Struggling on new machine (DeVilbiss): high HI and tired

[Greendirt]

I am quite perplexed about how things are going with a new machine. I'm a bit concerned and am hoping for some input / suggestions from this great forum!

I was diagnosed with OSA (AHI 48, oxygen sat 90%) in August and have been using APAP since. I am 42, otherwise healthy and of normal weight.

During a trial on the ResMed S9 AutoSet, my AHI was well controlled (0.9 on average with many nights between 0.0 and 0.7) on low pressures (95th percentile 6.3) and I felt great. It was getting so good I was seeming to need less sleep each night. Looking back on the only ResScan report I have, it says the average AHI of 0.9 for a two week period was made up of Centrals 0.7 and Hypopnea 0.2

When the trial ended, I bought the DeVilbiss IntelliPAP Auto (I had a non-data loaner in-between) and have just completed two weeks on it. Since then I have been very tired, especially in the afternoon, although I have dreamt some nights (ie: some REM sleep) AI has been negligible (1 or 2 events per night) but HI has been about 5 or 6 per hour with the last two nights at 9 and 13 per hour respectively.

So far as I know I have straightforward OSA with no other issues going on and with an APAP in APAP mode and all the bells and whistles turned off, or on minimum settings, I should be getting adequate therapy. On the S9 (and the Phillips Auto for a couple of weeks before that) I had none of this hassle – I just responded to the therapy immediately and AHI was very low. Something is amiss here but I do not know what it is.

Following is from SleepyHead data from last night, statistically the worst night, although I actually feel better than I have other nights. According to SleepyHead, there were exactly 100 hypopnea and 1 apnea for the night. (Sorry for the formatting, not quite up with pasting / linking images into this forum as yet...).

AHI 13.35
Hypopnea 13.21
Obstructive 0.13
Clear Airway 0.00
NRI 0.00
Leak Idx 0.0
V.Snore 0.00
Exh. Puff 0.00

Min Avg 90% Max
Pressure 6.00 7.92 3.60 9.00
AHI/Hr 0.00 11.31 8.00 29.00
Leaks 0.00 6.86 6.40 28.00
Total Leaks 29.00 39.21 18.80 57.00
Snore 0.00 0.03 0.00 1.00

(Sorry again... in edit mode the columns are neat and easily readable, when submitted the spacing disapears. But I hope you can see there are four columns of numbers with Min, Avg, 90% and Max as the column headers). The 90% presure of 3.6 is obviously wrong but is what SleepyHead reported.

A more typical night (statistically) was a week prior when I was very tired but before I bumped the minimum pressure from 5 to 6.5 (my 95th on the S9) in an attempt to reduce the HI):

AHI 5.23
Hypopnea 5.23
Obstructive 0.00
Clear Airway 0.00
NRI 0.29
Leak Idx 0.00
V.Snore 0.00
Exh. Puff 0.00

Min Avg 90% Max
Pressure 4.00 5.18 4.67 11.00
AHI/Hr 0.00 3.59 7.33 15.00

(Leaks and snores were similar to above and seem normal / acceptable)

This is SmartCode data for the last 7 nights.

95th Percentile Pressure 9.0
90th Percentile Pressure 8.0
AHI 8.0
Pressure Plateau Time 4%
High Leak Flow Time 0%
NRI 0.50
EPI 0

Over the last two weeks I have raised the minimum pressure from 5.0 to 6.5, capped pressure at 10.5, backed off the pressure relief (SmartFlex, plus inhale and exhale rounding) to the lowest setting without turning it off (ie: 1), and turned off the delay / ramp function. With the pressure relief and rounding backed off, breathing now feels a lot more like the S9 did but the reported HI remains high and I'm tired and don't feel refreshed in the morning (yet). I know it's a good idea to make one change and wait a week or two to assess. But I'm not fine tuning here, just trying to get in the rough ball park or find a problem to fix as quick as I can to overcome the tiredness.

I am thinking I may have gone too high on the minimum pressure and I am going to back it down to 5.0 tonight in case I've triggered centrals with too much pressure. But the APAP is setting higher pressures than 6.5 anyhow (per the SmartCode data), so I'm not sure if the change is going to make any difference in reality. (I know 6.5 is low, but ResScan did report centrals at similar pressures. My home sleep study reported a 'respiratory disturbance index' of 48 with no further breakdown as to apnea, hypopnea or centrals).

I have no titrated pressures: from the home sleep study it was directly onto an APAP and the needed pressures were inferred from that. I don’t want to talk to the doctor about this yet since he will only help with machines bought in Australia, preferably from his business – that is about US$2200 for an S9 as opposed to half that from the US and half that again for the DeVillbiss (I pay from my own pocket). So, I think he'd just blame my choice of machine, recommend I buy an S9, and I'd be none the wiser. (What country of purchase or make of device has to do with offering medical advice, I do not know).

I capped the pressure at 10 since on the numbers I have I shouldn’t need to go any higher and if the machine gets to about 12 it wakes us up with the racket it makes and it has to be turned off and on again. I have to keep it on the floor because of the noise anyhow, whereas the S9 was OK on the table next to me.

I have wondered if the algorithm in the S9 suits my OSA and the deVilbiss doesn't. Or that my machine is the 1 in 100 DeVilbiss that are faulty (so the seller tells me) and that's why it's so noisy. Or maybe I just need more time on it and it'll all come good by itself (I doubt it).

I'd be really glad for any comments / suggestions.

[yardbird]

My Devilbiss Intellipap is still the quietest machine I've ever owned and it is now 3 years old. If yours is making a lot of noise, I would think that the machine needs attention straight away.
That's my first reaction to your post. So, let's make sure that you have a properly working machine FIRST and then go on from there.

You might want to find access to a manometer to check the machine pressure and see if it's accurate, assuming you are comfortable doing that.... or find someone who can test it FOR you. The noise thing bothers me though. There's no way it should be making a racket at 12cm pressure....

[ozij]

I have wondered if the algorithm in the S9 suits my OSA and the deVilbiss doesn't. Or that my machine is the 1 in 100 DeVilbiss that are faulty (so the seller tells me) and that's why it's so noisy. Or maybe I just need more time on it and it'll all come good by itself (I doubt it).

I'd be really glad for any comments / suggestions.

I tried the DeVilbiss Auto. Its algorithm was not good for me. I did not buy it. I tried a Respironics M-Series. Its algorithm was not good for me. I tried a ResMed S9. It's algorithm was good for me. I bought it.

If it was me , I'd Insist on having the possibly faulty machine swapped for the type of machine I did well with. I would not invest any more of my time and my health in an algorithm that might work if the machine were not faulty, when I had already experienced success with another machine.

Many people do well with any aglorithm. Some don't.

[cindjo717]

I am a little lost with the algorithm , what exactly is it? Is it the rhythm of the pressure of the air blowing into the mask?

[Pugsy]

I am a little lost with the algorithm , what exactly is it? Is it the rhythm of the pressure of the air blowing into the mask?

No, it is not the rhythm of the pressure blowing.

The different manufacturers of machines haves slightly different definitions and methods of dealing with the events they detect. They simply go about preventing events in a different manner. Some people do better with the way one brand goes about preventing the events than they might do with another brand's way of preventing events. It has to do with machine's internal software algorithm and possible variations in the machine's settings.

All brands have the same goal...prevent events....but the road they take to reach that goal is not the same road.

[Emilia]

Your machine should not be noisy.... mine is so quiet I can't even hear it. The algorithm for the Intellipap is quite different from the S9 so don't compare apples and oranges. You need to continue to tweak things until you get the right combo, and doing it even in tiny increments of .5 can make huge difference. Your 95%tile of 9 tells me a range of 7-11 may be a good place to try. What are your flex settings? I keep my Smart Flex set on full time at 2 with iRounding at 1 and eRounding at 2. Higher numbers on those settings will impact your therapy pressures.

For the noise issue.... are you using a hose cozy? I wonder if your are hearing more noise at a higher pressure due to the hose not being covered. It does help buffer that sound. Others have found that placing the machine on a dense mouse pad or a piece of dense foam helps.

check your PM... I am sending you a couple of things via links.

[Greendirt]

Hi - Thanks to everyone for your replies. I've just woken up now, feeling OK and HI was down to 4.21 (go figure... but still much higher than my target of 1-2) with a 90% of 7cmH2O, average of 6.21. I should know by this afternoon how I really went!

In answer to questions - I am using a hose cozy and I have checked the pressure with a manometer - all good. So even if it is faulty in some respect, it is at least putting out the pressure it says it is. SmartFlex and inhale an exhale rounding are all set to 1. Thanks ofr the 7-11 suggestion and PM Emilia; I'd tried 6.5-10.5 and theat's where I got the HI of 13.21, back to 5-10.5 and I got 4.21. So, all seems odd to me. But I might try that pressure again and see if I get the same result.

There are three distinct noises at any pressure and it's a bit dramatic (or so it seems in the wee hours) at above 12cmH2O - a buzz, a squeak and air rushing (at the machine, not hose / mask). It's a pain to get it back to the US to be checked and to arrange a local machine in the interim, but maybe that's what I need to do. Other than this hassle, I really quite like the unit. Nonetheless, if the milder algorithm of the DeVilbiss compared to the S9 (or at least that's how I read it) is not doing the job for my OSA then I have to change, as ozij suggests. Although I was OK on the Phillips too, an F&P loaner wasn't so good for me either - maybe I am a one algorithm guy! (But any change would be out of my own pocket.... so I'm a bit circumspect about doing that....).

Thanks to all! It seems I'm not misisng anything too major and the options are pretty clear.

[archangle]

Don't forget that you can just set the machine for manual pressure and no exhale relief and forget about algorithms entirely. If your therapy works good with manual pressure, that's great.

[peterg]

[quote="Greendirt"). It's a pain to get it back to the US to be checked and to arrange a local machine in the interim, but maybe that's what I need to do..[/quote]

are you sure that us Australians have to send it to the US. I didnt get a reply email to DB australia, and I will phone them soon perchance they might have a look at my noisy machine when I go to Sydney soon.
still, we paid half price buying from US , so even buying another one for spare parts seems better.
I wonder also if Resmed and Respironics have local warantee servicing for US bought machines (like Lenovo Laptops)

[yardbird]

Set your machine on a good mouse pad. The kind with a rubber bottom, not a cheap foam or plastic one. My IntelliPap had an odd buzz when I first got it. When you said "buzz", I remembered. The "feet" of the IntelliPap were transferring sound into the top of my nightstand. As soon as I isolated the machine from the nightstand, it was darn near silent.

A thin towel won't work. A book didn't work. I had suspected at the time it was just a coincidental harmonic of my nightstand vibrating to something exactly with the IntelliPap. Once I solved it, I forgot about it until now. Try the mousepad. Something else may work but it CAN'T BE COMPRESSable or you'll get the sound again.

At least that was my experience. If they've changed the feet in the last 3 years, I could be missing the point on YOUR sound problem. Try this and let me know.

[peterg]

Set your machine on a good mouse pad. The kind with a rubber bottom, not a cheap foam or plastic one. My IntelliPap had an odd buzz when I first got it. When you said "buzz", I remembered. The "feet" of the IntelliPap were transferring sound into the top of my nightstand. As soon as I isolated the machine from the nightstand, it was darn near silent.

A thin towel won't work. A book didn't work. I had suspected at the time it was just a coincidental harmonic of my nightstand vibrating to something exactly with the IntelliPap. Once I solved it, I forgot about it until now. Try the mousepad. Something else may work but it CAN'T BE COMPRESSable or you'll get the sound again.

At least that was my experience. If they've changed the feet in the last 3 years, I could be missing the point on YOUR sound problem. Try this and let me know.

I'd recommend grip cloth, though I haven't tried it for this purpose, it's made of rubber and does the same for speakers etc. also waterproof.

http://www.ebay.com.au/sch/i.html?_nkw= ... m270.l1313

[Greendirt]

Thanks again everyone. Back up to an AHI of 10 last night, although not as tired through the day. Maybe I'm adjusting to that level? I will consider, as archangel suggested, trying CPAP rather than APAP. And thanks too for the suggestions of dampening via under-mats for the machine; I'll give it a go. At present it's on a big book on the floor.

As to warranty, as raised by peturg, as far as I understand if one buys from the US one is required to go back through the US seller for warranty. I'd be interested if DeVilbiss say otherwise. But it's something factored into the deal at the outset and the much lower price off-sets the cost and hassle a bit, as noted. But still annoying, costly and inconvenient.

ResMed seems to be particularly keen on separating markets and require their dealers to sell only within their own market – so a US ResMed dealer can only sell in the US by contract with ResMed. ResMed in Australia will, so I'm told, absolutely refuse to deal with warranty for a US-sold ResMed machine (despite being Australian-made). Maybe that's so they can still charge double in Australia; who knows?

Thanks again, GD

[Emilia]

An AHI of 10 is too high, although DeVilbiss's research says 10 or under is OK. I could never buy into that as I feel decidedly different at 3 then I do at 1.5. You should strive for an AHI under 5, IMHO, to feel optimal. It will come.... you just need to be patient and keep tweaking things.

[peterg]

As to warranty, as raised by peturg, as far as I understand if one buys from the US one is required to go back through the US seller for warranty. I'd be interested if DeVilbiss say otherwise. But it's something factored into the deal at the outset and the much lower price off-sets the cost and hassle a bit, as noted. But still annoying, costly and inconvenient.

just confirming I spoke to Deviliss Sysdney and they wont have anything to do with honoring warantees for units brought overseas. pity, but it wont stop me refusing to pay double for the same product, as I might as well buy 2 for the price of one and have a spare. (less as the himidifier only needs to be purchased once)

Im trying to track down the smartlink module, but my chances of getting that for the $150 ($100 without software) of US price is, as we say here Buckleys

http://wiki.answers.com/Q/What_does_the ... hance_mean


edit: spelling mistakes

[Emilia]

You could try using Sleepyhead which now works with the DeVilbiss Intellipap... it is open source and beta but seems to give good data. http://sourceforge.net/projects/sleepyh ... t/download Created by a forum member!