Help! First night on S9 Autoset was a disaster!

[Laurie1041]

Hi,

I just received my new APAP yesterday and read the User's Guide 3 x before using last night. I also have a new nasal mask - ResMed Softgel which seems to be very comfortable.

Within one hour, I could no longer stand it. I felt like I was suffocating. My doctor's Rx is for 7 cm. My machine is set for 4-12 cm. I questioned my tech about the huge gap and she said, "That's what your settings were on the loaner APAP "(I don't know the make or model). She went on to say, "You will probably stay at around 4 cm". Huh?

What is the problem? Is it the machine settings, my mask, or both? I am feeling a bit frantic. Did I choose the wrong machine for me? I slept pretty well for 7 days with the loaner APAP and an EasyLife nasal mask. I had to stop using the EasyLife nasal mask because it was breaking down my skin across the bridge of my nose (headgear was not too tight).

Please help!!

[DoriC]

Please tell that tech to reset it to your Dr's RX with minimum of 7cms, they can leave the maximum where it is. You're probably having a hard time breathing at that low pressure and having apneas as well. Stand your ground and if necessary call the Dr. Good luck and keep us posted.

[Uncle_Bob]

Laurie most people feel like the suffocate at anything below 6cm.

Look at the links below my avatar picture (currently a tasty burger) download the S9 clinicians manual. Page 16, clinical setup menu. Hold down the bottom button and the dial control at the same time for 3 secs. Here you can change your machines settings, you can then change your min pressure to 7cm.


-UB

[XSnorer]

I would say that you did not choose the wrong machine, unless it were defective. The S9 and many of the other comparible machines are wonderful machines. My guess would be that either your S9 settings are not what they need to be for you, or that the change in mask is contributing to your issues. The S9 has an EPR setting which might need to be adjusted.

[elena88]

Oh gosh, sorry youre having a tough time..

that s nine is a fabulous machine, you have a winner there..

but, its sort of like giving someone a brand new porsche, and they dont know how to drive a stick yet..


so you just need to get in that menu and find out if that pressure is too darn low for you..

also get the clinicians manual, and download the 3.11 software, and youll REALLY have the reins on that pony!

I will pm you with something helpful...

[DoriC]

Laurie most people feel like the suffocate at anything below 6cm.

Look at the links below my avatar picture (currently a tasty burger) download the S9 clinicians manual. Page 16, clinical setup menu. Hold down the bottom button and the dial control at the same time for 3 secs. Here you can change your machines settings, you can then change your min pressure to 7cm.

-UB

UB, I was hoping you'd jump in with that info, I didn't want to overwhelm Laurie. BTW, get rid of the hamburger and bring back those boys!

[scrapper]

Laurie.......

It takes more than a day.........you've been given excellent resources for help, you've got an excellent machine, and you've got all of us.

Hang in there.............

Try increasing the pressure to 7 tonight as suggested, arrange your headgear comfortably, and read or watch tv for awhile before bedtime........and hopefully tonight will be better.

You've got nowhere to go but up!

[kempo]

You not getting enough air Laurie. Move up the bottom number.

[Laurie1041]

Hi Uncle_Bob and everyone who responded,

Thank you, thank you! I got the message. Too bad my DME are such morons. After driving all the way out to see my DME for troubleshooting and to get them to raise me to something more realistic, here is what I got:

Me: "I can't breathe. I feel like I am suffocating. I did not feel this way on the loaner machine."
Tech: "You are perceiving that you cannot breathe. You are getting sufficient air. Your loaner machine
(without humidfier) was set at the same settings - 4-12 cm and you were using the EasyLife Nasal
Mask. Now you have the SoftGel mask and it is probably the mask that makes you feel like you
can't breathe. You need to try nasal pillows".
Me: OK, but the doctor said my average pressure was 7cm. Can't you kick it up to 6-10 cm? Isn't it
true that the settings should be tighter - maybe -2/+2 cm? I'll try the nasal pillows too. But I have
to be able to breathe."
Tech: "No it's not true that the pressures should be "tighter". If you have an A/H episode the machine
will only deliver the pressure that you need to open your airway. Your settings are 4-12 cm."
Me: "But those were the settings that my doctor ordered when he suspected that I had been over-
titrated in my titration study to 12 cm. I used the loaner machine with settings of 4-12 cm so
that my doctor could zero in on a more suitable pressure for me. My doctor said my average
pressures for 7 days of data was between 7 and 8 cm and ordered a straight CPAP machine set
at 7 cm. I was unable to tolerate straight CPAP so he switched me to an Auto."
Tech: "Your settings are fine at 4-12 cm. It could also be that you are noticing a difference in air
pressure because you did not have a humidfier with the loaner and now you have a humidfier.
The humidifier can seem like you are getting less air. Use the nasal pillows and call me next
week".
Me: Gives up at this point and takes the nasal pillows home.

So is anything that my tech said true? Frankly it sounds like a bunch of malarkey! I got the info and I will make the change and report my findings tomorrow. Hugs to all, Laurie

[DoriC]

I'm sorry I even directed you back to the DME, I was hoping you'd be one of the lucky ones. Uncle B knows best! What this tech doesn't understand is auto settings don't react immediately and that if your avg pressure is 8cms and you're sitting at 4cms it's got a long way to go to prevent or eliminate events, besides having that suffocating feeling must be very uncomfortable. We'll all be interested in an update, good luck!

[Slartybartfast]

Laurie,

DoriC, it's all your fault. No Halloween candy for you!

Laurie, your doc ought to know that the DME is taking it upon themselves to alter the prescription he wrote. Seems to me there should be at least an ethics violation somewhere in there.

I was in the middle of composing a reply to you when I saw your message pop up. You were absolutely correct. If the doc wrote 7, then it's for CPAP, not APAP. And there's no harm in leaving the top off of the range for the time being. It's more important that the lower number be closer to your titrated pressure.

One reason that you're feeling poorly is that the S9 is smart enough to know when you're sleeping and when you're not. Sort of like Santa. If your breathing rate and flow characteristics indicate to the machine that you're still awake, it will sit there and idle along at whatever starting pressure the machine was programmed to have and wait for you to get to sleep before it starts doing its thing. I expect the DME set the starting pressure at 4. I can't breathe at that low pressure. I need at least 6. I'm more comfortable at 8. A lot of people simply turn off the ramp and starting pressure feature altogether after they've become accustomed to the mask.

And re: the pressure being different with a humidifier, that's simply not the case. The S9 literature states that the pressure is the pressure delivered to the mask, not the pressure at the blower. That's why the machine wants to know during setup what kind of hose (regular or Slimline) you're using. The internal diameter and therefore the surface area and pressure drop along the length of the hose are different, and the S9 takes that into account when it adjusts or reports pressures.

Your DME is the sort that everyone here complains about.

[Uncle_Bob]

Laurie,

Its sounds like you have not been as lucky with your doctor and DME as you have been with your machine.
Given that you have read the user manual three times already and you have found this forum i would say you rank A++ for enthusiasm so far
reading the clinicians manual will put you in more control by allowing you to change your pressure and monitor events and leaks. It looks like elena has kindly sent you a PM with software information that will add even more control to your therapy. I hope you do not get to overwhelmed with all this information. It is wise to make changes and observe the outcome over a period of time rather than jump in and start changing various therapy settings at once.

It does sound like a priority step one is getting that lower pressure changed. Then we can see how that goes and what your leak rate is? Then you can start looking at events. Fun fun fun

Once you have installed the ResScan software the clinicians manual (different from the manual for the machine !!) can be found on your hard drive under c:\program files\resmed\ResScan3\ResScan Clinician's Manual.pdf).

here are my top tips for newbies that may not be obvious from the manuals :

you need to turn on "sleep quality", that's how you get the machine to record detailed data.
you need to sleep with the SD card in the machine at night for the machine to record the detailed data.
you need to tell the software to download the detailed data, the default is summary data only.
Download the data to ResScan on your computer at least every 7 days if you want ALL the detailed data.

You might want to read up over the weekend ready for your test on Monday

Good luck
UB

[Janknitz]

Your DME is the sort that everyone here complains about.

I've been following Laurie on another forum too. This "wonderful" DME tried to upcharge her $300 extra for an auto-machine Fortunately, Laurie is a quick learner and put them in their place about that.

I think, Laurie, that your awful experience trying to get your machine of choice is indicative of the entire experience you are going to have with this DME. Not to be trusted or relied upon.

You've gotten some great advice here (see, I told you this forum rocks!). Enable your data, tighten up that pressure range (or run it in CPAP mode--just because you have an auto doesn't mean you MUST use it in auto mode), and you should have a better experience.

What nasal pillows mask did you get? IMHO nasal pillows are THE BEST, but often require a bit of tweaking and a good fitting (which I don't trust your DME to have done) to really work for you. So let us know and hopefully we can fill in some quick tips to make tonight more of a success than night 1.

Be sure to dial in the nasal pillow setting on your S9, and some people find they need slightly more pressure with nasal pillows--forewarned is forearmed.

[Slartybartfast]

Geez, not only are they (DME) unscrupulous, authoritarian and ign'rnt, but they're thieves as well! Bad combo! Sorta' like Congress, now that I think about it, but that should change in a couple of days. At least until the new class of horse-thieves becomes complacent.

Jan, you make a good point. Just 'cause you have an APAP doesn't mean you MUST run it that way. Until you get the range set right and are dialed in on your mask, it might be worthwhile just to run it at 7 for a week or so and see what happens.

I just received the Climateline hose from CPAP.com for my S9 Autoset and while I'm experimenting with it I've been running at my titrated pressure of 11 cm. 'Cause I know and trust that number and how it was arrived at. First night I slept like a baby. Nose irritation from my Opus 360 mask went away due to application of a nasal moisturizer called Ayr. It's so similar, both physically and chemically to K-Y, the latter would be a good/cheaper substitute. Anyway, I slept like a baby. AHI next morning was 0.2. Last night I took the family out for Chinese food. More than we could eat. And last night my AHI was 7.5. Worst I've ever had. Might be the salt and the little red peppers in the Kung Pao, which I eat just to bug my kids, or it might have been the MSG, though they say they don't use it. However, despite the numbers, I still slept like a baby. Felt fine when I awakened, though my day of reckoning with those indigestible little red peppers is fast approaching. I know, TMI!

Point being, don't be in a hurry. Experiment, but remember that your titrated pressure wasn't simply plucked out of the air. You can always go back to that number when trying something new.

[elena88]

Laurie,

you have had some awful luck so far with the dme, and the doc and all that..

but you have a top notch machine now, so that is the biggest hurdle.. you may not feel like it right now, but
you are in an excellent position to really make your therapy work...

When I got here, I didnt even know where the SD card in the autoset was!

so, if you need click instructions, or a little hand holding, or a walk thru this and that, youre going to get it..

Soon, youll be downloading your data, and even posting it on the forum!

This place is like the sherlock holmes of cpap therapy, so you landed in a great spot with a terrifc machine, and
a wonderful attitude!

elena

p.s. I would love to slap some sense into your dme! I had the worst ones when I started.. but now I found a great one, so can you!
Some do mail order too!