Help! My new Devilbiss only worked for one night (long)

[newanvil]

Hello, all. I'm a new cpaptalk.com member, although I've been lurking for a while. But now I'm in need of real expertise, so I joined!

I'm in need of some mentoring and guidance in my apnea therapy. In short, I recently lost my health insurance, right about the time I was beginning a relationship with a new doctor to explore a move from CPAP to auto-pap. As a result, I paid for a new Devilbiss Intellipap AutoAdjust out of my pocket, but don't have access to any resources to help figure it out. And while it worked great the first night, I now fear something is wrong and I don't know how to fix it. My story and questions are below. Any help is greatly appreciated.

I'm male, 47, 220 pounds. I was diagnosed 5 or so years ago with "moderate" OSA. First attempt was with an oral device, which only slightly worked. For the past 4 years, I've used a Fisher & Paykel SleepStyle 600 CPAP, ResMed Quattro FF mask, and REMZzzs. I've been accessing the clinical menu and changing the pressure myself for the past 2 years, after multiple sleep studies produced multiple "correct" pressure settings. What I've learned is that while a given setting may work for a while -- say, a pressure of 10, with mild humidity and climate controls -- at some point, compliance always drops off and new settings must be used.

As my success rate was never more than 50% at any given time, I finally started exploring an APAP machine. As I was thrown off my health insurance unexpectedly, I decided to purchase a Devilbiss Intellipap AutoAdjust with SmartLink out of my own pocket. The very first night, it worked better than I could imagine, and I slept the best sleep in many years. Since then, however, it hasn't worked at all. My high pressure setting is 15, my low is and the "SmartFlex" is on, and set at 3 all around.

So far, my experience has been:

• When I first tried the machine, I was aware of the difference in inhalation and exhalation pressure for the first time. I could feel the pressure increase as I breathed in, and decrease on on out, which I felt was significant in helping me breathe properly. Since then, however, the machine has acted very much like a CPAP, with constant pressure and no change on inhalation and exhalation.
  
  The Smartcode shows the first night maximum pressure reached 8.5. Since then, it has not gone past 4.5.
  
  The morning after the first night, the machine suddenly started up all on it's own, even though I had the mask off and laying on the bed. Since then, the "auto-on" and "auto-off" functions have not worked.
  
  I am unable to sleep, as the machine in five tries has acted like a CPAP machine with the pressure set way too low.

My questions are:

• This can't be right, can it?
  
  How can I tell if I've accidentally set the machine wrong or caused this behavior?
  
  Is there a chance the sensor or something else is at fault?
  
  What should I do?

Finally - I know how to access the clinical menu, but I'm not sure what some of the settings should be. Is there a guide that can help me begin to effectively titrate myself and manage my own care?

Thanks for reading, and any help you can provide.

[Julie]

Try - http://apneaboard.com/CPAP%20Adjustment.htm and look lower down on the page for your machine' manual - it's there, but you'll have to send an e-mail for it (there are instructions about doing that just below the list - and make sure you request the right one for your machine ).

[Emilia]

Send me a PM with your email address and I can send you the manual and a good publication from DeVilbiss to help you understand their machine better. I'll address your issues then.... I am AFK / on iPod so I'll type more later.

[jmcanzo]

It could be defective, But you say you bought it new. Then it does have a 3yr warranty. I have had mine auto turn on once in awhile when not wearing it, seems to be if I throw the mask on the bed..(maybe the air pressure changes as it is falling to the bed) LOL

[Slartybartfast]

It might be defective. There's said to be a period of "infant mortality" with electronics. Yours might have succumbed to SIDS. Fortunately you're within the warranty period.

That said, I'd go into the clinician's manual and reset to factory conditions then try again. And as regards feeling the onset of pressure, the "Darth Vader" effect can be annoying. You need to get into the Smartflex submenu and set the IRND and ERND to "round," or soften the onset and cessation of pressure at the beginning and end, respectively, of inspiration and expiration. I set my machine to 5 on both and it feels just like my S9 Autoset (which is good).

The rounding is explained in this flyer. http://www.devilbisshealthcare.com/file ... 04RevB.pdf The graph on lower right shows the rounding.

One of the double-edged aspects of the Intellipap that distinguishes it from other APAPs is that it is possible to tweak the settings and customize the machine to suit your preferences. However, you can end up with problems like you described if you tweak inappropriately or mistakenly.

[robysue]

My questions are:

• This can't be right, can it?
  No---something is not right. I believe you indicated the machine is brand new, not used. I'd take it back where you bought it and ask for a replacement under warrenty
  
  How can I tell if I've accidentally set the machine wrong or caused this behavior?
  Check the settings in the clinical menu to make sure you have everything set up the way you want it to be set.
  
  One note about the "the machine ... has acted like a CPAP machine with the pressure set way too low" problem: Exhalation relief often is disabled/limited at pressures below 6 or 7 cm. After all, if the pressure is only 4cm to begin with, reducing the pressure further may lead to CO2 build up in the mask due to insufficient venting. So if the machine really is running at 4.5cm, that would likely explain why you aren't noticing the increase/decrease of pressure on the inhale/exhale breathing cycle.
  
  Is there a chance the sensor or something else is at fault?
  Yes. And the fact that the machine is brand new probably increases the chances that this is the problem. I think you just got a defective machine that's showing the defects right from the start.
  
  What should I do?
  Take it back where you bought it and ask for a replacement under warranty issues. If they won't agree to simply replace the machine, have them do a thorough inspection of the machine and put something in writing about what they find or don't find.

Finally - I know how to access the clinical menu, but I'm not sure what some of the settings should be. Is there a guide that can help me begin to effectively titrate myself and manage my own care?

Tell us the settings as shown in the clinical menu. And that might help folks make some good suggestions about what to tweak.

[newanvil]

Thanks to all for chiming in with their expertise. I've already learned a ton about the machine and what to do.

Here's where I am since the OP: I have now used the machine no less than 8 times - 4 times for overnight, and 4 for naps. I have checked the SmartCodes each time, and have viewed the SmartLink 3 times (I had to buy a Windows machine first, since I only had a Mac). At no point did either of the sources of information show that the 95th Percentile Pressure or 90th Percentile Pressure higher than 4.5 and AHI greater than 0 with the exception of the first night, when the 95th Percentile was 8.5.

Based on feedback here and offline by the kind Emilia, I've set the high pressure setting at 10 and kept the low at default five, as the most believable titration value I had received in the past was 8. Currently, my SF is set to on Full Time at 2, with iRounding at 1 and eRounding at 2 (although before last night, it was 3 for each one). I've also set my Apnea and Hypopnea % and duration settings to their most sensitive as of yesterday.

Last night, I had some success in that I was able to feel changes in pressure during the period of falling asleep (after the 10 minute delay period) and woke to a feeling of sleeping the whole evening through (I'd say last night was 75% to 80% "successful"). Both the SmartCode and SmartLink, however, showed no changes in 95th/90th Percentile, nor AHI registers. Further, this afternoon's nap failed completely--poor sleep, and no sense that the pressure ever left 5.0cm at any time. SmartCode reporting for this afternoon shows no change whatsoever.

At this point, I'm concerned less about the SmartFlex operation than I am at what seems to be behavior that suggests the machine is not responding to the need to change pressure beyond the low end default pressure at any time during sleep. I'm certainly ready to call my equipment provider and suggest a return, but if there's a chance that the situation is either operator fault or fixable, I'd rather take that route as sending it back means more hassle than I'd like. But, if that's what's needed, then I will.

Again, I can't thank enough everyone who's lent me their expertise so far.

[Slartybartfast]

When I got my Intellipap last February, I got a little carried away with tweaking the settings and the machine ran away with me one night. That can easily happen if you set it up with too much sensitivity. Besides apneas, hypopneas and especially snoring are what seems to induce the pressure to rise with the Intellipap. If those settings don't result in some pressure excursions, it's a good indication something's amiss with that particular machine.

[Emilia]

I have to agree that something is amiss with your machine. I'd either call the provider from whom you purchased the machine and ask for assistance, or see if you can return it for a new one. Another possible resource for help would be to send a PM to the forum user, DeVilbiss Marketing, who is a rep for the company and frequents this forum. She is extremely helpful to DeVilbiss Intellipap users here so don't be shy about doing that. She may be able to shed some light on what may be the problem and guide you to reset your machine. On the other hand, she may also suspect it is defective and help you with getting a new one from your provider.

Good luck!!

[tomandlu]

[quote="newanvil"]The morning after the first night, the machine suddenly started up all on it's own, even though I had the mask off and laying on the bed. Since then, the "auto-on" and "auto-off" functions have not worked.

This is exactly what happened to me. One afternoon two weeeks ago the machine just started up all by itself and wouldn't turn off. Then that night, the auto on/auto off didn't work, and it didn't adjust pressure. I bought the machine new in January from CPAP.COM.

It is under warranty, I sent it back to CPAP.COM but I was told they they couldn't find anything wrong with the unit. They've sent it back to the manufacturer and I was told it will be 6-8 weeks before I hear anything.

I had my first Intellipap for a year and a half w/o issues, but because of insurance and DME issues wanted my own unit (not "rented"). I went to another DME locally who gave me two used machines, BOTH of which had the exact same fault - auto on/auto off wouldn't work and it wouldn't adjust pressure.

The likely cause is a faulty pressure sensor. Your unit, my three units - sounds like a trend. I am very disappointed as I think the Intellipap is an outstanding machine from a size/noise perspective. I've tried several others and I keep going back to this one. Now I am just sleepless, grumpy, angry, frustrated... I thought going w/CPAP.COM was a good deal because they only charged $400 something for my unit (I had to pay out of pocket too). Now I would gladly have paid much more to not be told by some twit he can't find anything wrong with it. It's broken. It isn't about the settings. If auto on/auto off do not work and they are confirmed "on" in the menu... then hey, the machine ain't working.

GRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR

[DaveLP]

I just received my Intellipap from cpap.com a couple of weeks ago and it came in with 10.0 hours on it. I assume that's the result of in house testing before shipment. I now have 145 hours on it with no problems.

My auto-on function works well, so far. It comes on with the second breath I inhale every time. I'm thinking that they changed the sensor or the firmware to delay auto-on for a few seconds or the second inhale to prevent false start-up triggers.