Going from ResMed S8 Auto ver1 to S9 Auto

[Adrian_Roy]

Hello everyone. I have OSA and have been using CPAP treatment for approximately 4 years. I started out with a ResMed S8 Vantage Auto v1 with the Mirage mask (mouth and nose). When I started on CPAP treatment, I was 340lbs., had crushing sleepiness in the daytime, and constantly waking up with sore throats and disturbing my wife with snoring and jerking around in the bed. I have since lost 150lbs. through diet and exercise, but according to the logs on the S8, I still have an HI of about 1.5, but my AI is 0. So, for now, my doctor is keeping me on CPAP.

I have been upgraded to a ResMed S9 Auto as of two days ago. When I tried the S9 at the clinic, it felt a little different than my S8. I couldn't really put my finger on what it was. I have no EPR on my S8, and EPR is turned off on the S9, so it wasn't that. The best way I can describe it is that on the exhalation, the machine seemed to stutter ever so slightly in it's ability to maintain the correct pressure. But, since it was so minor, I figured maybe it was just the way the S9 worked.

Anyway, my nightly pressure is usually between 7 and 8. The first night I slept using the S9 was a disaster. I woke up with the machine chugging away at 12 and the mask getting blasted off my face. This was strange as I haven't needed that kind of pressure in a VERY long time. The pressure was so bad, I had to stop the machine and start it again so it would start at 4 and let me get back to sleep. Shortly after that, I woke up again, only this time my stomach was full of air. This never happens to me. By never, I mean only 3 or 4 times over a period of 4 years, and each time it's been because I was positioned funny or had eaten a lot right before going to bed. It took about 20 minutes of burping, but I sorted myself out and got back to bed. But again, I woke up with the machine blasting away again, this time at 14.

I had no mask leaks, I hadn't changed anything in my nightly routine but the machine itself. At this point, I decided to give up on the S9 and go back to the S8. I pulled the S8 out from under my bed, plugged it in, changed the hose from the S9 back to the S8, and drifted off as per usual without any more problems. I woke up a few hours later at my regular waking hour with the S8 chugging along at 6.4.

Has anyone else noticed anything different from the pressure delivery between the S8 and the S9? Again, my S8 doesn't have EPR, so I didn't want it enabled on the S9. I didn't want to change ANYTHING about my treatment - simply get a new machine in anticipation of my S8 giving out eventually. I have only heard positive things about the S9, but this miscalculation in pressure is out of control. The machine is completely unusable for me.

If I can't figure out what's going on, I am going to have to start trying other brands, and I don't want to do that. I like ResMed, especially their masks, and just want the same type of treatment I had with the S8. The folks at the sleep clinic are scratching their heads at this point. I called ResMed, but they were all together unhelpful and simply said to talk to my doctor. I tried to explain to them that I was just asking about any possible differences between the treatment delivery between the S8 and the S9 and they couldn't seem to understand that it wasn't a question about my particular medical case.

So, again, I'd really like to hear from folks that have:

1. Used and liked the S8 Vantage Auto (version 1) with the Mirage face mask (nose/mouth).
2. Have upgraded to the S9 Auto and either found or not found any differences.

Best Regards,

Adrian

[msradar65]

My thoughts here are do you have the limits wide open? If so, then why? If your normal pressure is around8...then why not set the auto for 6-10 and leave it there. The S9 will chase large leaks by ramping up the pressure.

I have never used S8 so I can't speak to that. I have only used S9 auto...and I run mine on 10-15. No issues with run away pressure.

I think you may have the limits too open. Also get sleephead or rescan so you can monitor your therapy.

[Pugsy]

What are the pressure settings now on the S9 Auto? Sounds like it is 4 minimum 20 maximum.
It is wanting to go to high pressures for some reason.....it isn't known to chase leaks but maybe it is. Normally it is not known to have runaway pressures like you are having. Normally there is some sort of reason.

You can change the maximum to much lower so that you don't get the huge pressure blasts but you need to try to figure out why it is wanting to go so high. Get SleepyHead (all information is in my signature link lower left of this post) and let's see what is going on to cause the machine to want to go so much higher.

They did change the algorithms between the S8 and S9. There is also a setting in the clinical menu that you can change so that the rhythm breathing is altered. I believe this is independent of EPR. Not sure though. Do you have the clinical manual for this new machine? If not send me a private message with your private email address and I will send it to you as a pdf attachment (can't do attachments with this forum email system).

[Adrian_Roy]

Thanks very much for the replies!

I will download sleepyhead and see what I can get out of it and report back if you don't mind. Any additional advice or help would be greatly appreciated.

As for the capping off the pressure, I thought about that. But the limits on my S8 are 4 and 20 as well, so I didn't want start changing things around. If the S8 runs at a reasonable pressure with the upper limit wide open, I feel the S9 should be capable of doing this as well. Pressure capping may ultimately be the final solution, but I'd like to see if I can figure out where the problem is first.

Again, thanks so much!

Adrian

[archangle]

The S9 is a lot "smarter" than the S8. The S9 may very well have good reasons for thinking you need the higher pressure. Airflow limitations would be a likely reason. It can also be mistaken as well.

Don't forget you can tame the runaway S9 if needed, including turning the max pressure down and slowly raising it to let you get used to the higher pressure if you decide you need it.

[Adrian_Roy]

Well, I don't even really know where to begin. I guess I'll just try to summarize the two problems I am still having with my new S9 Auto 3 days in after having used an S8 Auto v1 for about 4 years.

Problem #1: Stomach/GI gas
This is really the only reason why I am complaining. The GI pressure that builds up for me by using the S9 is unbearable. I have had it once or twice over 4 years when using the S8, but this is way worse, and it has happened every night. Same tube, same mask, same me, just the S9 has changed. It is completely unbearable. Can anyone tell me what is the S9 could be doing to cause this?!?!?! EPR is off, and the rest of the settings are the exact same as on the S8.

Problem #2: Over-pressure
This is less of a problem as it is more of a concern that this may be somehow related to problem #1. Since I lost weight, my S8 has been happy to treat me at between 7 and 8. It's been that way for over a year. With the S8 at this average pressure, I have an HI of 1.6 and an AI of 0. On the S9, however, it wants to run in the low to mid teens each time. This is even with an AHI of 0 and leak rate of 0. I have downloaded the SD card data to SleepyHead and I can see it starting out between 7 and 8, and then for no reason it starts boosting pressure to the point where it causes a leak and then I wake up.

*sigh*

If anyone wants to see the log data, I can send it. This is really frustrating.

[Pugsy]

Could you please post an image of your SleepyHead daily report graphs. Be sure to include the Leak graph. You can turn off the AHI graph and the mask pressure graph as they aren't really needed and then get leak on same image.

EPR off? Might want to try turning it on so that you are getting less pressure during exhale.
Some people have a threshold of sorts where above so and so pressure they get really bad aerophagia and below it they don't.
Sounds like the S9 algorithm wants to go past your threshold. Why? don't know but you can limit the max and see what it does to your data. If it is just wanting to fix some flow limitations or snores it might be better to let those happen so you can have less discomfort from the aerophagia. Sometimes we have to compromise.

[Adrian_Roy]

Here are the two reports in PDF format. I hope this is readable. If not, please let me know:

http://coldspringhead.ca/public/s9-day1.pdf
http://coldspringhead.ca/public/s9-day2.pdf

[sol]

First impression you need more sleep, two hours isn't sufficient. Work on your sleep hygiene and sort out any problems you might have

[Pugsy]

Are the short hours of sleep related to the aerophagia? Is this about what you get each night? Only been 3 nights though?
Only thing I can think of for the pressure increases are the flow limitations but they aren't horrible but maybe enough to drive up the pressures.

If it were me I would limit the max in an attempt to find the threshold for aerophagia and see what the AHI looks like at that threshold. Even maybe try straight cpap at 8 (where the S8 liked to go) with EPR on.

Why EPR off? Does it bug you? It would help lower the overall pressures and maybe help the gas.

[Adrian_Roy]

Yes, the short hours of sleep are because I am completely at the end of my rope and need to switch back to my S8. The aerophagia is unbearable with the S9. The S8 causes me no issues at all.

I have only had the S9 for about 5 days, but each night it's entirely consistent. After about an hour, I need to switch back to my S8.

I'll try EPR tonight, and also try limiting the pressure to 9 or so.

Thanks!

[chunkyfrog]

My Autoset woke me up at first with runaway high pressure;
I lowered the top end to a couple of cm above my titrated pressure and it solved the problem.
The few events that still get through are an acceptable trade-off for a good night's sleep and almost NO centrals.

[wilsonintexas]

I would try the ERP..... I helps me.

I have been having problems with bloating as well... I am not taking simethicone before I go to bed and it helps.....

[n0hardmask]

Hello everyone. I have OSA and have been using CPAP treatment for approximately 4 years. I started out with a ResMed S8 Vantage Auto v1 with the Mirage mask (mouth and nose)...<snip>
So, again, I'd really like to hear from folks that have:
1. Used and liked the S8 Vantage Auto (version 1) with the Mirage face mask (nose/mouth).
2. Have upgraded to the S9 Auto and either found or not found any differences.
Best Regards,
Adrian

Hi, Adrian,
I have also used the S8 Vantage and S7 Autoset before that; for about a year total. Both with nasal masks and chin straps, and a Brux guard. Haven't used the Mirage, but I can tell you I've never had anything like the runaway problems you describe with the S9. The leak chasing is not uncommon with a change of masks, but that doesn't sound like your situation.
It's posible you have a defective APAP, in which caase it needs to go back "to it's maker". Keep checking in; there's a lot of experieince hanging around this forum. When something's been happening, I suspect somebody here has heard of it. Good luck and don't throw out the Vantage- I think it's a pretty good machine. PS, when you go back to your DME, why don't you take both machines and have a pressure check on both to see how they agree on pressures? Good luck!

[ubitsa]

Hello everyone. I have OSA and have been using CPAP treatment for approximately 4 years. I started out with a ResMed S8 Vantage Auto v1 with the Mirage mask (mouth and nose). When I started on CPAP treatment, I was 340lbs., had crushing sleepiness in the daytime, and constantly waking up with sore throats and disturbing my wife with snoring and jerking around in the bed. I have since lost 150lbs. through diet and exercise, but according to the logs on the S8, I still have an HI of about 1.5, but my AI is 0. So, for now, my doctor is keeping me on CPAP.

I have been upgraded to a ResMed S9 Auto as of two days ago. When I tried the S9 at the clinic, it felt a little different than my S8. I couldn't really put my finger on what it was. I have no EPR on my S8, and EPR is turned off on the S9, so it wasn't that. The best way I can describe it is that on the exhalation, the machine seemed to stutter ever so slightly in it's ability to maintain the correct pressure. But, since it was so minor, I figured maybe it was just the way the S9 worked.
Yes you are right here the s9 maintain the correct even you exhaling



Anyway, my nightly pressure is usually between 7 and 8. The first night I slept using the S9 was a disaster. I woke up with the machine chugging away at 12 and the mask getting blasted off my face. This was strange as I haven't needed that kind of pressure in a VERY long time. The pressure was so bad, I had to stop the machine and start it again so it would start at 4 and let me get back to sleep. Shortly after that, I woke up again, only this time my stomach was full of air. This never happens to me. By never, I mean only 3 or 4 times over a period of 4 years, and each time it's been because I was positioned funny or had eaten a lot right before going to bed. It took about 20 minutes of burping, but I sorted myself out and got back to bed. But again, I woke up with the machine blasting away again, this time at 14.
The s9 love to work at bigger pressure, but have in mind that the s9 have a great algorithm to manage the snoring,apneas,flow limitation that the s8 can't, and of course you have check that the setting of pressure is the same at both devices


I had no mask leaks, I hadn't changed anything in my nightly routine but the machine itself. At this point, I decided to give up on the S9 and go back to the S8. I pulled the S8 out from under my bed, plugged it in, changed the hose from the S9 back to the S8, and drifted off as per usual without any more problems. I woke up a few hours later at my regular waking hour with the S8 chugging along at 6.4.

Has anyone else noticed anything different from the pressure delivery between the S8 and the S9? Again, my S8 doesn't have EPR, so I didn't want it enabled on the S9. I didn't want to change ANYTHING about my treatment - simply get a new machine in anticipation of my S8 giving out eventually. I have only heard positive things about the S9, but this miscalculation in pressure is out of control. The machine is completely unusable for me.
You can adjust the maximum pressure to the desire, and after that checking the info

If I can't figure out what's going on, I am going to have to start trying other brands, and I don't want to do that. I like ResMed, especially their masks, and just want the same type of treatment I had with the S8. The folks at the sleep clinic are scratching their heads at this point. I called ResMed, but they were all together unhelpful and simply said to talk to my doctor. I tried to explain to them that I was just asking about any possible differences between the treatment delivery between the S8 and the S9 and they couldn't seem to understand that it wasn't a question about my particular medical case.

So, again, I'd really like to hear from folks that have:

1. Used and liked the S8 Vantage Auto (version 1) with the Mirage face mask (nose/mouth).
2. Have upgraded to the S9 Auto and either found or not found any differences.

Best Regards,

Adrian