Airsense 10 Elite: can't breathe in

Hello all,

Just wondering if anybody could shed any light on this: I recently changed my Resmed S9 Elite (I think... the CPAP brick one anyway) for an Airsense 10 Elite. For the first couple of nights I saw an improvement but in the three months or so I've had it, it's been getting gradually worse. Its latest thing started some time between a fortnight and a month ago where I'd wake up in the middle of the night not being able to breathe in: it was still running but the pressure seems so low that I was practically inhaling the mask which was then closing up. This has increased from an occasional thing to now every night, and the machine's performance has got so bad that I actually feel better not using it.

The machine's pressure is set to 8, ramp is off, and SleepyHead isn't showing anything unusual at all: according to the machine's data it's staying rigidly at 8psi (or 8.5 some nights, oddly) with a small change as I'm breathing in and out. Nothing to suggest the virtual vacuum I'm creating when it's playing up. Dodgy pressure sensor, maybe?

I've seen a few other people having similar problems so I'm wondering if it's a design or manufacturing fault with certain A10s.

My background is being diagnosed with sleep apnoea just under 15 years ago and constantly using CPAP over that time: various Resmed machines, all with humidifiers. Probably the best of the bunch was the S9 even though it was too dumb to store any data. The machines are provided by the NHS (I'm in the UK) so the chances are I'll get the most basic model currently on offer. They do on rare occasions provided APAP but I'm told these are doled out to those who shout the loudest which I'm not terribly good at.

When first diagnosed I was having OAs about every 70 seconds throughout the night and the initial pressure was 13.5. Since losing some weight and starting HRT the pressure has been revised at 7-8psi and actually for about a week I can survive without it experiencing no apnoeas but it doesn't take long for my throat to become sore and swollen and for them to return: it's only partly weight-related and my throat has its own design flaws, also being rather prone to things like tonsillitis. Though CPAP actually works very successfully to deal with my OA events my quality of sleep is still atrocious: the respiratory clinic suspects narcolepsy and the neurological one says "lolno" which is how it's been for over a year and has caused an impasse with neither prepared to budge. :/ I often score badly on the Epworth tests as I don't understand what it means by "sleepy" (I'm autistic and it's a rather vague term). If it means very tired indeed then I score highly; if it means randomly passing out then I don't, given that my problem is that I can't sleep at all easily, which is why I'm so tired. But that's probably getting way off the subject; I'm afraid I tend to digress. Rather frequently.

Back to now, my situation is that the machine isn't really working for me because of this problem. I'm wondering if it's a setting gone awry or if the thing is just broken. I also seem to have a permanent headache overnight which feels like a bad sinus problem and I think they are getting mild infections regularly since using the new machine; my head also seems to get extremely cold in spite of the humidifier (which leaks: I informed Resmed but they never replied) and the heated tube which I switched to manual and set to 27⁰C which should be plenty. It hasn't been awesome.

Oh, and a chart, which will hopefully show up. This is a fairly typical night, one of the "argh, I'm inhaling my mask!" events would've been at the start of the long gap in the middle, but it doesn't show anything interesting. I'm also fairly convinced the leak rates aren't correct, though the mask isn't always 100% if it does leak I tend to wake up: I'm a very light sleeper. The only time it has really leaked is due to general idiocy (turns out nose pillows and a nose ring aren't compatible: which obviously comes as no surprise at all... to everybody who isn't me.)

Anyway. My apnoeas seem to be extremely well-controlled compared to where I was, and this is corroborated by the APAP version of an A10 they loaned me for a fortnight last summer, by which I mean one that actually worked properly. But this not being able to breathe thing is weird and it's definitely a thing rather than the imaginings of a semi-conscious halfwit: by the time I realise it's a problem and become fully conscious I've tested it, and sure enough, breathing in through my nose will suck the other side of the mask right up to my nostrils and obstruct airflow altogether until I give up.

Welcome to the forum.

I suggest adding EPR to your therapy. It doesn't appear to be on right now.
Do you know about EPR/exhale relief that is available on your machine?
If you don't...go here and request the clinical manual via email so you can read it and learn how to get into the clinical setup menu area where you can turn EPR on and make adjustments. I suggest playing with all the settings and see which one just feels better.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

Thanks, for both the welcome and the suggestion. I'll give it a try. It's "on", but set to ramp only; and while I don't 100% understand the settings, I'm guessing since I don't use ramp that means it's effectively off. I wonder if I should increase the pressure to compensate? It was actually much higher last summer, somewhere between 11 and 14 (I forget which) because nobody had reviewed it since I was originally diagnosed all those years ago, and the machine did come set at 13. There was a suspicion that due to the excessively high pressure it was over-saturating my blood and causing sort of central apnoeas so when the A10 APAP reported I only needed about 7 they pretty much halved it. But it seems they seem to have forgotten the update somewhere along the line.

If EPR is set to ramp only and you don't use ramp then you aren't using EPR.
Set it to full time.
Don't worry about adjusting the pressure right now to compensate for the drop during exhale. You may or may not need it even at this relatively low pressure unless you feel better with a higher pressure. Some people do just like a higher pressure...makes it feel like more air is moving.

From what is shown on this one report...I don't anticipate the AHI increasing overly much to the point of needing better prevention with more pressure. You have a lot of wiggle room for a few events to slide by without causing a problem...and it might not even happen anyway.

Since you have a bit of a history with centrals....let's be extra cautious and make one change at a time so we can better evaluate the results if they change.

I'll give that a try, but in a day or two: today I'll try running it without the reservoir as that seems to be really dodgy in spite of being quite new, given that it's inexplicably leaky and smelly, which seems quite bizarre.

I sent Resmed a message using their website first thing today, but they never replied. I know it's only a day but they also never replied to the one I sent a few weeks ago stating I was concerned about the amount of condensation in the reservoir's aperture. It's a pity their customer service is so terrible. If I need to get the machine replaced I'll try to ask for something that isn't Resmed but I'm not sure that's likely to happen, sadly.

Actually ResMed is one of the "good" brands. As far as customer service though...they all suck in that department mainly because the manufacturers really think of the doctors and equipment suppliers as their real customers. They usually tell patients to "get with their doctor or supplier" when they have a problem.

Was your machine for sure brand new? Or did the NHS give you a used one? Did you check the machine run hours to confirm it was new?

I think part of the problem is a lot of companies and organisations still don't really "do" email, rather frustratingly. They seem a lot nicer on the phone or in person, but emails often just disappear into a black hole. They used to be better in that regard but it's probably down to the individual responsible for that method of communication I guess...

The machine was new and had no running time clocked up. It still had the protective covers on the screen etc too. The reservoir was in its (sealed? can't remember) bag so I'm not sure what's gone wrong there.

Anyway, I ran it without the humidifier last night and though just one night isn't enough to say, it seemed a lot more agreeable than before and hasn't dried out my nose as much as I'd expected, so I'll stick with that set-up the next few nights and see how I get on. SleepyHead is still reporting a few large leaks, which surprises me (well, a bit: the strap on the mask has a habit of wandering up the back of my head), so I can't blame all of that on the reservoir, but I think it may have been responsible for doing something bad with the pressure.

Turns out it's not the reservoir (though the bad seal probably doesn't help) as the machine is still playing up. The other night it was back to producing very low pressure; trying to restart it saw the running pressure being barely more than the nominal airflow it generates to prevent condensation in the tube, so no wonder I feel like I can't breathe. Another restart saw more pressure but now I don't trust it to actually generate what it's set to, and it would explain a few things if it is generating a random but lower than expected amount of pressure. What's worrying is that the machine's data insists that it's producing 8 psi at all these times when it clearly isn't.

As it is, I'd say that the A10 is a bit of a liability and worse than not using CPAP at all. So I guess I'll be better off not using CPAP at all, though that's not really a viable long-term strategy. I'm not sure what to do next though given that the A10 was intended to replace an also faulty S9 that wasn't even that old. :/

My interpretation of having an issue, a bit like you describe, is that the machine, on inhale, can restrict the speed of the air which I was trying to inhale. That is, it is not just the minimum pressure (the one that keeps the airway open) but the second pressure during inhale needs to be raised, as I have a very restricted space (in my air canal, small nose as well) that means I needed the pressure on inhale to be higher. This led, I feel, to my success with a Bi-Level machine.

Pugsy is more knowledgeable than I in which order to test things. I suspect if the EPR does not help, she will suggest you slightly raise your pressure. But I should not say what she will say.

Just do not give up, there can be more experiments that might help you to get to where you want to be. Pugsy's first step is the right one, in my opinion. Usually Bi_level is defined by raising the IPAP (intake breath) by five points from EPAP (Exhale, the minimum pressure you need to keep your airway open) EPR does something similar with a higher pressure on inhale, but less than five points.

Oh, yes, good point: thank you for the reminder!

I do apologise for sounding rather negative earlier, I was tired and grumpy, entirely surprisingly after not using my CPAP last night. So I've now turned on EPR, which I hadn't done previously on the basis of "try one thing at a time" so I'll give that a go now.

Another random point which nobody has mentioned to me: I notice that the S9 and A10 also come in "for her" flavours which I'd always just assumed was a matter of styling but I've seen suggestions there may be more to it than that. Can anybody clarify?

Unfortunately my gender is slightly, erm, less straightforward than ideal and I suspect is why I have sleep apnoea in the first place. I'm trans (m-to-f) but historically when there's been typically male or female specific symptoms of something or other I've usually tended to have the female ones, e.g. female presentation of autism, more typically female symptoms of a heart attack (yeah, I got all the worst of the untreated sleep disorder problems! Diabetes, heart damage, high blood pressure etc) and so on; and perhaps significantly not a particularly "male" build, so thanks to random physiology for giving me a small chin and lower jaw and a female-sized neck that's not quite big enough to cram all the male amount of tissue, at least as my limited anatomical knowledge sees it. I have no idea what I am genetically but I guess it's not terribly important.

The S9 "for Her" AutoSet model has no difference at all from the regular S9 AutoSet except for the pink color. The Pink color was originally promoted and released during one of the breast cancer awareness weeks.

Now the AirSense 10 For Her AutoSet actually has a second auto adjusting (apap) algorithm available that is different from the regular apap algorithm.

The Elite model that you have isn't capable of auto adjusting at all.
It only offers the one mode of operation which is fixed cpap mode.
The regular AutoSet has fixed cpap mode plus the original auto adjusting mode.
The for Her AirSense 10 AutoSet has fixed cpap mode, regular original auto adjusting mode and the additional new "for Her" auto adjusting mode.

Thanks so much for the clarification! I'm actually not desperately keen on pink so I don't feel I really missed out there. Having said that, I'm also not especially keen on the S9's standard silver but at least it's a bit less "look at me, everybody!" With the A10 that's something for me to bear in mind if they decide to randomly offer me an APAP: probably not terribly likely but as I still have very serious sleep problems that are as yet unexplained they may change their mind in future. I have noticed that health organisations aren't entirely sure which approach to take with people like me and can sometimes be a little random so it would be up to me to steer them in the right direction. The NHS generally chooses the female path when there's a choice but it's not guaranteed (thinking of one time my, erm, escorts were instructed to deposit me on a male ward: fortunately the duty ward manager told them to bugger off. It doesn't happen often, though.)

Though not a CPAP matter, I got the results of the neurological sleep study back today. The upshot is that of the eight hours I spend in bed I get about six hours' sleep, but that's very broken up: my average sleep time is 15 minutes (the range is about 10-19) and the average time between them is five minutes (range about 2-10). That's not including the typical hour or two break I have from trying to sleep which is generally once or twice a night. Of that 15 minutes, the amount of time I spend immobile is significantly less, so the amount of actual sleep I'm getting is anyone's guess, really. Overall, it seems that the number of "sleeplets" I have per night varies between about 25 and 35.

The neurological sleep clinic's opinion is that there's basically nothing wrong with me and I should spend less time in bed. :/ Which happens regularly and just makes me feel worse.

Edit: actually that's according to the motion sensor, and the polysomnography indicates it may be more like 25 times an hour, though the results are somewhat opaque. Sadly, the results appear to have not actually been analysed by the clinician in the intervening months hence the lack of any useful diagnosis. Further edit: actually it's really very hard to interpret the results, which is kinda the consultant's job and she said little more than "get up earlier and get out more lol". Even though I struggle to stay in bed beyond 4:30am (and which will be 3:30am by the end of the month) and don't get out more because my social anxiety goes through the roof when I'm tired.