M Series Conundrum & Thoughts on Replacement CPAP

[rrl_edm]

I’ll apologize in advance because this appears to have grown into an embarrassingly long post. Guess I’m not skilled at making ‘a long story short’. And all this on Oscars night!

Since being diagnosed with sleep apnea over two (2) years ago, I’ve been using a Respironics M Series Auto CPAP with C-Flex. Overall, I’ve settled in pretty well with my equipment, with no major leak issues, etc. In fact, I wish I could ‘roll back the clock’ to when I first received my first CPAP machine.

After 18 months of experiencing good overall therapy, things kind of went downhill about 6 months ago. This is when I started being awoken frequently with the all too common runaway pressure problem and related flapping mask noise.

As info, I was originally set up with APAP and the limits set to 4 min, 14 max. I realize for many this is too wide a range and/or that many respond better to straight CPAP, and that CPAP also provides the additional benefit of avoiding pressure runaway. However, for 18 months I responded well and my 90% pressure was around 11.0 – 11.5.

In addition to pressure runaway and resulting mask leak noise causing sleep fragmentation, I also seem to be experiencing mildly sore throats on a more frequent basis.

Also, I’ve noticed my AHI numbers have increased somewhat, from low 3’s to high 4’s. Although this is a very small change in AHI, at least on the surface, and I know others here strive hard to get AHI numbers like these, I have not been feeling nearly as well rested. Perhaps this is attributable to other reasons and/or perhaps due to multiple issues (increased snoring, sleeping position, etc.)?

Previously, problems with pressure runaway were very infrequent and isolated events, which leads me to suspect that ‘something’ has changed. Unfortunately, I do not yet have the data analysis software, but I’m in the process of obtaining this.

Interestingly, all my problems seem to have started when I exchanged my ailing M Series Auto CPAP with C-Flex machine and received an exact like-in-kind replacement by my service provider. This was due to my original machine having shut itself down due to a moisture problem. I strongly suspect this was a direct result of returning home from some travel and having forgotten to empty the remaining water in the humidifier tank (doh!). As an aside, when I visited my service provider all I was looking for was a loaner machine for a few days, but they insisted on replacing my machine for a new one (can’t complain with that). Whether the arrival of the new machine is causal, contributory or just coincidental remains to be determined. However, the new machine stands out as being suspect to me.

For whatever reason, my replacement machine does not seem to be performing the same as my original, even thought the original settings were carried over to the new machine. I recently mentioned this to the RT. However, given the forgoing problems their current strategy is to perform a week long titration study to establish a baseline using my existing machine in APAP and set wide open to 4 / 20. Perhaps this will become the topic of another post. Back to my machine woes.

For starters, when previously using my original M Series Auto, it sounded like I was on an ‘iron lung’. My wife refers to this as the ‘Darth Vader’ noise. Also, the C-Flex feature was quite obvious and very sensitive to changes in setting. In fact, after initially being set up with C-Flex on 3, I dropped it down to 2, which was a better ‘sweet spot’ for me. Overall, the M Series provided a nice stream of pressurized air that I found comfortable and that worked really well for me.

By comparison, the new M Series Auto is considerably quieter and doesn’t seem to ‘breath’ the same way as the original machine. While you’d think I’d be delighted about reduced noise levels, it actually leads me to suspect a problem. Also, changing the C-Flex setting seems to have little, if any effect? I wouldn’t necessarily go so far as to say that C-Flex is not working entirely, because I do get some relief on exhalation, etc.

Additionally, I’m also experiencing the high frequency blow motor ‘whine’ that others here have reported on. Although it seems to come and go, it is consistently noticeable when the machine spins down after being shut off. All this from a machine with only 4400 hours on it!

Although I’ve previously and occasionally visited this forum over the years, I’ve recently drilled down into the various posts and have read up on anything that may be related to my problem(s). What a fantastic resource this forum provides with a tremendous wealth of user experience.

Anyway, in addition to any comments that others may have on my ongoing problems, I’d appreciate hearing what others may have to say with regard to getting a back-up machine. Actually, the new machine will presumably become my everyday machine and my current one the backup.

Currently, I’m looking at three options for a new CPAP machine:

1) Remstar Auto CPAP with C-Flex ‘tank’ model (used, but with very low hours):
- seems to be a big hit with many users here
- had one as a loaner for a few days before getting my first CPAP and really liked it (probably better than the newer M Series)
- appears this machine is well designed and built like a 'tank' (pun intended)
- perhaps not a good choice as now getting ‘long in the tooth’
- repairs may be an issue if ever required

2) Respironics M Series Auto CPAP with A-Flex:
- 'the devil I know' but with the addition of A-Flex (which many like)

3) IntelliPAP AutoAdjust Travel CPAP:
- this one seems to be catching a lot of attention
- presumably experiencing popularity due to being new kid on the block, small size, price, etc.
- perhaps I’ll respond better to a non Remstar / Respironics machine
- however, sure would be nice to try one out first (however, may not be possible)

With the above in mind, I'd really appreciate your thoughts, comments and/or suggestions.


Robert

[cflame1]

Keep in mind... if you go with the tank, your current humidifier won't work.

It's a good machine however.

[rrl_edm]

Thanks for the comment.

Fortunately, the 2 used Remstar 'tank' machines I'm considering come fully equipped, including humidifier.

Robert

[OldLincoln]

Robert, I may be off base here, but you said all was well until you replaced your machine with a like machine. However, this one is louder with Vader Breath and your treatment has degraded. Are you sure it is truly the same? It is APAP with C-Flex but not A-Flex, right? All settings including C-Flex are the same? Also the mask and the hose setup?

I would expect identical machines to be identical in behavior. The Vader Breath has been identified here associated with A-Flex or C-Flex (can't remember which) set at 3, and setting it lower helped. Another thing for me is hose routing - when passed right next to the mask all is louder.

I would be a bit anxious after 18 good months to start chasing machines and might want to get a like loaner from the DME to try first. Maybe the replacement is a dud.

[Goofproof]

Since you have had a data machine all this time, have you gotten the program and reader so you can tell what's up with your treatment? That would be and was my first project.

Also it the "Classics both work OK, and are affordable, I'd get them both, that would cover any problem with repairs, and all three can use the same software setup. I'd make my main concern, getting the data so I could get my treatment under control. Jim

A large pressure range on APAP, doesn't cut it!

[rrl_edm]

Robert, I may be off base here, but you said all was well until you replaced your machine with a like machine. However, this one is louder with Vader Breath and your treatment has degraded. Are you sure it is truly the same? It is APAP with C-Flex but not A-Flex, right? All settings including C-Flex are the same? Also the mask and the hose setup?

I would expect identical machines to be identical in behavior. The Vader Breath has been identified here associated with A-Flex or C-Flex (can't remember which) set at 3, and setting it lower helped. Another thing for me is hose routing - when passed right next to the mask all is louder.

I would be a bit anxious after 18 good months to start chasing machines and might want to get a like loaner from the DME to try first. Maybe the replacement is a dud.

Actually, it's the other way around. My first M Series Auto C-Flex had the Darth Vader thing going on. Presumably, this is related to the properly working C-Flex feature. However, my replacement machine, also M Series Auto C-Flex, DOES NOT have the pronounced Vader sound. This is what leads me to think it is not working properly, amongst other things.

I started out by visiting my service provider and all I really wanted was for them to lend my another M Series Auto C-Flex so I could A/B with my machine so as to verify whether I had a dud, or not. However, upon hearing my tale of woe they decided to have me undergo a week long titration and chose to ignore the machine issue, at least for the moment.

The funny thing is that I did bring my machine along and all they did was essentailly power it up to see if it started (and without a mask connected at that) . Guess they're clinicians and not technicians after all. However, they do provide really great service, so I'm assuming that after we finish up with the titration we can get back to the potential 'dud' machine issue.

Thanks.

[rrl_edm]

Since you have had a data machine all this time, have you gotten the program and reader so you can tell what's up with your treatment? That would be and was my first project.

Also it the "Classics both work OK, and are affordable, I'd get them both, that would cover any problem with repairs, and all three can use the same software setup. I'd make my main concern, getting the data so I could get my treatment under control. Jim

A large pressure range on APAP, doesn't cut it!

Yeah..I’m in the process of obtaining the program and SmartCard reader. Should have done this a long time ago, but wasn't overly compelled to do so as everything was going well.

I've read a number of posts here about narrowing the APAP pressure range and that this enables the APAP machine to respond 'quicker' to apneas, avoids potential sleep disturbances for those who are sensitivite to pressure flucuation, etc. However, I'm still a bit confused (pardon my learning curve on this).

I understand how limiting the maximum presurre in APAP will avoid potential pressure 'runaway' and the problems that go with this. This makes sense. However, I'm still unclear about the mimimum pressure side of the equation and why raising the pressure is beneficial? Assuming the max is properly set, and other than when the APAP is first started and ramping up from the min pressure towards the required pressure zone, wouldn't the APAP generally tend to work the same regardless of the minimum pressure setting? What am I missing here?

Interestingly, when I mentioned to the RT about raising the APAP minimum pressure to narrow the range, she asked why anyone would do this? Perhaps she was just feeling me out to test my understanding. However, I sensed she really believes that setting the min = 4 is the way to go on my machine. While I don't doubt for a moment that the RT has a lot of experience at providing good patient care, perhaps she's never researched and/or experienced the benefits of raising the minimum pressure.

Hopefully, someone here can set me straight.

[Goofproof]

A 3 CM range seems to work best, it does because the time it takes for the machine to respond to events exceeds the bodys need for help holding the airway open. While the machine is deciding to apply more pressure, you are already having a apnea event. Also all setting the machine higher than your worst level of need does is cause more leaks and discomfort, and worse treatment. some of us make sounds when we breath heavy that the machine sees as snoring, causing it to react badly. Jim

[rrl_edm]

Jim, I think the 'light just went on'.

Previously, I assumed that if my APAP was set to a min = 4 and a max of 14, which yields a pressure range of 11, that the APAP would work in a narrow range anyway centered around the average and 90% pressure.

However, what I'm now understanding is that this auto range may still represent a large spread, say 5-6 cm-H2O or whatever the case may be. Obviously, this is a considerably larger range than manually setting the APAP to a tighter pressure range such as the recommended 3 cm-H2O range.

Have I got this right? I assume if I had experince with the data analysis software that this would have been more apparent to me. (Don't give upon me yet...software on its way)

Thanks.

[Goofproof]

Say a 3 cm range, 1 cm past your best CPAP pressure and 2 cm under, You still get the extra pressure relief when you don't need the pressure, and you are covered incase you end up on your back, (the Worst position). With a FF mask, mask leaks aren't as much of a issue, but if you use a nasal mask, just a little more pressure than you have to have can really make mouthleaking worse. When the Remstar sees you are having a apnea. it doesn't just jump to the pressure needed to hold the airway open, it steps the pressure and checks what's going on, that takes time, too much if it's got to go to far.

The software is of great vaule, as it allows you to see what happened and when, it makes seeing trends easier. Jim