ResMed s9 AutoSet does not help me

[tony52]

I bought a ResMed s9 AutoSet machine from Shopper's Home Healthcare in Toronto, Canada on JUne 9th, 2010. By June 25, I used the s9 for about 10 nights. The total accumulated hours of use was about 41 hours. The s9 did not help my sleep. It did not improve my sleep quality. Every time when I woke up I felt the machine blowing strong pressure air on my face. When I awake, There should be no obstruction in my airway. Therefore the machine does not need to continue deliver high pressure to my airway. That was said a key future of auto pressure-titration mechanism. With this s9, I slept less hours that it was previously. For example, previously, after a night shift work (I am a health care professional), I should be able to sleep about 4 hours or more, at least 3 hours in the morning. With this s9 I slept maximum only 2 hours and then woke up with a feel of high air pressure on to my face as I just mentioned above.

I went to see my sleep doctor on June 21st, and reported the problem to my doctor. My doctor decreased my S9 pressure range from 5 - 12 to 5 - 9 cm of water. But The problem remained the same. I gave up since June 26th, and have not used the s9 again. It was a considerable waste of money ($1,585 Canadian, with mask and other accessories the total cost was $1,993 ). I read a lot of reviews online about the S9 AutoSet before I bought the s9. Almost every one gave a positive review on S9 AutoSet. For about 10 years, I have learned from several medical textbooks that CPAP was/is the standard answer for obstructive sleep apnea. Now I am less trustful to those medical textbooks than I was previously. My advice is always have a month or at least 1 week of trial of the CPAP/APAP machine before you buy it. CPAP/APAP is not returnable as far as I know.

[Wulfman]

All things being equal, your story doesn't surprise me a bit. Too many people have misconceptions about Autos/APAPs. The reality is that the changing pressures disturb the sleep of many people.

I would strongly suggest setting your machine to CPAP mode and trying a fixed pressure. If you had a sleep study and titration, set it to the pressure you were titrated for.

You didn't mention what mask you were using, so you may also be having mouth-leaking problems.


Den

[PetrusKy]

Every time when I woke up I felt the machine blowing strong pressure air on my face...
... then woke up with a feel of high air pressure on to my face as I just mentioned above.

In my limited experience, I'd say that's a mask fitting problem. What kind of mask are you using?

[torontoCPAPguy]

I am quite surprised by your statement to be honest... and I would take it up with Shoppers Healthcare as well because they are a big firm and may just give you a refund or credit. BUT I am more concerned with your results and suggest that perhaps you need to have EPR (Exhale Pressure Relief) set to maximum and your unit set to CPAP only at a reduced pressure sufficient to prevent OSA events. I know that it takes some getting used to and frankly, after three weeks on full life support with a machine actually breathing for me, I do not find the ramping necessary at all. Nor do I find the pressurized airflow a bother at all except when my mouth opens and the air comes out of it.... I am going to resolve that issue shortly (tonight).

If you are in need of CPAP DO NOT GIVE IT UP!! Your life may depend on it and I am being perfectly serious here. It is not a quick fix at all and I assure you that for many folks it takes weeks if not months to find the right fitting mask, the right pressure, get used to it, and so on. And getting a data recording machine is going to be a help as well. Forget letting Ontario help you out - even with the government's $800 kick-in you will be getting screwed. But a machine on one of the auction sites and you can get that S9 for $550 complete with humidifier. And $60 for a mask and $60 for climate control hose. I am going to switch from my S8 Autoset II to my S9 Auto tonight after having just tried it out this afternoon.... and will be looking at the graphs tomorrow in ResScan to see my results; actually, will be looking at the screen on the blower to see my results as I wake up. I use the Mirage Activa LT mask Size Large Wide as it fits my face and seals fairly well but am still trying a couple of others this month, also bought on the auction sites for $50 each instead of the $350 that Shoppers will hit you for.

DO NOT GIVE IT UP. You will begin to feel better eventually and have more energy and better ability to work out and exercise and you will be better able to lose weight and so on. It is a blessing and if I had to I would hook up a leaf blower and run a long hose to keep the air flowing as without it I am a dead man sometime soon due to low blood oxygen saturation and resultant high blood pressure; in the hospital they were worried I was going to have a stroke or pop my Aorta right off my heart at one point. No longer. BP is under control and SO2 is always above 90% (it was VERY low in the hospital due to pneumonia). I monitor everything while sleeping and while exercising all the time to make sure. Understand that medicine in Ontario is a money making operation these days and YOU must be your own advocate. Without my wife's assistance I would still be sitting on the curb at the side of the hospital.... they gave me little cardio pulmonary evaluation and assistance or rehab (I couldn't even walk when I left without the use of a wheelchair or wlaker at best) It took me four months to roll over in bed. I was that sick and weak. But with constant pestering and refereals I have seen the best heart specialists, cardiopulmonary specialists and rehab therapists in town and I am now healthy except for damaged lungs which take a long time to return to their best possible situation. YOU must educate yourself on CPAP and OSA and everything that ails you and make your own final decisions. You cannot trust the MD's these days as they are in a hurry. I was recently prescribed new meds by my endocronologist and did not like the way they made me feel so I returned to my old meds and told my family MD that is what I wanted to do. No problem. Here's a Rx. My blood sugar is fine thank you. And if I eat right, I don't even need the pills. Ditto the blood pressure.... if I exerciese regularly and stay away from salt like th plague my BP is alos almost under control. Lost a few pounds and the pills will be gone I am sure. But I must continue with them as long as my SO2 has any chance of going low and BP going high; the beta blockers (I think) keep my heart pumping at just the right level to ensure BP is regulated regardless. In fact, when I didmy stress test last week they couldn't get my heart rate over 110 BPM no matter how hard they tried to kill me on the treadmill. I just kept going and going until my time ran out. I think I screwed myself cuz they are going to kick me out of rehab now and I need a structured programme. I am going to push for another referal from my cardiologist, family MD and endocronolist. Plus the director is a friend of the family. You gotta play all your cards to get the best care you can today.

But the bottom line is that YOU MUST perservere. Had I not. Had my family not. I would not be here talking to you today as sure as the nose on your face. So please, rather than just packing it in, speak to your specialists, change sleep clinics, see a respirologist (Dr. Abe Borne on Leslie in Toronto is a professor at U of T and one of the best). Join "best doctors" or just research whom is the best in their field and push to see them right away.... ask for cancellations and keep bugging to get in quickly as we did. Or you will wait until you are dead and buried to get an appointment. Push. Push. Push. Ask intelligent questions and bring blower data with you so that they have everything at their fingertips... including xrays and anything else you have.... the sleep study BELONGS TO YOU and they must release it to the other doctors at your request. Always ensure that your test results go to every doctor that you see. EVERONE. They all need the whole picture and they need to see that you are going to be a pain if they dont' take care of you.

Good luck. Keep at it.

[Physician]

Every time when I woke up I felt the machine blowing strong pressure air on my face...
... then woke up with a feel of high air pressure on to my face as I just mentioned above.

In my limited experience, I'd say that's a mask fitting problem. What kind of mask are you using?

Agree. A mask fitting issue.

[tony52]

Thank torontocpapguy and other people who gave me reply.

3 people already suggested that the problem could be in the mask fitting. I exchanged my mask once with the Shoppers Home Healthcare sale woman. The mask I currently have is a Respironics ComfortGel FULL. Other description on the mask is " M 1040141CE", which I do not know what it stands for. Because it is an exchange mask, the sale woman did not gave me a box for the Respironcs mask. She just wrapped the mask and put it into a cloth bag, and gave it to me. I felt the Respironics ComfortGel full face mask fitted me well. The ResScan did not indicate mask leaking was a problem. I also visited the sleep doctor, and the doctor did not mentioned the issue of mask leaking. But I understand, we should not totally rely on physician.

I did set the EPR to 3, that is the maximum number of the EPR could go.

A few months before I bought this S9 AutoSet, I had a straight CPAP trial. The straight CPAP did not work for me. That was one of the reasons I insisted on buying an APAP instead of CPAP.

It is nice to hear someone from Ontario Canada to give me advice. I did not receive any money assistance from Ontario government for the purchase of s9 APAP machine because they said my sleep lab test result did not qualify for the assistance. I did talk to the sale woman regarding a possible returning of my s9. Here is what I wrote to her on June 27, 2010:
"...I still feel the machine makes me sleep less hours rather than
improving my sleep. I have not used the machine since Friday June 25th
. I now go back to use my homemade chin strip at night. I probably
will not use the s9 any more. Since I bought this machine on June 9th
and started to use it on June 11th, the total hours of my usage of the
machine is 41 hours and 41 min according to the report statistics (an
equivalence of 1 week continuous use). Could you please let me know
if your store policy, or the ResMed policy, allows cpap customer to
return cpap within one month (even with certain percent of
re-stocking fee)?

I will keep the mask because I have exchanged it once ..."

The sale woman at Shoppers Home Healthcare did no allow me to return the S9. I called her. She did not answer my call. I left message in her voice mail. She did not call me back. Here is what she wrote to me on July 5th, 2010:
"...The machine that you purchased was a special order item. The machine can not be returned".

Most of my education was from other country. I does not know how to do with this problem.

I have long years of sleep problem. I often got a dream that I was drowned under water and struggling until I woke up with air hunger. I made the diagnosis of OSA by myself. I asked my doctors to have a sleep lab test and confirmed the OSA. I think my sleep problem cause my tiredness and decreased memory. But I guess my general health for now is probable not too bad yet. I have no blood pressure problem, no diabetes. I stay away from alcohol, smoking, and drug. I will no longer use ResMed. But can other manufacturers CPAP/APAP make a difference? What about the dental approach? Can anyone share their experience with dental approach for their OSA?

[Wulfman]

My doctor decreased my S9 pressure range from 5 - 12 to 5 - 9 cm of water. But The problem remained the same.

I did set the EPR to 3, that is the maximum number of the EPR could go.

In my opinion your machine setup is contributing to your problems. The EPR setting is dropping your "effective pressure" by 3 cm. when you exhale.......and your minimum pressure is way too low. You're getting very little (if any) therapy and I'm not sure how you can breathe at all.


Den

[tony52]

"In my opinion your machine setup is contributing to your problems. The EPR setting is dropping your "effective pressure" by 3 cm. when you exhale.......and your minimum pressure is way too low. You're getting very little (if any) therapy and I'm not sure how you can breathe at all.


Den[/quote]


As I wrote from the beginning, my chief complaint was air pressing on my face and woke me up earlier than my usual. Even after I woke up in bed and continued to breathe with the system & mask on, I still felt the uncomfortable high air pressure on my face. It was not about feeling "no air" or too low pressure.

[ozij]

I bought a ResMed s9 AutoSet machine from Shopper's Home Healthcare in Toronto, Canada on JUne 9th, 2010.
By June 25, I used the s9 for about 10 nights.
The total accumulated hours of use was about 41 hours.

I should be able to sleep about 4 hours or more, at least 3 hours in the morning. With this s9 I slept maximum only 2 hours and then woke up with a feel of high air pressure on to my face as I just mentioned above.

I went to see my sleep doctor on June 21st,
My doctor decreased my S9 pressure range from 5 - 12 to 5 - 9 cm of water.
But The problem remained the same. I gave up since June 26th, and have not used the s9 again.

Hi Tony
The above are factual statements you made about your therapy with the S9.
You also asked about dental devices. try http://www.talkaboutsleep.com they have a dental sleep medicine forum.

What you told us about your therapy is proof the you did not give yourself a chance to get used to it. The following is for anyone in a similar situation who may be interested in giving the therapy a better chance.

• Many of us start out on the verge of panic because of the pressure blowing in
• It takes time of use, consistent use,every night, for the body and mind to get used to the pressure. Eventually the sense of pressure simply is no longer there.
• Start habituating yourself to the pressure by setting the machine so that the highest pressure is reaches is the highest pressure you can just tolerate.
• Raise this pressure gradually every 5-7 days.
• Consider using the machine in CPAP mode - that way pressure changes will not wake you.
• EPR does not affect the air blowing in -- in only affects your exhale pressure. If EPR is set too high, causing the pressure on inhalation to be too low, you may wake because of obstructive events occurring when you've finished exhaling.
• EPR only makes the exhalation feel different
• Forget all your expectation of how well or how long you should sleep with the machine. Make a point of sleeping with it. Do not remove the mask and continue sleeping without it.
• If you need to remove the mask, get out of bed, do something relaxing till you're ready to sleep again, then put the mask on and settle down to sleep.

You cannot force yourself to sleep - but you can promise yourself that there will simply be no sleeping without the maks. Mask off = no sleep. Doing that will give you a chance to learn this new way of sleeping. Otherwise - forget about it.

[frh]

Tony, what you wrote about too much pressure made me want to respond. At 4 months, I am still trying to work this stuff out for myself, and probably don't know what I am talking about. (And I am still trying to recover from the brain fog caused by more than 20 years of untreated sleep apnea.) So feel free to read what I have to say in that context.

My AHI has only been staying under 5 for a couple of weeks. My successes are still coming 1 night at a time. Last night for instance my AHI was up to 8.5 and although I don't remember doing it, I ripped the mask off after 2-1/2 hours of sleep. What I do remember is the sensation of the mask and my mouth feeling like they were filling up like a balloon. (Guess who is going to run out of energy by noon.) That is totally different from the night before night when I realized I was not mouth breathing in the full face mask.

This may not apply to you, but I discovered when I had my S9 on auto, it was responding to mask leaks with more pressure. More pressure was causing my AHI to be all over the place. When I set it back to CPAP at my titrated pressure of 6, I felt like I wasn't getting enough air, but I started having better nights.

When I saw my new neurologist / sleep doc, he said something I did not expect. He said I know my body better than he does and gave me permission to adjust the pressure as I see fit. Then he suggested leaving it on CPAP, but turning it up to 10. At 10, my AHI went up and I started having centrals. So I split the difference and 8 seems like a good pressure for me with a nasal pillows mask.

But I scratched the inside of my left nostril last week and it got infected. So the doc wants me to keep an antibiotic cream on the scratch and use my full face mask for a week. My gut instinct is I need less pressure with the Mirage Quattro mask. So I plan to lower it back to my titrated pressure of 6 long enough to figure it out.

If you think the mask is leaking and your machine is set at 5 to 9, you are probably mostly getting 9 cm. Try putting it on CPAP at 6 and see if that makes you feel better. Take the CD card out of your S9 every day and upload the data to your computer. Aside from how you feel, reviewing that data is the only way you are going to know how you are doing on CPAP. If you don't have the ResScan software, ask and someone will send you a PM.

If you give up, the tiredness and decreased memory will just continue to get worse until you find yourself unable to work or function. As simple as it might sound, I could not have typed this 4 months ago.

[torontoCPAPguy]

My doctor decreased my S9 pressure range from 5 - 12 to 5 - 9 cm of water. But The problem remained the same.

I did set the EPR to 3, that is the maximum number of the EPR could go.

In my opinion your machine setup is contributing to your problems. The EPR setting is dropping your "effective pressure" by 3 cm. when you exhale.......and your minimum pressure is way too low. You're getting very little (if any) therapy and I'm not sure how you can breathe at all.


Den

+1 for the Wulfman
I would have to agree, as uneducated as I am, that a minimum pressure of 5 cm H2O is absurd and it is what my sleep doc prescribed for me essentially on our first and only titration on CPAP. Yech. Made zero difference. Then he called back and said oooops! I meant 9.8 cm. on CPAP. Still not great but better. In the end I bought my own Autosets and am presently using the S9 Auto's with terrific results thus far. At 10.8 - 15 cm I may have reached perfection because I get a whole whack of zero's across the board every morning except this morning, cuz last night I reduced the bottom end pressure back to 9.8 out of curiousity and had a plethora of OSA events last night. Tons of them and TONS of shallow breathing. So I am sorta tired today. What a huge difference. In fact, I am whacked out here. Ready for a nap after 8 hours in bed 'sleeping'. Tonight, back to 10.8 - 15 and let's see what the difference is. Can it be that a difference of only 1 cm at the bottom end makes such a big difference? I believe so because the blower does not have to take time to compensate for impending OSA events.... it is already preventing them and if I change position in bed and need more pressure it realizes this and takes care of business on its own!

So that's my story and I have posted essentially the same remarks in a seperate thread because I just had to share the information with my forum friends and at the same time ask the question (between the lines)... can only 1 cm of difference at the bottom end make such a huge difference in therapy efficacy? It would appear that yes it can. Tonight will tell. And I will report back on that thread for those that have an interest.

Your greatest weapon against this deadly OSA condition and the conditions surrounding it? Education and education and education. You are not going to get it from your sleep doc unless you have one heck of a good one. And the problem is that once you have chosen a sleep doc, there is not another doc in the land that is going to contradict him or her. That's the way it works. So self education and experimentation with masks and gear is a must.

Good luck. Eventually, I believe in my heart, that if you perservere and can afford to experiment with masks and blowers, you will arrive at the best mask for YOU and the best blower for YOU. For me it is, right now, the Mirage Activa LT and the ResMed S9 Auto with the ResScan software and clinician manual so I can make my own adjustments as I get educated. Or maybe it's just luck? I don't know but I know today is going to be spent napping and in front of the TV mostly as I am just totally whacked out here. With wishes for a better night tonight (and I am sure it will be).....

Sleep tight... good night.... don't let the bed bugs bite!

[Janknitz]

I don't quite understand this. You state you are a health professional, but you are taking shots in the dark. Are you new to CPAP? If so, 10 days is NOT a fair trial. You need to give it time AFTER you have found the right settings.

The S9 autoset is a data capable machine. What does the data tell you? Instead of whining and complaining that the autoset doesn't work, why don't you look at WHAT is happening and what changes might be necessary to make it work for you??? I may be wrong but it doesn't even sound like your sleep doctor looked at the data--he just made a change based on guessing. Too bad your sleep professionals are not helping you be successful at this treatment.

You need to look at the data and see what is precipitating those increases in pressure that make you so uncomfortable. The data should give you valuable information. If it's a mask or mouth breathing issue, as others have suggested, you will see leaks. If the pressure or EPR are not set correctly, looking at the data will tell you what's going on by identifying the types of events that are contributing to your pressure increases (OA's, HI's, CA's???), how they are occurring, and when they are occurring. Then you can slowly, carefully, and scientifically adjust the variables to get better therapy.

You spent a lot of money on a machine that has very good data reporting capability. You wasted your money if you are not going to even bother looking at it. The best machine in the world is only as good as its operator.

[torontoCPAPguy]

Janknitz does make an interesting point and that is that you need to get yourself educated and used to your equipment; it took me months to really get the hang of it and get educated and comfortable enough with the data I was getting to actually make a change in my own treatment; and what was the end result? An improvement coming out of the sleep clinic versus almost perfection after titrating MYSELF. And ONE cm difference in pressure presented at the bottom end of my range makes a HUGE HUGE HUGE difference in my results. The S9 Auto is a wonderful machine but was probably waaaay expensive at Shoppers. I would visit my GP and see if he will sign an Rx for that APAP machine or go back to the sleep clinic or RT and see if he/she will do the same. If not, you are stuck. I can tell you for a fact that I am NOT at all happy with my sleep clinic and sleep doc and it is only by the Grace of God and my own personal perserverence that I am at the point I am at. And I blame it all on this forum, without which I would be lost in the dark.

I don't claim to be an expert, but I do claim to be a success with my therapy and give little credit to the sleep clinic and loads of credit to this forum; mind, you have to sort the wheat from the chaff on here as we are not all experts. What we do have is loads of experience and that counts too.

Ask Shoppers if they will price match anyone; the only place I know of to get a great price is on the auction site as ResMed is controlling both domestic pricing and the ability to export (in either direction). So, what you will pay $1200 for stateside is only $550 on the auction sites. And what I paid $650 for only months ago stateside from regular suppliers was $2500 by the time I got away up here. It is just plain nuts and you really need to be an educated consumer when it comes to CPAP/APAP gear. Especially if you are going to experiment with masks and replace them as you should, every six months or whatever. (Although I have a friend using the same mask for ten years).

Keep at it and don't give up. The mask, the air blowing in one's face, etc., is all part of getting used to your new best friend. If you truly need CPAP and DO NOT perservere the consequences can be dire. DON'T GIVE UP. I have had the best few days of sleep this week past that I have had in 40 years with my new S9 Auto. I changed the settings last night by ONE cm. Worst night of sleep in a long time. Keep at it, get used to it, perservere. Your life will improve; of that I have no doubt whatsoever.