My ResMed S9 Elite is a used cpap. I need help with cpap treatment

[DaveL]

Background....my ResMed S9 Elite is a used machine I bought from a friend at work who couldn't stand cpap equipment. She sold it to me.

I have so much to learn.

My machine is set up to my pressure (11). It has a ResMed humidifier.  I use a ResMed N20 mask (nasal mask). I sometimes mouth breath, so I use a cushion under my jaw with strap to keep my jaw closed.  I watch for dry mouth and check my machines report almost daily. Normal indications are about 7-7 1/2 hours of sleep. AHI is usually below .5 as displayed.  I get up once nightly for a quick trip to the washroom; sometimes have trouble getting back to sleep.

My mask was replaced every 6-9 months until recently.  Finances are hard, so this may be extended.  I've tried full face masks. (I have a bump and sore under my nostril that won't go away, from a WISP mask.  Talk about surgical removal. (No, I don't want that.)

Sleep Doc.  Oh my. It was terrible for 12 years. He retired; I never attended the new sleep doc; however, he was fired at the hospital so it's just as well.) Ontario Canada, where I've never had any say in selection of any specialist. 3 weeks ago I was referred to a new sleep doc and had a sleep study.  Results are pending.  Tech told me that I shall meet with the specialist and get 2 prescriptions.  pressure. mask.  I'll share when I get them.  This confirms OSA, and basic treatment is successful.

My question is: am I doing things right? machine is set to my old pressure.  11.  Humidifier is used nightly.  Heated hose I added myself. Machine is quiet and works well. Regret that it's not a better machine such as an autopap. I would love to do self titration. I can't.

Can you guide me through setup? I just got the clinician's manual.  I want to use this machine well and receive the most comfortable and best treatment I can.

I've been doing this a long time. It's time I became my own advocate and learn what I need to get the best care I can, and see that making changes suggested here will improve my health and treatment.

Thanks
Dave

[Sleeprider]

It sounds like you have continued using 11-cm pressure with very good results. We can sometimes provide a better interpretation of therapy when we see detailed data of typical sessions. I'll start with a couple questions, and we can go from there. First, have you tried any pressures other than 11.0? Do you use EPR? How do you characterize your comfort levels, aside from the mask sore and nightly arousal to use the bathroom?

This is the easiest tutorial on entering clinical settings https://www.apneaboard.com/resmed-s9-cpap-setup Options on the S9 Elite are limited to a single pressure, but you can use EPR for comfort and as a limited bilevel control for flow limitation and hypopnea events. Given your good results at 11.0, I think we can safely suggest adding EPR for comfort if you are not already using it. Once EPR is in place, and assuming event rate remains low, you may want to try slowly lowering CPAP pressure to see where events increase. That would be a sound approach to determining a minimum therapeutic pressure. Overall, a pressure of 11.0 is pretty good, and your use of a cushion with a strap sounds a lot like the Dr. Dakota Snoring Stop alternative to a soft cervical collar. Again, easier to judge effectiveness if we see some typical charts. You have been at this a long time, and it's unfortunate your medical team has not been helpful. When it is time for you to pursue a new machine, an Autoset might offer some advantages with variable CPAP pressure, and we should be able to give you some pointers on getting that. You bought your S9 from a friend, so I assume your insurance has a high deductible or there are obstacles to getting one through that avenue. Maybe you can clarify.

[DaveL]

Sleeprider your response is very helpful.

I have the clinician's report in front of me. Tonight I'll set EPR as you suggested.
I'm waiting (impatiently) for new sleep doc's review of my sleep study done almost 3 weeks ago. That's my first sleep study since 2008.

The last cpap machine I bought cost me $2,000 Canadian out of pocket. I bought a terrible machine. It was noisy and disturbed my wife. The mask (no substitutions) was poor quality and uncomfortable. My DME was atrocious. I reviewed, and I could have bought an apap machine cheaper ordering from the US. The sleep doc's hospital owned the DME franchise.

However, I could not qualify for an autopap according to the sleep doc I had at the time.

A co-worker offered her ResMed S9 Elite with humidifier for sale. She is my earth-angel. It's changed my life. I added a heated hose. I set it up best I could.

Since then I've lost my benefits at work due to my age. I'm now 72...I'm working because I have to, and have no pension. I'm grateful to be able to work, and I'm proud of what I do (construction--getting schools built for the second largest school board in Canada)

My quest is to learn more, implement changes that improve treatment and comfort and find the best equipment and best source/price.

(My in-laws include an American Doctor; he has regularly said that we have socialist medicine. He doesn't understand.
Reality is that education and health care cost a huge amount. We have a small population, high costs and a relatively poor economy. To compensate I see many exclusions for things that used to be provided.

I am hearing disabled and an OSA patient. Both of these areas have much higher equipment costs in Canada than in the US. I'm working at ways to find equipment more reasonably priced.

Tonight I shall set EPR! I'll get back to you with results. I'll meet with my new specialist; once I see the pressure they recommend I'll have them set it. Once I'm under the radar there I'll talk about regulating pressure. (I think restrictions here are criminal. Practicing medicine without a license? (old sleep doc) Bah. Humbug.)

I'm not very good with SleepyHead. I do have it installed on my old iMac (my only computer). I need to figure out how to get screenshots off my iMac to share. I'm computer illiterate. My computer hates me!

I'll read the link that you enclosed. I'm very grateful. I've got some learnin' to do!

Dave

[Sleeprider]

Dave, we have many Canadian members that have found CPAP equipment at reasonable prices from Canadian suppliers, including the Autoset with mask for prices similar to U.S. Check out Supplier #32, and perhaps some other ideas will also be offered. Anyway, the Elite is a very good machine and will meet your needs comfortably and effectively. Feel free to share any information here as you go forward and we will give you hopefully useful feedback or reassurance. One reassurance I can offer is that it is not a criminal offense nor a practice of medicine for an individual to change their own CPAP settings on a machine they privately acquired or even on provided by provincial healthcare. Canada has much more important matters to prosecute.

[DaveL]

You help more than you know!

My first sleep doc (25+ years ago was really good. Dr Ferguson.
My second sleep doc (15+ years ago was sleep doc from h-ll. First statement was to inform me that he would yank my license if I wasn't compliant. I've always been compliant. I've missed 1 night in 25 years.
I'm hoping for great results from my 3rd sleep doc. Third time is the charm after all!

Your links will help me. For now my S9 Elite is a really good machine. It's almost silent. The humidifier and heated hose make life so much better. I have it set for max. 86 degrees? I've had several heater hoses. They're ResMed and plugged into my machine. Frankly air from the hose doesn't feel that warm. I never had a heated hose before.

My pad is a face pad used in a child's baby carrier backpack. I have a strap on it. ... Strap holds the pad on my neck, under my jaw. It goes around my neck, and I tighten it to keep the pad in place. Looks funny. Works better than any jawstrap I've purchased. Goal is to keep my mouth closed so I don't mouthbreath. Seems to work. No dry mouth when I use this; I often had dry mouth with the chinstraps I used that I bought from my DME. (I used my chinstrap --not pad--during my recent sleep study. The tech woke me up to say I was mouth breathing. He cautioned me to keep my mouth closed, and implant this thought in my brain. Somehow that worked. The rest of the sleep study was fine. His ruling--nasal mask is fine ResMed N20) I've tried about 7 loaner full face masks--good trials. The last one was the best. ResMed F20. However, it leaked a lot and my numbers were bad.

DaveL (Toronto )

[DaveL]

I am so impressed. The supplier you identified will provide me huge savings over my DME. My DME charges $350 for an N20 (large) with medium headset. That's in a sealed bag with no testing/fitting required because I've used the bag before.
I'll check their cost for an autoset machine.

DaveL


Edit:  Wow.  Autoset machine is incredible.  There's no excuse for buying a machine from my sleep doc. And he will only sell cpap to me.

[DaveY]

See this thread for discounted APAP in Canada....you will probably need a prescription however:

http://www.apneaboard.com/forums/Thread-...P-discount

CPAP Machines Canada is the only Canadian online CPAP supplier that does not require a prescription (see their FAQ). With a mask, their Airsense 10 Autoset for Her or standard and hoses are $899.

Dave

[DaveL]

Thanks so much!

When I checkedAmazon doesn't need a prescription

Price you showed me is so much better! They ship with pressures set at 20/4 according to their page.

Bless them for advancing OSA care in Canada.

Thank you!
DaveL

[DaveL]

See this thread for discounted APAP in Canada....you will probably need a prescription however:

http://www.apneaboard.com/forums/Thread-...P-discount

CPAP Machines Canada is the only Canadian online CPAP supplier that does not require a prescription (see their FAQ). With a mask, their Airsense 10 Autoset for Her or standard and hoses are $899.

Dave

Thanks!
DaveL

[DaveL]

I really like the Dr Dakota pad! 

Its shaped better than anything Ive tried. I've looked for a cervical collar too. No luck.

amazon.ca doesn't carry many products that Amazon.com carries. I'll go look.  Thanks.

My comfort levels are generally good. My mask leaks a little, sometimes. My chinstrap shave been terrible. I have a bald spot on the back of my head; straps slide off there. The one I've had for several years has ear-holes. I've had 4 of these. Expensive, and they stretch.

DaveL 

It sounds like you have continued using 11-cm pressure with very good results. We can sometimes provide a better interpretation of therapy when we see detailed data of typical sessions.  I'll start with a couple questions, and we can go from there.  First, have you tried any pressures other than 11.0? Do you use EPR? How do you characterize your comfort levels, aside from the mask sore and nightly arousal to use the bathroom?

This is the easiest tutorial on entering clinical settings https://www.apneaboard.com/resmed-s9-cpap-setup Options on the S9 Elite are limited to a single pressure, but you can use EPR for comfort and as a limited bilevel control for flow limitation and hypopnea events.  Given your good results at 11.0, I think we can safely suggest adding EPR for comfort if you are not already using it.  Once EPR is in place, and assuming event rate remains low, you may want to try slowly lowering CPAP pressure to see where events increase.  That would be a sound approach to determining a minimum therapeutic pressure.  Overall, a pressure of 11.0 is pretty good, and your use of a cushion with a strap sounds a lot like the Dr. Dakota Snoring Stop alternative to a soft cervical collar.  Again, easier to judge effectiveness if we see some typical charts.   You have been at this a long time, and it's unfortunate your medical team has not been helpful.  When it is time for you to pursue a new machine, an Autoset might offer some advantages with variable CPAP pressure, and we should be able to give you some pointers on getting that.  You bought your S9 from a friend, so I assume your insurance has a high deductible or there are obstacles to getting one through that avenue.  Maybe you can clarify.