Resmed S9 Heater

[jrfoster]

I am not one to use the heated humidifier that much since I don't like warm/hot air coming into my mask. I am basically a passover guy. That being said, I have tried the setting with my new S9 machine and even when I set it at 1.5 or 2 I feel no warmth. This am I turned it up to 3. When I shut it off and removed the water chamber it was not very warm. My old CPAP if you had it at a setting of 2 it was too warm for me. Anybody have experience with the heated humidifier with the S9? Thanks.

[moondoggy]

I too have an S9 and the vapor that comes in the mask is indeed cool. I run mine at 3.5 or 4.0. Make a note of the water level when you fill the unit up at night and then what the level is the next time you fill it up. If the level has gone down then you'll know for sure that the unit is working as designed.

[jrfoster]

Thanks, I will give it a look in the am. I don't mind a warm feeling but not a hot one! I am not using the heated tube with climate control either. Don't know if it worth the investment or not since I don't have a problem with rain out.

[moondoggy]

Thanks, I will give it a look in the am. I don't mind a warm feeling but not a hot one! I am not using the heated tube with climate control either. Don't know if it worth the investment or not since I don't have a problem with rain out.

My MedTech told me the heated hose is really worth the money but in my case my insurance was paying for it anyway. What I was told by someone on this forum or another is that the water gets heated up and if you don't have a heated hose the humidity can condensate in the hose and cause rain outs. In my case my nasal passages will swell and close off it I don't have enough humidity and I've had 1 case of afib as a result from not being able to breath effectively at night so I run my unit at humidity of about 4 all the time and I think the heated hose is a benefit for me and may be for you also as it may allow you to run at a higher humidity rate too.

[jrfoster]

So what you are saying is that heated humdification helps to keep your nasal passages open? I have problems with one side of my nose always closing up. I don't want to use nose drops all the time....so warm humidified air will help keep it open you think?

[-tim]

The S9 has a secret setting that then gives you a menu option for temperature and humidity level if you use their heated hose. This seemed to reduce the air temperature.

[jrfoster]

The S9 has a secret setting that then gives you a menu option for temperature and humidity level if you use their heated hose. This seemed to reduce the air temperature.

Really, a "secret setting" ? I'll have to get a heated hose and check it out then!

[moondoggy]

The S9 has a secret setting that then gives you a menu option for temperature and humidity level if you use their heated hose. This seemed to reduce the air temperature.

Really, a "secret setting" ? I'll have to get a heated hose and check it out then!

Well, I don't know about "secret" but I do know that when I got my S9 system it only allowed me to adjust the temperature which I found out is not the temperature of the air but the temperature of the heated hose. To make a long story short the inability to be able to adjust the humidity caused me to have medical issues and in a discussion with my Med Tech I mentioned that I had started adjusted the temperature and he said that would do nothing to increase the humidity and only adjusting the machine's configuration would allow me the capability to adjust both. He told me that to adjust both I had to bring my machine in so he could set it up a different way which I did. Now I can adjust both based on the temperature and humidity of the outside air air and I have not had any additional problems since.

[robysue]

The "secret setting" is the Climate Control setting located in the Clinical set-up menu: If the tech who sets the machine up is kind and thoughtful, s/he will set the machine up with the Climate Control setting to Patient. That setting allows the patient to fully control the ClimateLine hose if/when they decide to use one: The patient can then choose between Auto and Off for his/herself. In Auto, the machine is supposed to maintain a relative humidity of 80% in the air inside the hose. In Off, the patient can independently choose the appropriate humidity level and the appropriate temperature most that makes him/her most comfortable.

But most techs seem to set up the Clinical menu's Climate Control to Auto, which allows the patient to change the temperature, but not control the humidity level directly. And if the Climate Control setting is set to Auto in the Clinical menu, this also prevents the patient from changing the Climate Control in the Patient menu from Auto to Off.


There are several other Clinical Menu settings that can be set to limit certain important features of the S9---features that can increase/decrease your comfort level while using the machine and limit your access to your own data. They include:

• Max ramp. This sets the maximum ramp time the patient is allowed to choose from the patient Ramp menu. It can be set anywhere from Off to 45 minutes. When set to OFF, it prevents the patient from using the ramp altogether. The default setting is 45 minutes. And unless the patient chooses a shorter length ramp time, the ramp period will be 45 minutes. In other words, every time the machine is restarted during the night, there will be a 45 minute ramp up period.
• Start Pressure. This sets the starting ramp pressure. The default is 4cm. Many patients would do better if that beginning ramp were set up closer to their prescribed pressure. No matter how the Start Pressure setting is chosen, the patient cannot change the starting ramp pressure on the S9. (Note that on the System One, the situation is reversed: The patient can control the starting pressure, but not the ramp time. A genuinely patient-friendly machine would allow the patient to control both the starting ramp pressure and the ramp time.)
• EPR. The Clinical Menu's EPR controls both whether EPR can be used and if used whether it will only be used during the Ramp period or whether it will be on all night. There is no provision for the Patient to override this choice if the tech chooses Off or Ramp Only in this setting. The default setting is OFF.
• EPR level. If the tech has allowed EPR to be used (either for only during the ramp or for the full night), then the patient will be able to choose the EPR level from the Patient set up menu. (And the patient will be able to turn EPR off if it is bugging them from the Patient set up menu.) If the tech chooses a particular level or sets this setting to OFF, then the patient is stuck: S/he cannot change the level of EPR from the patient menu. So if the EPR is insufficient or is too much, the patient is "stuck" with an uncomfortable setting until s/he successfully badgers the tech into changing this Setting. And the default setting is OFF.
• Sleep Quality. The default setting is Usage, but patients really need this to be set to On. When Sleep Quality is set to Usage, the only data the patients can access through the LCD is the compliance data. You want the machine to tell you all the efficacy data. A good question that I don't know the answer to is this: Does the machine record the full efficacy data when the Sleep Quality is set to Usage? Anybody with an S9 who cares to risk losing a night's worth of data to find out?
• SmartStart. When set to Patient this allows the patient to decide whether s/he wants to use the SmartStart feature. (SmartStart allows the machine to turn itself both ON and OFF based on whether it is detecting breathing.) The default setting is Off, which means the patient cannot opt to use SmartStart, which could be very inconvenient if the machine is placed very close to the floor. On the other hand, if this is set to On in the clinical menu, the patient cannot turn the SmartStart feature off, which could be problematic if you've got some really, really nasty leak problem: A large enough leak can cause the machine to lose track of your breathing, and then the machine turns itself off while you are still asleep.

Of course there is a way to "correct" comfort settings mistakes made by the tech who set the program up: We patients can get hold of the Clinical manual and, if we're daring, go into the Clinical menu and change the setting ourselves. The techs, the DMEs, and the sleep docs don't approve of it, but we are the the ones who use the dang machines night after night in our own bedroom, and we need to be able to experiment with the comfort features to find the combination of settings that works for us.

[jrfoster]

Thank you for that educational post. My DME will work with me on what I need and even said that since I have been on CPAP for 6 years and have "controlled" my own therapy very well, he has no problem with me "tweaking" the settings.

Someone on this forum posted to me awhile back that she had the link to the S9 clinicians manual and would make it available. I would like to have it. Anybody know where that is?

[robysue]

PM Pugsy and she'll give you the link.

[Sparky123]

The ResMed H5i humidifier is designed to work in a couple of ways. In the Auto setting mode, it works on relative humidity. In the Manual setting mode it will work off of room temperature. The Patient mode gives the user a choice. I am a sleep disorders techonolgist who sets patients up on PAP. This question is asked a lot, and there are plenty of people who have problems and question regarding the H5i/S9 humidifier. My concern is the auto setting for the humidifier and it's apparent inability to satisfy patients who really need humidity. The main reason that a PAP humidifier is used is to relieve the drying out effect of air blowing across the moist surface of the nasal and oral airway. It is not meant to replace the ambient humidity in the room or house, but to provide augmented therapeutic levels of humidity targeted specifically to the nasal and oral airway. The traditional humidifier heats water to create therapeutic levels of humidity. The temperature of the water is higher than the room air causing the water give up moisture in the way of vapor. The cooler your bedroom is, the lower the temperature setting needs to be to create the added humidity. Many people will also complain of water accumulating in the tube or even the mask. This is caused by the humidifier setting turned up too high in a cool room. Tricks to counter this include using the heated tubing, or an insulating fabric wrapped around the tube, or simply turning the humidifier heater down. The warm moist air is simply cooling down in the tube before it reaches your mask. the temperature drop causes condinsation to develop inside the tube. With the new H5i humidifier in the Auto mode, relative humidity is used as a indicator for the heating of the humidifier hot plate. The problem with this is that people on CPAP need augmented levels of humidity and the responsiveness of the new H5i is not adequate in many situations. The home care technologist can set your humidifier to the Manual or Patient mode. It will then need to be manually activated. Just dial over to the humidifier screen and press the knob on the right side of the unit down for 3 seconds and you will have manually activated the humidifier. It will then operate based on room temperature. You can adjust the setting then with the knob. Most patients I've worked with like to operate the humidifier in this fashion much better, but everyone is different. I find it amazing that some people don't even like humidity.

[robysue]

The home care technologist can set your humidifier to the Manual or Patient mode. It will then need to be manually activated. Just dial over to the humidifier screen and press the knob on the right side of the unit down for 3 seconds and you will have manually activated the humidifier. It will then operate based on room temperature. You can adjust the setting then with the knob. Most patients I've worked with like to operate the humidifier in this fashion much better, but everyone is different. I find it amazing that some people don't even like humidity.

And that's why this particular setting SHOULD be set to Patient in the clinical menu: So that those who have different preferences are not stuck using settings that don't work for them. We should not have to take our machines back to the DME to change a patient comfort setting. That wastes everybody's time, and it's also a bit humiliating for us patients to have beg someone else to change a setting that we should be able to control ourselves.

[jrfoster]

Good discussion going that I really appreciate. I just got a heated hose. I have turned the climate control to auto. I understand that keeps the hose at 80 degrees and adjusts to the humidity of the room? Is 80 degrees for the hose an average temp? I keep the humidifier set at 2 for the time being. Will auto be ok? As you can tell I an new to all this humidifier stuff. My bedroom is usually between 69-71 degrees at night.

[robysue]

I understand that keeps the hose at 80 degrees and adjusts to the humidity of the room?

No. When set to Auto, the ClimateLine hose keeps the humidity in the hose at 80% relative humidity. In other words, it will direct the humidifier to heat the water up enough to get the relative humidity that high.

In the Auto mode, you the patient can select the temperature, but you will have NO control over the humidifier setting. And if the humidifier has been set (via the patient setup menu) it will be ignored.

Is 80 degrees for the hose an average temp? I keep the humidifier set at 2 for the time being. Will auto be ok? As you can tell I an new to all this humidifier stuff. My bedroom is usually between 69-71 degrees at night.

If the temperature is set to 80 degrees and the Climate Control is set to Auto, then the machine is going to do its darnedest to deliver 80 degree air that has a relative humidity of 80%.

I don't have the foggiest what an "average" temp for the hose is. I think many people do set the temp a few degrees warmer than their bedroom. And some set it quite a bit warmer. It all depends on how much heat you like.

And if you've been keeping the humidifier at 2 without the heated hose and you find such a low setting comfortable, you may find that the default 80% relative humidity may be too damp for your tastes. But if you were forced to compromise on the humidifier setting because of rainout issues, then you may like that 80% relative humidity just fine.

In other words, you'll know what you want after you spend some time sleeping with the heated hose.

If you and your nose feel overly warm, turn the temp down. If you and your nose feel too cool, turn the temp up.

If the temp is comfortable, but the nose feels dry, switch the climate control to Manual and set the air temp and the humidifier setting separately.

If the temp is comfortable, but the nose feels too wet, switch the climate control to Manual and set the air temp and the humidifier setting separately.