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ResMed S9 to A10 "upgrade" - Huge jump in AHI, CA, H, OA events - battling machine
#1
ResMed S9 to A10 "upgrade" - Huge jump in AHI, CA, H, OA events - battling machine
Hello Apnea Board, first post. 

Quick Background: I had my sleep study in 2011, diagnosed with Sleep Apnea with an AHI of 9.0 during the study and prescribed a ResMed S9 Elite CPAP that was set to 7cm. Because I was given a nasal mask as a mouth breather with severe allergies and nasal passage issues (Apria Heathcare = incompetent) my CPAP therapy didn't last long. Bagged the machine and put it in the closet. Fast forward to December 2019 and I'm averaging 4-5 hours sleep a night, always tired, etc. etc. and I drag out the S9, order a heated hose and buy a ResMed AirFit F30 full face mask off Ebay, and started reading this forum.

Used the S9 for nine days (December 1st to 9th) (pressure still set to 7cm by Apria Healthcare), average AHI was 8, then dropped to the 2.6 range.

Twelve day business trip, no CPAP.

Started again on December 22nd, more reading of this and other Sleep Apnia forums, increased pressure to 8cm, then 12cm. From Dec. 22nd to Jan. 3rd my average AHI had been as low as 0.85 and as high as 2.43, but I seem to average around 1.79. More importantly I have been sleeping for nearly 8 hours a night!

I thought an APAP machine might be helpful so I got a ResMed AirSense 10 AutoSet from a seller on OfferUp (1360 hours, nearly new) super cleaned it, set APAP with a min of 6cm and max of 12cm... started using it January 4th and the results have been disastrous.
  • Jan. 4th - Average AHI 5.08, max for the night was 20
  • Jan. 5th - Average AHI 7.65, max for the night was 18, I was only able to sleep 4.5 hours
Here are my issues:
  • I feel like I am struggling to breathe, or like I am breathing through a straw with the A10. I turned on EPR last night and set it to 2cm thinking that that might help and it didn't
  • I feel like I am re-breathing my exhaled air
  • The humidifier us using (dispensing) an absurd amount of water. 3x the quantity as the S9 Elite
  • The machine is loud, not the machine itself but my exhaling through it. It sounds like I'm Darth Vader. The S9 Elite wasn't nearly as loud
  • Huge jump in Clear Airway events
  • Jump in Hypopnea events
  • Now seeing RERA events with the A10 that I don't really know what they mean

I was hoping that the APAP feature would help me get to a correct pressure level and that the advanced reporting of the A10 would be helpful. So far it's been a boondoggle.

I'm attaching OSCAR screenshots of the last night of use of my S9 Elite and last night's A10 use. I'm still learning how to interpret all this data, use these machines, and get used to CPAP/APAP in general so any tips would be greatly appreciated!

[attachment=18760] [attachment=18761]
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#2
RE: ResMed S9 to A10 "upgrade" - Huge jump in AHI, CA, H, OA events... battling machine
Welcome! It's good to hear you're treating your apnea. I'm sure the experts here can help you with the settings for your new machine. To help them help you, could you replace the AHI graph with the Flow Limitations graph (for 1/5)?
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#3
RE: ResMed S9 to A10 "upgrade" - Huge jump in AHI, CA, H, OA events... battling machine
(01-06-2020, 11:39 AM)Dormeo Wrote: Welcome!  It's good to hear you're treating your apnea.  I'm sure the experts here can help you with the settings for your new machine.  To help them help you, could you replace the AHI graph with the Flow Limitations graph (for 1/5)?

Dormeo, thank you for the welcome! I've only been lurking for a short while and don't quite know what info is important for initial troubleshooting, thank you for the guidance!

It appears this forum doesn't allow post editing, so I've re-screenshot both 1/4 (S9) and 1/5 (A10), adding the Flow Limitations graph and attached them below.

Please let me know if there is any other info or additional screenshots I can provide, or a less compressed (1 hour, 30 minutes, 2 minutes?) view. Thanks in advance!


[attachment=18768]  [attachment=18769]
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#4
RE: ResMed S9 to A10 "upgrade" - Huge jump in AHI, CA, H, OA events... battling machine
On January 3 on fixed pressure of 12 and no EPR your events were mostly a blend of hypopnea and obstructive with some random CA. January 5, you switched to Autoset mode with a pressure range of 6 to 12 and EPR 2 and you got whacked by some CA and OA clusters. Not a very friendly introduction to auto pressure, but don't be too discouraged, it just might take some time to get used to it. I think we can start by dropping EPR to 1 and just leave the pressure alone for now.

On your charts please replace the AHI chart with flow limitation. It's clear your pressure rose ahead of the first obstructive apnea and flow limits are the most likely cause. Any chance you may have had a bit of chin-tucking going on at that time? It is a fast increase in pressure. I don't want to let this cluster of CA scare you out of EPR. I think in the long run it is going to help you with comfort and to reduce the hypopnea, but a slower introduction might help.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: ResMed S9 to A10 "upgrade" - Huge jump in AHI, CA, H, OA events... battling machine
(01-06-2020, 12:06 PM)Sleeprider Wrote: On January 3 on fixed pressure of 12 and no EPR your events were mostly a blend of hypopnea and obstructive with some random CA. January 5, you switched to Autoset mode with a pressure range of 6 to 12 and EPR 2 and you got whacked by some CA and OA clusters.  Not a very friendly introduction to auto pressure, but don't be too discouraged, it just might take some time to get used to it.  I think we can start by dropping EPR to 1 and just leave the pressure alone for now. 

On your charts please replace the AHI chart with flow limitation. It's clear your pressure rose ahead of the first obstructive apnea and flow limits are the most likely cause.  Any chance you may have had a bit of chin-tucking going on at that time?  It is a fast increase in pressure.  I don't want to let this cluster of CA scare you out of EPR. I think in the long run it is going to help you with comfort and to reduce the hypopnea, but a slower introduction might help.


Thank you SleepRider, I think I was in the process of replacing my screenshots when you were typing your post. I've posted updated shots that include Flow Limitation just above your post.
  • I'll drop the EPR on the unit to 1 tonight.
  • I have indeed noticed myself dropping my jaw just when falling asleep. Initially it was causing leaks with the mask at my chin, and I had to find a happy medium between tightening/loosening the upper and lower straps on the headgear. I have the leak issue solved, but I see what you're saying. I just ordered The Eliminator Sleep Pillow, thank you for the links in your footer and  the Wiki, it should be here on Thursday or Friday.

If anyone has any ideas on why I feel like I'm "fighting" for breath with the A10 and did not have this feeling with the S9? It's noticeable, to the extent that I'd bet if I had a pulse oximeter, it'd show a decrease in my SpO2.

Same for RERA. I don't really know what it is and what it means.
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#6
RE: ResMed S9 to A10 "upgrade" - Huge jump in AHI, CA, H, OA events... battling machine
Better data last night. I was very tired from only getting four hours the night before. Also Nyquil (I have the flu) and remembered my melatonin.

- Minute Vent, higher
- All other numbers lower. Weird

[attachment=18792]
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#7
RE: ResMed S9 to A10 "upgrade" - Huge jump in AHI, CA, H, OA events... battling machine
Last night's results. 

Had to stop the machine and reset my mask because I awoke to an unresolvable air leak at the bridge of my nose. Looks like this AirTouch F20 is shot after less than 30 days of use. What a scam...

Seeing lots of RERA events.

[attachment=18824]
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#8
RE: ResMed S9 to A10 "upgrade" - Huge jump in AHI, CA, H, OA events... battling machine
Well, at least CA is good despite everything else sucking!  Too-funny
Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
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#9
RE: ResMed S9 to A10 "upgrade" - Huge jump in AHI, CA, H, OA events... battling machine
The flow limits are cranking up your pressure, so let's start putting some EPR back in, and hopefully the CA won't come back this time. EPR 2, keep everything else the same.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: ResMed S9 to A10 "upgrade" - Huge jump in AHI, CA, H, OA events... battling machine
(01-08-2020, 10:40 PM)Sleeprider Wrote: The flow limits are cranking up your pressure, so let's start putting some EPR back in, and hopefully the CA won't come back this time. EPR 2, keep everything else the same.

That's where I was previously, but I'll give it a shot.  Wink
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