# Newbie Needs Advice on First Night with S9 Autoset

[jpkman]

Good Afternoon All,

Great board and I'm sure glad that I found this space. I have gained a lot of insight into sleep apnea, but seeing as how there are so many variables and so much to learn, I still need a ton of help. Now in the interest of full disclosure I want to say that I have obtained a Resmed S9 Autoset with H5i, ClimateLine tube, and a Mirage Activa LT nasal mask FROM A FRIEND. I'm a 39 year old male and I have been having major sleep issues for a long time which has actually resulted in various medical problems including weight gain and low testosterone (I actually have to administer injections of testosterone twice a week). Not to mention a wife who gets no sleep b/c of my snoring. It has been suggested to me by three different medical professionals that I may suffer from sleep apnea. Two of these Drs. suggested that I participate in a sleep study in order to determine if that was indeed the case. I can't really explain my thought process behind my decision, but I had absolutely zero desire to do this, and so I never did. I even went to a dentist a couple of months ago and based on the lack of space in my throat (the airway), wanted to make me an appliance to be worn at night to combat the apnea. My apnea (if indeed this is what I have) went untreated, and I spend all day feeling like complete and utter cr@p. Almost zombielike on most days.

So my friend had a brand new machine and was not able to remain compliant, so it came into my possession. Through the wonder that is the internet I was able to obtain the manual, clinician's manual, as well as the ReScan software. I found out how to do a hard reset of the machine, and I erased all of her data so now it will just be my data on the card. I set it up last night with minimal difficulty, but I could not figure out how to determine the exact humidity level to use so I just left it on 80%. Is that good or do I need to change it? What is the optimum humidity level? Is there a separate temperature and humidity level or is it one and the same?

I came into the office this morning with my SD card, and was successfully able to download the various reports. The problem that I am having is that when I go to either save them to pdf or print them, with the exception of the ReScan software ID information at the header of the report, the remainder is totally blank. No data. How can I remedy this? I would like to be able to post my data to the board so I can get some input from you guys and gals.

As far as my first night with the machine, I guess it was OK. I was only able to wear the mask for about 6 hours. Is that OK for a first night? Any tips/tricks to adapt better? My wife reported this morning that I did not snore at all last night. Also, she usually has to wake me in the morning, and I am so tired and groggy that it takes me forever to get my bearings and actually get out of bed. This morning I was able to wake up on my own, and I don't know whether this is a placebo effect or not, but I actually felt much better than I normally do. What do you think? Placebo?

One of the bits of information on the ReScan report deals with leaks. I am having trouble deciphering this and would love to know whether I need to adjust my mask or not. The info under Leak is:

Median: 8.4
95th Percentile: 21.6
Maximum: 168.00

Is this OK?

Sorry for the long post. I hope someone can assist me with my questions so I can finally return to the land of the living..............

THANK YOU ALL SO MUCH!!!

[Pugsy]

Humidity preference is entirely up to your own personal comfort. There is no "better" setting particularly. Mainly whatever feels comfortable for you.

Regarding leaks...ResMed says that they can handle leaks up to 24 L/min and above that therapy and ability to score events may be compromised.
Maximum leak is the most leak you had...at 168 L/min...quite large but not unusual for the first night fiddling with the mask.
95% leak number means that for 95% of the time you were AT or Below that leak number. With the high max..it is to be expected the 95% will be elevated. Not a huge problem for first use at all.
Median average is 8.4 L/min and quite acceptable. I suspect that if you look at your actual leak line that for most of the night your leak line was well below that 24 L/min line and nothing to worry about. Short spikes past 24 L/min aren't the end of the world as long as they are short lived. Easy to see on the leak line itself if you spent much time past that magic red line.

Most of us use a screen shot of the report to post images for forum comments.
Here is how I do it.
Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.

Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

[jpkman]

Thank you so much Pugsy. I have tried to do as you instructed, so we'll see how it turns out. I was not able to fit all the info into one screenshot, so I took several.












Is this OK? Can you read it? Any advice?

THANK YOU!!!

[Pugsy]

I don't know how come reports are large yet tiny but I see enough.

Pressure settings appear to be 5 cm minimum and 20 maximum. Is the 5 cm comfortable for you? Some people find that low of a pressure rather stifling and others get along with it just fine.

Your leak line is all over the place but that is not unusual for a first night. As you get used to all this stuff it will settle down.

Generally accepted standard for AHI is less than 5 and you are fine there. No urgent need to change anything to improve anything there. If pressure variations seem to disturb your sleep you might consider limiting the pressure range a bit but other wise no real need. Perhaps increasing the minimum to your median pressure or thereabouts. Maybe 7 cm. Might help the response time to the events if you give the machine a bit more of a head start but certainly no imperative need at this point. It is the first night and all in all a very decent night for doing all this yourself.

[jpkman]

Thanks so much for the quick reply Pugs. I have certainly not done it all by myself. The info on this board is what has enabled me to get started. Gotta love the internet.

What do you suggest I do as far as the leaking is concerned? Is it simply a matter of tightening the nasal mask or is there more to it?

THANKS!!!

[Pugsy]

What do you suggest I do as far as the leaking is concerned? Is it simply a matter of tightening the nasal mask or is there more to it?

Tighter isn't always better. Odd but quite true. Too tight is often worse than too loose in regards to leak and for sure comfort.

Could you please add your equipment to your profile...here's how wiki/index.php/Registering_Equipment_in_User_Profile please use text as the images are small and we can't see model clearly.

I only have experience with the nasal pillow mask but generally the masks "float" on your face. Perhaps others with experience with your Mirage Activa LT can offer ideas. Also if the cushions get "tired" they need to be replaced..so it might depend on how much use the mask had prior to your receiving it.
Make sure appropriate choice is made in the mask selection feature of the machine. It doesn't affect therapy but can potentially affect the reported leak rate a bit. Did you see the video about fitting your mask? http://www.cpaplibrary.com/nasal-masks.html

[archangle]

Welcome to our little community.

Try the SleepyHead program. It's free, works well, and will give you another view at your data if you're having trouble figuring things out with ResScan.

Please put your equipment info into your profile so we can see it in all your posts. There's a link at the bottom of this post on how to do that.

[jpkman]

AWESOME!!!!!!

Thanks a million.

Tried fiddling with the mask last night and believe it or not, the leak got WORSE (but AHI was better). Oh well, back to the drawing board. Since I wasn't fit by a Dr., I'm wondering whether this is the right mask for me. Any tips on picking out the right mask?

BTW, for examples sake (and b/c I never had a sleep study), let's say that AHI with CPAP is 3, is there anyway to tell what AHI would be without a machine?

Thanks again!!!

[Pugsy]

BTW, for examples sake (and b/c I never had a sleep study), let's say that AHI with CPAP is 3, is there anyway to tell what AHI would be without a machine?

No. There is to way to tell for sure what the AHI would be without a machine. The closest you could come would be if you used the minimum of 4 cm at straight cpap of 4. That is as low as the machine will go and even 4 cm offers therapy value. It might give an idea but not a 100% accurate "without the machine" number. For some people 4 cm seems a bit stifling..especially after using more pressure. While we sure won't suffocate at 4 cm...it may feel that way for some people. When I used my APAP to screen my sister and husband for OSA neither of them were comfortable at 4 cm (which was what I wanted to use to get an idea like you were wondering about) and I had to settle with 6 cm due to their comfort. Took my sister about 30 seconds at 4 cm to rip the mask off complaining of suffocation.. So if you experiment with 4 cm...just a heads up on that.

Mask choice..highly personal. I think the easiest to seal are the nasal pillow masks. From simple physics..less surface to have to mess with. You might look at the nasal pillow mask that I use. Quite comfortable and very easy to get to seal with a minimal amount of tension.

Of course mask purchase online requires a RX which you don't have which really limits your purchasing ability but replacement parts don't require a RX and you can "build your own mask" from replacement parts. This is how EBay sellers have bypassed the RX requirement. All pieces are individual replacement pieces...sometimes only one piece is missing. Of course you need to know your replacement pieces and not miss something.

Give me a few minutes and I will scout EBay for what parts are needed for the mask I use. It is a highly popular mask and while a few people don't do well with it....many more do very well with it.
Mainly it is headgear...short hose assembly and nasal pillows. Side strap covers are optional and you can make your own easily.

[jpkman]

WOW!!! Thanks Pugs, you are super AWESOME!!!

Stepping out of the office for a bit, but I will be back shortly...........

[Pugsy]

Okay, here is what I found for the Swift FX. These are Buy it Now items....there are some auctions going on but for stuff like this I don't want to fool with waiting. Many of these EBay sellers are DMEs selling on the side. Hey...for folks needing a mask...we do whatever we have to do.

Bear in mind that the Swift FX entire package is around $127 online and comes with 3 sizes of pillows.
There are size versions of the Swift FX...the standard dark blue headgear fits most people...male or female. A few women have smaller heads and there is "Swift FX for Her" sized headgear in pink or light blue. My first Swift FX was the dark blue...I almost couldn't get it adjusted small enough but I was able to use it. I am small petite female with not a tiny head but not large either.
Short hose assembly which is the little tube from the long hose on your machine to the nasal pillow...is standard for either male or female and it doesn't matter what the headgear color is.

In the past I have seen headgear and short hose assembly packaged together quite reasonably...not today though.

These are the best prices that I saw a few minutes ago.
Short hose assembly $44.99 with about $2 mailing. ww.ebay.com/itm/Resmed-Mirage-Swift-FX- ... 416157bc27 Believe it not this is a decent price when compared to others on EBay and online suppliers.

Headgear.. Buy it now $33 free shipping.
[urlhttp://www.ebay.com/itm/Resmed-Swift-FX-Headge ... 4cfb5f46ab[/url]

Nasal pillows...they come in 4 sizes...XSmall...Small...Medium...Large. Size has nothing to do with size of your nose...it has to do with the the size of the nostril opening. Since these sellers above are obviously a DME seller they likely will also offer a nasal pillow if you ask. Unsure of price but if they include it in same package you save shipping costs...so remember that factor.

Being male...most likely you will need a medium or large... medium is the most commonly sought after size on the thread where people swap pillows...so if playing the odds...I would go with medium first.
Sometimes I have seen sellers offering 3 sizes in one package (the for Her package has the XS and the regular package has the large..with small and medium being common to both) Of course not today...
No package deals.

I saw a seller offering a package of 2 Large pillows for $12.49 Buy it now price with free shipping.
Actually a very fair price...my copay after insurance is that much. You can poke around the various pillow choices to get an idea but mostly they seem to be around $10 plus shipping....

First choice would be to check with the seller of the headgear and/or short hose assembly to see if they had a nasal pillow they would sell. Often they will and sometimes they throw one in for free.

So for about $95 you have a mask that online even with RX costs $127
Headgear.... $33
short hose....$47
nasal pillow..$15

Side strap covers that I mentioned
http://www.ebay.com/itm/Resmed-Soft-Wra ... 4ab2d47cd0

to be honest you can make better ones yourself if you are the least bit handy with some scraps of fleece but I am lazy...and I bought mine from Padacheeks..better softer and thicker fleece.. a little more money but Karen who, has this business, is a forum member and a CPap user and her stuff is better quality. So worth it in my opinion.
http://www.padacheek.com/PAC_SwiftFX.html

And the above is how we get around the RX requirement.. there are other mask models offered in a similar manner on EBay. Just gotta know which pieces you need.

[Pugsy]

BTW.. I have seen better prices for the Swift FX in the past..just not today on EBay.. You know how it is with EBay sellers. I saw the headgear and short hose assembly go for around $40 total Buy it Now price a while back... Heck of a good deal. Those are rare though. Some of the sellers are asking the same prices as online suppliers for their parts. Still not a bad deal considering you don't have an RX.

The seller with the $33 headgear is the same seller that I got my heated hose from. Prompt shipment and I would definitely buy from them again if I needed something. I see in their EBay store they also offer the nasal pillows but a bit steep in their price for that item compared to the others.

[jpkman]

Pugs:

I am a VERY restless sleeper. I toss and turn a gazillion times during sleep. I very rarely sleep on my back. Mostly on my side if I can, but usually on my stomach. Is there a specific kind of mask for this type of sleeping pattern or does it not matter?

Also, when I purchased the equipment from my friend she told me that she only used it about 3 times. Well last night I was fiddling around with the settings and I noticed that the machine had 130 Run Hours. It would appear to me that she definitely used it quite a bit more than 3 times. Was I duped?

THANKS!!!

[Lizistired]

When you post your graphs, it works better if you post a screenshot of the detailed view and don't bother with the report function. You can set the detailed view to show Pressure, Events, Flow, Flow limitation, Leaks, Minute Ventilation, and snore if it shows anything. Set how many graphs to view with the little graph icon to the right of the serial number.

[jpkman]

Thanks a lot. You mean like this?