Anybody else noticed this on the modern machines?

ResmedUser · Post by **ResmedUser** » Tue Feb 08, 2011 3:51 pm

sydneybird wrote:I have a hard time believing that 0.1 cm H2O or even 0.5 has any meaningful clinical significance for the majority of people, but I do understand it is important for you. You have a Manometer, so why don't you be proactive in calibrating your machine yourself and check it every month or so? You are lucky that ResMed provides 0.1 increment adjustment. Respironics is 0.5.

Resmed allows for changes in increments of .2, not .1. In your sleep, Ive noticed their increments go in .1 increments. But as far as setting the machine, its .2 increments. Respironics is indeed .5 which I think is pretty shoddy.

Look, I do not understand what is so difficult to understand. My original CPAP pressure, titrated in a sleep lab years ago by a sleep technician/RT, is 11.0. I got an APAP that blew 11.1 while set at 11. I did wonderful at that. Now when I would adjust the thing a few tenths of a point below 11, my OSA symptoms would begin coming back bad. Vice versa, at an increased pressure of just a few tenths of a point, I get sharp stomach pains and it overactivates my zoloft and I become agitated and cannot sleep well.

So its back to the basics again, of what my sleep medicine doctor and sleep technician decided, 11.0. I can tolerate plus or minus .1. Like10. 9 to 11.1. Those are my variances, I have discovered thru trial and error over several years. I was on CPAP before many of you here were.

I get a machine that is not blowing right and either my OSA comes back or I get intolerable side effects. I am angry about that because I think for what you spend on a fancy APAP, they should about be dead on. I do not understand what is difficult to understand about that.

Ive had two S9s now in less than one month. One from a DME, another from CPAP.com. Both blow about the same when set at 11, well BELOW what I need.

All you can get on these modern machines is approximate pressures. You cannot get near exact pressures. That is shoddy engineering and design. They should not charge what they charge for such shoddy craftsmanship. Yet they put all these gizmos that you dont need on them, but they dont even blow at what they are supposed to when programmed. WTF?

Mikey

SleepingUgly · Post by **SleepingUgly** » Tue Feb 08, 2011 4:42 pm

Mikey, what kind of a doctor is prescribing your Zoloft? Is it a psychiatrist? May I ask for what reason you are on it? Either way, please TELL the prescribing physician that you are having increased symptoms that you don't feel are being properly addressed with CPAP as they were in the past.

nanwilson · Post by **nanwilson** » Tue Feb 08, 2011 4:43 pm

I can't keep silent any longer Mikey. I have read a few of your posts and the battering you are giving the wonderful people here is completely unjusified. If you have problems with the manufactrurers---take it up with them, the good folks here can't fix you, they have tried. SO STOP ACTING LIKE A FIVE YEAR OLD AND GO COMPLAIN TO SOMEONE THAT WANTS TO LISTEN, THE FOLKS HERE DO NOT. YOU DON'T KNOW HOW TO LISTEN WHEN THEY TRY TO HELP YOU. YOU SAY YOU WANT TO LEAVE OUR FORUM, SO FOR ******S SAKE GO DO IT!!!!! GOODBYE!!!!
Friends: Stop feeding this troll, all he wants is validation, he's not happy unless he is stirring the pot.
Cheers
Nan

Goofy · Post by **Goofy** » Tue Feb 08, 2011 4:55 pm

sydneybird wrote:I have a hard time believing that 0.1 cm H2O or even 0.5 has any meaningful clinical significance for the majority of people, but I do understand it is important for you. You have a Manometer, so why don't you be proactive in calibrating your machine yourself and check it every month or so? You are lucky that ResMed provides 0.1 increment adjustment. Respironics is 0.5.

I guest they could put in a much more expensive pressure gauge with dynamic feedback control, but that might be an undue expense for a non-issue. I would suspect that if they set the machine to be spot on at 10, it would be off at lower/higher pressures. Then there are mask differences, hose differences, humidifier versus no humidifier.

Your RX might be 11, but how do you know it is not just a WAG by the doctor? But again, I understand that for you, you have symptoms above and below 11 by 0.1 cm H2O (if I remember correctly) and I am glad that you know this and can set the machine accordingly. I have symptoms below 8 and above 11 so I have a generous level of tolerance of 3.0 cmH2O +/- 0.5. What I don't understand is if CPAP.com sent you a machine set at 11.2 and it put out 11, just like you asked for, what's the beef?

I'm looking at my manuals for my Respironics; +/- 0.5 below 10, and +/- 1.0 above 10. The machine can only be adjusted in 0.5 cm H2O increments. The instructions for verifying the pressure requires a manometer to have a +/-0.3 cm H2O accuracy. They also specify a whole list of verification requirements, a certain swivel connector, only the foam filter, a certain end cap, an O2 enrichment assembly, etc. By the time you put your plumbing on, even the amount of water in your tank, who knows what pressure you are at? All the tolerances and pressure drops start to add up. The humidifier can reduce the pressure by 0.3 at 60 LPM flow (60 LPM is about 4 cm H2O). A note in the manual says that pressure varies according to local altitude and barometric pressure. Respironics has an offset feature for their various masks to compensate for mask flow resistance. I wonder what the tolerance is for that? Oh, by the way, don't put too many curves in your hose which will change the pressure as well.

Does anyone have an RX that specifies a pressure to the first decimal place level of detail? I doubt that as well.

After all that has been posted, it appears that the ResMed machine is the best one for you because of the 0.1 cm H2O setting ability and thus it is far from being crap, or at least the least crappy of the bunch. (Why is it that when I see CPAP I always think "CRAP"?)

Disclaimer: I do not work for a CPAP manufacture but I am an engineer with a fluid dynamics background.

Hey Mikey,

Please re-read this post. I hear that you are frustrated and yes the equipment costs way more than any of us would like to pay for. Because of the variances that sydneybird stated could be some of the reason the "engineers" either couldn't get the pressure set exactly or possibly by law had to include the variances so the "average" person would be with in a certain range of the prescribed pressure.

ResmedUser wrote:
NightMonkey wrote:
ResmedUser wrote: I might look into that jaw procecure where they break and reset your jaw to fix your airway.

Mikey

Here is some financial help on that surgery. I will do the first half of the procedure for no charge.

Communicating threats over the Internet?

Mikey

Also I didn't see any threat here, just someone wanting you to stop venting your anger in a mean way. Again, we hear your frustration loud and clear and the reason most of us are out here is because we are either frustrated ourselves or have been there and want to help someone else. If venting out here helps you, please don't take it out on us when we are only trying to help and since we aren't with you daily we can only comment on what you post. Sometimes that is hard because what is put in writing doesn't always get the whole point across and that is why people continue to ask questions and even though the answer may seem obvious to you, it may not be so obvious to others.

ResmedUser · Post by **ResmedUser** » Tue Feb 08, 2011 5:40 pm

SleepingUgly wrote:Mikey, what kind of a doctor is prescribing your Zoloft? Is it a psychiatrist? May I ask for what reason you are on it? Either way, please TELL the prescribing physician that you are having increased symptoms that you don't feel are being properly addressed with CPAP as they were in the past.

Yes it is a psychiatrist. Who else would it be? I was being treated for severe depression for a decade prior to being put on CPAP, I already stated that in other strings here. The CPAP treatment dramatically helped my depression. My psychiatrist already knows about it, he knows everything I tell the guy everything. I have a low opinion of psychiatry, they strung me along for years when I was complaining of severe sleep issues.

I know and have forgotten a hundred times more about psychopharmacology than you ever have or ever will, I know all the tricks and tips. Ive had an ECT consultation before. Like I said, I was about ready to die before CPAP. Shortness of breath, chest pains, chest tightness, severe irritability...all went away after first being put on CPAP and stayed under control with CPAP until recently with my machine breaking on me.

Then I gradually backslid, because the machines I had were not the same as my original. Ive stated that a hundred times here.

CPAP activates my antidepressants. Too much pressure and it activates the antidepressant too much. Too little pressure and my antidepressant is not activated enough and also my OSA symptoms come back. When the pressure is "just right" everything is cool and thats how I was for three and a half years. My maximum pressure is way over what my minimum and really should be more than what it currently is, but the zoloft "activation" keeps me from increasing the minimum pressure.

Its just a shitty situation all around. I wish I had started with CPAP first and then after that had been tweaked and perfected, then added psychopharmacology on top of it. But I did the opposite, its my own fault I self referred myself to the psychiatrists I thought I was mega clinically depressed years ago.

Mikey

ResmedUser · Post by **ResmedUser** » Tue Feb 08, 2011 5:42 pm

Goofy wrote:
sydneybird wrote:

Here is some financial help on that surgery. I will do the first half of the procedure for no charge.

Communicating threats over the Internet?

Mikey[/quote]

Also I didn't see any threat here, just someone wanting you to stop venting your anger in a mean way. Again, we hear your frustration loud and clear and the reason most of us are out here is because we are either frustrated ourselves or have been there and want to help someone else. If venting out here helps you, please don't take it out on us when we are only trying to help and since we aren't with you daily we can only comment on what you post. Sometimes that is hard because what is put in writing doesn't always get the whole point across and that is why people continue to ask questions and even though the answer may seem obvious to you, it may not be so obvious to others.[/quote]

Thats your opinion. What I got was someone was offering to break my jaw...thats communicating a threat over the Internet.

Mikey

BlackSpinner · Post by **BlackSpinner** » Tue Feb 08, 2011 5:52 pm

Face it Mikey - you back slid because you were to stupid to check your data and adjust your pressure and now you want to blame everything on someone else.
ALL YOU HAVE TO DO IS READ YOUR DATA AND ADJUST YOUR PRESSURE! Yeesh, my 84 year old mother with dementia is capable of reading her blood sugar meter and adjusting her insulin why is is so difficult to get that through your head! READ your data and make adjustments, it is that simple.

Oh and that 84 year woman when she was in her 40's went back to school and got her masters in Library science, you are never to old to go back to school, with your attitude you should make a fortune as a lawyer.

scrapper · Post by **scrapper** » Tue Feb 08, 2011 6:16 pm

CPAP activates my antidepressants. Too much pressure and it activates the antidepressant too much. Too little pressure and my antidepressant is not activated enough

and the dog ate my homework.........yes sir, I believe you.

I have some swamp land to sell you too........it's worth a mint.

rosiefrosie · Post by **rosiefrosie** » Tue Feb 08, 2011 6:23 pm

Mikey, are you bipolar? Are you taking your meds?

rosie

DreamDiver · Post by **DreamDiver** » Tue Feb 08, 2011 6:32 pm

ResmedUser wrote:You get them and hardly any of them actually blow at the pressure they are supposed to blow at. For example if your minimum APAP pressure is 11, when you set your computer settings to 11, I and my DME are getting actual readings either under or over 11. For example I have had three Resmed APAPs in the last year and not one was correct. One was set for 11, but blew at like 10.6. I exchanged that one and got one that blew a 10.9 at 11. Then a third Resmed APAP, at a setting of 11, it blows at 10.6 and my DME had to artificially raise the setting to 11.2. And it STILL does not blow a true 11! If I raise that one to 11.4 to artificially boost the real pressure, it then blows 11.3. Really exact, good engineering and manufacturing, huh?
Mikey

When the S9 is set to CPAP, it should react like a CPAP, showing 11 on the manometer when the machine is dialed in at 11. Mine does. However, I notice when I set it to APAP, the pressure is undoubtedly lower than 11, even when the base pressure is set to 11. I wonder if it has more to do with the algorithm of APAP and less to do with being imprecise. Did you test yours in CPAP or APAP mode?

GeneS · Post by **GeneS** » Tue Feb 08, 2011 6:43 pm

Mickey
One reason could be that the pressure is measured at the machine and you need the pressure at your mask. There is a pressure loss in the tubing between the machine and the mask and I did not check out your machine but they sometimes compensate for this loss by adding pressure at the machine. The pressure loss varies with flow, tubing length, diameter etc. Leaks can increase flow and pressure loss. When you inhale pressure tends to drop a little and when you exhale pressure will tend to rise a little. A prescription setting of 11 may not mean that the pressure measured at the machine should always be at 11. I am not sure what is going on with your machine but these are some of the things that could affect pressure slightly.
GeneS

ResmedUser wrote:You get them and hardly any of them actually blow at the pressure they are supposed to blow at. For example if your minimum APAP pressure is 11, when you set your computer settings to 11, I and my DME are getting actual readings either under or over 11. For example I have had three Resmed APAPs in the last year and not one was correct. One was set for 11, but blew at like 10.6. I exchanged that one and got one that blew a 10.9 at 11. Then a third Resmed APAP, at a setting of 11, it blows at 10.6 and my DME had to artificially raise the setting to 11.2. And it STILL does not blow a true 11! If I raise that one to 11.4 to artificially boost the real pressure, it then blows 11.3. Really exact, good engineering and manufacturing, huh?

Then this high end Respironics I got recently from my DME. My own DME guy admitted to me he had to set it at 11.5 to get it to blow an 11. Actually it blows more like an 11.3 artificially adjusted like that.

My prescribed minimum pressure is 11. Not 10.6, not 10.7, not 10.8, not 11.3.

WTF is up with these CPAP manufacturers? It did not used to be like this. When I got my original gear years ago all of them blew what they were programmed to blow.

I think I am going to start looking for other ways to treat my OSA. I could still lose another forty pounds. I might look into that jaw procecure where they break and reset your jaw to fix your airway. Ive also been told I have some excess tissue in the back of my throat. Seems like Resmed and Respironics are not paying attention to quality control like they used to and just going for the money and screw the patients.

Anybody know of a German made CPAP manufacturer? They still do things right.

Mikey

ResmedUser · Post by **ResmedUser** » Tue Feb 08, 2011 7:46 pm

BlackSpinner wrote:Face it Mikey - you back slid because you were to stupid to check your data and adjust your pressure and now you want to blame everything on someone else.
ALL YOU HAVE TO DO IS READ YOUR DATA AND ADJUST YOUR PRESSURE! Yeesh, my 84 year old mother with dementia is capable of reading her blood sugar meter and adjusting her insulin why is is so difficult to get that through your head! READ your data and make adjustments, it is that simple.

Oh and that 84 year woman when she was in her 40's went back to school and got her masters in Library science, you are never to old to go back to school, with your attitude you should make a fortune as a lawyer.

No, the reason I backslid was 1) my old GOOD machine broke and 2) none of the replacement machines I have gotten since then I can get adjusted to the right pressure. I can only get them to approximate pressures, which are all either slightly too low or slightly too high.

Mikey

ResmedUser · Post by **ResmedUser** » Tue Feb 08, 2011 7:48 pm

scrapper wrote:
CPAP activates my antidepressants. Too much pressure and it activates the antidepressant too much. Too little pressure and my antidepressant is not activated enough
and the dog ate my homework.........yes sir, I believe you.

I have some swamp land to sell you too........it's worth a mint.

What the hell is so hard to believe about that? Its well known that CPAP can make antidepressants work when otherwise do not work well. Where the hell is your brain at? What are you, stupid or something?

Mikey

ResmedUser · Post by **ResmedUser** » Tue Feb 08, 2011 7:50 pm

rosiefrosie wrote:Mikey, are you bipolar? Are you taking your meds?

rosie

No I am not bipolar. Bipolars do not take SSRIs, they take mood stabilizers. Are you aware that OSA patients untreated or improperly treated can be IRRITABLE and RESTLESS and MEAN? Its called oxygen deprivation and sleep deprivation (and also impatience for STUPIDITY).

Mikey

ResmedUser · Post by **ResmedUser** » Tue Feb 08, 2011 7:52 pm

DreamDiver wrote:
ResmedUser wrote: Mikey
When the S9 is set to CPAP, it should react like a CPAP, showing 11 on the manometer when the machine is dialed in at 11. Mine does. However, I notice when I set it to APAP, the pressure is undoubtedly lower than 11, even when the base pressure is set to 11. I wonder if it has more to do with the algorithm of APAP and less to do with being imprecise. Did you test yours in CPAP or APAP mode?

I already tried that wondering the same thing. Set at CPAP mode, it blows at 10.6 when set at 11 on CPAP mode. Ditto for APAP mode. The problem is Resmed and these companies, evidently they decided that approximate pressures are "OK."

Mikey

Anybody else noticed this on the modern machines?

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Re: Anybody else noticed this on the modern machines?

Re: Anybody else noticed this on the modern machines?

Re: Anybody else noticed this on the modern machines?

Re: Anybody else noticed this on the modern machines?

Re: Anybody else noticed this on the modern machines?

Re: Anybody else noticed this on the modern machines?

Re: Anybody else noticed this on the modern machines?

Re: Anybody else noticed this on the modern machines?

Re: Anybody else noticed this on the modern machines?

Re: Anybody else noticed this on the modern machines?

Re: Anybody else noticed this on the modern machines?

Re: Anybody else noticed this on the modern machines?

Mask	Humidifier

Additional Comments: I actually own the Resmed S9 full maxed out APAP, but Id rather have an older S8 APAP as I think the S8 APAPs were better.