you happen to have any centrals in either of your sleep studies with and without cpap titration?
What are your pressure settings? CPAP or APAP mode?
CPAP and APAP machines don't respond to centrals. They aren't supposed to as stated by others but there are a small percentage of CPAP and APAP users who develop centrals in response to pressure.
Might also look at your event graphs to see if the centrals are possibly sleep onset or semi awake centrals.
A central index of 7 an hour is more than I would want to see unless I was pretty sure they weren't real centrals.

[squid13]

All I have is summary's but on the Polysomnogram the PSG data was 87 apeneas (central 14, obstructive 73, mixed 0) and a 141 hypopneas for an AHI of 50.1 My pressure is 7 and 10. Said my AHI was 0 at 9 cm/H20

[Pugsy]

PSG data was 87 apeneas (central 14, obstructive 73, mixed 0) and a 141 hypopneas for an AHI of 50.1

For roughly 4 1/2 hours of sleep pre cpap? That is a central index of roughly 3.1 per hour.
Did your titration study happen to mention any centrals?
If you are routinely seeing Central index of 7 or so then it appears to have doubled on cpap therapy.
I would be taking a close look at the event graphs to see if there seems to be any pattern to those centrals and/or discussing this with your doctor when you go for follow up. They may not mean anything but I would want to check it out just to make sure.

If the 7 central index is not common and you normally see half that number then I wouldn't be so worried about an occasional weird night.

[squid13]

My therapist at my DME is good and has been on CPAP for 10 years and 30 years as a therapist and I was talking to him about it and said to bring my SD card in and will take a look at it. I value his opinion and if need be I'll make an appointment with the Doctor. Thanks for all your help, there is so much to learn on this subject.

[dtsol]

Thanks, everyone. Very helpful so far. I'm still wondering; are others using this machine finding it effective compared to other machines they've used?

[Uncle_Bob]

I get a good night's sleep with my S9 Elite. I do not have the Autoset. Which one do you have? Take a moment to complete your equipment profile under user control panel top left.

But your own equipment profile says you have an Autoset

[moccasin]

I started using a ResMed S9 Autoset after 3 months' success with the Respironics Remstar Plus. Had to switch to the ResMed when I changed insurance. (not fun) From the first night I used the S9, I experienced pulsing continuously on inhalation and often on exhalation, too. I returned one machine and the replacement S9 did the same thing. My doc was not familiar with the machine, so asked the medical supply to give me a different type machine to try. I was given an Elite II and have had no pulsing pressure. I am feeling more rested, too. That constant pulsation must be fairly rare. I have posted on a couple boards seeking answers and have found only a few references to what I experienced. What was even more odd was that after taking off the mask, my breathing would continue to "pulse" as it did with the mask on. By the way, the pulsation usually occurred or was noticeable when I awoke in the night or in the morning and the pressure was full-on at 8.0.