Runaway pressure S9 Autoset with H5i and Climate Line. Help?

[chunkyfrog]

Which machines have the advanced autoset algorithm?
I got mine in Feb, 2011.

[Slartybartfast]

Just googled it. FOT used to determine whether airway is open or closed. So it's nothing new. Same algorithm that has been in the S9 for years.

http://www.resmed.com/us/products/s9_se ... nc=dealers

[MobyTheMinnow]

From what I have read there are 2 kinds of pressure ramping with "Autopap" machines. And perhaps you are not used to the S9. One will adjust downwards faster. One will adjust upwards faster. I believe the S9 ramps up faster and downwards slower so if it ramps up high to start off with for it to adjust down takes time too much time. Your Resmed "auto" settings can be adjusted by yourself if you are interested in the clinicians manual they are available on this site for your education all you have to do is email them (the info is on this site somewhere, I dont think I am allowed to give that out or I would tell you how right now). I would move your machine down from 15 to 11 like your other machine and try it for a few days.

There is also an exhalation adjustment that goes from 1 to 3. I tried it and I did not like it. It is so your not fighting against the machine with your exhale but with my mask I did not feel like I needed to use it and I did not feel as refreshed by my sleep. By the way my grandparents were Norweigen and you can send me some lefsa bread for helping

[MobyTheMinnow]

The manual is available on the apneaboard website. If you google apneaboard it will come up and on the google page it lists change cpap pressure. Good luck.

[Burkebang]

Update.

I have now gotten to try a third S9 Autoset and it behaved excactly the same as the two others. I tested the latest machine with both my Mirage FX and a Swift FX mask. While the Mirage FX sendt the machine streight to max pressure as shown in the video, with the Swift FX the machine took longer to start upping the pressure and actually setteled at 9.3 cm/h2o. So my impression is that these machines have an extremely hyper algorithm.

It's allmost an outrage for me that two different masks should make the machine behave so differently and actually affect the therapy the machine gives. That is to me an indication that something is wrong with the whole design of the algorithm. The mask should have little or no impact on how the APAP algorithm works.

My first two machines have been checked from head to toe by Resmed and have been found to be in proper working condition. This means that for me, the S9 is simply not usable at all as an APAP with a wide pressure range. Using an APAP with a narrow pressure range makes no sense to me, I might as well just use streight CPAP.

My current PRS1 works very well, it never increases the pressure while I breathe normally before going to sleep and everything it does during the night makes sense. My average pressure with the PRS1 is less than half of the S9. I hope that it's only me that the S9's does not like or else I can understand why so many swears by narrow APAP ranges...

[Burkebang]

Here is the data from the video test. The machine has not recorded the correct pressures, so there has to be a real problem here. I have also tested one more machine, with the same results.

There is also no reason for any flow limitation to be recorded. I was sitting up and I was completely healthy while performing the test.

[archangle]

Flow limitations can happen even if you're awake. They're a measure of the shape of your airflow waveform. If you have some sort of restriction in your airway, your waveforms will have more of a square wave shape than a sine wave shape. I presume someone with UARS might show a flow limitation all the time.

Apparently, the S9 uses this measure to try to prevent apneas, and will increase pressure when it sees flow limitations or some sort of poor breathing pattern.

There's nothing that obvious about the flow limitations in the results you posted. However, I don't know that much about the numbers the S9 puts on flow limitations and if those numbers would be considered to be high.

[Burkebang]

Flow limitations can happen even if you're awake. They're a measure of the shape of your airflow waveform. If you have some sort of restriction in your airway, your waveforms will have more of a square wave shape than a sine wave shape. I presume someone with UARS might show a flow limitation all the time.

Apparently, the S9 uses this measure to try to prevent apneas, and will increase pressure when it sees flow limitations or some sort of poor breathing pattern.

There's nothing that obvious about the flow limitations in the results you posted. However, I don't know that much about the numbers the S9 puts on flow limitations and if those numbers would be considered to be high.

I don't have UARS only OSA. I have no problem with my lungs and my airways are wide and in great shape according to the ENT that examined me when I had my sleepstudy. If my normal breathing, while sitting up, causes the machine to report flow limitation that it responds to with increasing the pressure, there has to be something wrong.

Here is another shorter test I performed that same day with a more detailed view of the flow. This time the machine reported the pressure increase correctly...

[chunkyfrog]

I find that running my machine with a range from 10-14 with EPR of 2 gives me more comfort than straight cpap.
My reported pressure has held below 13 for many months, but my average AHI is 0.7.
When I ran a higher maximum, it tended to 'run away' from me, and wake me a lot, with worse, not better events.
Maybe some of us trigger the darn thing too easily.

[Burkebang]

I find that running my machine with a range from 10-14 with EPR of 2 gives me more comfort than straight cpap.
My reported pressure has held below 13 for many months, but my average AHI is 0.7.
When I ran a higher maximum, it tended to 'run away' from me, and wake me a lot, with worse, not better events.
Maybe some of us trigger the darn thing too easily.

I think that is a very good possibility. If so, find it more and more likely that there is a design flaw with the S9, because neither PRS1 or Devilbiss machines does any such things for me, there is no problem having 15 as my max pressure with them. With my IntelliPAP, I even had the max pressure at 20 for most of the time and it never went anywhere near max when in use.

The nights I was actually able to sleep with the S9's, using long ramp time, my pressures also averaged around 12-13. But I knew from the IntelliPAP that this is twice of what I normally need. I have confirmed the effect of my treatment with the IntelliPAP machine many times with my pulseoximeter over the 5 months I used it and I never had any worrysome desats. So I was severely over treated by the S9's.

My best guess is that the problem is because of a too hyper detection algorithm, combined with a poorly designed and noicy humidifier and maybe made even worse by the extra resistance in the slim hoses. This is of coarse speculation, but based on my reallife testing and observations with no less than 4 different S9's.

[archangle]

I don't have UARS only OSA. I have no problem with my lungs and my airways are wide and in great shape according to the ENT that examined me when I had my sleepstudy. If my normal breathing, while sitting up, causes the machine to report flow limitation that it responds to with increasing the pressure, there has to be something wrong.

I don't think you really have enough info to support those conclusions. However, the AutoSet doesn't seem to work "correctly" for you. Sometimes auto machines simply don't find the "right" pressure. That's yet another reason everyone should have a full data machine, check the results, and make adjustments to get the best therapy.

Luckily, the PRS1 Auto seems to work well for you.

[DougalMcDougal]

i regularly find whilst awake with my mask on that towards the end of expiration, the S9 sends a pulse of 3 air vibrations up the tube
- i presume this is its way of testing the level of air resistance but bot sure if it counts it as an event
- it seems that it is too sensitive if it does this during regular breathing - it makes me speed up my breathing rate whilst awake in order to avoid the vibrations happening