Color Me Excited

I received a Resmed S8 AutoSet II with the H4i humidifier and the Mirage Quattro mask today. Doctor promised me he would put a rush on it but the sleep technician who actually turns the doctor's order into a prescription didn't get the message. That was Friday; Monday I called to check on the progress and the tech told me I needed a titration for the proper pressure. Talk about "This is the way we do it because Medicare requires it." I told him nothing in the L171 requires a pressure titration but it is needed for setting up a non-auto machine but auto machines work with a range. I knew I really didn't know but logic and reading L171 says there is a trial period during which time the doctor hopefully chooses a set of initial settings either based upon a titration or experience. I asked to speak to the doctor and was told he was out of the office this week...how inconvenient for me. I asked to speak to another sleep doc (this is the pulmonary dept. of a large hospital) and the dept. sec'y gave me the third degree; I prevailed; she talked to the other doc and the tech got the message. The DME gets kudos for prompt attention and very good service.

Having FSHMD I have been down this road before and know that you have to be persistent.

I tried it out for a couple of hours this afternoon. Of course the tech who delivered it gave both my caregiver and me a complete demonstration, made sure the mask fit and admonished us to use distilled water in the humidifier. He left and I told my CG I want to try it out; I didn't want to try it for the first time a bedtime in case we got something screwed up. Needless to say, we did. She put the mask on my head, put water in the machine and turned it on. I lay back watching TV and listened. The "thing" roared like a run away vacuum cleaner. So much for 24 dB. I thought, the mask improved my hearing! But it was really easy to breath on exhale (I had flunked the titration part of the 2 part sleep test because the mask didn't fit at all (I was there on a Sunday night and the selection of mask sizes was abysmal) and I was not able to exhale against the inhale pressure.

Them I noticed that the cover on the humidifier was not clicked closed. BOY! What a difference.

OK, now I am a whiz at getting into the clinicians menu (delivery guy left the manual that clearly says "Remove before delivery to user.") The leak rate for my trial was 1.8 (not surprising with the humidifier door open.) There was also something about flow rate of 12.7 which I assume is either an average or a highest value. Machine range is set to a low of 5 and a max of 15. I am going to leave that alone for now until I have a few nights under my belt.

Now for an appeal to the common wisdom. What else should I learn to watch? Or keep my cotton picking fingers off?

Someone will certainly know, I am a Respironics guy right now. But I thought I would respond because I want your thread to be near the top so someone with good experience of Resmed machines.

Good Luck

Glad you like your equipment you received today, keep up the good work

Sounds like you're on top of things. Let us know if questions come up after sleeping with the machine and mask. You probably already know you have to check the screen before noon on Resmeds machines, otherwise you'll see zilch. Hope your early experience is good.
Kathy

I like your attitude! Keep those cotton picking fingers on your machine and your therapy. That's what many/most of us here have found works!

It can be very helpful to track your nightly data. You can access it every morning, either through the clinician's menu or by pressing and holding the left and right buttons for a few seconds until the "Efficiency Menu" comes up. This will give you data regarding your pressure, leak rate, AI, HI and AHI. Leak should be as low as possible, and you want an AHI of less than 5.0.

If you are accessing the clinicians menu, I would advise writing down all of the current settings so that if you make any changes and want to undo them you will know what to change them back to.

Good luck and keep us posted as to your progress.

Rogelah, you're off to a good start.

When you're reviewing nightly data, you'll be looking for a leak rate as low as possible. Work with the mask (including the "teflon tape fix", which you can look up) until you optimize it, for comfort and low leak rate. Be careful about tightening the mask (you don't want to crank it down, tight). The mask depends upon a certain amount of looseness for the seal to inflate. I was warned that 90% of the tightening should be done with the lower straps.

Once the leak rate is looking good, preferably below 0.50 L/sec, then the AHI number is the next thing to look at. With successful therapy, AI will be approaching 0.0, and preferably AHI will be below 5.0. If you have low leak rates, and high AHI, then that is the territory where some will start increasing their minimum pressure. Be sure your sleep doctor knows what you're doing. Don't attempt it on your own if you don't know what you're doing.

Guy

Keep us posted on your leak rates and AIs and HIs. I have your particular machine also and recently learned how important the correct range of pressure can be in keeping your numbers down.

Good luck!

Donned the mask at 9:30 pm. The mask fit paradigm almost gagged me because I wasn't expecting it. Settling time 45 minutes which is good for me. The only thing I did was experiment with the humidity and eventually just turned it off. At 2:30 am I wasn't asleep and felt pretty good from just breathing enough air. I still didn't fall asleep. At 7:30 am I had my caregiver hook me back up because I was feeling sleepy. Still nothing although it was obvious the mask was not the right size; I had asked for large and they had sent medium. Now medium would have worked if I didn't open my mouth too wide. I am a big-time mouth breather and opening wide pulled the plastic down on bridge of my nose which was a get this thing off my face now event. A call to the DME resulted in an "Oh! my god!" and a promise to send out a large. The new large is now in my possession.

I feel a need to dump my brain about my breathing problem. Obviously I have sleep apnea confirmed by a PSG. But, and I am not a doctor and I do not play one on TV, the FSHMD has caused the muscles that assist in breathing, the chest wall and the abdominal, are weakened and do not expand my lungs beyond half-full (except that once in a while I get a yawn reflex or I can somehow get a doozy of an inhale). So even if I am not sleeping I get a tremendous value just from good breathing depth.

T have noticed in the last 6 months that, even when awake, I would slow or seemingly stop breathing. Also in the last 6 months the FSHMD has affected my upper body even more. So I use the APAP not only for sleep bur for non-sleep. Eventually my doc says I'll need a BiPAP.

So tonight we go with the new large mask.